Feeling Fine vs. Structurally Sound: The Complex Reality of Tendinopathy Management in Elite Athletes
Tendon overuse injuries, or tendinopathies, are a significant burden in elite sports, causing pain, reducing athletic performance, and sometimes curtailing careers. Managing these conditions effectively is paramount, but the path to recovery is often far more complex than simply waiting for pain to subside. How can teams ensure their injury management strategies truly address the underlying issue and safely guide athletes back to peak performance?
A recent longitudinal study published in the European Journal of Sport Science sheds light on this challenge (Seidler et al., 2025). The researchers followed elite athletes with early-stage Achilles and patellar tendinopathy for one year, monitoring both their clinical symptoms (pain, function via VISA scores) and tendon structure using ultrasound imaging.
The Clinical vs. Morphological Disconnect
The study revealed a critical complexity: the potential disconnect between how an athlete feels and the actual state of their tendon tissue. Over the year, athletes reported significant clinical improvements – their pain lessened, and their function scores (VISA-A and VISA-P) increased substantially. Based on symptoms alone, recovery seemed well underway.
However, the ultrasound told a more nuanced story. Morphological (structural) improvements within the tendon tissue were described as "modest". While some positive changes occurred, particularly a reduction in peritendinous thickness in Achilles tendons, patellar tendons often remained enlarged even after a year. This discrepancy highlights a major pitfall in tendinopathy management: relying solely on subjective symptom reports may provide an incomplete picture of tissue healing and readiness for load.
Implications for Managing Athlete Workload
This disconnect poses significant challenges for managing athlete workload and optimizing training protocols. If an athlete feels better but their tendon structure hasn't fully adapted or repaired, returning to high training loads too quickly could risk re-injury or the development of persistent, chronic tendinopathy.
The study implemented "pain-guided activity modification", a common strategy where training load is adjusted based on pain levels. While valuable, the Seidler et al. findings suggest this may need to be augmented. Deciding how to modify load effectively requires interpreting not just the pain score, but also understanding the structural context provided by imaging and integrating this with other athlete performance analysis data. Making informed decisions requires a deeper level of sports science expertise.
Navigating Complexity with Expert Sports Science Consulting
Furthermore, while the study identified some baseline factors offering prognostic insights (e.g., lower initial Power Doppler signals and better initial VISA scores correlated with better morphological outcomes ), predicting individual recovery trajectories remains challenging. We also know that structural abnormalities can exist before symptoms even develop, emphasizing the need for proactive monitoring strategies beyond just reacting to pain.
Applying sports science effectively in this context means moving beyond simplistic protocols. It requires the ability to:
Critically evaluate sports research insights, like those from the Seidler study.
Integrate and interpret multiple data streams – clinical symptoms, functional scores, imaging results, training load data.
Translate this complex information into actionable sports science strategies tailored to the individual athlete and their sport's demands.
This is the specialized capability PASS | Practical Application of Sport Science delivers. We provide sports science consulting that bridges the gap between research, complex data, and practical application. We help teams navigate the intricacies of injury management, ensuring that decisions about managing athlete workload, rehabilitation progression, and return-to-play are truly evidence-informed, considering both how the athlete feels and the underlying biological reality. Our expert analysis provides the foundation for robust team optimization and helps secure a sustainable competitive edge by prioritizing long-term athlete health.
True recovery from tendinopathy isn't just about silencing symptoms; it's about ensuring structural resilience. Let PASS help you navigate the complexity.
Reference:
Seidler, M., Svensson, R.B., Meulengracht, C., Christensen, K.Ø., Brushøj, C., Kracht, M., Hjortshoej, M.H., Magnusson, S.P., Bahr, R., Kjær, M. and Couppé, C. (2025). One‐Year Follow‐Up of Clinical and Morphological Outcomes in Elite Athletes With Early‐Stage Lower Extremity Tendinopathy. European Journal of Sport Science, 25, e12303. https://doi.org/10.1002/ejsc.12303
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