It is clear that not all athletes presenting with tendon pain are the same. For example, it does not seem likely that an athlete at FC Barcelona who has a four-day history of a painful Achilles tendon has the same problem as a 50-year-old recreational football player who has had pain for six months. As you will see later in the module, this elite athlete might be treated with a short period of rest while the older athlete might need an aggressive strengthening programme. To reflect the differences between these patients, and to attempt to understand them better, a “continuum” model has been proposed.1
- Reactive tendinopathy
- The elite athlete described above is likely to have “reactive tendinopathy”. This term refers to an acute overload of the tendon causing thickening and pain in the tendon. It is more common in the young athlete and is produced through increases in training load or commencement in training if previously sedentary. Imaging studies at this time show mild fusiform swelling. The proposed treatment is a period of relative rest and analgesia.
- Tendon disrepair
- This involves a worsening of the tendon pathology with breakdown of the tendon matrix. The symptoms are likely to have been present for longer. It may be possible to see some hypoechoic areas or neovascularity within the tendon on ultrasound.
- Degenerative tendinopathy
- This stage generally occurs after the symptoms have been present for a prolonged period. It is more common in older athletes, like the recreational athlete described above. Tendon changes, including neovascularity and hypoechoic regions, are common during this stage. These patients are likely best treated with aggressive eccentric strengthening.
Dr Ricard Pruna
Sport and Exercise Medicine