I focus on Dr. Jill Cook’s papers introducing the tendon pathology continuum from 2009 and her paper from 2016 revisiting this model with new evidence. Based on her papers, I’ll break down what tendinopathy is and how to actually improve it based on this updated model.

Main topics covered:

• Previous tendinitis definition
• Current understanding of tendinopathy
• What doesn’t work when treating tendinopathy
• Components of tendon rehab
• Tendon rehab timeline
• Role of injections and shockwave therapy in tendon rehab

References:

• Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine, 43(6), 409–416. https://doi.org/10.1136/bjsm.2008.051193
• Cook, J. L., Rio, E., Purdam, C. R., & Docking, S. I. (2016). Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?. British journal of sports medicine, 50(19), 1187–1191. https://doi.org/10.1136/bjsports-2015-095422 
• Martin, R. L., Chimenti, R., Cuddeford, T., Houck, J., Matheson, J. W., McDonough, C. M., Paulseth, S., Wukich, D. K., & Carcia, C. R. (2018). Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. The Journal of orthopaedic and sports physical therapy, 48(5), A1–A38. https://doi.org/10.2519/jospt.2018.0302
• Silbernagel, K. G., & Crossley, K. M. (2015). A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation. The Journal of orthopaedic and sports physical therapy, 45(11), 876–886. https://doi.org/10.2519/jospt.2015.5885
• Garzón, M., Balasch-Bernat, M., Cook, C., Ezzatvar, Y., Álvarez-Lliso, Ó., Dueñas, L., & Lluch, E. (2024). How long does tendinopathy last if left untreated? Natural history of the main tendinopathies affecting the upper and lower limb: A systematic review and meta-analysis of randomized controlled trials. Musculoskeletal science & practice, 72, 103103. https://doi.org/10.1016/j.msksp.2024.103103
• Malmgaard-Clausen, N. M., Jørgensen, O. H., Høffner, R., Andersen, P. E. B., Svensson, R. B., Hansen, P., Nybing, J. D., Magnusson, S. P., & Kjær, M. (2021). No Additive Clinical or Physiological Effects of Short-term Anti-inflammatory Treatment to Physical Rehabilitation in the Early Phase of Human Achilles Tendinopathy: A Randomized Controlled Trial. The American journal of sports medicine, 49(7), 1711–1720. https://doi.org/10.1177/0363546521991903
• Murphy, M., Travers, M., Gibson, W., Chivers, P., Debenham, J., Docking, S., & Rio, E. (2018). Rate of Improvement of Pain and Function in Mid-Portion Achilles Tendinopathy with Loading Protocols: A Systematic Review and Longitudinal Meta-Analysis. Sports medicine (Auckland, N.Z.), 48(8), 1875–1891. https://doi.org/10.1007/s40279-018-0932-2 

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