Tendinopathy: Pathological tendons are stronger than healthy tendons

What is tendinopathy

Tendons are generally thicker with tendinopathy. This can be associated with pain. The theory is that the tendon has potentially become degenerative. Which is the predominate belief behind why the structure has become painful. Tendinopathy can effect any tendon within the body. Although most commonly it is associated with the patella tendon of the knee, the achilles and extensor muscles of the forearm (tennis elbow).

Changing Beliefs

There is growing evidence that such pathological tendons actually have a greater abundance of healthy fibres than supposedly normal tendons. These findings would suggest they are therefore stronger as a result.  This is an important message to understand during rehabilitation. As the fear of further damage can be more debilitating than the pain itself .  Knowing the tendon is strong will most likely have a positive effect on activity levels.


Rehabilitation of tendinopathy will always require some form of progressive loading. Tendons essentially transmit the forces from muscles to bones to initiate movement. So it makes sense that loading through exercise is without doubt the most effective form of treatment. However it is the pacing of load which is key to successful outcomes. Physiotherapists have an important role in guiding the rehabilitation process.

Exercising with Pain

If you are experiencing tendon pain this does not necessarily mean complete exclusion from your sports. It is often possible to continue participation. However the level of pain and the type of sport will tend to dictate whether an individual can participate.

Other Types of Treatment

Shockwave therapy has become increasingly fashionable over recent years, however the evidence to support it’s efficacy as a treatment is inclusive. Multiple injections into tendons also tends to lead to poorer outcomes. Surgery is not superior in the long term to an exercise approach and therefore should not be considered a first choice treatment strategy . 

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