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ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology
  1. Alex Scott1,
  2. Kipling Squier1,
  3. Hakan Alfredson2,
  4. Roald Bahr3,
  5. Jill L Cook4,
  6. Brooke Coombes5,
  7. Robert-Jan de Vos6,
  8. Siu Ngor Fu7,
  9. Alison Grimaldi8,
  10. Jeremy S Lewis9,
  11. Nicola Maffulli10,
  12. SP Magnusson11,
  13. Peter Malliaras12,
  14. Sean Mc Auliffe13,
  15. Edwin H G Oei14,
  16. Craig Robert Purdam15,
  17. Jonathan D Rees16,17,
  18. Ebonie Kendra Rio4,
  19. Karin Gravare Silbernagel18,
  20. Cathy Speed19,20,
  21. Adam Weir21,
  22. Jennifer Moriatis Wolf22,
  23. Inge van den Akker-Scheek23,
  24. Bill T Vicenzino24,
  25. Johannes Zwerver25
  1. 1 Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
  3. 3 Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  4. 4 La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
  5. 5 Department of Allied Health Sciences, Physiotherapy, Griffith University, Nathan, Queensland, Australia
  6. 6 Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
  7. 7 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
  8. 8 School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
  9. 9 Department of Allied Health Professions, University of Hertfordshire, Hatfield, UK
  10. 10 Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, London, UK
  11. 11 Department of Clinical Medicine, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
  12. 12 Department of Physiotherapy, Monash University Faculty of Medicine Nursing and Health Sciences, Frankston, Victoria, Australia
  13. 13 Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  14. 14 Department of Radiology & Nuclear Medicine of Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  15. 15 Department of Physical Therapies, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
  16. 16 Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  17. 17 Headley Court, Defence Medical Rehabilitation Centre, Surrey, UK
  18. 18 Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
  19. 19 Department of Rheumatology/Sports Medicine, Cambridge University Hospital, Cambridge, UK
  20. 20 Cambridge Lea Hospital, Cambridge, UK
  21. 21 Department of Sports Medicine, Aspetar hospital, Doha, Qatar
  22. 22 Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
  23. 23 Department of Sports Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  24. 24 Department of Physiotherapy, University of Queensland, Brisbane, Queensland, Australia
  25. 25 Department of Sports Medicine, University Medical Center, Groningen, The Netherlands
  1. Correspondence to Dr Alex Scott, Department of Physical Therapy, University of British Columbia, Vancouver V6T 1Z4, Canada; ascott{at}

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Persistent tendon pain that impairs function has inconsistent medical terms that can influence choice of treatment.1 When a person is told they have tendinopathy by clinician A or tendinitis by clinician B, they might feel confused or be alarmed at receiving what they might perceive as two different diagnoses. This may lead to loss of confidence in their health professional and likely adds to uncertainty if they were to search for information about their condition. Clear and uniform terminology also assists inter-professional communication. Inconsistency in terminology for painful tendon disorders is a problem at numerous anatomical sites.

Historically, the term ‘tendinitis’ was first used to describe tendon pain, thickening and impaired function (online supplementary figure S1). The term ‘tendinosis’ has also been used in a small number of publications, some of which were very influential.2 3 Subsequently, ‘tendinopathy’ emerged as the most common term for persistent tendon pain.4 5 To our knowledge, experts (clinicians and researchers) or patients have never engaged in a formal process to discuss the terminology we use. We believe that health professionals have not yet agreed on the appropriate terminology for painful tendon conditions.

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The authors of this paper, a group of international clinical and research experts from different disciplines, aimed to achieve a consensus in terminology for persistent tendon disorders. We ran a Delphi and consensus process that culminated in a face-to-face meeting at the fifth International Scientific Tendinopathy Symposium (ISTS) in Groningen, the Netherlands, on 26 September 2018 (placeholder for sentence about the other two papers and accompanying editorial if they get accepted). Here, we present the resulting consensus statements on terminology for persistent tendon pain.


Our two-stage Delphi design, consensus process consisted of an online survey followed by a face-to-face meeting. One of us (AS) drafted 11 statements about terminology …

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