Understanding Tendon Pain Part II

Understanding Tendon Pain Part II

Understanding Tendon Pain

Part II - Assessment of Tendon Pain/Injury

Zac Caughey

For an accurate diagnosis of tendon injury, a thorough assessment is needed. Key parts of patients’ history can help to identify the injury’s causes. To confirm the diagnosis of a tendon injury, City Baths Physiotherapists use a variety of subjective questions and physical assessments.


Graphic explaining the definition of Tendinopathy. Recall from Part I:when tendons are overloaded, their structure changes. Tendons usually contain Collagen I fibres, but these are replaced with Collagen II when too much stress is placed on the Tendon. This degeneration weakens the tendon. These structural changes are known as Tendinopathy

Subjective assessment

Detailed athletic history is a critical component of tendon assessment. Tendon injury has hallmark signs, including:

  • Tendon pain stays localised
    i.e. pain is only on the area around the tendon and does not spread with taking weight onto the painful side
  • History of pain coming on slowly, made worse by increased loading patterns
    i.e. fast sprinting will be more aggravating and painful than slow jogging for Achilles
  • Often exhibits a warm-up pattern
    i.e. pain decreases with activity

It is important that your physiotherapy assessment addresses abnormal tendon pain. The following symptoms suggest a source of pain other than tendon pathology:

  • sudden pain when exercising
  • pain at low loads (e.g. light weights; cycling)
  • pain at rest or at night
  • pain that spreads out from source point under load
Table listing typical features various tendinopathies. Achillies tendinopathy: Pain that stays in the Achillies during loading Worsens with running/plyometric activity Morning stiffness & pain in tendon Worse after an extended period of inactivity Warms up (pain gets lesser) with activity but is worse the next day. Patellar tendinopathy: Pain in the patella that increases with loading Worsened by jumping, changing direction and prolonged sitting (esp. in car). Hamstring tendinopathy: Pain at the very bottom of your pelvis (back/posterior side), where it connects to your thigh (anatomically, the ischial tuberosity). Worsened by sitting, driving, uphill running/walking Adductor tendinopathy Pain in the inner thigh Worsens with change of direction

The final and most crucial factor in determining whether tendon pain is caused by tendon pathology is changes in training load. Changes in training load include things like increasing training frequency or intensity. Greater stresses in the lower limb of the athlete may also result from changes in the surface or shoes worn while exercising.

Objective Assessment

Confirming the diagnosis of tendon injury and excluding alternative causes are the goals of comprehensive objective tests. This is necessary to guide appropriate and efficient care. City Baths Spinal and Sports Medicine physiotherapists conduct a thorough assessment, to find areas of weakness in the athletes’ lower limb movement patterns and determine whether an increase in tendon load has resulted in tendon pain.

Our physiotherapists use questionnaires, as well as strength, endurance, and power testing, to confirm tendon pathology diagnoses. These are critical for understanding athletes’ tendon capacity and addressing deficits that may exacerbate the injury.

Examples of objective testing methods used by City baths Physio physiotherapists. Achilles tendon testing: Slow double leg heel raises Slow single leg heel raises Continuous double leg jumps Continuous single leg hops Forward hops Patellar tendon testing: Double leg squats Single leg squats Double leg jumps Single leg jumps Stop jump Hamstring tendon testing: Double leg slow bending forward Single leg slow bending forward Double leg fast bending forward Single leg fast bending forward Fast single leg change of direction Adductor tendon testing: Adductor squeeze with bent knees Standing adduction against resistance Copenhagen adduction exercise Change of direction Kicking


Athletes are often referred for imaging by their GP to identify tendon injury; but recent studies have shown that imaging alone does not confirm tendon pathology as the cause of pain. Asymptomatic athletes can also present with tendon pathology on imaging. Imaging is helpful, but before confirming a diagnosis, it is crucial that imaging results match the clinical symptoms. To identify a tendon injury, the team at City Baths Physio use extensive testing and questioning.

How early should you book your physiotherapist appointment?

Don’t hesitate if you have recently increased your activity and are experiencing pain in your tendons – you could make your injury worse!

Your physiotherapist will oversee your rehabilitation and help you return to your activity goals as safely as possible.

Why choose CBSSMC?

  • Thorough assessment & accurate diagnosis.
  • Rehabilitation program relevant for your sport, activity or goals.
  • Clinical Pilates studio – incorporate reformer or mat Pilates into your rehab program!
  • Experienced physiotherapists – we’ll find the right practitioner for you.
  • Convenient Melbourne CBD location – walk, PTV or drive!
  • Flexible appointments – before and after work times available.

If you think you’re experiencing tendon pain, or have been diagnosed with a tendon injury, make an appointment with one of our experienced physiotherapists today!

Stay tuned for Part III - Treatment of Tendon Injuries

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  1. Malliaras P, Cook JL, Kent P. Reduced ankle dorsiflexion range may increase the risk of patellar tendon injury among volleyball players. J Sci Med Sport. 2006;9(4):304-9.
  2. Cook JL, Khan K, Kiss ZS, Purdam CR, Griffiths L. Repro – ducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players. British journal of sports medicine. 2001;35(1):65-9
  3. Moller M, Lind K, Styf J, Karlsson J. The reliability of isokinetic testing of the ankle joint and a heel-raise test for endurance. Knee Surg Sports Traumatol Arthrosc. 2005;13(1):60-71.