9 Inalienable Truths About Tendinopathy

Chelmsford Physio • August 26, 2025

There is a lot we do not know about Tendinopathy, but there are some inalienable truths that you should know as a clinician and patient (the references below provide proof).

1) Tendinopathy does not improve with rest

The pain may settle but returning to activity is often painful again because rest does nothing to increase the tolerance of the tendon to load.

2) Although there are some inflammatory biochemical and cells involved in Tendinopathy, it is not considered to be a classic inflammatory response

Anti inflammatories may help if you have very high pain levels but it is unclear what effect they have on the actual cells and pathology.

3) Tendinopathy can be caused by many different risk factors

The main factor is a sudden change in certain activities – these activities include:


  1. Those that require the tendon to store energy (i.e. walking, running, jumping).
  2. Loads that compress the tendon. Some people are predisposed because of biomechanics (e.g. poor muscle capacity or endurance) or systemic factors (e.g. age, menopause, elevated cholesterol, increased susceptibility to pain, etc). Predisposed people may develop tendon pain with even subtle changes in their activity.
Tendinopathy

4) Exercise is the most evidence based treatment for Tendinopathy

tendons need to be loaded progressively so that they can develop greater tolerance to the loads that an individual needs to endure in their day-to-day life. In a vast majority of cases (but not all) Tendinopathy will not improve without this vital load stimulus.

5) Modifying load is important in settling tendon pain

This often involves reducing (at least in the short-term) abusive tendon load that involves energy storage and compression.

6) Pathology on imaging is NOT equal to pain – pathology is common in people without pain

Also, if you have been told you have ‘severe pathology’ or even ‘tears’ this DOES NOT necessarily mean you will not get better or have a poorer outcome. Further, we know that even with the best intentioned treatment (exercise, injections, etc) the pathology is not likely to reverse in most cases. Therefore, most treatments are targeted towards improving pain and function, rather than tissue healing, although this still is a consideration.

Tendinopathy

7) Tendinopathy rarely improves long term with only passive treatments such as massage, therapeutic ultrasound, injections, shock-wave therapy etc

Exercise is often the vital ingredient and passive treatments are adjuncts. Multiple injections in particular should be avoided, as this is often associated with a poorer outcome.

8) Exercise needs to be individualised

This is based on the individual’s pain and function presentation. There should be progressive increase in load to enable restoration of goal function whilst respecting pain.

9) Tendinopathy often responds slowly to exercise

You need to have patience, ensure that exercise is correct and progressed appropriately, and try and resist the common temptation to accept ‘short cuts’ like injections and surgery. There are often no short cuts.


By Chelmsford Physio • October 27, 2026
In modern physiotherapy, clinical expertise remains fundamental, but technology is transforming how we assess, monitor and guide rehabilitation. One of the most valuable innovations is the use of force plate technology, and at our clinic we utilise the VALD ForceDecks to provide objective, reliable data throughout a patient’s rehabilitation journey. Rather than relying solely on observation or subjective feedback, ForceDecks enable us to accurately measure how your body produces and absorbs force. This allows us to identify movement deficits that may not be visible to the naked eye, track progress over time, and make evidence-based decisions regarding exercise progression and return to activity. What are VALD ForceDecks? VALD ForceDecks are dual force plates that measure the forces generated through the feet during a wide variety of movements. Using highly sensitive load cells, they capture detailed information about strength, balance, power, asymmetries and movement strategies. Common assessments include: Countermovement jumps Squat assessments Single-leg balance testing Sit-to-stand testing Isometric strength testing Landing mechanics Hop testing for return-to-sport decisions Within seconds, the software analyses hundreds of metrics that provide clinicians with objective insight into a patient’s physical performance. Why Objective Assessment Matters Traditional physiotherapy assessments rely on observation, manual muscle testing and patient-reported symptoms. Whilst these remain valuable, they can miss subtle deficits that increase the risk of delayed recovery or re-injury. ForceDecks allow physiotherapists to quantify movement rather than estimate it. For example, following an ACL reconstruction, a patient may appear to squat evenly. However, ForceDecks often reveal significant offloading of the surgical limb, reduced eccentric control or delayed force production. These hidden compensations can then become specific treatment targets. Objective measurements also improve communication between clinician and patient. Seeing measurable improvements in strength or symmetry provides reassurance that rehabilitation is progressing, even when symptoms fluctuate. Monitoring Progress with Precision One of the greatest benefits of ForceDecks is the ability to track rehabilitation over time. Instead of simply asking whether someone feels stronger, we can measure improvements in: Peak force production Limb symmetry Rate of force development Jump height Landing forces Balance performance Weight distribution This enables rehabilitation programmes to be progressed based on measurable performance rather than arbitrary timelines. Improving Return-to-Sport Decisions Returning to sport too early remains one of the biggest risk factors for re-injury. Research has consistently demonstrated that persistent strength deficits and movement asymmetries can remain long after pain has resolved. ForceDecks help clinicians identify these deficits before an athlete returns to competition. Objective testing can assist with: Assessing readiness to return to running Evaluating landing mechanics Measuring explosive power Identifying left-right asymmetries Monitoring fatigue Reducing the risk of subsequent injury Rather than relying on a single test, ForceDecks contribute to a comprehensive return-to-performance assessment that combines physical capacity with clinical reasoning.
By Ben Jones • October 27, 2026
On 23 and 24 October, I represented Chelmsford Physio at VALDCon London, held at Lord's Cricket Ground. VALD makes the ForceDecks force plates and DynaMo dynamometer we use in clinic to measure strength, power and left-right balance. The two days brought together physios and sports scientists from elite sport, including England cricket, British Athletics and professional football. They shared how they use testing to guide rehab and return to sport. Here are the takeaways most relevant to you, and how we're bringing them into the clinic. 
By Chelmsford Physio • October 14, 2026
Based at Riverside Leisure Centre in Chelmsford, we are excited to introduce our ultrasound-guided injection service.