According to Cook and Purdham, there are stages that a Tendon goes through before it becomes 'degenerative'.
However when it does get to the 'degenerative' stage, does that mean it's the end of the line?
Nope not at all. You see Tendons adapt (as does the rest of the body). Of course we may not go back to how we were before, but that's ok.
Degeneration is a normal part of aging. And it's actually found that degeneration does NOT have to come with pain and dysfunction.
In fact you can have pain and disfunction with NO degeneration at all (which is why imaging is worthless for the majority of people….yes there are exceptions but we are speaking generally here).
So what does that mean for someone who has been told they have a degenerative tendon?
Well, as the body adapts they will have 'normal' parts of tendon too and it's this part of the tendon that we need to focus on, NOT the degenerative part.
As expertly put by Sean Dockings, we need to 'Treat the doughnut and not the hole'.
If there is no pain and dysfunction despite degeneration then we look at training the doughnut (the normal part of the tendon) as opposed to the hole (the degenerative part).
And if there IS pain and dysfunction this is referred to as reactive-on-degenerative which means we STILL look at treating the doughnut (the reactive part) as opposed to the hole (degenerative tendon).