Tendon pain is one of the most common reasons people seek physiotherapy. Many patients are told they have tendonitis, while others hear the term tendinopathy. These words are often used interchangeably but they don’t mean the same thing.
Understanding the difference matters, because it can directly affect how your injury should be managed and how long recovery may take.
What Is Tendonitis?
Tendonitis refers to acute inflammation of a tendon.
It typically occurs:
- After a sudden increase in load or activity
- Following a new or unfamiliar movement
- In the early stages of tendon pain
Common features of tendonitis
- Relatively sudden onset
- Localised pain and tenderness
- Pain with movement or loading
- Sometimes warmth or swelling
In true tendonitis, inflammation is the dominant process. This phase is usually short-lived and may settle with appropriate load reduction and early management (Khan et al., 2002).
What Is Tendinopathy?
Tendinopathy is a broader term that describes chronic tendon pain associated with tendon degeneration, rather than inflammation.
Research has shown that most long-standing tendon pain does not involve significant inflammation (Cook & Purdam, 2009).
Common features of tendinopathy
- Gradual onset over weeks or months
- Pain that improves with warming up, then worsens later
- Reduced strength or endurance
- Pain that returns after activity or the next day
In tendinopathy, the tendon structure changes:
- Collagen fibres become disorganised
- Tendon thickness may increase
- Load tolerance decreases
This is why rest alone often doesn’t fix the problem.
Why the Difference Matters
Calling a long-standing tendon issue “tendonitis” can lead to incorrect treatment strategies.
If it’s treated like inflammation:
- Excessive rest may be prescribed
- Anti-inflammatories may be overused
- The tendon may become weaker and less tolerant to load
If it’s recognised as tendinopathy:
- Load is progressively reintroduced
- Strength and capacity are rebuilt
- Recovery is more sustainable long-term
Evidence strongly supports exercise-based rehabilitation as the cornerstone of tendinopathy management (Malliaras et al., 2013).
Can Tendonitis Turn Into Tendinopathy?
Yes and this is very common.
If an acute tendon overload is:
- Repeated
- Poorly managed
- Returned to too quickly
the tendon may fail to fully recover and progress into a chronic tendinopathy.
This is often seen in:
- Runners with Achilles pain
- Athletes with patellar tendon pain
- Office workers with elbow tendinopathy
How Physiotherapy Management Differs
Tendonitis management may include:
- Short-term load reduction
- Pain-modulating strategies
- Gradual return to activity
Tendinopathy management focuses on:
- Progressive strength loading
- Tendon-specific exercises
- Load management rather than rest
- Education around pain vs harm
Pain during rehab does not always mean damage, but it does need to be carefully monitored and dosed (Silbernagel et al., 2007).
Do Scans Help Differentiate Them?
Imaging such as ultrasound or MRI can show tendon changes, but:
- Structural changes don’t always correlate with pain
- Many people have abnormal tendons with no symptoms
Clinical assessment and symptom behaviour remain more important than scan findings alone (Scott et al., 2015).
Key Takeaways
- Tendonitis = short-term inflammatory response
- Tendinopathy = long-term tendon overload and degeneration
- Most persistent tendon pain is not inflammatory
- Management should focus on appropriate loading, not rest alone
- Getting the diagnosis right leads to better outcomes
If you’ve been dealing with tendon pain that keeps returning, it’s worth having it properly assessed so treatment matches what’s actually happening in the tendon. Our physiotherapists will be able to help you with this. Appointment can be made by clicking here.
Read more….
To learn more about Hip Bursitis, check out our blog HERE
To learn more about Tennis Elbow Vs Golfer’s Elbow check out our blog HERE
To learn more about Patella Tendinitis, check our our blog HERE
References
Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? British Journal of Sports Medicine, 43(6), 409–416. https://doi.org/10.1136/bjsm.2008.051193
Khan, K. M., Cook, J. L., Kannus, P., Maffulli, N., & Bonar, S. F. (2002). Time to abandon the “tendinitis” myth. BMJ, 324(7338), 626–627. https://doi.org/10.1136/bmj.324.7338.626
Malliaras, P., Barton, C. J., Reeves, N. D., & Langberg, H. (2013). Achilles and patellar tendinopathy loading programmes. Sports Medicine, 43(4), 267–286. https://doi.org/10.1007/s40279-013-0019-z
Scott, A., Docking, S., Vicenzino, B., Alfredson, H., Murphy, R. J., Carr, A. J., & Cook, J. L. (2015). Sports and exercise-related tendinopathies. Nature Reviews Disease Primers, 1, 15009. https://doi.org/10.1038/nrdp.2015.9
Silbernagel, K. G., Thomeé, R., Eriksson, B. I., & Karlsson, J. (2007). Continued sports activity with pain monitoring in Achilles tendinopathy. The American Journal of Sports Medicine, 35(6), 897–906. https://doi.org/10.1177/0363546506298279