Tendinosis myth
Although it was certainly progress to stop referring to all symptomatic tendons as ‘tendinitis’; does referring to all chronic tendons as ‘degenerative’ risks throwing the baby out with the bathwater? Ironically, it is now the ‘tendinosis’ paradigm that has itself become just as deeply ingrained in the medical literature as the original tendinitis concept. This has had two detrimental consequences. First, it oversimplifies our understanding of the pathological processes. Second it may lead us to ignore potentially effective treatments in chronic tendinopathy.
It is not suggested that acute inflammation is the dominant pathology in all phases of established tendinopathy. However, it is likely that elements of the inflammatory response play a role in the progression or continuation of tendon disrepair. If so, could anti-inflammatory strategies be therapeutic in the chronically pathological tendon? Let us examine the case for the involvement of inflammation and inflammatory mediators in chronic tendinopathy.