Clinical reasoning for hip and knee tendinopathies

Tendinopathy is the clinical presentation of pain and dys­function within a tendon. Tendon pathology is usually pres­ent; however, tendon pathology can exist without symptoms. Tendon pathology results in disruption of the structure of the tendon matrix and a change in the cells and matrix proteins. The transition of a tendon from normal to a degenerative pathology is a progressive change. The continuum of tendon pathology is a conceptual model of four stages of pathology to describe this transition: reactive tendon pathology, ten­don dysrepair, degenerative tendinopathy, and reactive on degenerative (Cook & Purdam, 2009; Cook et al., 2016). Ten­don structure can be normalized in the early stages but is not possible in the latter stages of the continuum.
The model aims to assist clinicians in understanding tendinopathy presentations and direct their management (Cook & Purdam 2009). The primary focus at every stage is improving pain and function. Recent reflections on the model support its usefulness as a clinical reasoning frame­work to enhance clinician understanding and guide diag­nosis and management of tendinopathy (Cook et al., 2016). Specifically, the ability to integrate tendon structure with pain, dysfunction and load capacity may allow clinicians to target treatment at the critical limiting factors. The aim of treatment is to reduce load-related pain and improve func­tion; these are closely connected.