For years, we were taught about the inflammatory response, which was thought to be the  origin of our patient’s (PT’s) pain. The cardinal signs are all there: the tendon seems swollen or thickens, the PT is tender to palpation, the tendon may feel warmer along with a sudden onset of pain, etc. The usual thinking is that, collectively, these symptoms are an “itis” – tendinitis! Though research has found that all such inflammatory agents are indeed present, at least in the acute stage, it is not clear that they are the sole cause of the nociceptive signal. 

In turn, over the last 10 years, tendon researchers such as Jill Cook have re-branded this condition as TendinoPATHY! Even though their findings have shown great validity and positive results, the amount of clinicians and doctors that still diagnose “TendinITIS” is shocking. One fact is clear to us now: your patient’s tendon pain is directly related to load. 

Interesting, but what does “load” mean? It refers to the work done by the tendon during a specific activity. That load was not received well and provoked a negative response of the tendon. As a result, the upset tendon is just telling us that it is unhappy with that load. The more we can increase our PT’s load-bearing capacity, the happier their tendon is going to be. Keep in mind, though, that not every load and tendon is created equal. Having great capacity in tensile load does not mean that we are prepared to sustain an increase in friction or compression load. 

Read about some key concepts and thoughts on how to understand tendon pain here on