Lower body tendons
Achilles, patellar & hamstring tendinopathy
Understand why lower body tendons become painful, what the pain actually means, and how to build back the capacity they need to let you move freely again.
Clear guidance from a registered clinician — no hype, no guessing
Why lower body tendons get overloaded
Lower body tendons carry some of the highest loads in the body. Every step, squat, and jump asks these structures to store and release energy — and when training load spikes faster than the tendon can adapt, pain follows.
The good news: tendons respond exceptionally well to progressive loading when done correctly. The goal isn't to rest until the pain disappears — it's to find the level of load the tendon can tolerate and systematically build from there.
Achilles Tendon
What's happening
The Achilles tendon connects your calf muscles to the heel bone. It manages enormous loads during walking, running, and jumping — making it one of the most commonly overloaded tendons in the body.
Common symptoms
- Morning stiffness and pain at the back of the heel
- Pain that warms up during activity and returns after
- Gradual onset of pain with increased training load
- Tenderness to direct palpation along the tendon
✓ What to do
- 1 Load management — reduce, don't eliminate, aggravating activity
- 2 Isometric calf holds for early pain relief (5 × 45s, 70% effort)
- 3 Progress to heavy slow resistance: bilateral → single-leg heel raises
- 4 Address training volume and footwear as contributing factors
Patellar Tendon
What's happening
The patellar tendon connects the quadriceps to the shin bone and is critical for jumping, squatting, and stair climbing. Overload is especially common in jumping athletes and people who ramp activity too quickly.
Common symptoms
- Pain at the bottom of the kneecap (inferior pole of patella)
- Pain with jumping, landing, and deep knee bends
- Stiffness after prolonged sitting or first steps in the morning
- Often gradual onset linked to training spike
✓ What to do
- 1 Isometric leg press or wall sit holds for immediate pain reduction
- 2 Decline board single-leg squats to target patellar tendon loading
- 3 Heavy resistance training through full range — slow tempo (3-4 seconds)
- 4 Monitor training volume; avoid back-to-back high-load sessions
Proximal Hamstring Tendon
What's happening
The proximal hamstring tendon attaches to the sitting bone (ischial tuberosity) and is commonly irritated by prolonged sitting and hip-flexion activities like running hills or yoga.
Common symptoms
- Deep buttock pain, especially when sitting on hard surfaces
- Pain with sustained hip flexion (sitting, stairs, hills)
- Uncomfortable running — worse uphill or at speed
- Localised tenderness at the sitting bone
✓ What to do
- 1 Reduce compressive loads: avoid deep hip flexion sitting, foam rolling the area
- 2 Isometric hamstring holds (supine or bridge position)
- 3 Progress to Nordic hamstring curls and Romanian deadlifts — with a forward lean
- 4 Patience: proximal hamstring is a slow responder — allow 3–6 months
Hi, I'm Paul — an RMT who got frustrated with how tendon pain is treated.
I've dealt with tendon pain myself, and I've spent years watching patients go through the same exhausting cycle: rest, cortisone, feel better, re-injure, repeat. The frustrating part is that the research on how to actually fix tendons has been clear for over a decade. Most treatment just hasn't caught up.
I built PainFreeTendon to close that gap — to give people access to evidence-based guidance that's honest about timelines, practical about what to do, and grounded in how tendons actually work.
More about meWhat makes this different
Grounded in current research
Every recommendation on this site reflects the latest tendinopathy science — load-based rehab, pain science education, and progressive capacity building.
Specialized, not general
This site does one thing: tendon pain. Not general fitness, not broad rehab advice. Deep focus on the condition most clinicians undertreat.
Practical, not theoretical
Clear next steps, not academic abstracts. Designed for people navigating real life — not a clinical protocol for researchers.
Ready for a program built around your tendon?
Move from understanding to action. Our structured programs give you a clear, progressive path from pain to full capacity.