Clinical reasoning for hip and knee tendinopathies

Ebonie Rio, Sue Mayes, Katia Ferrar, Craig Purdam, Michael Freeman, Jill Cook

Research output: Chapter in Book/Report/Conference proceedingChapter


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.
Original languageEnglish
Title of host publicationHip and Knee Pain Disorders:
Subtitle of host publicationIntegrating manual therapy and exercise
EditorsBenoy Mathew, Carol A Courtney, César Fernández-de-las-Pen̋as
Place of PublicationEdinburgh
PublisherHandspring Publishing
Number of pages26
ISBN (Electronic)9781913426149
ISBN (Print)9781913426132
Publication statusPublished - 2022
Externally publishedYes


  • tendinopathy
  • hip
  • knee
  • tendon pathology
  • tendon matrix
  • tendon disrepair


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