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Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy
  1. J L Cook1,
  2. C R Purdam2
  1. 1
    Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
  2. 2
    Department of Physical Therapies, Australian Institute of Sport, Canberra, Australia
  1. Dr Jill Cook, 221 Burwood Highway, Melbourne 3025, Australia; jill.cook{at}


Overuse tendinopathy is problematic to manage clinically. People of different ages with tendons under diverse loads present with varying degrees of pain, irritability, and capacity to function. Recovery is similarly variable; some tendons recover with simple interventions, some remain resistant to all treatments.

The pathology of tendinopathy has been described as degenerative or failed healing. Neither of these descriptions fully explains the heterogeneity of presentation. This review proposes, and provides evidence for, a continuum of pathology. This model of pathology allows rational placement of treatments along the continuum.

A new model of tendinopathy and thoughtful treatment implementation may improve outcomes for those with tendinopathy. This model is presented for evaluation by clinicians and researchers.

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  • Competing interests: None declared.

  • Funding: Jill Cook was funded by a Club Warehouse Visiting Fellowship to the Australian Institute of Sport Physical Therapies department. Club Warehouse had no direct or indirect involvement in the production of this manuscript.