Stop Stretching Your Insertional Tendinopathy!

Lack of stretching can cause injury, and often people think the cure for that injury is to stretch it out. Well, I am here to tell you that not all injuries benefit from stretching. In fact, some are actually made a lot worse by stretching.

Insertional tendinopathy is one example of an injury that is worse off with stretching.

What is Insertional Tendinopathy?

Tendinopathy is an umbrella term for the various types of injury that can affect a tendon, including inflammation and degeneration, and is characterised by pain. A typical presentation of tendinopathy is pain felt in the initiation of loading, such as when you start to run or squat.

Tendon load does not solely come from tension, but there is also an important concept of compression that is often not fully explained.

A good example of a tendon that is compressed is the Achilles. As the Achilles attaches to the heel bone it curves around the edge of the heel (imagine a rope on a pulley curving around a wheel).

Let’s look at the following analogy to help explain. I once towed an old farm car with a tractor, and the rope I used came at a high angle from the back of the tractor down to the front of the car, curved under the bumper and onto the axle where I tied it on. After pulling the car for about 10m the rope snapped, not in the middle of the rope, but where the rope curved under the bumper. The rope had worn itself by rubbing on the bumper.

The compressive load in this scenario is the rope pressing on the bumper of the car. Putting pressure on a rope as it is pulled by the tractor, pulls on the resistance of the car. This is a similar example to how tendons like the achilles, hamstrings and gluteals can compress on bones which they wrap around as they come into their attachment point. Usually the tendon is at a slightly differing angle to their line of force at its attachment as it is compressed around a bone.

Insertional tendinopathy is irritation of the tendon where it attaches onto the bone, which is where the compression occurs. It is characteristically different to the other form of tendinopathy in that the pain source is not in the middle of the tendon, but where the tendon attaches to the bone (at its insertion).

For years, we have been managing insertional tendinopathy through stretches and exercises, often with varied results. The more severe the tendinopathy, the less likely stretching would help. In fact, stretching results in further compression of the tendon at the irritation point, which actually worsens the pain.

For more information on exercises that help improve an insertional tendinopathy see our blog on Achilles Tendinopathy.

If you would like a review of your insertional tendinopathy management come and one of our Physio’s at Bend + Mend. We have three convenient locations in Sydney’s CBD.

Campbell Hooker

About Campbell Hooker

Campbell Graduated from AUT University and has worked in private practice in both Australia and in London. Campbell has a keen interest in sporting injuries, office based injuries and the neck. He has worked at grassroots and elite levels of rugby union and league, and with surf lifesaving. He has recently taken to triathlon where he spends most of his spare time. Campbell has an interest in neurological conditions and has a Neuroanatomy degree out of Otago University. He utilises a number of methods when both analysing and treating patients, including dry needling and the Sarah Key Method.


  • Avatar Ian Wallace says:

    Hi Campbell,
    Thank you so much for this article: “Stop Stretching Your Insertional Tendinopathy!
    I’ve had heel pain in my right heel for over 5 months without being able to have much improvement. I was told by my Podiatrist I had plantar faciitis and he sold me expensive orthotics for $650 Cdn, which I wore for 2 months with no improvement, and stopped using them. And he said to do stretching & strength exercises. Simple weight bearing stretches causes more pain, and could only do certain foot exercises.
    Then I went back to see him, and all he said was I’m getting old and that’s all we can do. My MD said the same things. 🙁
    I figured I had tears in the achillies at the insertion point, because that is where the pain is.
    Finally after 5 months of pain and frustration and minimum physical activity, I was able to get an ultrasound, which indicated I have calcium deposits on the achillies. I’ve also been having shoulder pain indicating possible rotator cuff tears. It turns out I also have no tears, but do have calcium deposits there as well.
    In all my searching on the internet, your explanation re: Stop Stretching Your Insertional Tendinopathy made the most sense regarding my issues. And in all my searching for heel pain I had not found anything mentioning calcium deposits…
    So, I just wanted to thank you for your article and info, and as I wasn’t able to find any info on your site re: calcium deposits/calcific tendonitis prognosis, treatments, stretches & exercises. Maybe I just wasn’t able to look in the proper area?

    Hope you guys down south get a handle on the Covid 19 problems there. Stay safe.
    Cheers from Canada!
    ian wallace
    Live for today, hope for tomorrow.

    • Avatar Phyllis Murdock says:

      Ian you may want to look into a procedure called percutaneous needle aspiration and lavage. It is used for calcific tendinitis.
      Phyllis Murdock
      (I have the calcium deposits in my achilles too!)

  • Avatar Ace says:

    Hi im 18 years old male and I have golfers elbow on both elbows I think it’s because of long hours on computer. I have it for 2 months but i rested it for about a month now. What can I do? Can I strengthen it?

    • Hi Ace,
      Thank you for your question.
      Like all injuries the most important aspect is making sure you have an accurate diagnosis. Golfers elbow is a broad diagnosis and includes a number of structures. You are correct to assume strengthening may help with a tendon injury, but there are many different structures that could cause elbow pain, especially when you have it on both sides.
      Once you have an accurate diagnosis, lets assume you do have tendon pain, you need to modify the loading on the elbow. Too much and you are going to hurt it, too little and you wont help the elbow mend itself. It is a balancing act that often is best guided by a physiotherapist.
      If you are in Sydney it would be great to see you in clinic and review your elbow pain. We do offer Online Telehealth consultations if you are outside of Sydney also.
      Please reach out if I can help further.
      Kind regards,

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