Tendinopathy treatment (tennis elbow, Achilles, patellar) (Tendinopathy management)
Non-surgical management of painful, overused tendons such as tennis elbow, Achilles and patellar (jumper's knee) tendinopathy, where a gradual loading and rehabilitation programme is the mainstay.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Progressive loading and rehabilitation (usually physiotherapy) is the main, best-evidenced treatment for most tendinopathy — injections and machines are add-ons, not replacements.
- Recovery is usually slow: many tendons take weeks to many months to settle, and pushing hard through pain can make things worse.
- Most people improve without surgery; for tennis elbow, for example, the great majority recover within about a year.
- Be cautious of any clinic that guarantees a cure, downplays exercise, or sells repeated paid injection courses.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
A correct diagnosis, so you are treating the right problem and not missing another cause of pain
Your pain is from a different cause (for example nerve, joint or referred pain) that needs a different diagnosis and treatment.
You start the agreed programme and settle aggravating activities. Some soreness when exercising is normal and expected; it should be tolerable and settle...
A clear written exercise programme with progressions and a realistic timescale.
You start the agreed programme and settle aggravating activities. Some soreness when exercising is normal and...
Exercises are gradually progressed. Many people notice early changes in how the tendon feels, though pain can...
A typical point to review progress. If you have followed the programme but not improved, the clinician may adjust...
Many tendons are substantially better by now, and people are returning to fuller activity or sport with continued...
What is tendinopathy treatment?
Tendinopathy is pain and reduced function in a tendon that has been overloaded or overused — common examples are tennis elbow (outer elbow), Achilles tendinopathy (back of the ankle) and patellar tendinopathy or 'jumper's knee' (below the kneecap). The tendon does not heal in the simple way a cut does; it adapts slowly to load, which is why recovery usually takes time.
The mainstay of treatment is a structured, progressive loading and rehabilitation programme — usually guided by a physiotherapist — alongside settling the things that overloaded the tendon in the first place. This is the part with the strongest evidence, and most people improve with it, even though it can feel slow.
Injections and machines (such as steroid injections, platelet-rich plasma, high-volume injection, prolotherapy or shockwave therapy) are sometimes offered when a tendon is not settling. These are adjuncts at best — extra options to consider alongside rehabilitation, not proven cures, and the evidence for many of them is mixed or limited. They do not replace the exercise programme.
This guide explains what responsible tendinopathy treatment looks like, what to expect from recovery, and how to spot a provider who is over-promising.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Loading rehabilitation versus injections for tendinopathy
| Approach | Loading rehab | Injections / machines |
|---|---|---|
| Role | Mainstay treatment | Adjunct at best |
| Evidence | Strongest | Mixed or limited |
| Speed | Slow but durable | Sometimes faster, often short-lived |
| Main downside | Takes patience | Cost, post-injection flare, variable benefit |
Injections and machines are usually considered alongside rehabilitation, not instead of it. They should not be sold as a guaranteed fix.
Preparing for your treatment
- Write down when the pain started, what makes it worse, and any training, work or footwear changes around that time.
- List the treatments you have already tried, including how long you did each exercise programme and whether it helped.
- Bring a list of your medicines and any other health conditions, especially diabetes, inflammatory arthritis or previous tendon problems.
- Be ready to discuss your goals — for example returning to a sport, work task or daily activity — so the plan can be tailored.
- Wear or bring clothing that lets the clinician examine and watch the affected area move.
- Think about how much time you can realistically commit to daily exercises, as this strongly affects results.
What happens
A first appointment with a physiotherapist, GP or sport and exercise medicine doctor usually involves taking your history and examining the tendon and the joints around it, watching how it moves and what reproduces your pain.
Many tendinopathies are diagnosed from the history and examination alone. Imaging such as ultrasound or MRI is not always needed, but may be arranged if the diagnosis is unclear, symptoms are severe or not settling, or other problems need ruling out.
The clinician then explains the likely diagnosis and agrees a plan with you. For most people this centres on a progressive loading programme with clear instructions, a realistic timescale, and a review date. If adjuncts such as injections or shockwave therapy are discussed, a good clinician explains the uncertain evidence and that these sit alongside, not instead of, rehabilitation.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Your pain is from a different cause (for example nerve, joint or referred pain) that needs a different diagnosis and treatment.
- You have signs of a tendon rupture or another problem needing urgent or surgical assessment.
- You have an underlying inflammatory or systemic condition driving the pain that needs medical treatment in its own right.
- You are unwilling or unable to engage with a loading programme, which is the part most likely to help.
Delay or rearrange if…
- You have sudden severe pain, a snap, or weakness suggesting a possible rupture — seek urgent assessment first.
- There are signs of infection (spreading redness, heat, fever), especially after a recent injection.
- The diagnosis is uncertain and red-flag symptoms (such as night pain, fever or unexplained weight loss) have not been explained.
- You are in an acute, very painful flare where a short period of relative rest and pain relief is sensible before progressing exercise.
Alternatives to discuss
- A period of watchful waiting with self-care, as many tendinopathies improve with time and load management.
- Simple measures alone — activity change, topical anti-inflammatory gel, braces — for milder cases.
- The NHS pathway, including self-referral to physiotherapy in many areas.
- Referral to a sport and exercise medicine consultant or orthopaedic surgeon if a sustained programme fails.
- Surgery in a small minority, considered late and only after non-surgical treatment has been properly tried.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- A correct diagnosis, so you are treating the right problem and not missing another cause of pain
- A structured plan with the best-evidenced treatment (progressive loading) at its centre
- Realistic expectations about how long recovery is likely to take
- Avoiding unnecessary, costly or unproven treatments
- A clear point to seek further review if you are not improving
- Most people improve and avoid surgery
Risks & complications
- Slow progress that tests your patience — tendons often take months, not days
- A temporary increase in soreness when you start or progress loading exercises
- Symptoms returning if you stop exercises or return to heavy activity too quickly
- Choosing an adjunct (injection or machine) that does not help and adds cost
- Side effects of adjuncts, such as a flare of pain after an injection
- Diagnosis turning out to be something other than simple tendinopathy, needing different treatment
- A weakened or partly torn tendon, which can occasionally follow repeated steroid injection (one reason steroid is generally avoided in or near the Achilles)
- A complete tendon rupture, which needs urgent assessment
The biggest risk with tendinopathy is not danger but disappointment: expecting a quick fix, abandoning the exercise programme, or paying for repeated injections that have not been shown to cure the problem. Ask any clinician what the evidence is for what they are recommending, and what the plan is if it does not work.
Published figures to discuss
Outcomes vary a great deal between people and between tendons. Recovery depends on the tendon involved, how long symptoms have been present, how well the loading programme is followed, and the underlying load and health factors. Because many studies use different programmes and outcome measures, precise success rates are hard to quote and should be treated cautiously.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Slow recovery | Common; often months rather than days | Tendons adapt slowly and need progressive loading rather than only rest. | Guide sourcesClinical context |
| Pain flare with loading | Common | Some pain during rehab may be acceptable, but symptoms should settle and not progressively worsen. | Guide sourcesClinical context |
| Injection or passive treatment overused | Common pitfall | Injections, shockwave or PRP should not replace an appropriate strengthening and load-management plan. | Guide sourcesClinical context |
| Tendon rupture or alternative diagnosis missed | Uncommon but important | Sudden pop, bruising, major weakness or systemic inflammatory symptoms need reassessment. | Exercise vs wait-list in chronic tennis elbow (RCT) — PMCncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is usually no physical 'recovery' as such, because this is non-surgical treatment. Instead, 'afterwards' means following the programme and gradually returning to the activities that matter to you as the tendon settles.
- A tolerable ache during and shortly after loading exercises
- Day-to-day ups and downs in pain rather than a smooth, steady improvement
- Slow progress overall — improvement measured in weeks and months
- Needing to keep up some strengthening even after the worst pain settles
- Temporary soreness or a flare if you do too much too soon
Aftercare
- Do the prescribed exercises consistently — this is the part that does most of the work.
- Aim for a tolerable ache during loading, not severe pain; do not simply 'push through'.
- Reintroduce sport or heavy activity gradually, as advised, rather than all at once.
- Use simple pain relief such as topical anti-inflammatory gel or paracetamol if needed, as advised.
- Keep your review appointment so progress can be checked and the plan adjusted.
- Tell your clinician if pain is getting worse, not better, or if function is dropping.
- If an injection or shockwave course is suggested, ask how it fits alongside your exercises and what the plan is if it does not help.
- Written exercise programme with clear progressions
- A realistic recovery timescale agreed with your clinician
- A review date booked
- A note of which activities to ease off and how to build back up
- Pain relief (e.g. topical gel) to hand if advised
- A clear plan for what happens if you are not improving
- Contact details for questions between appointments
⚠ Get urgent help if…
- Sudden severe pain or a snapping or popping sensation in the tendon — possible tendon rupture, seek urgent assessment
- A sudden gap, weakness or inability to push off, point the foot, straighten the knee or grip — seek urgent assessment
- Increasing redness, heat, swelling, fever or feeling unwell, especially after an injection — possible infection
- Calf pain, swelling, redness or breathlessness — seek urgent help as this can suggest a blood clot
- Numbness, tingling or weakness spreading beyond the tendon
- Pain that is rapidly worsening or waking you at night and not following the expected pattern
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good outcome is a tendon that lets you do the activities that matter to you with little or no pain, achieved mainly through a loading programme and sensible activity management. For many people this is realistic, though it usually takes time and ongoing strengthening.
No treatment can guarantee a pain-free tendon or stop the problem ever returning, and tendons that have been symptomatic can flare again with overload. Honest care focuses on function and steady progress rather than promising a permanent cure.
Improvements gained through strengthening tend to last well, particularly if you keep up some loading exercise and avoid sudden spikes in activity. Tendinopathy can recur, especially if the original overload returns, so maintenance matters. Any benefit from injections or shockwave therapy is more variable and is not guaranteed to be lasting.
Related tests, treatments or support
Tendinopathy treatment often combines several elements at once — for example load management plus a strengthening programme plus simple pain relief. Adjuncts such as injections or shockwave therapy, if used, are added to this rather than replacing it. Your clinician should explain how the parts fit together and why each is being recommended.
Follow-up & long-term care
You should have a planned review, often around 6–12 weeks, to check progress and adjust the programme. If you are improving, reviews may space out; if not, the clinician may arrange imaging, reconsider the diagnosis, discuss adjuncts, or refer you to a sport and exercise medicine consultant or orthopaedic surgeon. Onward referral should be based on a sustained, well-followed programme not working — not on impatience.
- Keep up a maintenance level of strengthening exercise after the worst pain settles.
- Increase training load and intensity gradually rather than in sudden jumps.
- Address contributing factors such as footwear, technique or workload.
- Restart or progress your exercises early if symptoms begin to return.
- Seek review rather than self-prescribing repeated injections if a flare does not settle.
Repeat, follow-on and what comes next
- Many people need their programme adjusted at least once if progress stalls.
- Symptoms can recur, particularly if loading returns to high levels too quickly, and a further course of rehabilitation may be needed.
- If adjuncts are used and do not help, the sensible next step is to revisit the diagnosis and programme rather than simply repeat the injection.
- A small number of people are referred on for specialist or surgical opinion when a well-followed programme has not worked.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear written exercise programme with progressions and a realistic timescale.
- A named contact and a planned review to check progress and adjust the plan.
- An honest discussion of adjuncts as options, not cures, with a plan B if they do not help.
- Clear warning signs for when to seek urgent help (possible rupture or infection).
- A sensible threshold for onward referral if a well-followed programme is not working.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether you are paying for a specialist consultation, physiotherapy sessions, or both
- The number and frequency of physiotherapy or rehabilitation sessions
- Whether imaging (ultrasound or MRI) is arranged, and who reports it
- Whether adjuncts such as injections or shockwave therapy are recommended (often charged per session or course)
- Follow-up appointments and any onward referral
- Whether a written report or letter is needed for work, insurance or sport
- The cost of the initial assessment and what it includes
- The likely number and cost of physiotherapy or rehabilitation sessions
- Whether imaging and its reporting are included or separate
- The cost of any suggested injection or shockwave course, and how many sessions
- What follow-up is included
- The cancellation and rescheduling policy
- What happens, and what it costs, if you are not improving and need further care
On the NHS? Tendinopathy assessment and physiotherapy are available on the NHS when clinically indicated; private care is often used for faster physiotherapy access, a specialist sport and exercise medicine opinion, or imaging.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being offered an injection or machine without a clear explanation that loading exercise is the mainstay.
- No honest discussion that recovery is usually slow and can take many months.
- Adjunct treatments presented as proven cures rather than as options with mixed or limited evidence.
- No agreed plan or review date for what happens if you do not improve.
- Being sold a fixed package of repeated injections before a rehabilitation programme has been properly tried.
Marketing red flags
- Guaranteeing a cure or a specific recovery time for a tendon problem.
- Downplaying or skipping exercise in favour of paid injections or machines.
- Pushing repeated, expensive injection courses, especially without reviewing whether earlier ones helped.
- Claiming a single treatment 'regenerates' or 'heals' the tendon as a certainty.
- Recommending steroid injection into or around the Achilles without discussing rupture risk.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What is the diagnosis, and how confident are you without a scan?
- What does my loading and rehabilitation programme involve, and how long should I give it?
- How will we measure whether it is working, and when will we review?
- If you are suggesting an injection or shockwave therapy, what is the evidence and how does it fit alongside my exercises?
- What is the plan if I do the programme properly but still do not improve?
- Are there any activities I should avoid or change while I recover?
- What warning signs should make me seek urgent help?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Can I get tendinopathy treatment on the NHS?
Why is my tendon taking so long to get better?
Do I really need injections or a machine to fix it?
Should I rest completely until it stops hurting?
Are steroid injections a good idea?
When should I worry that it might be a tear?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Tennis elbow NHS — Tennis elbow treatment Versus Arthritis — Achilles tendinopathy NICE — Autologous blood injection (incl. PRP) for tendinopathy (IPG438) NICE — Extracorporeal shockwave therapy for refractory plantar fasciitis (IPG311) Faculty of Sport and Exercise Medicine UK Exercise vs wait-list in chronic tennis elbow (RCT) — PMC
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Platelet-rich plasma (PRP) injection · High-volume injection for tendinopathy · Prolotherapy · Shockwave therapy (ESWT) · Barbotage for calcific tendinopathy