Tendinopathy is proposed as a load-driven continuum of pathology, not an "-itis"
Treatments are placed along the continuum, so the fix is load modification, not anti-inflammation
Key Findings
The abstract's claim: overuse tendinopathy is clinically heterogeneous (age, load, pain, irritability, function; some tendons recover with simple interventions, some resist all treatments), and neither "degenerative" nor "failed healing" alone explains that heterogeneity.The review proposes, and provides evidence for, a continuum of pathology, which allows rational placement of treatments along the continuum; the model is presented for evaluation by clinicians and researchers.
The model's stages (full text; not checked against the abstract): reactive tendinopathy — a short-term, non-inflammatory proliferative response to acute or unaccustomed overload; the tendon thickens and can revert if load is reduced; tendon dysrepair — failed healing with matrix breakdown and some neovascularity, partially reversible; degenerative tendinopathy — cell death and disorganised matrix with little capacity for reversal.
From the full text (not checked against the abstract): degenerative and normal tissue coexist, so the healthy tissue around a degenerative lesion can be strengthened even if the core does not "heal"; position on the continuum is set by load history and the individual, moving up with excess load and back with optimised load.
Practical Application
The model reframes a painful tendon as a load problem placed somewhere on a continuum, with treatment chosen by position — so stop "rest until it stops hurting" and coach the load: find the recent spike (volume, intensity, hills, plyometrics, new shoes, cadence) that tipped it and reduce that spike, not activity to zero. (Coaching translation of the model; the abstract gives no protocol.)
Scope: the coach manages load; a clinician diagnoses. Refer atypical pictures (night pain, rapid swelling, a "pop"/tear, systemic features, pain not tied to load). (Not from this paper; the base's own practice.)
Limitations
Conceptual model, not a trial; discrete stages are a simplification; "inflammation absent" is now nuanced (some immune signalling participates) — the practical takeaway (load, don't rest) is unchanged; the paper gives no dose.
How this entry was checked and changed
Why this level
regraded 2026-09-27 from C: narrative review proposing a model (rubric C+), not expert opinion alone
Content correction 2026-09-27
Level C -> C+ per the 2026-09-26 rubric (narrative review / model paper).
Stage descriptions and the "coexisting tissue" point labelled as full text: the abstract only states that a continuum is proposed and that treatments can be placed along it.
Sport line normalised to "general"; section pointer §70 replaced with refIds; the referral list labelled as the base's own practice.
Revision 2026-10-16: the Practical pointer to REF-627 no longer reads "isometrics for pain"; it notes that the pain relief was not confirmed (REF-1147, REF-1149).