Tendinopathy in Runners: What It Is and How to Fix It

Runners in Hillsboro know the feeling. A stiff Achilles in the morning. A nagging pain near the knee or ankle that eases once you warm up, then comes back harder the next day. For years this was casually labeled “tendinitis,” but science has moved on, even if the language has not.

The correct term is tendinopathy. That distinction matters, because it changes how runners should approach recovery and which treatments actually work.

What Is Tendinopathy?

Tendinopathy is persistent tendon pain and loss of function related to mechanical loading, not inflammation. This definition comes from an international scientific consensus aimed at cleaning up decades of confusing terminology.

In practical terms, tendinopathy means the tendon has adapted poorly to load over time. Instead of a healthy, spring-like structure that stores and releases energy during running, the tendon becomes less tolerant to stress. Pain appears during or after activity, stiffness shows up in the morning, and performance drops.

Common sites for runners include the Achilles tendon and the patellar tendon, though the same principles apply elsewhere.

Tendinopathy vs Tendinitis, Why the Difference Matters

“Tendinitis” implies inflammation. That idea drove decades of treatment focused on rest, anti-inflammatory medication, injections, and passive treatments. The problem is that persistent tendon pain does not necessarily show meaningful inflammatory cell activity. What researchers consistently find instead are structural and mechanical changes in the tendon tissue itself.

Calling it tendinopathy shifts the goal from calming inflammation to restoring the tendon’s ability to handle load. This is why anti-inflammatory approaches often fail, and why manual therapy often does not fix the problem. Hands-on treatments like massage or joint mobilizations (nudging on the joint, shaking the joint, etc.) might feel good temporarily, but they do not change tendon capacity. That is why they are unfortunately not considered effective solutions for tendinopathy.

Why Runners Develop Tendinopathy

Running is a repetitive loading activity. Tendons thrive on load, but only when the load is appropriate. Problems arise when training volume, intensity, or frequency increases faster than the tendon can adapt.

Research shows runners with Achilles tendinopathy demonstrate measurable deficits in strength, endurance, and hopping performance compared to uninjured runners.

These deficits are not just symptoms, they are part of the condition itself.

Add factors like higher body mass, reduced calf or thigh strength, and pain-related fear, and you have a tendon that is being asked to do more with less capacity.

What Runners Can Do Right Now

Managing tendinopathy does not require complete rest, and stopping all running often makes things worse. Tendons need load to recover, but that load must be intelligent.

First, respect pain guidelines. Mild to moderate pain during exercise is acceptable, typically up to 5 out of 10, as long as symptoms settle within 24 hours. Pain that spikes and lingers means the load was too high.

Second, reduce chaos in training. Sudden jumps in mileage, pace work, hills, or speed sessions are common triggers. Small, controlled changes allow the tendon to adapt.

Third, load the tendon directly. Isometric and resistance-based exercises are not optional extras. They are the treatment. Multiple studies show that progressive tendon loading improves pain and function in tendinopathy.

Fourth, stop chasing passive fixes. Massage, scraping, dry needling, and similar manual techniques do not improve tendon structure or load tolerance. They may create short-term symptom relief, but they do not address the root problem.

Why Progressive Loading Works

Tendons are mechanosensitive tissue. They respond to load by becoming stiffer and stronger when the loading stimulus is appropriate. A large systematic review from 2022 (basically a research article reviewing all the relevant research on that specific topic) by Dr.Stephanie L. Lazarczuk and her co-authors showed that mechanical loading leads to meaningful improvements in tendon stiffness and material properties, especially with higher strain resistance training.

This is not about random exercises. It is about applying the right load, at the right intensity, with enough time for adaptation. Programs that progress from isometric holds to slow resistance and eventually to energy storage activities like hopping consistently outperform older eccentric-only approaches.

The Role of Physical Therapy for Runners

This is where physical therapy becomes invaluable. Not generic physical therapy, but runner-specific and tendon-focused care.

A physical therapist experienced with tendinopathy does several critical things. They assess strength and endurance deficits that are not obvious during running. They identify load errors in training. They design a progressive loading plan that respects pain while rebuilding capacity. And they guide return to running without fear-based restrictions.

Studies on runners with Achilles tendinopathy show that education combined with pain-guided progressive exercise leads to meaningful improvements in function and satisfaction. The education piece matters because understanding that pain does not equal damage reduces fear and improves adherence.

Importantly, truly effective physical therapy for tendinopathy does not rely on manual therapy as a primary tool. Manual techniques do not change tendon stiffness, strength, or load tolerance. Progressive loading focused exercise does.

Why This Matters for Runners in the Portland Metro Area

Runners in Hillsboro, Beaverton, Aloha, Forest Grove, and Portland train year-round. Hills, wet weather, treadmill seasons, and spring race build-ups create perfect conditions for load errors. Tendinopathy thrives in that environment when recovery strategies lag behind training ambition.

The good news is that tendinopathy is not a life sentence. With the right approach, runners return to full training stronger than before. Tendons adapt slowly, but they adapt reliably when treated correctly.

The uncomfortable truth is that there is no shortcut. There is no magic hands-on fix. There is only progressive loading, patience, and smart guidance. Fortunately, the evidence is clear, and when runners follow it, outcomes improve.

If you'd like to learn more, feel free to reach us by clicking the contact button or just simply call/text us at (971)-364-0909.