Degenerative condition of the tendon. Tendinopathy can be associated with microtears of the tendon, but these should be distinguished from acute major tendon tears.

Assess patients with tendinopathy for modifiable predisposing factors and biomechanical abnormalities that may be amenable to correction (eg posture, motor control). Advise patients to avoid or modify activities that aggravate discomfort or place high loads on the affected tendon.

Management

• For most tendinopathies, rest not recommended
• Physio for progressive loading program starting with isometric loading followed by eccentric or eccentric-concentric loading.
  • no response after 6-month rehabilitation program, refer to a specialist.
• Paracetamol and NSAIDs for short-term pain relief.
• corticosteroid injections used with caution in tendinopathy involving major weightbearing tendons such as the patellar, tibialis posterior and Achilles tendons.

The following therapies are not recommended because of insufficient evidence of benefit in the management of tendinopathy, and inadequate study of treatment harms: stem cells, autologous conditioned serum, platelet-rich plasma, platelet-rich fibrin matrix, polidocanol, prolotherapy and dry needling.