Assessment
Your physiotherapist discusses your symptoms, goals, medical history and lifestyle, then completes a thorough assessment. Initial appointments are typically 45 to 60 minutes, so there is time to do it properly.
What We Treat
Tendinopathy Treatment in London
Tendon pain is the most misunderstood problem in the clinic. Rest makes it feel better and get worse, pushing through makes it angry, and the thing that actually works is load applied in the right dose at the right time. Get that right and tendons are among the most reliable things we treat.
Overview
Understanding tendinopathy
Tendons connect muscle to bone and they adapt to the load you put through them. Tendinopathy is what happens when that load rises faster than the tendon can keep up with, or when it drops away and then returns suddenly.
The tendons we treat most:
- Achilles: pain at the back of the heel, worst on the first steps of the morning.
- Patellar: pain at the front of the knee in jumping and change-of-direction sport.
- Gluteal: pain on the outside of the hip, often worse lying on that side at night.
- Elbow: tennis and golfer's elbow, in racket sport and in people who have never held a racket.
- Rotator cuff: shoulder pain on reaching overhead.
- Hamstring: deep pain at the sitting bone, common in runners.
They behave the same way wherever they are. They are slow to change, they respond to progressive loading, and they reward consistency far more than intensity. We will tell you honestly at the first appointment that this takes months rather than weeks, because a plan you abandon at week four does nothing.
Physiotherapy builds the loading programme, which does the actual work. Shockwave therapy is our option for the stubborn ones, and running gait reviews address the loading pattern behind lower-limb tendon pain. See also foot and ankle, knee and shoulder pain.
Excellent
From 4 five-star Google reviews
Source: Google
I first started using Tom last year to help relieve back pain, he has been extremely helpful and now he's supporting me with sprint and fitness training, whilst helping with any minor injuries. Can't recommend him and his team more highly.
I went to Tom with a shoulder injury that had not improved for several months. Tom is very knowledgeable and quickly identified the issue and put me on a course of exercises that, in conjunction with a couple more sessions, steadily resolved the problem. I would highly recommend him.
Parinita was brilliant! Identified my knee problem immediately, used a range of equipment and exercises not only to strengthen my knee, but to maintain it and improve my running long-term.
Excellent service! Sanchez is a true professional who helped me heal a previous injury. Highly recommend!
Tendinopathy treatment can help to:
Get the dose right
The whole game with a tendon is loading it enough to drive change without tipping it over. We work out how irritable yours is, set the starting point from that, and adjust it at every visit rather than handing you a fixed sheet.
Stop the cycle of rest and relapse
Rest, feel better, return, hurt again. It is the most common pattern we see and it is why tendons get a reputation for being untreatable. Breaking it means loading through the problem in a controlled way instead of avoiding it.
Use shockwave where it earns its place
For the stubborn ones, shockwave has one of the strongest evidence bases of any tendon treatment. About 80 per cent of patients report a marked reduction in pain after 3 to 4 sessions. We screen for contraindications at every visit.
Load it where the equipment is
Tendons need real resistance, and the later stages need more than a band. Our clinics in Crouch End, Marylebone and Henley are based inside gym facilities, so the loading you need at month three is in the same building as your assessment.
Know whether it is working
Tendon pain is slow, so it needs measuring rather than sensing. We track morning stiffness, load tolerance and strength against your own baseline, which tells us whether to progress or hold well before you would feel the difference.
Fix what caused it
Almost every tendon problem traces back to a change in load: new mileage, new shoes, a new programme or a return after time off. If we do not find and change that, it comes back in the next training block. So we look for it.
Why it happens
What causes tendinopathy?
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A rapid increase in training volume, intensity or hill and speed work
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Returning to sport after a break at the load you left off at
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Sudden change in footwear, running surface or gym programme
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Age-related change in tendon structure, with most cases presenting between 30 and 60
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Repetitive occupational load, particularly gripping, lifting and overhead work
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Metabolic factors including diabetes and raised cholesterol, both associated with tendon pain
What happens at your first physio appointment?
Initial appointments are typically 45 to 60 minutes. You leave with a clear explanation of your condition, treatment recommendations, a report explaining it in simple language, and a personalised rehabilitation plan.
Follow-ups run 30 to 45 minutes, and we reassess at every visit rather than selling you a block of sessions up front.
A thorough, honest, and understandable explanation. Then the best treatment to get you back to a level of activity beyond your pre-injury status. If we can't get you better, we will recommend the world's leading healthcare professionals in London that can.
- Founded in 2015 by Tom Astley: 7 clinicians working across 3 clinics in Crouch End, Marylebone and Henley-on-Thames.
- Our team has successfully worked with local, national and international athletes at 6 major multi-sport events, from London 2012 to Gold Coast 2018, and we bring that expertise to everyone who enters our service.
- Rated 4.9 from 88 Google reviews; recognised by 5 major UK insurers, and self-funded patients book online with no GP referral.
Fees and insurance
Book directly online through Splose. Self-funded patients need no GP referral; if you are claiming through insurance, obtain prior authorisation before booking.
- Physiotherapy with Tom Astley: £85 initial consultation, £77 follow-up
- Sports and dance therapy with Laura Fornoni: £75 initial consultation, £70 follow-up
- Shockwave therapy: £230 for the initial consultation plus 3 sessions, then £80 per further treatment
- Running gait and performance reviews: £80 Base, £135 Intermediate, £185 Expert
- Recognised by Bupa, Cigna, Vitality, WPA and Simply Health
How physiotherapy works
from assessment to return to sport
Book today to get an assessment, advice, a report and a rehabilitation plan. We combine hands-on treatment with gym-based rehab to get you well, today, and we reassess at every visit.
Advice and report
A clear explanation of your condition and a report explaining it in simple language, alongside hands-on treatment: manual therapy, soft tissue techniques and joint mobilisation where they help.
Rehabilitation plan
Exercise rehabilitation tailored to your goals and condition, delivered through Track Rehab. Our clinics sit inside gym facilities, so the plan has the equipment and technology it actually needs.
Return
Structured programmes and return-to-sport testing before you go back, so you return safely and confidently. The goal is a level of activity beyond your pre-injury status, not just less pain.
What our physiotherapists treat
- Manual therapy and joint mobilisation
- Exercise rehabilitation through Track Rehab
- Dry needling for stubborn trigger points
- Shockwave therapy for chronic tendinopathy
- Sensor-based running gait analysis
- Sports massage, scar work and soft tissue therapy
- Women's health, Mummy MOT and postnatal rehabilitation
- Post-operative and ACL rehabilitation
- Return-to-sport testing
Treatment approach
How do we treat tendinopathy?
Physiotherapy & Sports Therapy
From £75Establishing how irritable the tendon is, setting the right starting load, and progressing it through the stages. This is the treatment; everything else supports it.
See treatment detail →Shockwave Therapy
£230 for 3 sessionsFor chronic tendon pain that has not responded to loading alone. About 80 % of patients report a marked reduction in pain after 3 to 4 sessions of roughly 10 minutes each.
See treatment detail →Soft Tissue Therapy
Price on enquirySoft-tissue work around the affected tendon reduces the protective guarding in the surrounding muscle, which usually makes the loading programme easier to progress.
See treatment detail →FAQ
Frequently asked
questions
Should I rest a painful tendon?
Complete rest is usually the wrong answer. It settles the pain briefly, then the tendon de-loads and hurts again as soon as you return. We reduce the aggravating load rather than removing it, then rebuild deliberately. Bone stress injuries are the exception and do need offloading.
How long does tendinopathy take to get better?
Months rather than weeks, and we would rather say that at the first appointment than at week eight. Most people feel meaningful change within 6 to 12 weeks of consistent loading, with the full picture taking longer. Consistency matters far more than intensity.
Is shockwave therapy worth it?
For chronic tendon pain that has not settled with loading alone, it has one of the strongest evidence bases available. About 80 per cent of our patients report a marked reduction in pain after three to four sessions. It works alongside the loading programme, not instead of it.
Why does it hurt most first thing in the morning?
Morning stiffness that eases as you move is one of the most characteristic tendon signs, particularly in the Achilles. The tendon stiffens overnight and needs load to settle. We use how long that stiffness lasts as a measure of whether your plan is working.
Related What We Treat
Get Started
Book a physiotherapy appointment
in Crouch End, Marylebone or Henley.
Tom Astley Physiotherapy • Park Road Pools & Fitness, Crouch End, London N8 8JN
BookAppointments typically available within 1–2 weeks