It is currently widely accepted that chronic tendinopathy is caused by a degenerative process devoid of inflammation. Current treatment strategies have focused on physical treatments including eccentric exercises, peritendinous injections of blood or blood products and interruption of painful stimuli. Results have been at best moderately good and at worst a failure.The evidence for degeneration alone as the cause of tendinopathy is surprisingly weak. There is compelling evidence that inflammation is a key component of chronic tendinopathy. Newer anti-inflammatory modalities provide alternative potential opportunities in treating chronic tendinopathies and should be explored further.