Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy

• Published in: British journal of sports medicine Vol. 43; no. 6; pp. 409 - 416
• Main Authors: Cook, J L, Purdam, C R
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine 01.06.2009; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Adaptation; Athletic Injuries - diagnostic imaging; Athletic Injuries - pathology; Athletic Injuries - therapy; Epidemiologic Methods; Evidence-Based Medicine; Exercise; Exercise - physiology; Humans; Pathology; Physical fitness; Sports medicine; Tendinopathy - diagnostic imaging; Tendinopathy - pathology; Tendinopathy - therapy; Tendons; Tendons - pathology; Treatment Outcome; Ultrasonic imaging; Ultrasonography
• ISSN: 0306-3674; 1473-0480
• DOI: 10.1136/bjsm.2008.051193

Overuse tendinopathy is problematic to manage clinically. People of different ages with tendons under diverse loads present with varying degrees of pain, irritability, and capacity to function. Recovery is similarly variable; some tendons recover with simple interventions, some remain resistant to all treatments.The pathology of tendinopathy has been described as degenerative or failed healing. Neither of these descriptions fully explains the heterogeneity of presentation. This review proposes, and provides evidence for, a continuum of pathology. This model of pathology allows rational placement of treatments along the continuum.A new model of tendinopathy and thoughtful treatment implementation may improve outcomes for those with tendinopathy. This model is presented for evaluation by clinicians and researchers.