Tendinopathy
Tendinopathy is a clinical condition characterized by pain and impaired function in a tendon, most commonly resulting from repetitive mechanical overload. It frequently affects the rotator cuff, Achilles, patellar, gluteal, and elbow tendons, and is prevalent among athletes and physically active individuals, but can also occur in sedentary populations and older adults.[1-4]
The pathophysiology involves a complex interplay of mechanical stress, inflammation, and vascular changes. Histologically, tendinopathy is marked by disorganized collagen fibers, increased microvasculature, altered extracellular matrix homeostasis, and enhanced cellular apoptosis. These changes lead to tendon thickening, swelling, and pain, especially during loading or movement.[1][5] The etiology is multifactorial, with intrinsic factors (age, genetics, comorbidities) and extrinsic factors (activity level, medications, environment) contributing to disease onset and progression.[2][4]
Diagnosis is primarily clinical, based on localized tendon pain during activity, tenderness on palpation, and functional limitation. Imaging modalities such as ultrasound or MRI are reserved for atypical cases or when initial management fails, as routine imaging is not required for diagnosis.[3][6]
Management centers on a progressive loading exercise program, particularly eccentric training, which is supported as the most effective first-line intervention. Complete rest is discouraged, as it may worsen outcomes. Adjunct therapies (physical modalities, injections) are considered for refractory cases, but evidence for their efficacy is limited. Surgery is reserved for persistent, severe cases unresponsive to conservative measures.[2-4][7]
Tendinopathy is often chronic and challenging to treat, with variable recovery times. Current research is focused on understanding underlying mechanisms and optimizing rehabilitation protocols to improve outcomes.[1][4-5]
Written by Dr Michael Roger
Family Medicine Consultant
REFERENCES
1.Tendinopathy.Nature Reviews. Disease Primers. 2021. Millar NL, Silbernagel KG, Thorborg K, et al.
2.Current Opinions on Tendinopathy.Journal of Sports Science & Medicine. 2011. Kaux JF, Forthomme B, Goff CL, Crielaard JM, Croisier JL.
3.Current Trends in Tendinopathy Management.Best Practice & Research. Clinical Rheumatology. 2019. Cardoso TB, Pizzari T, Kinsella R, Hope D, Cook JL.
4.Achilles Tendinopathy.Nature Reviews. Disease Primers. 2025. Traweger A, Scott A, Kjaer M, et al.New
5.Tendinopathy: The Interplay Between Mechanical Stress, Inflammation, and Vascularity.Advanced Science. 2025. Gehwolf R, Tempfer H, Cesur NP, et al.New
6.Pathways Driving Tendinopathy and Enthesitis: Siblings or Distant Cousins in Musculoskeletal Medicine?.The Lancet. Rheumatology. 2023. Crowe LAN, Akbar M, de Vos RJ, et al.
7.Achilles Tendinopathy Pathogenesis and Management: A Narrative Review.International Journal of Environmental Research and Public Health. 2023. Tarantino D, Mottola R, Resta G, et al.
