Most commonly this presentation is at the outside elbow (lateral epicondylagia also known as tennis elbow), the knee (patella tendon also known as jumpers knee) and the ankle (Achilles tendon).

This injury generally presents in two types of people:

1. Younger athletes where there has been a period of de-loading or non-training and then suddenly their training load increases markedly.
   This can result in an overload and failure of the tendons to adapt and the collagen (fibres that make up a tendon) fail and become symptomatic.
2. Middle aged patients who perform a repeated motion. Unfortunately as we age our tendons naturally become less tolerant of demanding tasks and can become damaged without warning.

Tendinopathy (formerly known as tendonitis but has a new name because it was discovered that there was no inflammation within the tendon) generally goes through three phases.

Reactive – the beginning of the injury, usually the first few weeks.

Failed Healing – a point when the patient has tried to ‘push through’ the injury for a number of weeks and induced further damage.

Degenerative – a point where irreversible damage has been done to the tendon.

It is much easier to treat and fix these problems if they are identified early in the reactive phase.

If they have progressed beyond this initial phase they are still amenable to therapy but this will involve a longer period of strengthening exercises to re-condition the collagen with the tendon to tolerate loading again.