08/06/2026
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.
Exercise for Tendinopathy
Exercise can be an excellent way to maintain strength, mobility and function while managing tendon issues.
Gluteal Tendinopathy
Helpful Exercises:
Bridge
Single-leg 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.
Really hope this information helps, I know I’ve had a few of these myself and they are so painful and debilitating. ###
