Tendons and Tendon pain such as your achilles, patella, tennis elbow, golfer s elbow  as professional sports are demanding better understanding of tendon pathology as injuries cause enormous financial issues both to the sports organisations and athletes.   Sports such as tennis, athletics, football  where in the past  a variety of injections have been used  have over the years proved to be detrimental the Long Term Life of Athletes   Here is this brilliant Model of Tendon Pathology which one has to thank all the researchers in to Tendon Pathology

So here is some interesting abstracts and articles via reading from the British Journal of Sports Medicine with appreciation to Professor Jill Cook   Professor Karim Khan  



A new model of tendon pathology


 Basic stages of tendinopathy


1) Reactive

2) Tendon Dysrepair

3) Degenerative


It is important to realise that tendinopapthy does not necessarily follow a linear progression from a reactive tendon to a degenerative one. The term tendinopathy dictates a continuum process and tendons may move in and out of pathology and between stages in response to loading and/or unloading. These stages will be examined in greater detail once we have looked at the changes that occur that move a healthy tendon to a tendinopathy.


Reactive Tendinopathy


Pathophysiology: This is a non-inflammatory proliferative response, which is basically a thickening and stiffening of the tendon in an attempt to reduce stresses and cope with the load. It is generally short term and the tendon can return to normal if the excessive load is reduced or sufficient time is given between loading.

Imaging: visible swelling and increased diameter (US/MRI).

Clinical signs: Most common in younger people and often follows a period of acute overload i.e. through rapid increases in training load or starting training if previously sedentary.

 Tendon Dysrepair:

Pathophysiology: As with a reactive tendinopathy this is an attempt at tendon healing. There is, however, greater matrix breakdown through collagen disorganisation and ground substance proliferation. Neovascularisation is also possible at this stage

Imaging: US and MRI will show increased matrix disorganisation and swelling and possible vessel infiltration.

Clinical Signs: This stage appears in chronically overloaded tendons. This has the potential to appear over a range of ages and loading environments.


Pathophysiology: There is progression of both matrix and cell changes and areas of cell death. Large areas of the matrix are disordered, filled with vessels (neovascularisation). Considerable diversity is apparent in the structure of the tendon.

Imaging: Extensive compromise of the tendon can be seen on US and MRI

Clinical Signs: More commonly seen in the older patient/athlete, but is also occasionally seen in younger athletes (often elite) with a chronically and severely overloaded tendon. However, the more classic presentation is the middle-aged recreation athlete, with focal swelling, who describe repeated bouts of tendon pain. If allowed to progress, this stage can eventually lead to rupture. Analyses of ruptured tendons have shown these degenerative changes in 97% of cases.

References:Allison GT, Purdam C. Eccentric loading for Achilles tendinopathy—strengthening or stretching? Br J Sports Med 2009;43:276–9.Gaida JE, Cook JL, Bass SL. Adiposity and tendinopathy. Disabil Rehabil 2008;30:1555–62.Coombes BK, Bisset L, Vicenzino B, A new integrative model of lateral epicondylalgia. Br J Sports Med 2009;43:252–8.Woo SL, Renstrom P, Arnoczky SP: Tendinopathy in athletes, Encyclopedia of Sports Medicine. Blackwell Publishing, Oxford, UK; 2007.Cook JL, Purdam CR: Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med 2009, 43(6):409-416.Langberg H, Ellingsgaard H, Madsen T, Jansson J, Magnusson SP, Aagaard P, Kjaer M: Eccentric rehabilitation exercise increases peritendinous type I collagen synthesis in humans with Achilles tendinosis. Scand J Med Sci Sports 2007, 17(1):61-66.


Qualifying mechanical stress

HERE IS ONE LINK BY  Professor Karim Khan on rehabilitation of Tendon Pathology 


Edinburgh Osteopath Helen How has over twenty-eight years experience of treating patients at the How Osteopathic Clinic (Trinity Edinburgh). Registered Osteopath Helen combines the latest advances in osteopathy with a gentle patient-centred approach to diagnosis and treatment ensuring that osteopathic treatment at the How Clinic is suitable for a wide-range of conditions including; back pain, neck pain, shoulder pain, knee conditions Helen uses Video Clips exercises educational information and outcome which is sent to your computer smartphone or iphone if you wish Treatment at the How Osteopathic Clinic is tailored to the individual and where necessary uses a combination of osteopathic techniques including, Traditional Osteopathy, Cranial Osteopathy, Electrotherapy, Vibrotherapy and Sports Remedial Massage. The holistic approach to osteopathy at the How Osteopathic Clinic, in addition to a full one hour treatment sessions, is designed to alleviate symptoms rapidly and can often significantly reduce the number of osteopathic treatments required. One of the few Osteopaths in Edinburgh and in Britain who uses the unique, gentle fleximatic vibrotherapy or shockwave therapy massage equipment combined with traditional osteopathic techniques in order to to find, feel and palpate those hard fibrotic bands of muscles which accumulate over the years of prolonged sitting, Helen has attended conferences held throughout the country; Helen has been using Shockwave Therapy for over 3 years now for Patella Tendons , Achilles Tendons Plantar Fasciitis and Tendon pain Hips, Upper Proximal Hamstring tendinopathy along with rehabilitation loading Contact Helen How, Registered Osteopath, 14 Craighall Gardens, Edinburgh EH6 4RJ To make an appointment contact Helen on 131 551 1044 or Text /Call 07889304762