It is thought that mechanical overload whether this is after an initial injury or over a long period of time can result in changes in the normal tendon. This is shown in the picture below.
A normal tendon has collagen fibres, a ground substance and tenocytes. When a tendon is pathological (tendinopathy) , there is an increase in disorganisation of the collagen fibres in the tendon, an increase in ground substance and a reduction in tenocytes.
(Thicker tendon with increased blood flow)
This process is maintained through repetitive trauma and typically presents with pain with immediate force (Typically first thing out of bed) which warms up over time.
The treatment options that are most suited to start the healing process in chronic tendinopathy are:
Deep tissue massage
Once healing has started support is needed for the repairing structures this can be in the form of: