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.

How Athletes Adapt Their Training to Cope with High Temperatures: The Science of Heat Acclimatisation

By Chelmsford Physio • July 29, 2026
Athletes competing in hot and humid environments face significant physiological challenges that can impair performance and increase the risk of heat-related illness. From marathon runners in tropical climates to footballers playing summer tournaments, the ability to tolerate and perform in high temperatures is a critical component of elite sport. As a result, many athletes use structured heat acclimatisation strategies to prepare their bodies for environmental stress.  What Is Heat Acclimatisation? Heat acclimatisation refers to a series of physiological adaptations that occur when an athlete is repeatedly exposed to hot conditions during training. These adaptations typically develop over 7–14 days and help the body improve its ability to regulate temperature, maintain performance, and reduce cardiovascular strain during exercise in the heat. Common methods include: ● Training in hot environments (natural or artificial heat chambers) ● Passive heat exposure (saunas or hot water immersion post-training) ● Adjusting clothing to increase thermal load during sessions ● Gradual exposure to increased environmental temperatures The goal is to safely stress the thermoregulatory system so the body becomes more efficient at dissipating heat.

Why Footballers & Athletes Use Ice Baths: The Science Behind Cold Water Immersion

By Chelmsford Physio • July 29, 2026
Ice baths, also known as cold water immersion (CWI), have become a common recovery strategy among elite athletes, particularly footballers. From Premier League changing rooms to Olympic training camps, many professionals immerse themselves in cold water after intense matches and training sessions. While the sight of players sitting in freezing water may seem extreme, there is growing scientific evidence explaining why this recovery method is so widely used. What Is an Ice Bath? An ice bath typically involves immersing the body (or lower limbs) in water between 10–15°C for 10–15 minutes shortly after exercise. The aim is to promote recovery by reducing muscle soreness, inflammation and fatigue, allowing athletes to perform consistently during periods of heavy training or competition. Why Do Footballers Use Ice Baths? Football is a physically demanding sport involving repeated sprinting, jumping, tackling, rapid changes of direction and high-impact collisions. These actions create microscopic muscle damage and trigger an inflammatory response. Cold water immersion is commonly used because it may help: ● Reduce delayed onset muscle soreness (DOMS) ● Minimise post-exercise swelling ● Decrease perceptions of fatigue ● Improve recovery between matches ● Maintain performance during congested fixture schedules For professional footballers playing two or three matches per week, rapid recovery is often as important as training itself. 

The Physio’s World Cup Playbook: Most Common Injuries at FIFA World Cup 2026 (and What to Do About Them)

By Chelmsford Physio • July 29, 2026
The FIFA World Cup is a unique tournament environment: elite athletes compressed into a short, high-stakes schedule, with repeated sprinting, sudden acceleration/deceleration, frequent collisions, and often limited time for full tissue recovery. It’s not surprising that the injury pattern in football tends to cluster around the lower limb—particularly the hamstrings, groin/hip-adductors, knee, and ankle. Across football research more broadly, these are repeatedly identified as the most common locations and/or injury mechanisms, even if the exact percentages differ by competition and injury-reporting method. Below is a physio-focused overview of the most common injury “types/regions” you should expect to see at World Cup 2026, along with practical assessment and management themes. 1) Muscle strains—especially hamstrings (HSI)  Why they happen in tournaments: Hamstring strain injuries (HSIs) are strongly associated with high-speed running and the physical demands of sprinting mechanics. In injury surveillance and football epidemiology, hamstring injuries consistently appear among the most common soft-tissue problems, with meaningful recurrence risk. What a physio will look for: - History: onset during acceleration/sprinting, feeling of “pull,” bruising (sometimes). - CNS/tissue considerations: prior injury, training load spikes, inadequate sprint exposure progression. - Clinical exam: focal tenderness, resisted muscle testing, and functional tests aligned to your local protocols (e.g., pain-free activation and lengthening tolerance). Rehabilitation themes: - Restore capacity for high-speed eccentric/concentric demands (not just range of motion). - Use progressive loading and functional return-to-play criteria to address reinjury risk—because football research highlights that the hamstring is one of the most frequently reinjured regions.