You've been resting it for weeks. Maybe months. You've been sensible, stayed off it, waited for it to settle. And it's still there - if anything, it feels worse the moment you try to get back to the things you love.
Here's what most people don't know: for tendon pain, rest is often the worst thing you can do. The question isn't whether to rest or push through - it's how to load the tendon in a way that actually lets it heal.
We sat down with Jonathan Maquiso, one of our Habit Health physios in Auckland, who recently attended a tendon symposium and regularly sees tendon pain in clinic. Here's what he wants every Kiwi with a sore tendon to know.
The short answer: Tendons need progressive load to heal, not rest. Resting removes the very stimulus your tendon needs to rebuild. The longer you wait without the right kind of movement, the harder recovery becomes.
Jonathan sees the same pattern in our Auckland clinics again and again. People try rest first. Then rest again. Then, after a few cycles, they finally come in.
"The most common is when they come in at six to eight weeks and they don't see any improvements at all," he says. "Sometimes it can be even months to even a year. They realise, oh, this doesn't just go away from rest."
Duration matters because it's a key indicator of what's going on. Muscular pain typically settles within 12 weeks. Tendon pain can linger well beyond six months, especially without the right management from the start. ACC covers treatment for many tendon injuries in New Zealand, so there's often less barrier to getting help than people expect.
The takeaway: If you've had pain for more than a couple of weeks and it hasn't changed, that's your signal to see a physio.
This comes down to a fundamental difference in how tendons and muscles are built.
Muscles have good blood supply. Tendons don't.
Muscles are highly vascular - when you damage one, your body quickly delivers the nutrients needed to repair it. Tendons have far less blood supply, so they heal more slowly and respond to a completely different stimulus.
"When you damage muscle, it being so rich with blood, it can send the nutrients it needs into those tissues to heal," Jonathan explains. "Tendon is a bit more opposite. They don't have the same blood supply, so they take a little bit longer."
Tendons are built to store and transfer force.
A tendon's job isn't just to connect muscle to bone - it also stores and transfers energy, resisting tensile forces, compression, and rotation. When you overload a tendon, that energy-storing function gets disrupted. The only way to restore it is to gradually expose the tendon to load again. Rest removes that stimulus entirely. The tendon doesn't get the signal it needs to rebuild. It just waits.
The 2024 Clinical Practice Guidelines from the Journal of Orthopaedic and Sports Physical Therapy are clear on this: complete rest is not indicated for tendon pain. Progressive loading exercise is the first-line treatment.
Someone rests for two or three months, the pain settles, and they think they're better. Then they try to return to running or sport and it comes back immediately - sometimes worse.
"They rest, there's no pain, and then the moment they get back to the things they enjoy, it's still there. If not worse sometimes."
Extended rest leads to:
The irony is real: the longer you rest, the harder it becomes to return to the activities you love.
Jonathan laughs about this. "If I step outside being a physical therapist, I wouldn't even understand what that means."
Here's the plain-language version: loading just means using it. Every time you stand, walk, climb stairs, or carry something, you're loading the tendons in your lower limbs. When a tendon is injured, it becomes sensitive to that load. The pain is your tendon saying: "This is my current capacity. I can't handle more than this right now."
Jonathan's clinic uses handheld dynamometers to measure how much force an injured tendon can produce compared to the unaffected side. If your unaffected leg produces 100kg of force but your injured leg manages only 20kg, that tells you exactly where to start.
From there, the programme builds gradually:
According to a 2024 analysis of 110 studies by the NIHR, resistance-based loading was consistently more effective than bodyweight exercise alone for tendon pain. If you're dealing with pain in a specific area like the foot or heel, our podiatry team can help assess what's driving it. For hand, wrist, or elbow pain, our hand therapy service offers the same tailored loading approach.
For tendon rehab, pain-free rehabilitation is actually a misreading of the evidence. Some pain during loading is not only acceptable - it's expected. The key is knowing where the line is.
|
Pain level |
What it means |
|---|---|
|
0-4 out of 10 |
Acceptable during exercise. Keep going. |
|
5-6 out of 10 |
Getting into the danger zone. Reduce the load. |
|
7-10 out of 10 |
Too much. Stop and reassess. |
"Four out of 10 or less will be good," Jonathan says. "The moment we start veering into the five, six, seven, eight - that usually means you're making the pain worse."
If walking is already painful, running is not the next step. You climb the ladder based on what your pain allows right now. Also pay attention to how your tendon feels the next morning - pain should settle back to baseline within 24 hours of exercise. If you're consistently waking up more sore the day after, the load was too much.
Two people with an Achilles injury can have completely different presentations, pain sensitivity, muscle weakness, and starting points.
"It's not really a one-size-fits-all approach," Jonathan says. "Everyone's got different types of reactions to different activities. Different combinations of pain and disability, muscle weakness, tendon thickening. Their pain sensitivity is different, their fear of damaging anything is different."
The right programme depends on:
Generic exercises from Google won't cut it. What works is a structured assessment and a loading plan built around where you're starting from right now.
"I just need to stretch it out" - Tendons don't respond to passive stretching the way muscles do. What they need is controlled load, not length.
"Rest it until the pain is completely gone" - Waiting for zero pain is a recipe for a longer, harder recovery. Find the load your tendon can tolerate now and build from there.
"Ice will fix it" - Ice can help manage acute pain short-term, but it won't address the underlying issue.
"I'll just push through and it'll toughen up" - Going too hard, too fast is one of the most common ways people make tendon pain worse. Pushing into high pain levels increases sensitivity, not decreases it.
"It'll sort itself out eventually" - Structured loading programmes produce clinically meaningful improvements within 12 weeks for most people. Waiting and hoping doesn't produce the same outcome.
Jonathan's answer is direct: see a physio.
"If you've had pain for longer than a couple of weeks and it hasn't changed at all, see a physio just to make sure you're not missing anything. You don't have to put up with pain for that long."
A physio will assess your tendon, measure your current capacity, build a tailored loading programme, and progress you safely over time. You don't need a GP referral to see a physio at Habit Health, and ACC may cover part or all of your treatment if your injury is eligible.
Jonathan is based at two Auckland locations and takes a tailored, evidence-based approach from day one. No referral needed.
Book online now with Jono at Habit Health Mt Wellington or Habit Health Greenlane.
Not quite right? We have physio clinics right across Auckland and nationwide. Find your nearest Habit Health clinic and book online today.