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.

33 Comments

  • 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.

    • 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!)

    • Ronald Finnigan says:

      Ian
      I also suffered from PF for 18 months. Walking cast, splint at night, walker, all the devices to no avail. What worked for me was laser therapy. After the 4th of 6 treatments, I could walk 2 miles with very little pain. Today, I walk 5 miles, six days per week. Pain is minimal. Good luck.

    • Mark Iaria says:

      Hi Ian
      Have you tried taking a silica supplement? It cleared up the calcium deposits on my thumb. My friend also had it and he had exactly the same problem as you on his foot. He spent a lot of money on ‘specialists’ beforehand. I’m very sceptical of supplements but from all accounts it appears to work
      Mark

  • 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,
      Campbell

      • Lorna Borg says:

        Hi Campbell I’m in Europe Malta. I have the same problem tennis elbow with pain on the outside of the elbow and recently radiating to shoulder . Its caused by a recent change in job requiring mouse use pc work, which started in Aug and inset of pain in October and treatment starting now in jan 2021. I have now started to immobilize the wrist for 3.weeks . 1st week 24 hours 2nd week 12 hours and 3rd week random use of this wrist immobiliser. I wasnt given any tips for exercises. The immobiliser has reduced the pain on lifting that started radiating to shoulder. Sadly its my dominant hand. Should I apply heat and cold. I practice yoga daily and with the sun salutations I do not have any pain without the wrist immobiliser. I dont want this for life . Any tips pls

        • Hello Lorna,
          Your injury sounds quite typical of something I would expect from a shoulder or a neck pathology instead of tennis elbow or wrist pain. I would advise a second opinion for an accurate diagnosis before proceeding with any treatment intervention. If you are satisfied with your diagnosis then continue with your treatment. In my opinion heat vs ice should be based on which one helps your pain more, there is some conflicting evidence to suggest one vs the other. You may also wish to revise how much exercise and what type of exercises you are doing for your injury.
          If you have access to an experienced clinician there is a lot to gain from reviewing movement tests. Alternatively we offer Telehealth consults with all of our experienced clinicians.
          Thanks for reaching out!
          Kind regards,
          Campbell

          • Ginelle says:

            I have this issue at my iliopsoas. I also have an overloaded TFL that I need to stretch but when I do it affects my iliopsoas at insertion points especially .
            The pain is chronic but goes away with ketoprofen.
            What are your thoughts on this

  • Jodi says:

    I have severe tendonitis in both achilles tendons (started 6 months ago) i cant really bend at the ankle without horrible pain. Three days ago my knee started hurting to bend while walking. Thinking my legs were just tired i let it go. Today the pain is horrible and i noticed my tendon like my achilles is super tight. I have fibromyalgia can this be causing my tendons to tighten so severely?

    • Hi Jodi,

      It sounds like a frustrating position to be in. I’m sorry to hear about your pain over the past 6 months. I think it would be wise to assess your Fibromyalgia as a potential contributor to your pain presentation. Although it is difficult to make an assumption without seeing you in clinic.

      If you are in Sydney it would be great to see you in the clinic. We also offer Telehealth consultations if you are unable to come in.

      Thanks for reaching out Jodi!
      Kind regards,
      Campbell

  • Cynthia says:

    All the results I can find for the knee refer to patellar tendonitis but my pain concentrates on the rear, outer side of my right knee where the fibula attaches (Lateral collateral tendon?) what do I do for fairly debilitating pain, stiffness & weakness that came on suddenly with no injury?

    • Thank you for your question Cynthia. This sounds like an unpleasant knee indeed. If this pain has come on quite strongly with no indication or injury I would suggest getting this seen to at a local medical practice. There are a number of different things that could cause your pain but when they don’t have a mechanical cause or mechanism of injury we consider other causes. I would consider following this pain up with your medical practitioner, at least for peace of mind to start with, and then moving on to a Physio for further assessment and treatment.

      Thank you for reaching out Cynthia!

  • Michael Schaefer says:

    Hello , Mr Hooker
    I have been battling what was thought to be Sciatica but now think it’s Chronic Hamstring Tendinopathy. Have had an MRI and there are Calcium Deposits”Bone Spurs” on my sit bone. Dr. Says that there is no tear in the tendon from the said Calcium Deposits but when I sit, it still is causing me all kinds of pain. Do you think that those “Bone Spurs” need to come off? Should I seek another Doctors opinion? I’m desperate and can’t take this pain anymore. Thank you for listening and any advice would greatly be appreciated!

    • Hi Michael,
      Thank you for your question. Sitting pain is not nice, especially if you have an office job. My opinion is always the same when it comes to this type of pain. Make sure you have an accurate diagnosis before proceeding with any treatment intervention. Pain in this region might still be attributable to your lower back, or to the bone spur or something else altogether. The MRI is a handy tool to help us confirm diagnosis but it still has its limitations, for example, the image doesn’t show your pain relationship with sitting. Make sure you are adamant your pain is due to your spurs before proceeding further!
      If you would like a second opinion I would always recommend a review with an experienced clinician. If you are in the Sydney region then we have 4 convenient locations in the CBD or offer Telehealth consults online.
      Thanks again for your comment!

  • Charlotte Davison says:

    Hi,
    I am a 21 year old female and have been having a mild ache in the back of my calf I have been reading up on Dr. Google and it has put all sorts in my mind, I have come to the conclusion it may be something to do with my tendon as I tend to do a lot of running however over the Christmas break I did stop for a while ans have just started it back up?

    • Hi Charlotte,
      Thanks for your comment. It is frustrating to have pain limiting something we take for granted, you are definitely not alone! Dr Google has a great way of helping broaden our horizons on potential underlying pain contributors. I would always take this approach with a grain of salt. My opinion is always the same when it comes to this type of pain. Make sure you have an accurate diagnosis before proceeding with any treatment intervention. If you are satisfied with your diagnosis then treatment may involve some kind of load modification approach – changing what you do, how much you do it and making sure you don’t over do it. It can be a tricky balancing act. If you would like some guidance on how to manage your calf and are in the Sydney region then we have 4 convenient locations or offer Telehealth consults online as well.

      Thanks again for your comment!

  • Ardit says:

    Hi!
    Very informative article! I’ve been struggling for a year now from left iliopsoas tendinitis ( the diagnose was just confirmed by MRI, left iliopsoas tendon thickness), which was caused after a strain during soccer game. I have stopped workout/sports activities and have been resting for the last 3 weeks. I have felt some minor improvements in pain however still feel contracted in the area. I would really appreciate you suggestion weather I should start stretching, doing issometric strengthening contraction or give it some more rest?

    Thank you in advance!

    • Hi Ardit,
      This is a particularly interesting diagnosis as it is quite rare. In my opinion this may either 3 things. Firstly, it may be an injury in conjunction with other pathology. In this instance I would suggest reviewing particularly your lumbar spine, hips and muscles of the core and leg to see any contributing factors. Secondly it may be that the injury is isolated to the Iliopsoas and this has not had proper addressing and has therefore become what is called a tendinopathy. Again, I think this is quite rare but for this injury we need to consider load management approach – exercise the muscle but not over doing it! Thirdly, it maybe that the MRI has detected a thickened tendon as an incidental finding, not necessarily contributing to your pain experience. This is quite common, MRI’s are now more sensitive, sometimes what they detect are not the pain source.
      Seeing a skilled Physio clinician is going to provide the most benefit for you, your priority is to be absolutely sure your diagnosis is accurate!
      If you are in Sydney I would love to review your hip pain. We also offer Telehealth consultations for people outside of Sydney.
      Thanks for your question!
      Kind regards,
      Campbell

  • Lena Noel says:

    Hello!
    I haven’t been diagnosed with tendinitis, but I suspect it due to the recurring pain I’ve had in my left leg for a couple years. It first happened when I over-extended my leg and I felt a stretching sensation behind my knee. The pain can go away for months but it returns in the same spot. I believe I’ve injured one of my hamstring muscles just above the knee. I wanted to ask if rolling out my calf and hamstring muscles can be helpful instead of stretching after a jog. Unfortunately not jogging isn’t really an option for me, and I work long shifts on a job that I spend a lot of time on my feet on.

  • Florida Hughes says:

    Hi Campbell,
    I have been diagnosed with Achilles Tendonitis. It’s horrible. I just want the pain to be gone. I had tendons and ligaments repaired along with a calcaneal osteotomy in 2017 and I was told that the biggest problem I would have from the surgery was tightness in the Achilles tendon, however I did not expect it to be this painful. I have tried everything the doctor has suggested and I may be overstretching, which I never would have thought of that. I do have a question, do you think acupuncture would work for the pain? Any suggestions would be greatly appreciated.
    Thank you,
    Florida

    • Hi Florida,
      I understand your frustration, you have had quite a journey so far. As far as I can understand there may be a number of factors that influence your pain. It is difficult to say if acupuncture will help. I would suggest a review of your Achilles to differentiate the likely causes. There are many many things which could cause pain in the heel region and the most important thing is to understand why it is recurring.

      Understanding why you get pain will then help you implement a pain reduction strategy, if that includes acupuncture or stretches or strengthening or a combination, we wont know this until we understand the pain drivers. An experienced physiotherapist will be a great place to start.
      If you are in Sydney I would love to review your heel pain. We do also offer Telehealth consultations.
      I hope this helps, thank you for your question Florida.
      Kind regards,
      Campbell

  • Samantha Clifton says:

    Hi great article and I’m really hoping you can give me some advice. I was diagnosed with Tibialis Posterior Dysfunction in my left foot back in November 2020. Seen a physio for several sessions who gave me gentle stretching excercises and told to alter some shoes. I’ve worn inserts in my shoes for year as I have flat feet and I am also double jointed and additionally suffer with an arthritic knee on the same leg. This I can live with but the foot is really getting me down now. No real improvement and I am reluctant to keep spending money with no progress. I haven’t been great at doing all the excercises I must admit but was told to start Bentley stretching. I am on my feet all day as I’m a gardener by day, injury happened at work when ankle went over I think on uneven surface.
    Any advice as to what I should do would be hugely appreciated.
    Thanks in advance.
    Samantha

    • Hi Samantha, thank you for sharing your story. You have an interesting case and this is something I enjoy working with.
      My best advice, which is very applicable to you, is to be absolutely certain you have the correct diagnosis. There are so many things that contribute to pain and everyone has a different story so find someone who is willing to go through your story with you and give you an accurate diagnosis.
      Secondly if you are happy with the diagnosis I would advice following through with the treatment program. If it is a tendon issue then finding the right amount of exercise is important, and then sticking to the plan. I would also add that if all of your pain is attributable to the tendon then you would need to be diligent with your program because a tendon doesn’t improve rapidly. They can be sensitive structures that require a bit of nurturing.
      I hope this helps you Samantha.

      If you have any questions I would suggest a telehealth consult where we can discuss your injury further? Or if you are based in Sydney come in and see me in clinic.

      Thanks,
      Campbell

  • Sally MacKenzie says:

    Hi Campbell

    Great article. I have tender spots at the top of both my gluteus. It feels like a pulled muscle (can’t run or push off) but I suspect it is calcium build up where the tendons wrap around the hip. So would stretching make it worse? Should I have an MRI or ultrasound to see if there is calcium build up. Would massage or rolling on a tennis ball help to loosen up tightness? Or is that the same as stretching.? Thanks Sally

    • Hi Sally,

      I understand the frustration your pain must give you. It is never nice, regardless of the situation. My advice would be to go and see your local clinician for a review. Gaining an insight in to the cause of the pain is your most important step. This may be a low back injury, it could also be a functional movement pain. It may also be a hip issue. You should get a complete assessment of the possible causes for your pain.

      A scan can be helpful at times however you need to be sure you are scanning the correct structure, and if that structure warrants a scan.
      If you are based in Sydney it would be great to see you in clinic to assess you. We can also offer Telehealth services if you cannot get in to the clinic?
      Kind Regards,
      Campbell

  • George says:

    Hi, I have partially ruptured my adductor longus (on the attachment to the hip bone) 9 months ago. I’ve been to doctors and rehabilitating for last 5 months, and doctors only recommend stretching and strengthening the tendon after the rupture was ‘closed’ and scar tissue formed. But reading your article tells me stretching worsens the pain on the tendon attachments to the bone. But I can feel my hip flexor is tight and I feel better after I stretch in warm water. But if that doesn’t help long term, can you advise what should I do?

    Kind regards and thank you very much in advance,
    George

    • Hi George,
      Thank you for your comments. Your Doctor is correct. You should start to progressively strengthen your tendon when it has capacity to do so. Stretching this tendon is likely to put it under the natural stresses it requires to heal, and therefore I believe this is beneficial also.
      The composition of the origin of the adductor longus is different to the insertion point of the Achilles tendon, which was thew basis of the blog post. The adductor would respond differently to stretching and I do not see it as harmful under the right guidance.
      If there is an issue with stretching then you would be wise to reassess the time you stretch this for, or the force you are stretching. I am not entirely against stretching this injury in the mid to long term however. Keep stretching if you are getting benefit from it George.
      If you would like any further advice I would recommend coming in to the clinic. Otherwise we offer Telehealth consultations also.
      Let me know if you have any further questions. Thanks George!
      Kind Regards,
      Campbell

  • Shawn Andrew Franz says:

    Would it still be beneficial to stretch other parts of my leg while recovering from this? Can I still stretch my hamstrings as long as I don’t dorsiflex my foot or is this compressing the tendon at the achilles as well? Thanks!

    • Hi Shawn,
      Yes in theory yes you can, this is fine to do. I would encourage looking after other parts of your body while recovering. If that means you can unload your Achilles and heel (by avoiding dorsiflexion) while you stretch other structures then great!
      Thanks for the question.
      Campbell.

  • Hi Campbell,
    I am a 60 year old who was very active. I typically went to the gym 6 days a week and worked on ellipticals trainers for 30 minutes a day and lifted weights. After COVID-19 arrived I walked 4 miles per day. In Jan. 2021 developed what i thought was hip bursitis which was very painful and after Xrays to eliminate hip erosion, I was told to get PT and steroid injections, The steroid injected made the pain worse and gave me no relief. An MRI reveal “Mild” gluteus minimus tendinoses and no bursa alterations. I have been suggested to possibly have back issues, FAIs, or piriformis syndrome but nothing definitive – even the mild tendenosis is not a definitive cause. I have been undergoing Physical therapy to treat tenenosis that invovled a lot of stretching of my hamstrings and IT bands, leg lifts while laying on ones sides, clam shells and monster walks with resistance bands to strengthen the abductor muscles. Is this the right kinds of exercises and do I need to worry about stretching the tendinopathy? I am 10 months into this saga and spend a lot of time using crutches to get around. DO you have any advice for me. Thanks for your advice. Sincerely, Steve

    • Hi Steve,
      Thank you for taking the time to write to me. I appreciate your question.
      I am in the same boat as you on this one. It seems a little odd.
      As I have said in other responses the number one thing to consider is if you have the correct diagnosis. I would hope you have ruled out the other things you have mentioned, particularly the lower back.
      I would suggest going back to your clinician to re test other possible sources of pain, or getting a second opinion just to be sure.
      I hope this helps.
      Thank you once again for taking the time to write to me Steve.
      Kind regards,
      Campbell

  • Randy says:

    I’m a swing dancer. I have a Mortons neuroma on my left foot so I tend to dance with my weight on my left heel. This caused the heel of my shoe to wear unevenly which caused a repetitive stress injury where I hyperextend my achilleas tendon when I stepped backwards. When I stretch my calf I feel a sharp pain on the outside/left bottom of my heel where the tendon attaches. Is stretching past the point of feeling some pain good? Does some pain promote healing or cause more damage? Or, should I stop stretching as soon as I feel pain?

    Thanks

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