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Achilles tendinopathy is the term used to describe the clinical entity of localised Achilles tendon pain that is associated with load-bearing activities. Achilles tendinopathy as a term was agreed on the 2018 International Scientific Tendinopathy Symposium Consensus (ICON) statement—which followed an expert meeting in Groningen (the Netherlands).1 Having uniform terminology is important for many reasons. But a clinical term is not the same as a diagnosis with clear diagnostic criteria. Clear diagnostic criteria help patients understand their problem, guide treatment and determine prognosis. Naming a medical condition can be likened to naming a recipe, but the exact ingredients used can differ between chefs. In this editorial, we discuss the diagnostic challenges, where ‘top chefs’ disagree which ingredients are present in mid-portion Achilles tendinopathy.
The paradigm shift in diagnosing injuries in sports medicine
Many medical diagnostic tests are often validated by comparing them to a gold standard (eg, imaging, surgical or histological findings). Most sports injuries and long-standing musculoskeletal pain conditions have unclear pathogenesis and lack clear gold standards (consider patellofemoral pain). When imaging was added to the clinical diagnostic criteria in patients with patellofemoral pain it added no value.2 The classic tissue-based diagnosis paradigm has been increasingly abandoned. A paradigm shift towards using history and clinical examination …