Tendon degeneration is a normal age-related trajectory due to cellular senescence, leading to inflammation and pain.

“the older we get it doesn't necessarily matter whether it's overuse or under use these things will happen because that is just the normal trajectory of tendon problems tendon pathology the tendon cells over time start to degenerate just like all of our cells and they go through process of senescence like all tissue and those senescent cells produce those factors that lead to degeneration of the tendon causes inflammation incredible amount of pain and it's hard to treat it's hard to reverse the process”