Tendon problems are common, particularly as we get older. As we age, tendons naturally undergo changes that make them less strong and less able to cope with strain. This happens because the building blocks of the tendon change over time.
Put simply, the tendon tissue becomes less well organised and less resilient than it once was. As a result, tendons are not as good at handling stress and load as they were in younger years.
Because of these changes, tendons in older adults can become painful — or even tear — during activities that don’t seem especially demanding. Simple movements such as stepping off a curb, reaching overhead, or doing everyday household tasks can sometimes trigger pain.
Tendon pain usually develops when the demands placed on the tendon exceed what it is currently able to tolerate. This can happen when we do too much too soon, lift or push something heavy, or move in an unfamiliar or awkward way. Activities like walking faster than usual, climbing more stairs, gardening, or suddenly “getting active again” are common situations where tendon pain may begin.
Importantly, tendons are also more vulnerable after periods of rest, illness, or reduced activity. During these times, tendon strength and capacity decrease, meaning that even your previously “normal” level of activity may temporarily be too much. This is one of the reasons why staying active over time is so important.
Age-related tendon problems are also strongly linked with certain health conditions, including diabetes, obesity, high cholesterol, chronic kidney disease, thyroid disease, and various vascular and connective tissue disorders. Some medications, such as statins and fluoroquinolone antibiotics, are also associated with an increased risk of tendon problems.
Tendons already have a limited blood supply, and this reduces further with age. This leads to slower tissue repair, reduced delivery of nutrients and oxygen, and a less effective response to small areas of damage. As a result, tendon healing in older adults is often slower and sometimes incomplete, which increases the risk of symptoms recurring.
Common tendons affected in older adults include the rotator cuff (shoulder), achilles tendon, gluteal tendons (side of the hip), and patellar tendon (knee).
Interestingly, degenerative tendon changes are often painless at first. Instead of pain, people may notice weakness, reduced endurance, or a gradual decline in function. This helps explain why spontaneous tendon ruptures — such as achilles, rotator cuff, or long head of biceps tendon tears — are more common in older adults.
Medical imaging can sometimes make tendon problems look worse than they actually are. Ultrasound and MRI scans often show thickening, degeneration, or partial tears even in people who have no pain at all. As we often say in medicine, “Treat the person, not the scan.” Research consistently shows that the appearance of a tendon on a scan does not predict how well someone will recover.
So, what helps tendons recover?
Tendons do not heal in the same way as other soft tissues, which means they need to be treated differently. Current research strongly supports exercise as the most effective treatment. Carefully loading the tendon is the only intervention shown to improve tendon strength and structure.
Initially, the load on the tendon usually needs to be reduced. This may involve temporarily modifying daily activities, work tasks, or exercise — and sometimes using strapping, braces, or orthotics. This is an important step and cannot be skipped.
Early exercises are often static (isometric) contractions held for longer periods. These can help reduce pain while maintaining some strength.
From there, gradual and progressive strengthening is introduced. Research supports slow, controlled loading — often including eccentric exercises — to rebuild tendon strength. Progression needs to be steady and measured, typically over weeks to months.
Because everyone is different, rehabilitation needs to be individualised. Factors such as general strength, balance, movement patterns, and overall health all play a role. Your physiotherapist is well placed to design, monitor, and adapt a program to suit your needs. Exercise programs usually need to be followed for at least 12 weeks, and often longer in older adults.
It is also important to consider the wider impact of tendon pain in older people. Tendon problems can lead to:
- Reduced confidence with movement
- Avoidance of activity
- Loss of independence
- Increased risk of falls
For this reason, early intervention that focuses on strength, confidence, and safe load management is crucial.
Most long-standing tendon pain in older adults is degenerative rather than inflammatory. This is why anti-inflammatory medications and corticosteroid injections are generally not recommended. Research shows that corticosteroid injection often provides poor long-term results and may even increase the risk of tendon rupture. Reducing pain without restoring tendon strength does not solve the underlying problem. We need to increase the capacity of the tendon.
The good news is that tendons still respond to exercise, even in older age. Research shows that although tendon adaptation happens more slowly as we get older, meaningful improvements in pain and function are still very achievable.
Avoiding movement altogether can actually make tendons less tolerant over time. Carefully guided exercise, paced activity, and adequate recovery help tendons rebuild strength and confidence. With the right support and a gradual approach, most people can return to meaningful activities safely and comfortably.
In summary, tendon problems in older adults are largely related to age-related changes, reduced load tolerance, and slower healing. However, with the right approach, tendons remain adaptable, trainable, and capable of recovery at any age.
Juli-Ann Riley
Riley Physiotherapists
