Lesson

Pathogenesis

Tendon pathology in athletes has traditionally been referred to as “tendinitis”. This phrase implies that the condition involves an inflammatory response. A large number of histopathological studies have failed to show the presence of any inflammatory markers. It is likely that tendinopathy is more related to loading and overuse. This is supported by studies that have shown that affected tendons have a disorganised collagen structure, abnormal tenocytes and an increase in ground substance.

In professional football, the incidence of both patellar tendinopathy and Achilles tendinopathy is more common during the pre-season than during the competitive season. This may reflect a sudden increase in training volumes – or a greater overall training volume. While these conditions only represent 2.5% of all injuries, they represent between 20-27% of all re-injuries. This illustrates how difficult they can be to treat.

Click in the following image to show an image displaying both ‘normal’ and ‘abnormal’ Achilles tendons.

Normal and abnormal Achilles tendons. Abnormal tendons show collagen disarray, increased extracellular matrix (glycosaminoglycans), neovessels and increased number of fibroblasts.

Tendon pathology does not appear to be related to inflammation in the vast majority of cases – rather overuse and tendon disrepair.

Dr Ricard Pruna

Sport and Exercise Medicine