Tendinopathy: Why Your “Stubborn” Injury Isn’t Going Away (Yet)

If you're dealing with a nagging tendon injury — maybe in your Achilles, your elbow, your shoulder, or your knee — you're not alone. And if you're wondering why it's still hanging around after weeks (or even months) of rest, manual therapy, and rehab exercises - you're definitely not alone.

Tendinopathies can be some of the most frustrating injuries to experience — not because they’re untreatable, but because they don’t behave like most other injuries. They linger. They flare up. They seem to get better, then worse again. And sometimes it feels like nothing is working.

So, why is that?

Let’s break it down.

The Tendon Journey Isn’t Linear

Tendons connect muscle to bone. They’re built to handle a lot of load — like running, lifting, throwing, or even just carrying groceries. But when they’re overloaded too quickly or too often, they start to break down. That’s tendinopathy.

And here’s the tricky part: you don’t usually tear a tendon overnight. You wear it down gradually. And unfortunately, it rarely heals overnight either.

In fact, tendinopathy follows a continuum — a kind of journey with stages. And depending on your activity levels, stress, sleep, and treatment, you can move both forward and backward along that path.

The Three Stages of Tendinopathy (And What They Feel Like)

1. Reactive Tendinopathy (The Warning Sign)

This is the early stage. You’ve done a bit too much, and your tendon reacts. It becomes swollen and irritated.

How it feels: Sore during or after activity, maybe tender to touch. But it often settles quickly with rest.

The good news: You’re early in the process, and with the right load management and exercise, you can turn it around easily.

2. Dysrepair Stage (The Frustrating Middle)

This is where many people get stuck. The tendon structure starts to change — your body tries to repair it, but not very effectively.

How it feels: Ongoing stiffness, pain with use, soreness that lingers longer. Some days feel okay, others worse.

Why it’s tricky: This stage can drag on for months if it’s not managed properly. But it’s still very treatable.

3. Degenerative Tendinopathy (The Long Haul)

This is the long-term stage — the tendon starts to break down more significantly.

How it feels: Chronic pain, often even at rest. Weakness. Reduced function in daily life or sport.

Can it get better? Yes. But it takes time, consistency, and the right kind of loading. Surgery is rarely needed, but rehab needs to be smart and structured.

Why Rest (Alone) Doesn’t Fix It

One of the biggest misconceptions about tendinopathy is that it just needs rest. But here's the thing: tendons don’t heal like muscles. They don’t get much blood flow. So resting might reduce pain temporarily — but it doesn’t rebuild strength or capacity.

If you rest too much, the tendon gets weaker, which means it’ll be even more sensitive when you go back to activity. That leads to the classic boom-bust cycle: rest, feel better, return to activity, flare-up, rest again...

Sound familiar?

So What Should You Do?

✔️ Stay Consistent with Targeted Rehab

That usually means a progressive loading program — exercises that gradually build your tendon’s ability to handle stress again. It may not feel dramatic day to day, but over weeks and months, this is what drives real recovery.

✔️ Be Patient — Progress Is Slow But Real

Tendons adapt slowly. Sometimes treatment is helping not by making you feel amazing immediately, but by stopping things from getting worse. That’s still a win.

✔️ Don’t Chase the Pain — Trust the Plan

Pain isn’t always a sign of damage. A little discomfort during rehab is okay. The goal isn’t to avoid all pain, but to build tolerance over time.

Final Thoughts: You’re Not Failing — It’s Just a Different Kind of Injury

If you’re dealing with tendinopathy, and it feels like your progress is stuck, please don’t blame yourself. These injuries can be slow, stubborn, and mentally exhausting.

But with the right approach, they do improve. You’re not broken. You’re just dealing with a type of injury that needs a bit more strategy and a bit more patience.

And even if it feels like you’re not moving forward fast, you might be doing the most important thing of all: keeping the tendon from moving further in the wrong direction.

That’s progress, too.