Two tendons, one problem
Achilles tendinopathy is pain and thickening in the tendon behind the ankle, usually in the mid-portion two to six centimetres above the heel bone, sometimes right at the insertion. The signature is morning stiffness that eases with walking, pain that warms up during a run and hurts worse the next day, and a tender lump you can pinch. It is not rare and it is not only an athlete’s problem: a Dutch study of 57,725 people registered with general practices found an incidence of 1.85 per 1,000 patients a year, rising to 2.35 per 1,000 in adults aged 21 to 60, and only about a third of those cases were recorded as sport-related.
Patellar tendinopathy, still widely called jumper’s knee, is pain at the lower pole of the kneecap that hurts with squatting, jumping, decelerating and sitting for long stretches. It concentrates in sports that demand speed and power through the leg extensors: in a study of 613 elite Norwegian athletes across nine sports, 14.2% had current symptoms overall, but that ranged from 44.6% in volleyball and 31.9% in basketball to zero in cycling and orienteering. The same study is a caution about how long these things run — the athletes with current jumper’s knee had been dealing with it for an average of 32 months.
Both are load-capacity problems: the tendon has been asked to do more than it can currently tolerate, usually after a change in training, footwear or surface rather than one bad session. Our post on load spikes explains that pattern.
Loading works. Injections buy time you pay back.
The trial that changed Achilles management was Alfredson’s in 1998. Fifteen recreational athletes with chronic Achilles tendinosis, average age 44, all of whom had failed conventional treatment, did twelve weeks of heavy-load eccentric calf training. All fifteen returned to their pre-injury running, pain during activity fell significantly, and calf strength on the injured side caught up with the good side. A comparison group of fifteen with the same diagnosis had rest, anti-inflammatories, shoe changes and conventional physiotherapy; in no case was it successful, and every one of them ended up having surgery.
For the patellar tendon, a Danish randomised trial put 39 men through twelve weeks of either a corticosteroid injection, eccentric decline squats, or heavy slow resistance training. All three groups improved at twelve weeks. At the six-month follow-up, the two exercise groups had held their gains while the injection group had slipped back — and satisfaction was highest in the heavy slow resistance group, which also showed increased collagen turnover in the tendon. The lesson is not that injections never have a place; it is that an injection without a loading program tends to borrow relief from your future.
What heavy means in practice — the tempo, the reps, the progression — is set out in our guide to heavy slow resistance for tendon pain, which we will not repeat here.
Do I have to stop running?
Usually not. A Swedish randomised trial took 38 people with Achilles tendinopathy and let half continue running and jumping using a pain-monitoring rule while the other half stopped loading the tendon for the first six weeks. Everyone did the same strengthening program. There was no difference in how much the two groups improved — both were substantially better at twelve months — and no negative effect could be demonstrated from continuing to run.
The rule is about the morning after, not about the moment. Pain during a run that stays within tolerable limits, settles afterwards and has not worsened by the next morning is acceptable; pain that is worse the following day means the dose was too high. That single rule is what lets most of our runners keep a reduced version of their training while the tendon rebuilds — which matters as much for the head as for the leg.
How we assess a painful tendon in Daisy Hill
We take the training history first, because the change that caused it is usually in there — a jump in kilometres, a return to court sport after a layoff, a new pair of shoes, a block of hill work. Then we test the tendon under load: calf raise capacity and endurance on each side, single-leg hop and decline squat tolerance, ankle and hip strength, and how you tolerate spring rather than just slow load. Where a number will change the plan, our VALD force-plate testing gives us side-to-side symmetry rather than an impression.
Imaging is rarely needed — ultrasound and MRI show tendon change in plenty of people with no pain, so a scan confirms rather than decides. We refer promptly when the picture suggests something else.
Tendon pain at a glance
Rest settles a tendon and then it hurts again — loading is what changes its capacity · Heavy slow resistance held its gains at six months where a corticosteroid injection did not · You can usually keep running, judged by how the tendon feels the next morning · Recovery is measured in months, not weeks, and stopping early is the most common reason it comes back · Get urgent medical assessment for a sudden snap or pop with an inability to push off, or a hot, red, swollen tendon with fever.
What tendon rehab involves here
The programs run in our gym-based rehab space because they need real load — calf raises and leg press for the Achilles, squats and leg extension for the patellar tendon, progressed by weight rather than repetitions. Alongside that we manage what keeps feeding the problem: training volume, footwear and surface changes, and the calf, quadriceps and hip strength deficits that show up on testing. Dry needling is an adjunct for the muscle symptoms around a painful tendon, not the treatment.
Tendon problems rarely travel alone: Achilles pain often sits alongside plantar heel pain or old ankle sprains, patellar pain shows up in knees with other things going on, and tennis elbow follows the same rules.
Paying for tendon rehab in Logan
Private patients can claim on the spot through HICAPS — see our physiotherapy fees page. Long-standing tendinopathy is often managed under a GP chronic condition management plan, where Medicare rebates item 10960 at $63.40 from 1 July 2026, for up to five allied health visits a calendar year pooled across professions — detail on our Medicare physiotherapy page. DVA card holders are billed directly for accepted conditions, NDIS participants on plan-managed or self-managed plans can use their funding, and a tendon problem that developed at work may be claimable through WorkCover.
Book a tendon assessment in Daisy Hill
Daisy Hill Physio is at Unit 4, 11–13 Allamanda Drive, Daisy Hill QLD 4127 — in Logan City, Queensland, Australia (not Logan, Utah) — and treats runners, court-sport players and tradespeople from Springwood, Shailer Park, Slacks Creek, Underwood, Rochedale South, Cornubia and Loganholme. Book online or call 07 3209 2000 and tell reception which tendon it is. Physiotherapist Ben Birchall leads much of our tendon and endurance-athlete work; meet the whole team on our team page or read how to choose a physio in Logan.
Reviewed by Ben Birchall, Physiotherapist, Daisy Hill Physio. Content current at 23 September 2026. This page is general information, not a diagnosis — see a physiotherapist or GP for advice about your own situation.
Sources: Alfredson H et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 1998;26:360–366 · de Jonge S et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med 2011;45:1026–1028 · Lian OB, Engebretsen L, Bahr R. Prevalence of jumper’s knee among elite athletes from different sports. Am J Sports Med 2005;33:561–567 · Kongsgaard M et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports 2009;19:790–802 · Silbernagel KG et al. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy. Am J Sports Med 2007;35:897–906. Accessed 23 September 2026.
Related: running injuries physio for the wider picture on runner injuries.
