Introduction to Tendons
The tendon is a connective tissue structure that connects muscle to bone. Its function goes beyond being an anchor point: it acts as a transmitter of the force generated by the muscle to the bone, and has the ability to store and release elastic energy, acting similarly to a spring. This property is key in activities such as running or jumping, where load is absorbed and returned efficiently, thus reducing muscular energy expenditure.
Tendon injuries can affect people of all ages, activity levels, and types of physical activity, from elite athletes to sedentary individuals. The type of injury varies considerably: it can be a traumatic and acute rupture, or a chronic tendinopathy. In this article, we will try to understand tendinopathy, its causes, and recovery process.
Tendinitis, tendinosis, tendinopathy?
To understand the terminology associated with tendon pathologies, we first need to understand how these injuries occur. As knowledge about these processes has advanced, the terminology has also evolved.
Initially, the term ‘tendinitis’ was used as it was assumed that inflammation had a central role in its development. However, subsequent studies demonstrated that inflammation was not the main cause of the problem, leading to the use of the term ´tendinosis´to classify it as a degenerative process.
More recently, it has been shown that both theories had some truth. It is now understood that the process of tendon injury can have both inflammatory and degenerative phases. This has led to the use of the more current term, ´tendinopathy´, which encompasses all aspects of the development of these pathologies.
Nowadays, tendinopathy is defined as a complex condition characterized by pain, reduced tendon function, and lower tolerance to exercise, which in its earliest phases may be accompanied by inflammation.
Its presentation and clinical diagnosis…
The typical presentation of a tendinopathy is localized pain in the area of the affected tendon, often associated with an increase in activity. The pain experienced in this case is usually related to load: both overload and insufficient load can be detrimental to the health of the tendon.
However, there are also cases of tendinopathies – usually those in a more advanced state of degeneration – that are not associated with pain and may be asymptomatic.
An accurate diagnosis combines the patient's history, clinical examination, and, when necessary, selective imaging tests. This combination is what guides a truly effective treatment.
The diagnosis is primarily based on symptoms, clinical tests, and, in some cases, the presence of neovascularization (detectable by ultrasound). Through this assessment, possible causes, risk factors, and the state of the tendon within the injury process are identified – key information for designing an individualized treatment.
Your physiotherapy treatment…
As with any pathology, an individualised treatment is essential to achieve an appropriate and effective recovery.
Regarding the rehabilitation of tendinopathies, there are different physiotherapeutic interventions, including:
- Therapeutic exercise
- Manual therapy
- Dry needling
- Shockwave therapy
Currently, it is recognised that the most appropriate and successful intervention is exercise, mainly eccentric exercises and high-load slow execution exercises (HSR: heavy slow resistance).
This is because mechanical stimulation is fundamental for the repair and development of the tendon, as it promotes its remodelling and leads to long-term structural and functional improvement.
Another benefit of exercise, mainly in the acute stages of tendinopathies, is its effect on pain: it has been shown that isometric exercise can reduce tendon pain in the short term. This makes it a useful tool for managing pain in the early phases, before progressing to more demanding exercises.
Given that tendinopathies require controlled intervention with progressive load increase for rehabilitation, assessment and follow-up with a professional is important to ensure that the load is adjusted correctly to each phase of recovery, avoiding both excess and lack of stimulus.
References:
- 10.1016/J.JBSPIN.2024.105696
- 10.1002/ADVS.202506440
- 10.3310/TFWS2748
- 10.1007/S12178-025-09993-4
- HTTPS://DOI.ORG/10.1016/J.DISAMONTH.2021.101314
- 10.1002/JOR.22869
