Imagine a medical condition that is relatively common in a group of people who share similar characteristics. This condition is a common cause of morbidity leading to varying degrees of physical impairment. There is disagreement regarding specific pathological pathways, and a divergence of opinion concerning the importance of imaging. And finally, there are differing views on management of this disease with a recent explosion of treatments that have tenuous evidence supporting use in clinical practice. Such a scenario, if present in medicine, would lead to desperate calls for more research. Welcome to the world of tendinopathy.

Tendinopathy, tendinosis or tendon disease—we cannot even agree on a suitable name—is common in active individuals. There is a general consensus that tendon disease involves a degenerative process,1 although recent studies have demonstrated evidence of inflammatory pathways that question this consensus.2 Source of tendon pain generation remains elusive with contradictory evidence supporting local3 and centrally mediated pathways.4 Although imaging demonstrates specific changes of tendon disease, a recent meta-analysis questions whether tendon imaging has …