If you’ve ever struggled with persistent tendon pain—like tennis elbow, Achilles issues, or a nagging shoulder—you’re not alone. As someone who’s worked with elite athletes and weekend warriors alike, I’ve seen how confusing tendon recovery can be. The old-school model of “rest, ice, and wait” doesn’t always cut it—especially when we’re dealing with chronic injuries.
What I want to share today is a game-changing way to think about tendon injury, based on the model published in the British Medical Journal (BMJ). It breaks tendon injury into three progressive stages: Reactive, Dysrepair, and Degenerative. This framework helps us better target treatment before things spiral into long-term dysfunction.
Let’s break it down.
1. Reactive Tendinopathy – Your Tendon’s SOS Signal
This is your tendon waving a big red flag. It happens when there’s a sudden increase in load—maybe you started a new workout program, played extra pickleball games over the weekend, or sprained your ankle.
In this stage, the tendon responds by swelling and stiffening, but there’s no real structural damage yet. Think of it as a protective response: cells ramp up production of proteoglycans, which attract water and make the tendon thicker and stiffer. This can be painful, but it’s your best chance to reverse course.
What helps:
- Reducing load (temporarily)
- Gentle movement and blood flow
- ActivMend to accelerate the healing and blood flow
2. Tendon Disrepair – Microdamage Starts to Add Up
If you keep pushing through pain or don’t give the tendon time to recover properly, you enter the dysrepair stage. Now, the collagen matrix starts to break down. The once-organized fibers that give the tendon strength become disorganized and weak.
At the same time, the body tries to fix things by bringing in new blood vessels and nerves. Unfortunately, this can lead to increased pain sensitivity, even though the tendon might not look that damaged on imaging yet.
What helps:
- Eccentric strengthening exercises (slow, controlled loading is magic here)
- Smart rehab protocols that guide collagen reorganization
- Minimizing aggravating movements while retraining the tissue
- It is very important to use ActivMend in this stage to make sure you fully heal. If you do not, then it can reach the 3rd degenerative stage.
3. Degenerative Tendinopathy – The Danger Zone
This is the stage we really want to avoid. After long-term breakdown, the tendon becomes structurally compromised. There are areas of cell death, scar tissue, and minimal healing capacity. The tendon looks moth-eaten under a microscope—less collagen, more junk.
People in this stage often say things like “It’s been bad for years,” or “I just live with it.” But the danger here is that the tendon can rupture under normal loads—a sudden Achilles tear or shoulder pop that ends your season or your sport.
What helps:
- Ongoing loading strategies to maintain function
- Pain modulation strategies, since full reversal may not be possible
- ActivMend is only effective in this stage when combined with therapies that intentionally irritate the tendon—such as dry needling, sclerosing injections, prolotherapy, or shockwave therapy—to push the tissue back into the reactive phase where biological healing can occur.
Why This Model Matters
The traditional “tendonitis” model treated everything as inflammation. But chronic tendon problems aren’t about inflammation—they’re about failed healing. Understanding which stage you’re in allows for far more targeted, effective treatment. It also explains why rest alone rarely works—and why simply “pushing through it” can backfire.
Final Thoughts
Tendons are slow to heal—but not impossible. With the right strategy, even long-standing injuries can improve. If you’re unsure where you are in this process, talk to someone who understands the nuances—not just inflammation, but tissue remodeling, loading capacity, and real-world recovery.
Your tendons are tough. Let’s treat them smart.
