Aim Tendinopathy is a pain-dysfunction syndrome of tendons resulting from an imbalance between the processes operating within the tissue and the external factors to which it is exposed. Contemporary concepts of pathogenesis indicate the overlap of many mechanisms: from mechanical overload leading to abnormal matrix remodeling, through inflammatory processes, to intratendinous compression causing hypoxia and pathological vascularization. The aim of this study was to review information regarding the current state of knowledge about the pathogenesis and mechanisms driving tendinopathies, based on available scientific research. Material and methods: A comprehensive literature review was conducted, including clinical trials, systematic reviews, and meta-analyses that investigated the mechanisms influencing the pathogenesis of tendinopathy. Conclusions: The heterogeneity of the clinical and histological presentation confirms the multifactorial nature of tendinopathy and explains the therapeutic challenges and frequent treatment failures. The authors suggest that integrating knowledge regarding mechanotransduction, inflammation, metabolism, and the role of intratendinous pressure may provide a basis for developing more precise and effective treatment strategies for tendinopathy.