Overuse Tendinopathy (Tendonitis)

An overuse syndrome common in running with typical symptoms of localized pain that begins gradually from repetitive motions. Historically called tendonitis as it was thought to be primarily from inflammation but subsequent research points to poor or abnormal healing and thus more appropriately called tendinopathy.


Symptoms often begin gradually, and you may notice pain and/or stiffness and some tenderness to touch. They often begin after increase in training load (volume, vertical volume, etc.). The pain is sometimes worse at the beginning of a run or after the run.

Common Areas
Common areas in runners are Achilles (back of heel/calf), Patellar (Runner’s knee) and Anterior Tibialis (shin splints) but can occur in other places around the hamstrings and gluteal region.

Risk Factors
There are other factors such as increasing age and medications (certain antibiotics, steroids) that increase your risk.


If you experience tendinopathy during a race you will make the problem worse by continuing to run. But if you accept that and really want to finish and are willing to do the rehab after the race you can try gentle stretching, ice to the area and a topical pain relief like Diclofenac ointment. Realize that these short-term fixes may delay your long-term healing. We advise avoiding systemic (pill form) NSAID medication like ibuprofen when racing due to the potential harms to the kidneys.

Long Term
Resting the area is usually not enough as you need to initially rest the area and then build back the tendon with the appropriate strength and alignment. SO GO FIND A GOOD PHYSICAL THERAPIST. There are specific exercises (such as the Alfredson protocol for Achilles) that a professional can teach you.  They may also identify an underlying structural weakness elsewhere in your body that is contributing to the increased load on the tendon.

Other methods for long term healing that have been studied with variable results include heel lifts/bracing, Platelet rich plasma (PRP) injections, shockwave therapy, dry needling, and collagen supplementation among a few.


Prevention is key as this may take months to years to heal in many cases.
– Increase load in a thoughtful manner.
– Ensure appropriate footwear (zero drop may not be for every runner type).
– At the first sign of tendinopathy be aggressive about treating it and minimizing additional stress.


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