Tendinitis versus Tendinosis: What is the Difference and Why Does it Matter?
Tendons are tissue in our bodies that connect our muscles to bones. They are made of type 1 collagen and are strong and elastic. As with any structure in your body tendons can become injured and as a result cause pain. You are probably familiar with injuries such as tennis elbow and Achilles tendinitis which occur commonly in many individuals.
Most people refer to pain coming from a tendon as tendinitis; which is excessive inflammation of a particular tendon. This inflammation is usually caused by repetitive stress to the tendon involved that triggers your body’s inflammatory process and results in pain.
So, what is tendinosis? Tendinosis refers to injury of a tendon that also is a result of repetitive stress. The difference in tendinosis is that the pain resulting is not from inflammation of the tendon but degenerative changes in the tendon that cause the tendon to become weaker, have decreased vascularity, and have a disorganized collagen structure.
The treatment of these two conditions is very different. Tendinitis is a “chemical problem” so to speak. The treatment of this consists of rest, ice, anti-inflammatory medication, and possibly a corticosteroid condition. These treatments are designed to inhibit your body’s inflammatory process. Tendinosis on the other hand is a problem of degeneration. The treatment for this is specific loading of the involved tendon that will trigger your body to heal and repair that tendon properly (such as exercise or Augmented Soft Tissue Mobilization (ASTYM)).
So how do we know if pain coming from a tendon is tendinitis versus tendinosis? The biggest indicator is time. Your body’s inflammatory process will typically last anywhere from a few days to two or three weeks. Therefore, a tendinitis if treated with rest and anti-inflammatories should not last for more than a few days to a few weeks. Tendinosis however, can last for months or even years. By the time most people go to a medical provider to seek treatment it is likely that they are dealing with a tendinosis as opposed to tendinitis. Additionally, imaging such as diagnostic ultrasound or MRI can diagnose tendinosis versus a tendinitis.
So why does this matter? The inflammatory process is your body’s method for healing injured tissue. Therefore, if you have a tendinosis but treat it as a tendinitis you may be preventing your body from healing the degraded tendon involved and possibly making the degeneration worse. Therefore, having the correct diagnosis of your tendon pain matters quite a lot!
You might be wondering “if tendinosis is a result of degeneration of the tendon then wouldn’t exercising stress the tendon more and make the problem worse?” The answer to that question is yes and no. The way I explain this is to imagine that you want to strengthen your muscles, what do you do? You lift weights. Now if you do the proper exercises with an appropriate resistance you will stress your muscles in a way that will stimulate your body to make them stronger. If, however you do an exercise that is too demanding or use too much resistance the muscle involved will be stressed past its limit and result in a tear or rupture. The same principle applies to tendons. Loading the tendon at the right intensity with the proper movement will stimulate your body to strengthen it and overloading it will cause injury. Physical therapists have the training and skills to find the type of exercise that will facilitate the healing of the tendon without causing harm.
Another treatment for tendinosis is called ASTYM . ASTYM is a specific form of soft tissue mobilization that uses tools to stimulates your body’s ability to absorb improperly formed tissue and produce new healthy tissue. Extensive research has shown the effectiveness of ASTYM in treating tendinosis (https://prc.astym.com/prc/clinical/research/Research%20Overview.pdf). Here at Fyzical, we have several providers who are trained in this technique.
If you think that you may have tendinosis do us and yourself a favor and see a medical provider about it. Tendinosis is treatable but like most conditions the more it progresses the more difficult it can become to treat. If your doctor refers you for physical therapy come stop by FYZICAL so that we can give you the tools that you need to overcome your injury and get your life back!