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Physiotherapy · Tendon pain

Tendon pain physio in Phuket

Achilles pain, jumper’s knee, outer hip pain, tennis or golfer’s elbow. Tendons respond to the right kind of load. Our physios find which tendon and how irritable it is, then build its capacity step by step.

For runners, jumpers, padel and golf players, and anyone whose tendon pain keeps coming back.

Book a free physio assessment

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Rated 5.0 from 57 Google reviews

What the research says

Settled is not the same as ready

Rest can calm a sore tendon, but it does not rebuild its capacity, and symptoms can linger or return.1,2 Progressive loading is what guidelines recommend first.3,4

  • 4 of 16

    people whose Achilles symptoms had fully settled had full calf and tendon function back, in one study.5

  • 78%

    were at least moderately better a year after education plus exercise for outer hip pain, against 57% after one injection.6

  • 72%

    of people given a steroid injection for tennis elbow improved and then relapsed, against 8% after physio, in one trial.7

Long-standing does not mean hopeless. In studies of knee and elbow tendons, how long people had it did not predict who recovered.8,9

How we work

Load the tendon, then measure it

Tendons adapt to load. The aim is to load yours at the right level, progress on a clear rule, and test it, so feeling better and being ready are not confused.

  • Load it, don’t rest it

    A US physio guideline grades progressive tendon loading as the first treatment for Achilles pain and advises against complete rest.3 You keep moving within a simple pain rule.

  • Slow and heavy works

    In trials, heavy, slow strength work matched or beat older programs for the Achilles and the knee, with better attendance.10,11 Moderate loads can work too.12

  • Take the squeeze off

    Some tendons hurt when they are squeezed against bone: the outer hip when you cross your legs or lie on your side, the Achilles at the heel bone in deep ankle bends.13,14 Changing those positions is part of the plan.

  • Physio first, then coach

    Your physio rules out tears and other causes, sets your loads and signs off each stage. Your S&C coach then takes over the springy, sport-specific work.

Which tendon?

Four tendons we see most

Each tendon behaves a little differently, so your plan is matched to yours.

  • Above the heel

    Achilles tendon pain

    Pain and stiffness in the tendon above the heel, often worst first thing in the morning or at the start of a run. Guidelines advise at least 12 weeks of progressive loading.4 Pain right where the tendon meets the heel bone needs a different plan: in one 2025 trial, avoiding deep ankle bends, using heel lifts and skipping calf stretches did better.14

  • Patellar tendon, below the kneecap

    Jumper’s knee

    Pain just below the kneecap when you jump, land, squat or take stairs. A staged program of holds, strength, jumps then sport improved knee scores in a 76-person trial where symptoms had lasted a median of two years.15 In one small trial, heavy slow strength held its gains at six months while a cortisone injection’s faded.11

  • Gluteal tendons, side of the hip

    Outer hip pain

    Pain on the outside of the hip, often worse lying on your side, on stairs and on walks. Often called bursitis, it is mostly a squeezed tendon.13 In one trial of 204 people, education on positions plus progressive strength work beat a single injection on overall improvement at one year.6

  • Outside or inside of the elbow

    Tennis and golfer’s elbow

    Pain on the outside (tennis) or inside (golfer’s) of the elbow when you grip. In trials, about 9 in 10 tennis elbows improved within a year without active treatment,9 so exercise is about getting there sooner. Golfer’s elbow is less studied, and its plan borrows from tennis elbow research.16

Your recovery

Four phases, moved through by milestones

Each phase lasts at least a week, and your next-morning response decides when you move on. Expect months, not weeks.

  1. 01

    Typically 0 to 2 weeks

    Settle and hold

    Calm the tendon without stopping everything. Cut back the loads that flare it, change the positions that squeeze it, and start holds that load it without a flare. Your physio checks for anything that is not a tendon problem.

    Move on whenHolds at moderate effort with low pain, a settled next morning on most days, and other causes ruled out by your physio.

  2. 02

    Typically 2 to 12 weeks

    Build slow strength

    Slow, heavy strength work for the muscle behind the tendon, about three times a week, getting heavier every week or two: calf raises, squats and knee extensions, side-hip work, or wrist and forearm lifts.

    The handover gateHeavy sets of 6 to 8 reps green the next morning, your tendon score clearly better, and strength rising on retest. Your physio signs it off.

  3. 03

    Typically 8 to 16 weeks

    Build the spring

    Your coach adds what the tendon does in sport. Hops, jumps, landings and running for the Achilles and knee; heavier gym strength for the hip; heavier grip work for the elbow. One change at a time.

    Move on whenHops or heavier grip work stay green the next morning, and strength is close to your other side.

  4. 04

    From about 12 weeks

    Back to sport

    Running, padel, golf, Muay Thai and court sports back in steps: drills, training, then matches. Strength work continues twice a week after you return.

    Full sport whenTwo weeks of full training green the next morning, your sport steps completed, and a physio sign-off.

If your score has barely moved after about 12 weeks of good loading, your physio rechecks the diagnosis and discusses a doctor’s opinion.4,17

Between sessions

Let the next morning decide

Tendons often react the day after a session, not during it. Your physio gives you your pain number, from 3 to 5 out of 10 depending on the tendon.15,18

Check three things: pain during loading against your number, how the tendon feels the next morning, and whether morning pain is creeping up week to week.

  • Green: progress

    Pain within your number during, back to usual by the next morning, and no creep week to week. Progress one thing next session.

  • Amber: hold

    Pain a little over your number, or worse the next morning but settled within a day. Repeat the same session.

  • Red: step back

    Still worse after 24 hours, pain at rest, or a rising trend over two weeks. Drop back a step and message your physio.

Get medical help today if

  • A sudden snap or kick feeling at the back of the heel
  • You cannot rise onto your toes, or there is a dent in the tendon
  • A pop below the kneecap, then you cannot straighten your knee
  • Tendon pain during or after a fluoroquinolone antibiotic19
  • A hot, red, swollen joint, or fever with the pain
  • Calf swelling with breathlessness or chest pain: call 1669

Also the same day: pain putting weight on the leg after a fall, or new weakness lifting your fingers or thumb.

Offered an injection?

Fast relief, then what?

Injections can calm tendon pain quickly, and that is a real option to discuss with your doctor. The question is where you want to be a year from now.

For tennis elbow, one placebo-controlled trial found one-year results were worse after a steroid injection, with 54% relapsing.20 For outer hip pain, overall improvement at one year after an injection was no better than waiting.6 For jumper’s knee, a cortisone injection eased symptoms at 12 weeks, but scores slipped back by six months.11 PRP did no better than placebo injections in trials of the Achilles, knee and elbow.21,22,23

54%

relapsed within a year after a steroid injection for tennis elbow, in one trial20

12%

relapsed after a placebo injection in the same trial20

Patient reviews

What our patients say

Rated 5.0 from 57 Google reviews

  • “Came to see K. Meaw after a thigh injury due to overuse by playing tennis, I wasn’t able to walk and she helped me recover in 3 sessions plus taught me about strengthening my muscles to do sports.”

    GERARDO TAYGoogle review

  • “I honestly can’t thank Karim at Optimisefit enough … I’ve lived in five different countries and, unfortunately, had to deal with many injuries, so I’ve seen quite a few physios over the years. But no one has ever come close to the level of knowledge, care, and clarity that he brings.”

    Unfiltered OpinionsGoogle review

  • “Optimise is a fantastic set up, I have been working with Khun Meaw on a physio front, and she is awesome and really gets to the root of the problem and starts from there – could not recommend highly enough. Having seen a couple of different physios on the island, Khun Meaw is certainly number 1.”

    Jamie AllworkGoogle review

  • “I have been working with Khun Meaw on some strengthening exercises for my shoulders, hips and knees. … Her goal has been to give me the tools I need to work on my specific areas of need and not to keep me in an endless cycle of needing help……so professional and a joy to work with.”

    Catlin McCrackenGoogle review

  • “I started seeing Khun Maew last August for a knee issue and within 15 minutes she had identified a multitude of issues I’d been dealing with for more than 20 years … I have been pain free for 6 months and am now in the gym working to rebuild my mobility and strength.”

    Michelle LawlorGoogle review

  • “I had an impingement in my shoulder an Karim solved it within three sessions! Really amazing! I can only recommend going there.”

    Julian BarthGoogle review

  • “Meaw has been incredible. She helped me recover from long term neck and lower back pain and gave me personalized exercises that I now do daily. These have made a huge difference in my strength, mobility, and overall well-being. I’m so grateful for her expertise and highly recommend her to anyone looking for real, lasting results!”

    Jeff CraigGoogle review

Read all 57 reviews on Google

Questions

Tendon pain questions

Should I rest it until the pain goes?

Not completely. In one Achilles trial, people who kept running within a pain rule did as well as people who stopped running and jumping for six weeks.18 Rest settles pain; graded load builds capacity.

Should I stretch it?

It depends on the tendon. Stretches that pull the leg across your body squeeze the outer hip tendons.24,13 For pain at the heel bone, a program without calf stretching did better.14 Your physio tells you which apply to you.

Will a scan show how bad it is?

Not reliably. Scan findings did not predict who improved with exercise for jumper’s knee,25 and for outer hip pain, how bad the scan looked did not match pain or function.26

Do I need surgery if it has lasted months?

Rarely as a first step. Surgery was no better than exercise at 12 months for jumper’s knee,17 and no better than a sham operation for tennis elbow in one small trial.27 For the Achilles, it is only considered after at least six months of active treatment.4

Is golfer’s elbow treated the same as tennis elbow?

Probably similar, but it is far less studied. Our golfer’s elbow plan borrows from tennis elbow research and expert opinion, and we tell you that upfront.16,28

What happens at the free physio assessment?

Your physio finds which tendon is involved, checks for tears and other causes, and works out a starting load. You leave with a clear plan. It’s free, with no obligation.

Physio team

Your physio team

Meaw leads our clinical standards and checks every handover to your coach.

How physiotherapy works here
  • Meaw, Head Physiotherapist at Optimise

    Meaw

    Head Physiotherapist

  • Karim, Physiotherapist at Optimise

    Karim

    Physiotherapist

Also on the team Sukanya, Physiotherapist

Next step

Find out what your tendon can handle

Message us on WhatsApp to book your free physio assessment. We find which tendon, measure where you start and build your plan.

Book a free physio assessment

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Questions first? WhatsApp +66 65 914 1604

Low back painSciaticaShoulder painKnee arthritisRunner’s kneeACL rehabAnkle sprainNeck painHamstring strainMeniscus tearsHeel painHip arthritisFrozen shoulderRotator cuff tearsKnee and hip replacement
Sources (28)
  1. Lagas IF, et al. Incidence of Achilles tendinopathy and associated risk factors in recreational runners: a large prospective cohort study. J Sci Med Sport. 2020;23(5):448-452.
  2. Lagas IF, et al. How many runners with new-onset Achilles tendinopathy develop persisting symptoms? A large prospective cohort study. Scand J Med Sci Sports. 2020;30(10):1939-1948.
  3. Chimenti RL, et al. Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision 2024. J Orthop Sports Phys Ther. 2024;54(12):CPG1-CPG32.
  4. de Vos RJ, et al. Dutch multidisciplinary guideline on Achilles tendinopathy. Br J Sports Med. 2021;55(20):1125-1134.
  5. Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J. Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy. Br J Sports Med. 2007;41(4):276-280.
  6. Mellor R, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662.
  7. Bisset L, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939.
  8. Deng J, et al. Long-term prognosis of athletes with patellar tendinopathy receiving physical therapy: patient-reported outcomes at 5-year follow-up. Am J Sports Med. 2025;53(7):1568-1576.
  9. Ikonen J, et al. Persistent tennis elbow symptoms have little prognostic value: a systematic review and meta-analysis. Clin Orthop Relat Res. 2022;480(4):647-660.
  10. Beyer R, et al. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2015;43(7):1704-1711.
  11. Kongsgaard M, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009;19(6):790-802.
  12. Agergaard AS, et al. Clinical outcomes, structure, and function improve with both heavy and moderate loads in the treatment of patellar tendinopathy: a randomized clinical trial. Am J Sports Med. 2021;49(4):982-993.
  13. Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. J Orthop Sports Phys Ther. 2015;45(11):910-922.
  14. Pringels L, et al. Effectiveness of reducing tendon compression in the rehabilitation of insertional Achilles tendinopathy: a randomised clinical trial. Br J Sports Med. 2025;59(9):640-650.
  15. Breda SJ, et al. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. Br J Sports Med. 2021;55(9):501-509.
  16. Hoogvliet P, et al. Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. Br J Sports Med. 2013;47(17):1112-1119.
  17. Bahr R, et al. Surgical treatment compared with eccentric training for patellar tendinopathy (jumper’s knee): a randomized, controlled trial. J Bone Joint Surg Am. 2006;88(8):1689-1698.
  18. Silbernagel KG, et al. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med. 2007;35(6):897-906.
  19. Medicines and Healthcare products Regulatory Agency. Fluoroquinolone antibiotics: must now only be prescribed when other commonly recommended antibiotics are inappropriate. Drug Safety Update. 22 January 2024.
  20. Coombes BK, et al. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013;309(5):461-469.
  21. Barreto ESR, et al. Is platelet-rich plasma effective in treating Achilles tendinopathy? A meta-analysis of randomized clinical trials. Clin Orthop Relat Res. 2025;483(5):779-790.
  22. Scott A, et al. Platelet-rich plasma for patellar tendinopathy: a randomized controlled trial of leukocyte-rich PRP or leukocyte-poor PRP versus saline. Am J Sports Med. 2019;47(7):1654-1661.
  23. Karjalainen TV, et al. Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain. Cochrane Database Syst Rev. 2021;9(9):CD010951.
  24. Mellor R, et al. Exercise and load modification versus corticosteroid injection versus ‘wait and see’ for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BMC Musculoskelet Disord. 2016;17:196.
  25. Deng J, et al. Prognostic value of conventional ultrasound and MRI features for clinical outcomes in athletes with patellar tendinopathy after exercise therapy. Sports Health. 2026;18(3):597-607.
  26. Grimaldi A, et al. An examination of imaging findings in patients with clinically diagnosed gluteal tendinopathy: a secondary analysis of a randomised clinical trial. Arch Orthop Trauma Surg. 2025;145(1):347.
  27. Kroslak M, Murrell GAC. Surgical treatment of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. Am J Sports Med. 2018;46(5):1106-1113.
  28. See ZH, Loo CE, Jaafar Z. Eccentric exercise therapy for medial epicondylitis: a systematic review of clinical outcomes. Complement Ther Med. 2026;98:103364.

This page is general information based on the research listed here. It is not a diagnosis. Your physio will tailor the plan to you, and your surgeon’s or doctor’s instructions come first. Clinically reviewed by Meaw, Head Physiotherapist at Optimise, November 2026.