Tendinopathy 1

Home

Why Doesn’t Rest Fix Tendon Pain?

John Miller Physiotherapist Zoe Russell Physiotherapist
Article by
John Miller, Zoe Russell
Achilles tendon assessment for tendon pain load management during calf raise

Tendon pain often needs guided loading, not complete rest.

Rest usually does not fix tendon pain because it eases symptoms without rebuilding tendon capacity. A painful tendon may feel better after time away from walking, running, jumping, gym training, or sport. However, pain often returns when the same activity loads the tendon again.

Tendons respond to the right amount of load over time. Too much load can irritate a tendon. Too little load can reduce strength, endurance, and tolerance. Effective tendinopathy treatment aims to find the middle ground. The goal is to build capacity without repeated flare-ups.

If tendon pain keeps returning after rest, the issue may relate to overuse injuries, a sudden training spike, weakness, poor load progression, or reduced tendon tolerance. A physiotherapist can assess what is driving your symptoms and guide a safer return to activity.

Choose your clinic or appointment pathway

Appointment Options View Phone Numbers

Physiotherapy · Remedial Massage · Exercise Physiology · Private health funds and HICAPS

Why Doesn’t Rest Fix Tendon Pain?

Rest can lower pain because it removes the immediate demand on the tendon. However, it does not improve tendon strength, load tolerance, or the tendon’s ability to cope with repeated activity.

This is why many people feel better during rest, then become sore again when they restart running, walking, jumping, sport, or gym work. The tendon has had a break, but it has not gained the capacity needed for the task.

This pattern is common when people:

  • start a new sport, gym program, or walking routine
  • increase running distance, hills, speed, or training frequency too quickly
  • return to sport after time off
  • change footwear, surfaces, or workload suddenly
  • ignore smaller warning signs until symptoms build

Tendons are slow to adapt. Sudden changes in activity can exceed their current capacity. A long period of complete rest can also make the tendon less prepared for normal activity.

Should You Rest or Keep Moving With Tendon Pain?

Most tendon pain needs modified activity rather than complete rest. The aim is to reduce the most irritating loads while keeping safe, useful movement in your day.

Tendon Load Decision Guide

  • Pain settles within 24 hours: the load may be acceptable, but keep monitoring symptoms.
  • Pain increases during or after activity: reduce speed, volume, hills, jumping, or resistance.
  • Pain keeps returning after rest: the tendon may need a staged strengthening plan.
  • Pain is worsening or spreading: book an assessment to check the diagnosis and loading plan.

What Tendinopathy Treatment Usually Involves

Tendinopathy treatment usually combines load changes with progressive strengthening. This means reducing painful loads enough to calm symptoms while still giving the tendon a useful exercise stimulus.

Treatment may include:

  • short-term reduction of painful or high-load activities
  • specific tendon strengthening exercises
  • progressive reloading based on symptoms and goals
  • muscle strength, control, and movement training
  • biomechanical assessment where relevant
  • education about training load, pacing, and recovery

There is no single exercise plan that suits every tendon or every person. For example, an Achilles tendinopathy program may look different from a patellar tendinopathy, gluteal tendinopathy, or proximal hamstring tendinopathy program. Your tendon, activity level, strength, irritability, and goals all influence the plan.

How Does Physiotherapy Help Tendon Pain?

A physiotherapist can assess why the tendon became painful and what needs to change. Treatment should not only focus on short-term pain relief. It should also address why the tendon became overloaded or underprepared.

Physiotherapy management may include:

  1. Identifying likely causes, such as training error, weakness, reduced tendon capacity, or poor load progression.
  2. Checking for other pain sources, such as bone stress injury, bursitis, joint irritation, or referred pain.
  3. Prescribing suitable exercises to improve tendon strength, tolerance, and function.
  4. Planning a return to activity through gradual and measurable load progression.
  5. Using symptom relief options, such as taping, massage, or dry needling, when suitable.

Depending on the tendon involved, related issues such as peroneal tendinopathy, hip adductor tendinopathy, rotator cuff tendinopathy, or tennis elbow may also need tendon-specific rehabilitation.

How Do You Build Tendon Capacity?

Tendon capacity improves gradually. Most tendons respond well when the right load is repeated over time. This often means a staged strengthening program that progresses based on symptoms, recovery, and function.

Early on, you may need to reduce painful tasks such as sprinting, jumping, hills, deep squats, heavy lifting, or high-volume gym work. As symptoms settle, your program may progress toward heavier strength work, faster movements, and sport-specific loading.

This approach is often more useful than full rest because it improves the tendon’s ability to tolerate future load. For broader background, read more about tendonitis, tendinitis, tendinosis, and tendinopathy.

Quick Check: Is Rest Enough?

Rest may be enough for a mild short-term overload if pain settles and does not return with normal activity.

If pain keeps coming back, the tendon usually needs a plan that changes load, improves strength, and rebuilds tolerance in stages.

When Should You Seek Help for Tendon Pain?

You should consider a physiotherapy assessment if tendon pain:

  • keeps returning when you restart activity
  • has lasted more than two weeks
  • limits work, exercise, sport, or sleep
  • is becoming more irritable or widespread
  • does not improve with sensible load reduction
  • is linked with swelling, marked weakness, or a sudden change in function

Early guidance may help you avoid repeated flare-ups and long breaks from activity. It can also help check whether the pain is truly tendon-related or coming from another structure.

Common Tendon Pain Conditions

Tendon pain can affect many areas of the body. The right plan depends on the tendon involved, your symptoms, and the activities you want to return to.

General Tendon Conditions

Foot and Ankle Tendon Pain

Knee Tendon Pain

Hip, Groin and Hamstring Tendon Pain

Shoulder, Elbow, Wrist and Hand Tendon Pain

Frequently Asked Questions

Why doesn’t rest fix tendon pain?

Rest may ease symptoms briefly, but it usually does not improve the tendon’s strength or ability to tolerate activity. When you return to running, sport, gym work, or repeated daily loading, the pain can return because the tendon still lacks capacity.

Is tendinopathy the same as tendonitis?

Tendinopathy is a broader term for tendon pain and reduced tendon function. Tendonitis suggests inflammation. However, many ongoing tendon problems involve changes in load tolerance rather than simple inflammation alone.

What treatment usually helps tendon pain?

Tendon pain often improves with activity changes, progressive strengthening, and a clear load plan. The goal is to rebuild tendon capacity gradually, rather than stopping all activity and hoping the tendon adapts by itself.

Should you exercise with tendon pain?

Often, yes, but the exercise needs to match your tendon’s current tolerance. Some discomfort may be acceptable. Repeated flare-ups suggest the load is too high. A physiotherapist can help set suitable exercises and progressions.

How long does tendon pain take to improve?

Recovery time varies. Some people improve over several weeks. Others need a longer program over a few months. Duration depends on the tendon involved, symptom history, training load, strength, health factors, and rehab consistency.

When should I see a physiotherapist for tendon pain?

Consider physiotherapy if the pain keeps returning, lasts more than two weeks, limits activity, worsens with training, or does not improve with sensible load changes. Assessment can help confirm the likely cause and guide a safer plan.

Achilles tendon loading during supervised step-down for tendon pain rehab

Progressive loading helps rebuild tendon capacity.

What To Do Next

If tendon pain improves with rest but returns when you move again, the next step is usually not more rest. A better option is to identify the tendon’s current tolerance, reduce the most irritating loads, and rebuild strength in stages.

Book a physiotherapy assessment if tendon pain is limiting your work, sport, walking, running, gym training, or daily activities. Your physiotherapist can help you plan the right level of loading and return to activity with more confidence.

Choose your clinic and appointment pathway

Select a PhysioWorks clinic to continue to live booking, an appointment request or reception assistance.

Not sure what to choose? Compare appointment types
View all clinic locations and phone numbers

Follow PhysioWorks

Get physiotherapy tips, exercise videos, recovery advice and blog updates.

References

  1. Cardoso TB, Pizzari T, Kinsella R, Hope D, Cook JL. Current trends in tendinopathy management. Best Pract Res Clin Rheumatol. 2019;33(1):122-140. doi:10.1016/j.berh.2019.02.001
  2. Malliaras P, Barton CJ, Reeves ND, Langberg H. Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Med. 2013;43(4):267-286. doi:10.1007/s40279-013-0019-z
  3. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409-416. doi:10.1136/bjsm.2008.051193

Common Tendon Injuries

John Miller Physiotherapist jack campbell physiotherapist clayfield sandgate
Article by John Miller & Jack Campbell

Common tendon injuries are painful tendon problems caused by overload, repeated strain, or a sudden increase in activity. They often affect the Achilles, patellar, gluteal, rotator cuff, elbow, and wrist tendons. Most improve with the right diagnosis, load management, and progressive rehabilitation rather than rest alone.

Tendon pain is one of the most frequent reasons people seek help for persistent exercise or work-related discomfort. If you are dealing with a tendon problem, it helps to first explain tendinopathy, how it differs from other soft tissue injuries, and which body region is involved.

Key signs of common tendon injuries

  • Pain that builds with activity or the next morning
  • Stiffness after rest, especially first thing in the morning
  • Tenderness when pressing on the tendon
  • Reduced strength, jumping, gripping, or lifting tolerance
  • Symptoms that return when training load rises too quickly

Choose your clinic or appointment pathway

Appointment Options View Phone Numbers

Physiotherapy · Remedial Massage · Exercise Physiology · Private health funds and HICAPS

What are common tendon injuries?

Common tendon injuries are usually forms of tendinopathy, which means a painful tendon condition related to overload and reduced load tolerance. In practice, they often affect active people, manual workers, and anyone who suddenly increases training volume, intensity, or repetition.

Older terms such as “tendinitis” suggest pure inflammation, but many long-standing tendon problems involve changes in tendon structure, pain sensitivity, and function rather than simple acute inflammation alone. Modern tendon care usually focuses on the tendon continuum, symptom behaviour, and progressive loading.

What causes common tendon injuries?

Common tendon injuries are usually caused by overload that exceeds the tendon’s current capacity. This can happen with sport, gym training, running, repetitive work, poor recovery, weakness, stiffness, or sudden changes in footwear, technique, or training surface.

Other contributing factors can include age, deconditioning, metabolic health, previous injury, and biomechanics. In many cases, the tendon is not “damaged” by one event. Instead, symptoms build gradually when repeated loading outpaces recovery.

Where do common tendon injuries happen?

Common tendon injuries can affect many parts of the body, but some sites are much more common than others. PhysioWorks has detailed condition pages for the main tendon problems listed below.

Common tendon injury hotspots

These tendon problems are among the most common reasons people seek physiotherapy for repeated pain with walking, running, lifting, gripping, throwing, or sport.

Lower limb

  • Achilles tendon
  • Patellar tendon
  • Gluteal tendons
  • Hamstring tendon
  • Adductor tendon

Upper limb

  • Rotator cuff tendons
  • Biceps tendon
  • Tennis elbow
  • Golfer's elbow
  • Wrist and thumb tendons

Foot and ankle tendon injuries

Knee tendon injuries

Hip and groin tendon injuries

Shoulder tendon injuries

Elbow tendon injuries

Wrist and hand tendon injuries

How do you know if common tendon injuries are the problem?

Common tendon injuries often cause local pain, morning stiffness, tenderness, and reduced tolerance to load. The pain usually settles with warm-up, then returns later, the next morning, or when the tendon is loaded again.

Examples include pain with jumping in patellar tendinopathy, pain with gripping in tennis elbow, or pain when lying on the side in gluteal tendinopathy. Some tendon problems can also mimic bursitis, joint pain, or referred pain, so an accurate assessment matters.

3-step tendon recovery framework

1. Settle irritation

Reduce the aggravating load, modify training, and calm pain without stopping all activity.

2. Rebuild capacity

Progress strength and tendon loading gradually so the tendon can tolerate daily life, work, and exercise again.

3. Return with confidence

Build back into walking, lifting, running, jumping, gripping, or sport with the right progressions.

How are common tendon injuries treated?

Common tendon injuries are usually treated with education, load management, progressive strengthening, and a staged return to normal activity. Complete rest is rarely the best long-term answer because tendons generally improve when they are loaded well, not when they are avoided completely.

Treatment may also include technique changes, mobility work, footwear or equipment advice, taping, or short-term pain relief strategies. In some cases, imaging, injection advice, or medical review may be appropriate, depending on the tendon involved and how long symptoms have been present.

Load management matters

A successful tendon plan usually follows a simple path: reduce aggravating load, rebuild tendon capacity, then progress back to work, sport, or exercise. This load management approach is especially important for Achilles, patellar, rotator cuff, and elbow tendinopathies because symptoms often flare when activity rises too quickly.

If you would like an evidence-based overview of physiotherapy and rehabilitation, Healthdirect provides a helpful summary of physiotherapy.

When should you seek help for common tendon injuries?

You should seek help if tendon pain lasts more than a few weeks, keeps returning, affects work or sport, or causes weakness and loss of function. Early assessment can also help if you are unsure whether the problem is tendon-related or something more serious such as a tear, fracture, nerve problem, or inflammatory condition.

Urgent review is sensible if you felt a sudden snap, have major swelling or bruising, cannot load the limb, or suspect a rupture such as an Achilles tendon rupture.

Related tendon injury articles

  1. Tendinopathy: Causes, Symptoms, and Effective Treatments
  2. What Is a Tendinopathy?
  3. Biceps Tendinopathy
  4. Gluteal Tendinopathy
  5. Rotator Cuff Tendinopathy
  6. Proximal Hamstring Tendinopathy

Common tendon injuries FAQs

Is tendinitis the same as tendinopathy?

Not usually. Tendinitis suggests a more inflammatory process, while tendinopathy is the broader modern term used for most painful tendon conditions. Many persistent tendon problems involve tendon overload, pain, and reduced load tolerance rather than simple short-term inflammation alone.

Do common tendon injuries heal with rest?

Short-term activity reduction can calm symptoms, but tendons usually need progressive loading to recover well. Too much rest can reduce tendon capacity, which is why many people improve more with a guided rehabilitation program than with prolonged avoidance.

What exercise helps common tendon injuries?

The best exercise depends on the tendon involved, the irritability level, and your goals. Isometric, heavy slow resistance, eccentric, and sport-specific strengthening can all help when prescribed at the right stage and load.

Can scans confirm common tendon injuries?

Ultrasound or MRI can support diagnosis, but scans do not always match pain levels. A physiotherapist will usually combine your history, symptom pattern, strength, movement testing, and function before deciding whether imaging is useful.

How long do common tendon injuries take to improve?

Recovery time varies. Some reactive tendon problems settle in weeks, while longer-standing tendinopathy may take several months of steady load progression. A faster result is more likely when treatment starts early and training errors are corrected.

Can tendon injuries become chronic?

Yes. Tendon pain can become persistent when aggravating load continues, strength does not recover, or activity progresses too quickly. Chronic tendon problems often still improve well with a staged rehabilitation plan, but they usually take longer than recent flare-ups.

Should you stretch a sore tendon?

Sometimes, but not always. Stretching may help nearby stiffness in some cases, yet an irritable tendon can worsen if stretched too aggressively. Your exercise plan should match the tendon involved, symptom severity, and current rehabilitation stage.

What to do next

If you think you may have one of these common tendon injuries, book an assessment so the painful structure, load triggers, and most suitable rehab plan can be identified clearly. Good tendon rehab is specific to the tendon involved, your activity level, and the tasks that keep flaring your symptoms.

Your physiotherapist can help you reduce irritation, rebuild tendon capacity, and return to walking, training, work, or sport with more confidence.

Choose your clinic and appointment pathway

Select a PhysioWorks clinic to continue to live booking, an appointment request or reception assistance.

Not sure what to choose? Compare appointment types
View all clinic locations and phone numbers

Follow PhysioWorks

Get physiotherapy tips, exercise videos, recovery advice and blog updates.

References

  1. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409-416. doi:10.1136/bjsm.2008.051193
  2. Irby A, Gutierrez J, Chamberlin C, Thomas SJ, Rosen AB. Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments. Scand J Med Sci Sports. 2020;30(10):1810-1826. doi:10.1111/sms.13721
  3. Pavlova AV, Scott A, Rio E, et al. Effect of resistance exercise dose components for tendinopathy management: A systematic review with meta-analysis. Br J Sports Med. 2023;57(20):1327-1334. doi:10.1136/bjsports-2022-105754
  4. Chong HH, Mohd Nor NS, Mohd Nordin MNA, et al. Advancements in de Quervain Tenosynovitis Management: A Comprehensive Review of Conservative Options and Corticosteroid Injection Rehabilitation. J Hand Surg Asian Pac Vol. 2024;29(2):187-197. doi:10.1142/S2424835524400025

What Is Tendinopathy and How Is It Treated?

John Miller Physiotherapist Erin Runge Physiotherapist
Article by John Miller & Erin Runge
Tendinopathy Achilles heel raise load test assessing tendon tolerance

Assessing tendon pain and load tolerance.

Tendinopathy means tendon pain linked with reduced load tolerance. It can develop when a tendon is asked to do more than it can adapt to or recover from.

This can cause local tendon pain, stiffness, and reduced tolerance for exercise, work, or sport. A common example is Achilles tendinopathy. Tendon problems can also affect the shoulder, elbow, hip, knee, ankle, and wrist.

Quick answer: Tendinopathy is a sore, stiff, or weak tendon that has lost some ability to handle load. Care often includes education, activity changes, and graded strengthening.

Symptoms often build over time. Pain may start during running, jumping, lifting, gripping, walking, or daily tasks. Stiffness or soreness may then appear later that day or the next morning.

The term tendinitis is still common. However, many tendon pain problems are not mainly driven by inflammation. Modern care usually focuses on improving tendon load capacity. This may include eccentric strengthening exercises and other graded loading plans.

For a deeper guide, visit Tendinopathy: Causes, Symptoms, Treatment & Rehabilitation.

Choose your clinic or appointment pathway

Appointment Options View Phone Numbers

Physiotherapy · Remedial Massage · Exercise Physiology · Private health funds and HICAPS

How Does Tendinopathy Develop?

Tendinopathy develops when tendon load rises faster than the tendon can adapt. This can happen after a training spike, a new work task, a return to sport, or a change in technique.

Tendons connect muscle to bone. They also store and release energy during movement. When load and recovery are out of balance, the tendon may become painful and less tolerant.

Common Tendinopathy Triggers

  • Sudden increases in training volume or intensity
  • More speed, hills, jumping, gripping, or lifting
  • New shoes, surfaces, tools, equipment, or technique
  • Repeated work tasks with limited recovery
  • Returning to activity after time off
  • Strength, balance, or movement-control changes

This pattern is often seen in conditions such as patellar tendinopathy, rotator cuff tendinopathy, and gluteal tendinopathy.

Why Does Rest Alone Often Fail?

Rest may calm pain for a short time, but it does not rebuild tendon strength. Many people feel better, return to normal load, and flare again because the tendon has not regained capacity.

A better plan usually reduces the painful load first. It then rebuilds strength in steps.

What Are the Common Signs of Tendinopathy?

Tendinopathy often causes local pain near a tendon. It may feel stiff at first, then easier once you warm up. Pain can return later if the tendon has been overloaded.

  • Local pain near a tendon or tendon attachment
  • Morning stiffness or start-up pain
  • Pain that eases with warm-up, then returns later
  • Reduced strength, spring, power, or grip
  • Tenderness when pressing the tendon
  • Symptoms that flare after a load spike

Swelling, heat, or redness can occur, but these signs are not always present. Sudden severe pain, bruising, a snap, or major weakness needs prompt review.

How Is Tendinopathy Assessed?

A physiotherapist assesses tendinopathy by checking your symptoms, activity load, tendon strength, movement, and goals. The aim is to match the tendon problem to the task that triggers it.

Your assessment may include strength tests, functional tests, movement checks, and tender-point testing. It may also look at nearby joints, muscles, footwear, work demands, or sport load.

Ultrasound or MRI may help in persistent or complex cases. Still, scan findings need to match your pain and function. Some tendon changes appear on scans without causing symptoms.

Tendinopathy patellar tendon loading exercise with physiotherapist guidance

Building tendon load tolerance.

How Is Tendinopathy Treated?

Tendinopathy treatment aims to rebuild the tendon’s ability to handle load. Complete rest may settle symptoms briefly, but it often does not restore tendon capacity.

A physiotherapy plan may include:

  • Changing painful activities without stopping all movement
  • Progressive strengthening for the affected tendon
  • Pain-monitoring advice to guide safe loading
  • Movement, technique, footwear, or equipment changes where useful
  • Return-to-sport, running, or work-load planning

Some people also need help with linked tendon problems, such as common tendon injuries, tennis elbow, or Achilles tendon pain.

Should You Rest or Keep Exercising?

Most tendon pain needs smart load changes, not complete rest. The aim is to reduce loads that flare symptoms while keeping enough safe exercise to rebuild capacity.

  • If pain is mild and settles quickly: modify and monitor activity.
  • If pain worsens during or after activity: reduce load and review your plan.
  • If strength drops suddenly: seek assessment promptly.

How Long Does Tendinopathy Take to Improve?

Recovery time varies. Early tendon pain may improve within weeks when load is adjusted early. Longer-standing tendinopathy may take several months.

Your timeline depends on the tendon involved, how long symptoms have been present, your strength, and your work or sport demands. A runner, lifter, tradie, and office worker may all need different load plans.

Tendinopathy tendonitis tendinosis and tenosynovitis terminology comparison diagram

Tendon terms can describe different tissue changes.

What Is the Difference Between Tendinopathy, Tendinitis, and Tendinosis?

Tendinopathy is the broad term for tendon pain and reduced load tolerance. Tendinitis suggests inflammation. Tendinosis refers to longer-term tendon tissue change.

These words often get mixed in reports and conversations. For most people, the key question is not the label alone. The key question is how the tendon behaves when it is loaded.

When Should Tendon Pain Be Checked?

Book an assessment if tendon pain keeps returning, limits work or sport, causes morning stiffness, or reduces strength. Also seek care if symptoms are hard to explain or keep spreading.

Seek prompt medical review after sudden severe pain, a snap, rapid swelling, bruising, major weakness, fever, or unexplained redness and heat.

Related Tendon Guides

These pages help you move from a general tendon answer to a more specific pathway.

Frequently Asked Questions

Is tendinopathy the same as tendinitis?

No. Tendinitis means tendon inflammation. Tendinopathy is broader. It describes tendon pain, stiffness, reduced strength, and lower load tolerance.

Can tendinopathy improve without surgery?

Yes. Many people improve with education, load changes, and progressive strengthening. Surgery is usually considered only after suitable conservative care has not helped enough.

How long does tendinopathy take to improve?

Recovery varies. Early tendon pain may improve within weeks. Longer-standing tendinopathy may take several months, especially when sport, lifting, running, or work demands need to rebuild.

Should you exercise with tendinopathy?

In most cases, yes, but exercise needs to be adjusted. A physiotherapist can help set a loading level that challenges the tendon without repeated flare-ups.

Does an ultrasound or MRI always show the cause of tendon pain?

No. Scans may show tendon changes that are not painful. They may also miss how the tendon responds to load. Clinical assessment and function still matter.

When should tendon pain be assessed?

Book an assessment if tendon pain keeps returning, affects work or sport, causes morning stiffness, or reduces strength. Sudden severe pain or major weakness needs prompt review.

Tendinopathy Achilles hopping progression for return to activity

Progressing tendon strength and spring.

What To Do Next

If tendon pain keeps returning, limits activity, or feels hard to manage, get it assessed. Early guidance may reduce flare-ups and help you choose the right loading level.

For more detail, see Tendinopathy: Causes, Symptoms, Treatment & Rehabilitation.

Choose your clinic and appointment pathway

Select a PhysioWorks clinic to continue to live booking, an appointment request or reception assistance.

Not sure what to choose? Compare appointment types
View all clinic locations and phone numbers

Follow PhysioWorks

Get physiotherapy tips, exercise videos, recovery advice and blog updates.

References

These references support the tendon overload, loading, imaging, and rehabilitation principles discussed in this FAQ.

  1. Millar NL, Silbernagel KG, Thorborg K, et al. Tendinopathy. Nat Rev Dis Primers. 2021;7(1):1. doi:10.1038/s41572-020-00234-1
  2. Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision 2024. J Orthop Sports Phys Ther. 2024;54(12):CPG1-CPG32. doi:10.2519/jospt.2024.0302
  3. Cooper K, Alexander L, Brandie D, et al. Exercise therapy for tendinopathy: a mixed-methods evidence synthesis. BMJ Open Sport Exerc Med. 2023.
  4. Hijlkema A, Roozenboom C, Mensink M, Zwerver J. The impact of nutrition on tendon health and tendinopathy: a systematic review. J Int Soc Sports Nutr. 2022;19(1):474-504. doi:10.1080/15502783.2022.2104130

What Are the Most Common Running Injuries?

John Miller Physiotherapist Chelsea Gan Physiotherapist
Article by John Miller & Chelsea Gan
Runner with knee pain pointing to knee during physiotherapy assessment in clinic

Running injuries most often affect the knee, shin, Achilles tendon, calf, foot and hip. Many develop gradually when a recent running demand exceeds the capacity of a muscle, tendon, joint or bone.

Common pattern

Pain builds during a run, appears afterwards or feels worse the next morning.

Important clue

Symptoms often follow a change in distance, speed, hills, frequency, surface or recovery.

Seek assessment

Book earlier when pain changes your stride, causes limping or becomes sharp and localised.

Which running injuries are most common?

Running-related injuries can affect muscles, tendons, joints, bones and other supporting tissues. Some start suddenly, such as an ankle sprain or calf strain. However, many build over several runs as repeated loading exceeds the tissue’s current capacity.

The eight conditions below account for many of the knee, shin, calf, heel, foot and thigh symptoms reported by recreational runners.

Runner’s knee

Pain around or behind the kneecap. It commonly becomes noticeable during hills, stairs, squats or longer runs.

Shin splints

A broader area of exercise-related pain along the shin. Symptoms often follow a change in impact load or training volume.

Achilles tendinopathy

Pain and stiffness around the Achilles tendon. Morning stiffness and discomfort at the start of running are common features.

Plantar fasciopathy

Pain under the heel or arch. The first steps after rest may feel uncomfortable before symptoms ease with movement.

ITB syndrome

Pain around the outside of the knee. It may appear at a similar point during each run, particularly on hills.

Calf strain

A sudden or gradually worsening pain in the calf. Faster running, sprinting and hills can increase calf demand.

Hamstring injury

Pain at the back of the thigh or near the sitting bone. Symptoms may affect faster running, acceleration and longer strides.

Bone stress injury

Focal bone pain that may progress from running pain to discomfort with hopping, walking or normal daily activity.

Where do runners commonly feel pain?

Front or outside of the knee

Front-of-knee pain may relate to runner’s knee, also called patellofemoral pain. Symptoms often become noticeable during downhill running, stairs, squats or after sitting with the knee bent.

Pain on the outside of the knee may fit an iliotibial band presentation. However, several knee structures can cause pain in a similar area. The location alone does not confirm a diagnosis.

Along the shin

A broad area of tenderness along the inner shin often fits shin splints. By contrast, a small and sharply localised painful area raises more concern about a bone stress injury.

Shin pain warrants earlier assessment when hopping is painful, symptoms persist after exercise or discomfort begins affecting walking.

Behind the ankle or in the calf

Achilles tendinopathy commonly causes pain, stiffness or thickening around the tendon. Symptoms may feel worse during the first steps in the morning or when beginning a run.

A calf strain is more likely when pain starts suddenly during acceleration, hills or faster running. Significant weakness, swelling or difficulty pushing through the foot requires prompt assessment.

Under the heel or through the foot

Plantar fasciopathy often causes pain under the heel, particularly during the first few steps after getting out of bed or standing after rest.

Forefoot pain has several possible causes, including metatarsal overload, nerve irritation and bone stress. Persistent focal pain should not be managed simply by continuing to run through it.

At the hip, groin or back of the thigh

Hip and thigh symptoms may involve the gluteal tendons, hamstrings, hip joint or surrounding muscles. Proximal hamstring symptoms often sit close to the lower buttock and may become uncomfortable during faster running or prolonged sitting.

Groin pain has several possible sources. Assessment becomes more important when pain persists, affects walking or does not settle after a reasonable reduction in training.

Why do running injuries happen?

Running injuries rarely have one isolated cause. Instead, they usually reflect an interaction between recent training, previous injuries, recovery, health, tissue capacity and the demands of the runner’s chosen pace, terrain and distance.

Common contributing factors may include:

  • A longer individual run than your body has recently tolerated
  • Adding speed, hills and distance within the same training period
  • Returning quickly after illness, injury or a break from running
  • Insufficient recovery between demanding sessions
  • Reduced calf, thigh, hip or trunk capacity
  • A previous injury that has not regained full strength or running tolerance
  • A sudden change in shoes, running surface or training environment

Choose your clinic or appointment pathway

Appointment Options View Phone Numbers

Physiotherapy · Remedial Massage · Exercise Physiology · Private health funds and HICAPS

What are the early signs of a running injury?

An early running injury does not always begin with severe pain. Mild changes in comfort, stiffness or movement can appear before running becomes significantly limited.

During running

Pain starts earlier, becomes stronger or makes you shorten your stride.

After running

Soreness lasts longer than expected or increases later in the day.

The next morning

Stiffness, tenderness or pain is worse than your usual post-training response.

Other warning signs include swelling, reduced push-off strength, repeated pain at the same running distance and declining confidence in the affected leg.

Can you keep running with an injury?

Some runners can continue with a temporarily reduced load. Others need to pause running while the injury is assessed. The safest choice depends on the suspected tissue, symptom severity and how the condition responds during and after exercise.

Consider reducing or stopping the run when:

  • Pain continues to increase as you run
  • Your stride changes or you begin to limp
  • Symptoms remain clearly worse the following morning
  • You have sharp or highly localised bone pain
  • You lose strength, balance or confidence in the leg
  • Running causes increasing swelling

A minor symptom that remains mild, does not alter movement and settles promptly may allow a modified run. However, repeatedly testing an injury with the same aggravating session can delay recovery.

How are running injuries assessed?

A physiotherapy assessment usually begins by clarifying where symptoms started, how they respond to running and what changed before the problem developed.

Your assessment may include:

  1. Reviewing your recent training

    Your physiotherapist may compare distance, pace, hills, speed sessions, surfaces, footwear, recovery and recent interruptions to training.

  2. Examining the painful area

    Palpation, movement testing and relevant clinical tests help identify which tissues may be contributing.

  3. Checking strength and movement capacity

    Testing may include calf raises, hopping, squats, step tasks, hip strength or other movements matched to your symptoms.

  4. Reviewing your running where useful

    A running assessment can examine relevant movement patterns and how they interact with your current injury and training demands.

Imaging is not required for every running injury. However, a medical referral or imaging may be appropriate when the assessment suggests a fracture, significant tendon injury or another condition needing further investigation.

Physiotherapist guiding step-up exercise for lower limb strength and rehabilitation in clinic

How can physiotherapy help a running injury?

Physiotherapy aims to identify the likely injury, reduce aggravating load and rebuild the capacity needed for running. Your plan should reflect the affected tissue, your current symptoms and the type of running you want to resume.

Management may include:

  • Temporary changes to running distance, pace, hills or frequency
  • Progressive calf, knee, hamstring, hip or trunk strengthening
  • Mobility work when a relevant restriction affects function
  • Advice about footwear, surfaces and training structure
  • Movement or running retraining when it has a clear clinical purpose
  • A staged return-to-run program
  • Testing before faster running, hills or longer distances resume

Passive treatment may help some symptoms in the short term. However, rebuilding load tolerance and gradually returning to running usually remain central to rehabilitation.

Runners with recurring symptoms may also benefit from a dedicated running injury risk and performance assessment.

How can you reduce your risk of another running injury?

No strategy can prevent every injury. Even so, sensible progression and adequate recovery can reduce avoidable overload.

  1. Build one demand at a time

    Avoid making large increases in distance, speed and hills simultaneously.

  2. Watch individual long-run changes

    Compare a planned longer run with the longest distance you have completed recently, not only your weekly total.

  3. Keep regular strength work

    Calf, thigh, hamstring, hip and trunk exercises can support the physical demands of running.

  4. Respond early to warning signs

    Modify training when pain escalates, changes your stride or remains worse the following morning.

  5. Return gradually after a break

    Fitness can return faster than the load tolerance of bones, tendons and muscles after time away.

When should a runner book an assessment?

Consider booking a physiotherapy assessment when:

  • Pain is changing your running technique
  • You cannot progress training without another flare-up
  • Symptoms are worsening from one session to the next
  • Morning pain or stiffness is becoming more noticeable
  • Pain is sharply localised over a bone
  • You have swelling, weakness or difficulty walking
  • You are unsure how much running is currently safe

Earlier assessment is especially useful when a stress fracture, significant calf injury or Achilles tendon injury is possible.

Running injuries guide

Explore running-related conditions, treatment principles and return-to-running information.

Running assessment

Learn how strength, mobility, training and running movement may be assessed together.

Sports physiotherapy

Find out how sports physiotherapy can support injury rehabilitation and return to activity.

Common running injury FAQs

What is the most common running injury?

Knee pain, including runner’s knee or patellofemoral pain, is consistently among the most frequently reported running injuries. Shin splints, Achilles tendinopathy and plantar heel pain are also common.

Are most running injuries caused by overuse?

Many running injuries develop gradually through repeated loading rather than one traumatic event. However, “overuse” does not identify one cause. Training changes, recovery, previous injury, health and tissue capacity can all contribute.

What are the first signs of a running injury?

Early signs may include pain that begins sooner during a run, soreness that lasts longer afterwards, increasing morning stiffness or a subtle change in stride. Repeated symptoms at a similar distance also deserve attention.

Should I stop running when I have pain?

Stop or reduce running when pain escalates, changes your gait, causes swelling or remains clearly worse the following morning. Mild symptoms that settle promptly may allow modified activity, but the safe approach depends on the injury.

When is shin pain more serious?

Shin pain is more concerning when it is sharply localised, painful with hopping, present during walking or continuing after exercise. These features may indicate a bone stress injury and should be assessed promptly.

Can a running assessment prevent injuries?

A running assessment cannot guarantee injury prevention. It may identify useful changes to strength, training, recovery or movement when interpreted alongside your symptoms, injury history and running goals.

What causes knee pain when running?

Running-related knee pain may involve the patellofemoral joint, iliotibial band, patellar tendon or another structure. Training changes, reduced tissue capacity and a previous injury can contribute, so persistent pain should be assessed rather than diagnosed from location alone.

What should you do next?

Use the links above to compare your painful area with the most relevant condition guide. Meanwhile, reduce the running sessions that clearly aggravate your symptoms rather than repeatedly testing the same painful load.

Book an assessment when pain is changing your stride, limiting normal training or becoming more localised. A clear diagnosis and staged rehabilitation plan can help you return to running with appropriate progression.

Choose your clinic and appointment pathway

Select a PhysioWorks clinic to continue to live booking, an appointment request or reception assistance.

Not sure what to choose? Compare appointment types
View all clinic locations and phone numbers

Follow PhysioWorks

Get physiotherapy tips, exercise videos, recovery advice and blog updates.

References

  1. Correia CK, Machado JM, Dominski FH, de Castro MP, Fontana HB, Ruschel C. Risk factors for running-related injuries: an umbrella systematic review. Journal of Sport and Health Science. 2024;13(6):743–757. doi:10.1016/j.jshs.2024.04.011.
  2. Frandsen JSB, Hulme A, Nielsen RO, et al. How much running is too much? Identifying high-risk running sessions in a 5200-person cohort study. British Journal of Sports Medicine. 2025;59(17):1203–1211.
  3. Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. Journal of Sport and Health Science. 2021;10(5):513–522. doi:10.1016/j.jshs.2021.04.001.