Tendons are essential weight-bearing structures that are often affected by tendinopathy, which leads to pain and impaired mobility. In healthy Achilles tendons, no significant renewal of the weight-bearing collagen matrix seems to occur during adult life, but tendinopathy may lead to increased turnover. The carbon-14 ([14C]) bomb pulse method was used to measure lifelong replacement rates of collagen in tendinopathic and healthy Achilles tendons (tendinopathic: n = 25, born 1937-1972. Healthy: n = 10, born 1929-1966). As expected, the healthy tendon collagen had not been replaced during adulthood, but in tendinopathic tendon, a substantial renewal had occurred. Modeling of the [14C] data suggested that one half of the collagen in tendinopathic matrix had undergone continuous slow turnover for years before the presentation of symptoms. This finding allows for a new concept in tendon pathogenesis because it suggests that either the symptoms of tendinopathy represent a late phase of a very prolonged disease process, or an abnormally high collagen exchange could be a risk factor for tendon disorders rather than being a result of disease.-Heinemeier, K. M., Schjerling, P., Øhlenschlæger, T. F., Eismark, C., Olsen, J., Kjær, M. Carbon-14 bomb pulse dating shows that tendinopathy is preceded by years of abnormally high collagen turnover.