The elite athlete described above is likely to have “reactive tendinopathy”. This term refers to an acute overload of the tendon causing thickening and pain in the tendon. It is more common in the young athlete and is produced through increases in training load or commencement in training if previously sedentary. Imaging studies at this time show mild fusiform swelling. The proposed treatment is a period of relative rest and analgesia.
This involves a worsening of the tendon pathology with breakdown of the tendon matrix. The symptoms are likely to have been present for longer. It may be possible to see some hypoechoic areas or neovascularity within the tendon on ultrasound.
This stage generally occurs after the symptoms have been present for a prolonged period. It is more common in older athletes, like the recreational athlete described above. Tendon changes, including neovascularity and hypoechoic regions, are common during this stage. These patients are likely best treated with aggressive eccentric strengthening.