Written and clinically reviewed by Jeremy Swisher, MD
Start with the right question
Not every painful tendon has the same problem
Tendinopathy is a broad term for persistent tendon-related pain and reduced function. It often develops when the demands placed on a tendon outpace its current ability to recover and adapt. A sudden increase in running, jumping, throwing, lifting, work, or practice volume can contribute, but symptoms may also build gradually without one obvious event.
Tendon pain can occur at the Achilles, patellar tendon or quadriceps tendon at the knee, rotator cuff or biceps at the shoulder, the common extensor tendon or common flexor tendon at the elbow, and gluteal tendons at the hip. Pain near a tendon does not automatically prove that the tendon is the source. A partial or complete tear, irritation of a nearby bursa, joint arthritis, referred pain, nerve symptoms, or another condition may look similar at first.
That distinction matters. The goal of an evaluation is not simply to name a structure; it is to understand what is limiting you, which loads trigger symptoms, and what findings would actually change the plan.
Evaluation
A diagnosis built from your story, examination, and goals
The visit usually begins with how symptoms started, what has changed in your training or daily workload, which movements are difficult, and what you have already tried. Prior injuries, health conditions, medications, sleep, recovery, and sport or job demands can all add useful context.
The physical examination may assess tenderness, range of motion, strength, movement control, and the tendon’s response to progressively more demanding tasks. Depending on the area, that might include a heel raise, squat, hop, resisted shoulder movement, grip task, or another functional test. The examination also helps screen for a tear or a problem in a nearby joint, muscle, nerve, or bone.
When imaging can help, and when it cannot
Many tendon conditions can be diagnosed clinically. Ultrasound or MRI may be useful when the diagnosis remains uncertain, a significant tear is suspected, symptoms do not follow the expected course, or the result could change treatment. Imaging findings must be interpreted alongside symptoms and function: tendon changes can appear in people who have little or no pain.
Imaging is therefore a decision tool, not a scorecard for how damaged a tendon is or a requirement before rehabilitation can begin.
Non-operative care
Rebuild tolerance instead of chasing a quick fix
Most persistent tendon problems are managed without surgery. Treatment is individualized, but a plan commonly combines education, temporary adjustment of the most provocative activity, and progressive exercise. Complete rest can reduce symptoms briefly while leaving the tendon less prepared for the next increase in demand. The better target is often a manageable dose of loading that can advance over time.
Settle the most reactive phase
Modify the volume, speed, range, or frequency of the activity that is driving symptoms while maintaining safe conditioning where possible.
Build foundational strength
Static holds, slow strengthening through a comfortable range, exercises that emphasize the lowering phase, or heavier slow resistance may be used depending on the tendon, symptoms, and rehabilitation phase. No single exercise style is best for everyone.
Restore speed and sport demands
Running, jumping, changing direction, throwing, or faster loading is added progressively when appropriate.
Plan the return
Decisions are based on symptoms, strength, function, confidence, and the demands of the activity, not a universal calendar date.
Diagnosis-specific starting points include programs for Achilles tendinopathy, patellar tendinopathy in athletes, rotator cuff related shoulder pain, tennis elbow, golfer's elbow, and gluteal tendinopathy. Use them only after the working diagnosis and safe loading level are clear.
Physical therapy can be central to this process. Bracing, taping, footwear changes, or medication may help selected patients, but each has tradeoffs. A plan should account for health history and the demands you actually need to meet.
Where procedures fit
Ultrasound-guided injections or minimally invasive procedures may be discussed for selected conditions after the diagnosis, prior care, alternatives, and risks are reviewed. They are not automatic, do not guarantee recovery, and generally do not replace a progressive rehabilitation plan. A consultation does not imply that imaging or a procedure will occur the same day.
A specific shoulder condition
Calcific tendinitis of the shoulder
Calcific tendinitis occurs when calcium deposits form within a rotator cuff tendon. Some deposits cause no symptoms; others can be associated with substantial shoulder pain and restricted motion. The history and examination help distinguish it from a rotator cuff tear, frozen shoulder, arthritis, and other sources of shoulder pain. X-ray and ultrasound may help confirm the location and appearance of a deposit when those results are relevant to care.
Initial treatment can include activity modification, medication when medically appropriate, and rehabilitation to restore motion and shoulder function. For selected patients whose symptoms persist, an ultrasound-guided lavage procedure, often called barbotage, may be considered. Whether it is appropriate depends on the clinical picture and deposit characteristics. The expected benefits, alternatives, recovery plan, and potential risks should be discussed before deciding.
Prepare for your visit
What to bring and what to expect
- Bring: Prior imaging reports and access to the actual images, if available
- Bring: Physical therapy notes or a summary of exercises already tried
- Bring: A current medication and allergy list
- Bring: A short timeline of training, workload, or equipment changes
- Expect: A focused history and musculoskeletal examination
- Expect: Review of prior imaging alongside your symptoms and examination
- Expect: A working diagnosis and rehabilitation plan
- Expect: Selective imaging, procedure, or specialist referral when indicated
When tendon-area pain needs urgent attention
Seek prompt medical evaluation after a sudden pop with marked bruising, a new inability to push off the foot, raise the arm, or straighten the knee, or obvious loss of strength. Call 911 or seek emergency care for an open wound or visible deformity, a limb that becomes numb, cool, or pale, inability to bear weight after major trauma, or any other medical emergency. A hot, swollen joint with fever also needs urgent assessment.
For PTs and referring clinicians
Collaborative care when progress has stalled
Referral can be useful for diagnostic clarification, concern for a tear or bone stress injury, symptoms that do not match the expected pattern, consideration of point-of-care ultrasound, or discussion of an adjunct procedure. Please send relevant imaging, rehabilitation progress, and the clinical question when possible. The goal is to coordinate a plan that supports ongoing rehabilitation instead of interrupting it.
UCLA resources for healthcare professionalsCommon questions
Tendon pain FAQs
Does “tendinitis” mean my tendon is inflamed?
The term is commonly used, but persistent tendon pain is more often described as tendinopathy because the biology can involve changes beyond inflammation alone. The label matters less than identifying the correct tissue, how sensitive it is to activity, the resulting functional limits, and a workable rehabilitation plan.
Should I stop all activity until the pain is gone?
Not necessarily. Some activities may need to be reduced or temporarily paused, but safe movement and appropriately dosed loading are often part of treatment. The right level depends on the diagnosis, symptom response, and your goals.
Do I need an MRI before starting physical therapy?
Often, no. Many tendon conditions can be evaluated clinically and begin rehabilitation without MRI. Imaging is most useful when it answers a specific question that may change management.
How long will recovery take?
There is no reliable universal timeline. Duration of symptoms, tendon involved, severity, health factors, consistency of loading, and the demands of your activity all matter. Progress is better judged by symptom behavior, strength, function, and readiness for specific tasks.
Authoritative references
Sources and further reading
- American Family Physician: Management of Chronic Tendon Injuries
- British Journal of Sports Medicine: Dutch multidisciplinary guideline on Achilles tendinopathy
- American Academy of Orthopaedic Surgeons: Achilles Tendinitis
- Sports Medicine Today: Tendinopathy / Tendonitis
- UCLA Health: Jeremy Swisher, MD
This page provides general education and cannot diagnose a condition or replace an individual medical evaluation.