TY - JOUR T1 - Exploring the role of intratendinous pressure in the pathogenesis of tendon pathology: a narrative review and conceptual framework JF - British Journal of Sports Medicine JO - Br J Sports Med DO - 10.1136/bjsports-2022-106066 SP - bjsports-2022-106066 AU - Lauren Pringels AU - Jill L Cook AU - Erik Witvrouw AU - Arne Burssens AU - Luc Vanden Bossche AU - Evi Wezenbeek Y1 - 2022/11/02 UR - http://bjsm.bmj.com/content/early/2022/11/02/bjsports-2022-106066.abstract N2 - Despite the high prevalence of tendon pathology in athletes, the underlying pathogenesis is still poorly understood. Various aetiological theories have been presented and rejected in the past, but the tendon cell response model still holds true. This model describes how the tendon cell is the key regulator of the extracellular matrix and how pathology is induced by a failed adaptation to a disturbance of tissue homeostasis. Such failure has been attributed to various kinds of stressors (eg, mechanical, thermal and ischaemic), but crucial elements seem to be missing to fully understand the pathogenesis. Importantly, a disturbance of tissue pressure homeostasis has not yet been considered a possible factor, despite it being associated with numerous pathologies. Therefore, we conducted an extensive narrative literature review on the possible role of intratendinous pressure in the pathogenesis of tendon pathology. This review explores the current understanding of pressure dynamics and the role of tissue pressure in the pathogenesis of other disorders with structural similarities to tendons. By bridging these insights with known structural changes that occur in tendon pathology, a conceptual model was constituted. This model provides an overview of the possible mechanism of how an increase in intratendinous pressure might be involved in the development and progression of tendon pathology and contribute to tendon pain. In addition, some therapies that could reduce intratendinous pressure and accelerate tendon healing are proposed. Further experimental research is encouraged to investigate our hypotheses and to initiate debate on the relevance of intratendinous pressure in tendon pathology. ER -