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Br J Sports Med. 2007 April; 41(4): 187.
PMCID: PMC2658940

A clinical perspective to tendinopathy

J L Cook and J Karlsson, K M Khan

Short abstract

A major challenge for clinicians in sports medicine

Although there have been many advances in both understanding and treating tendinopathies over the past years, this clinical condition remains a major challenge for clinicians in sports medicine and a fear for elite athletes and recreationally active people. The aim of this issue of BJSM was to aggregate a number of high‐quality, clinically relevant peer‐reviewed, original and review papers.

Papers with a clinical perspective provide critical review and original data relating to both eccentric exercise and tendon vascularity. The research reported here builds on the foundations of research into eccentric training during the past 20 years; papers reveal new insights into this exercise regime and the effect it has on vascularity and pain. In addition to these papers on treatment, two outcome papers show a mixed long‐term outcome for patients with tendinopathy. Although there is no spontaneous recovery of full function in individuals with Achilles tendinopathy, in volleyball players it seems that sustained high tendon load does not result in increased risk of morbidity. Interestingly, this implicates individual factors in disease progression and outcome. One such factor, waist circumference, is reported as a potential factor in tendinopathy for the first time. We were delighted to receive submissions related to exercise therapy of upper‐limb tendinopathies, as clinicians have been crying out for studies in this region to guide practice. We also note that glyceryl trinitrate‐patch therapy has gained momentum among physicians in recent years. This safe, easy to administer approach, combined with exercise therapy, has strong evidence‐based support. In this issue its use, and possible mechanisms of action are critically revised and clinical recommendations are also given.

On the diagnostic front, data from an original paper highlights a standardised way of assessing athletes with groin pain. Although not yet the definitive answer for this problem, we feel that such an approach is an important step to consistent clinical diagnosis. A review of the genetic aspects of tendinopathy highlights recent innovation and pioneering work—another example of the axiom “Ex Africa Semper Aliquid Novi”. Also, research advances rely on an excellent animal model, which might help those aiming to understand the relevant literature or jump‐start anyone contemplating adding to this field of research.

However, although some excellent research is being published in this issue, it must be borne in mind that our knowledge is still lacking; for instance, in terms of biomechanics, diagnostics and return to sports. Moreover, the most important question, “where does the pain originate from,” is still not answered. Therefore, the research must go on. Especially we should continuously look for randomised controlled trials concerning the various treatment alternatives.

As is increasingly the case in the British Journal of Sports Medicine, papers came from all continents and authors represented a broad mix of clinical and scientific disciplines. The diversity of papers relating to clinical treatments, varying outcomes, perspectives on diagnosis and imaging as well as physiology and basic science reinforce the multifactorial nature of tendon disease. It does seem that such a transdiciplinary approach may be the key to future innovations. We thank the authors and reviewers for their timely contributions to this issue. And we pay homage to those pioneers who contributed substantially to this field in earlier research—with a particular nod to those superb dedicated tendinopathy issues of journals such as Clinics in Sports Medicine (1992, 2003) and Scandinavian Journal of Science and Medicine in Sport (1997, 2005).

Footnotes

Competing interests: None declared.


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