Assessment
A detailed history, then a thorough examination of movement, strength and the affected area. You leave with a working diagnosis you understand and a plan agreed with you, not handed to you.
What We Treat
Tendinopathy Treatment in London
A tendon has a set amount of load it can take, and tendinopathy is what happens when you ask for more: most often at the Achilles, patellar, gluteal or rotator-cuff tendon. We find the overload behind it and rebuild the tendon's capacity with progressive loading, the treatment backed by the strongest evidence.
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- Self-referral; no GP letter needed.
Overview
Understanding tendinopathy
Tendinopathy is the accurate modern term for a painful, overloaded tendon. The older word "tendinitis" implies inflammation, but research summarised in the British Journal of Sports Medicine (BJSM) shows most long-standing tendon problems are not primarily inflammatory: they are changes in tendon structure driven by load applied faster than the tissue can adapt.
We picture it as an injury bucket: on one side the tendon's capacity, on the other the demand you place on it, and pain arrives when demand tips over what the tendon can currently hold. That is also why complete rest tends to backfire, quietly letting the tendon lose capacity so the pain returns the moment you load it again. The Achilles, patellar (knee), gluteal (hip) and rotator-cuff (shoulder) tendons are the ones most commonly affected.
Treatment follows from that. In line with NHS guidance and the BJSM consensus, progressive loading is the primary, best-evidenced treatment: a graded, structured exercise programme that gradually rebuilds the tendon's tolerance, or in our terms, builds the bucket bigger.
At Kaizen our Chartered (CSP), HCPC-registered physiotherapists assess which tendon is involved and the overload behind it, then build that loading plan around how you actually train, work and move, with manual therapy and acupuncture alongside. We will tell you honestly when imaging or a specialist opinion is needed rather than rehabilitation alone.
Excellent
From 6 five-star Google reviews
Source: Google
David helped me when I started to have a strong tibia pain only 5 weeks before the marathon. I genuinely thought at some point that I wasn’t going to be able to do it and I did my PB!
After suffering with terrible back pain, Gus has helped me make huge improvements. Very professional and happy to explain the processes and treatments. Many thanks
Couldn’t recommend this physio team enough! They helped me recover from a knee injury 3 weeks before the London Marathon which I thought was going to prevent me from running it! Everyone was really friendly, supportive and genuinely cared about helping me reach my goal. Special thanks to Charlie, Gus, Brad and Stef!
I came to Dave with an ongoing injury that I’ve been struggling with for months! He helped sort it out straight away, also giving me some exercises to help target the area to get back to full strength. I’m now back to running pain-free already and training properly — I’ll definitely be recommending Kaizen Physiotherapy to my clients!
Gus worked miracles to get me running a marathon after being injured 6 weeks out. He worked out the issue really quickly and provided a clear and actionable plan to deal with it. The sports massages were the best I’ve ever had too — thanks Peggy! Can’t recommend Gus and Peggy enough.
I had such a positive experience working with Brad at Kaizen. He supported me through a meniscus tear and got me all the way back to running a half marathon and HYROX training. Everything was structured, progressive, and easy to follow, and I always felt like I was in safe hands.
Physiotherapy for tendinopathy can help to:
Name the tendon and the overload
Achilles, patellar, gluteal and rotator-cuff tendons each fail under a particular pattern of load. We identify which tendon is involved and the training spike, technique change or recovery gap behind it, because the plan only works when the cause is clear.
Calm pain without total rest
Complete rest lets a tendon lose capacity, so symptoms usually return when activity resumes. Relative rest works better: we temporarily reduce the aggravating load, keep everything else moving and use manual therapy or acupuncture alongside to manage pain.
Rebuild capacity with progressive loading
A graded, structured exercise programme is the primary, best-evidenced treatment, supported by NHS guidance and the BJSM consensus. Load rises in planned steps as the tendon adapts, rebuilding the tolerance your running, lifting or overhead work demands of it.
Strengthen the muscle behind the tendon
Tendons absorb load their muscle group cannot. Strength and conditioning deficits in the calf, quadriceps, gluteals or rotator cuff leave the tendon exposed, so we rebuild the whole unit rather than treating a sore spot in isolation.
Bring in shockwave when it is stubborn
For tendinopathies that have not settled with loading and time, we offer extracorporeal shockwave therapy, always paired with the rehabilitation plan and a clear diagnosis first. It is a proven add-on for stubborn Achilles, patellar, plantar and gluteal tendons.
Set honest timescales
Tendon tissue adapts slowly. Expect three months or more of consistent loading, sometimes longer for the Achilles or gluteal tendons, with milestones reassessed at each visit. We tell you honestly when imaging or a specialist opinion is the right next step.
Why it happens
What causes tendinopathy?
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A rapid spike in training, running mileage, or gym load that outpaces the tendon's ability to adapt
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Repetitive or sustained loading of one tendon (Achilles, patellar, gluteal, rotator cuff) without adequate recovery between sessions
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Strength and conditioning deficits in the surrounding muscle group, so the tendon absorbs load it is not prepared for
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Returning to full training too soon after a previous injury, before the tendon has rebuilt its capacity
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A sudden change in footwear, running surface, training pattern, or technique without an adaptation period
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Reduced tendon tolerance associated with age, certain medications, or metabolic and hormonal health factors
At your first appointment we work out what is really holding you back, then agree the plan with you before you leave.
Your initial visit runs 45–60 minutes: a detailed history, then a thorough examination of movement, strength and the affected area. We explain what we find in plain English and agree a working diagnosis together.
Treatment starts the same day, and you leave with the first exercises of a plan built around your goal.
Better than yesterday. Kaizen means continuous improvement: small, repeatable gains, built session by session, until you are back to what you love and no longer need us.
- One team across five London clinics: Soho, Liverpool Street, Marylebone, Canary Wharf and Wimbledon Village, plus online appointments.
- Rated 5.0 on Google across 218 reviews.
- Founded in 2022 by David Thomas and Gus Hadonou. You see the same physiotherapist at every visit, so each session builds on the last.
Fees and insurance
Book online through Jane and self-refer, with no GP letter needed. If you are using private health insurance, check your policy first: some insurers ask for a GP referral before your first session.
- Initial assessment and treatment: £155 for a full 45–60 minutes
- Follow-up treatment: £93, with your plan progressed at each visit
- Sports massage: £115 for 60 minutes, £155 for 90 minutes
- Performance MOT & Screening: £300 for a 90-minute screen with force-plate testing and a written report
- Recognised by Bupa, AXA Health, Aviva, Cigna, WPA and Allianz
Your journey
with Kaizen
Everything starts with a proper assessment. We find what is driving the problem, treat it, and build the strength that keeps it fixed, so you finish performing, not just pain-free.
Treatment
Hands-on care to settle symptoms and restore movement: manual therapy, with acupuncture, shockwave or soft-tissue work where they genuinely help. The first home exercises go with you the same day.
Rebuild
Progressive exercise that returns strength, control and load tolerance, from Reformer Pilates to strength and conditioning. Each follow-up reassesses against your baseline, so progress is measured rather than guessed.
Perform
Criteria-based milestones return you to work, sport and training. Discharge happens by mutual agreement once you can manage independently, with a Performance MOT available to catch the next weak link early.
We specialise in:
- Musculoskeletal and sports physiotherapy
- Western medical acupuncture (AACP)
- Physiotherapy-led Reformer Pilates
- Specialist hand therapy and splinting
- Shockwave therapy for stubborn tendons
- Strength and conditioning for rehabilitation
- Running and gait analysis
- Performance MOT and movement screening
Treatment approach
How do we treat tendinopathy?
Sports Physiotherapy
Sports-focused assessment identifies the tendon involved and the overload behind it, then delivers a progressive-loading programme with objective return-to-sport criteria. It is the best-evidenced treatment for Achilles, patellar, gluteal and rotator-cuff tendinopathy in active people.
See treatment detail →Physiotherapy
Hands-on physiotherapy combines diagnosis, education, manual therapy, and a structured loading plan to rebuild tendon capacity, with realistic milestones for recreational and working patients managing a painful, overloaded tendon.
See treatment detail →FAQ
Frequently asked
questions
What is the difference between tendinitis and tendinopathy?
Tendinopathy is the accurate term; tendinitis is largely outdated. "Tendinitis" implies inflammation, but research shows most long-standing tendon problems are not primarily inflammatory. They are overload-driven changes in tendon structure. This matters for treatment: rest alone rarely works, whereas progressive loading rebuilds the tendon's capacity over time.
What is the best treatment for tendinopathy?
Progressive loading is the primary, best-evidenced treatment, supported by NHS guidance and the British Journal of Sports Medicine consensus. A structured, graded exercise programme gradually rebuilds the tendon's tolerance to load. Manual therapy and acupuncture can help manage pain alongside loading, but exercise is the core of recovery, not an optional extra.
Should I rest a tendinopathy completely?
Usually not. Complete rest may ease pain briefly, but it lets the tendon lose capacity, so symptoms return when you resume activity. The evidence supports relative rest: temporarily reducing aggravating load while progressively rebuilding tolerance through structured exercise. Your physiotherapist guides the right amount of load for your stage of recovery.
How long does tendinopathy take to recover?
Tendon tissue adapts gradually, so recovery is rarely quick. Expect three months or more of consistent, progressive loading, sometimes longer for the Achilles or gluteal tendons. We set realistic milestones at your first appointment and reassess regularly. See a GP urgently if you suspect a sudden tendon rupture with severe pain or weakness.
Related What We Treat
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Kaizen Physiotherapy & Performance • 111 Charing Cross Road, Soho, London WC2H 0DT
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