Tendinopathy.
Treat the tendon you actually have.
Persistent tendon pain is often labeled “tendinitis,” but chronic tendon disorders involve changes in structure, load tolerance, and tissue behavior that require more than repeated rest or anti-inflammatory treatment.
Pain, structure, and capacity are related but not identical
A tendon can look abnormal on ultrasound and be painless, while a painful tendon can have relatively modest structural change. I use imaging to answer a clinical question, not to replace the history and examination.
Important distinctions include mid-substance versus insertional disease, partial tearing, calcification, enthesopathy, adjacent bursitis, paratenon involvement, and whether another structure is actually generating the symptoms.
Progressive loading is usually central
Progressive resistance
Loading programs are built around the tendon, sport, irritability, and current strength rather than a single generic protocol.
Movement & force
Technique, kinetic chain deficits, and abrupt changes in training load can matter as much as the tendon itself.
Time & adaptation
Chronic tendon change rarely resolves on the same timeline as an acute inflammatory injury.
Rest can reduce pain without restoring capacity.
The long-term target is usually a tendon that can tolerate the forces required by the person’s life or sport.
PRP is an adjunct, not a replacement for loading
For selected chronic tendinopathies that have not responded to a well-constructed rehabilitation plan, PRP or another image-guided procedure may be considered. The exact target matters, especially when disease is focal or insertional.
Go deeper on the decision-making.
What patients usually want to know.
Is tendinopathy inflammation?
Chronic tendinopathy is not simply persistent inflammation. It can include changes in collagen organization, cellular behavior, vascularity, matrix composition, and load tolerance.
Can ultrasound diagnose tendinopathy?
Ultrasound can show tendon thickness, echotexture, tears, calcification, neovascularity, enthesopathy, and adjacent pathology. Findings must still be interpreted in the context of symptoms and examination.
When do you consider PRP for a tendon?
PRP may be considered when the diagnosis is appropriate, symptoms are persistent, and a reasonable rehabilitation strategy has not produced adequate improvement. The evidence varies by tendon and clinical scenario.
Do steroid injections weaken tendons?
Corticosteroid can have a role around selected tendon-related conditions, but intratendinous steroid exposure and repeated injections are approached cautiously because of potential adverse effects on tendon tissue.
This page is educational and does not establish a physician-patient relationship. Individual treatment recommendations require an in-person clinical evaluation.