What is your first reaction when you find out your next patient has a long-term tendinopathy? I suspect you want to hide or get an urgent phone call that drags you away from the practice. You know that the person will have tried multiple interventions, probably had several injections, read all the literature about treatments for tendinopathy on the internet and want an immediate and lifelong cure. You also know that your assessment will take well into your next patient’s time allotment and even then it will remain difficult to prioritise treatments and to explain the rationale behind your plan to the patient. Even as a tendon researcher and part-time clinician whose practice consists solely of tendinopathy patients, my reactions to chronic tendinopathy patients are similar.

WHY ARE TENDONS SO DIFFICULT TO TREAT?

Tendon is incredibly complex tissue that refuses to behave in any sort of structured reparative way or respond to clinical interventions …