Lesson 1, Topic 1
In Progress


Tendon pathology in athletes has traditionally been referred to as “tendinitis”. This phrase implies that the condition involves an inflammatory response. A large number of histopathological studies have failed to show the presence of any inflammatory markers. It is likely that tendinopathy is more related to loading and overuse. This is supported by studies that have shown that affected tendons have a disorganised collagen structure, abnormal tenocytes and an increase in ground substance.

The continuum

It is clear that not all tendon injuries are the same. To reflect the differences between these patients, and to attempt to understand them better, a “continuum” model has been proposed.

Reactive tendinopathy

The elite athlete described above is likely to have “reactive tendinopathy”. This term refers to an acute overload of the tendon causing thickening and pain in the tendon. It is more common in the young athlete and is produced through increases in training load or commencement in training if previously sedentary. Imaging studies at this time show mild fusiform swelling. The proposed treatment is a period of relative rest and analgesia.

Tendon dispair

This involves a worsening of the tendon pathology with breakdown of the tendon matrix. The symptoms are likely to have been present for longer. It may be possible to see some hypoechoic areas or neovascularity within the tendon on ultrasound


This stage generally occurs after the symptoms have been present for a prolonged period. It is more common in older athletes, like the recreational athlete described above. Tendon changes, including neovascularity and hypoechoic regions, are common during this stage. These patients are likely best treated with aggressive eccentric strengthening.


A number of rehabilitation and physiotherapy interventions are widely used in the treatment of tendinopathy. In this chapter we just focus on the immediate address then the rest in the rehabilitation.

Acute phase

The use of cryotherapy on an acute tendon injury is a common practice. However, as with many of the therapies used, few studies have analysed their real utility from a scientific perspective. It is believed that cold reduces the blood flow in the tissue, pain, nerve conduction speed, the metabolic rate of the tendon and therefore, the oedema and inflammation of an acute injury. The main benefit is postulated to be analgesia, which might justify its popular.