Tendinopathy: What Is It and Why Is It So Common in Midlife Women?

Welcome to this week’s Fitness Pilates newsletter.

 Today I’m discussing tendinopathy, a topic that has come up several times in my classes and conversations this week. I always like to write about what’s topical and what many women are experiencing right now. 

I wonder if you’ve ever experienced tendinopathy or ongoing tendon pain yourself? I’d love to hear your experiences. 

As always, we have a busy week of workshops and courses coming up. On Wednesday, I’m presenting AI for FitPros, where I’ll show you how to reduce admin and save time using the power of AI. Then on Thursday, Kelly and I are delivering Fitness Pilates for Orthopaedic Conditions on the Reformer. Full details of both workshops are below if you’d like to join us.

Tendinopathy: What Is It and Why Is It So Common in Midlife Women?

If you’ve ever experienced a stubborn ache in your shoulder, hip, elbow, knee or Achilles tendon that just doesn’t seem to go away, you may have been dealing with tendinopathy.

Tendinopathy is one of the most common musculoskeletal conditions seen in active adults, particularly women in their 40s, 50s and beyond.

What Is a Tendon?

A tendon is a strong band of connective tissue that attaches muscle to bone.

Tendons transmit the force created by muscles, allowing us to move, walk, lift, climb stairs, carry shopping, exercise and perform everyday activities.

Examples include:

• Achilles tendon (calf to heel)
• Patellar tendon (thigh muscle to shin bone)
• Gluteal tendons (glute muscles to hip)
• Rotator cuff tendons (shoulder)
• Common extensor tendon (tennis elbow)

Healthy tendons are incredibly strong and can tolerate large amounts of force.

What Is Tendinopathy?

Tendinopathy is a condition where a tendon becomes painful and less able to tolerate load.

For many years it was called “tendonitis”, implying inflammation was the main problem. We now know that most long-term tendon pain is not primarily inflammatory.

Instead, the tendon undergoes structural changes.

The collagen fibres that normally run in neat parallel lines become disorganised.

The tendon may become thicker, weaker and less efficient at transmitting force.

This process is known as tendon degeneration or tendon dysrepair.

What Causes Tendinopathy?

The most common cause is a mismatch between load and capacity.

This means the tendon is being asked to do more than it is currently capable of handling.

Examples include:

• Starting a new exercise programme too quickly
• Sudden increases in walking, running or lifting
• Repetitive movements at work
• Poor recovery between workouts
• Long periods of inactivity followed by increased activity
• Reduced strength around a joint
• Age-related changes in connective tissue

Why Is Tendinopathy More Common During Menopause?

Oestrogen plays a major role in maintaining connective tissue health.

As oestrogen levels decline:

• Collagen production decreases
• Tendons become less elastic
• Tissue recovery slows
• Muscle mass decreases
• Tendons become less able to tolerate sudden loading

This is one reason why many women develop tendon problems during perimenopause and menopause despite never having had injuries before.

Common Tendinopathies in Women Over 40

Gluteal Tendinopathy

Location:

• Side of the hip

Symptoms:

• Pain lying on one side in bed
• Pain walking uphill
• Pain climbing stairs
• Pain getting out of a car

Achilles Tendinopathy

Location:

• Back of the heel

Symptoms:

• Morning stiffness
• Pain walking
• Pain after exercise
• Tenderness in the tendon

Rotator Cuff Tendinopathy

Location:

• Shoulder

Symptoms:

• Pain lifting the arm
• Difficulty reaching overhead
• Night pain

Tennis Elbow

Location:

• Outside of the elbow

Symptoms:

• Pain gripping
• Pain lifting objects
• Weakness through the hand and forearm

Patellar Tendinopathy

Location:

• Below the kneecap

Symptoms:

• Pain squatting
• Pain climbing stairs
• Pain rising from a chair

The Tendon Loading Continuum

Tendons don’t usually go from healthy to injured overnight.

Researchers describe three stages:

1. Reactive Tendinopathy

The tendon becomes irritated due to increased loading.

This stage is often reversible.

2. Tendon Dysrepair

Structural changes begin within the tendon.

Symptoms become more persistent.

3. Degenerative Tendinopathy

Long-standing changes occur within the tendon.

The tendon can still improve significantly with appropriate rehabilitation.

What Doesn’t Help?

Many people assume they should:

• Stop exercising completely
• Rest for weeks or months
• Stretch aggressively
• Massage constantly

Unfortunately, these strategies alone rarely solve the problem.

Tendons need appropriate loading.

What Does Help?

Research consistently shows that tendons respond positively to:

• Progressive strength training
• Controlled loading
• Patience and consistency
• Improved movement quality
• Gradual return to activity

The goal is optimal loading.

Fitness Pilates for Tendinopathy

Fitness Pilates can be an excellent way to maintain strength, mobility and function while managing tendon issues.

Gluteal Tendinopathy

Helpful Exercises:

• Shoulder bridge
• Single-leg shoulder bridge (if tolerated)
• Clams
• Side-lying leg lifts
• Standing hip abduction
• Standing balance work
• Sit-to-stand squats

Avoid:

• Deep hip adduction positions
• Crossing legs repeatedly
• Aggressive hip stretches

Achilles Tendinopathy

Helpful Exercises:

• Standing calf raises
• Supported single-leg calf raises
• Foot mobilisation
• Heel-toe walking
• Balance exercises
• Mini squats
• Controlled lunges

Avoid:

• Excessive bouncing
• Sudden increases in impact work

Rotator Cuff Tendinopathy

Helpful Exercises:

• Scapula retraction
• Arm openings
• Wall slides
• Four-point kneeling shoulder stability
• Swimming prep exercises
• Thoracic mobility

Avoid:

• Repeated painful overhead movements

Tennis Elbow

Helpful Exercises:

• Wrist mobility
• Forearm strengthening
• Grip exercises
• Shoulder blade stability exercises
• Postural correction work

Patellar Tendinopathy

Helpful Exercises:

• Wall squats
• Sit-to-stand
• Supported squats
• Step-ups
• Glute strengthening
• Standing leg work

Avoid:

• High-volume jumping

Key Takeaway

Tendinopathy does not mean your body is broken.

It means your tendon is asking for a different approach.

The combination of strength training, progressive loading, mobility work and intelligent movement is one of the most effective ways to improve tendon health.

I hope you find these newsletters helpful and feel free to use in yuor own newsletters and communications.

Please WhatsApp me on 07976 268672 or leave your feedback in the Fitness Pilates Facebook Group.

Rachel Holmes

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