Tendinopathy, Tendinitis, and Tendinosis

Tendinopathy, tendinitis and tendinosis are three different terms that often lead to confusion. Its important however to understand the differences – particuarly if you are suffering from these conditions.

Tendinopathy is a general term used to describe most tendon problems broadly.

Tendinitis is one of these tendinopathy problems and is caused by inflammation. It is primarily a pain problem. It usually occurs when a tendon becomes overloaded and inflamed as a result.

Tendinosis is a different, long-term tendinopathy condition that is the result of degeneration. It describes an injured tendon that has degenerated from overuse.

Tendinitis and tendinosis each reflects distinctly different conditions with a tendon, requiring different treatments.

Tendinopathy is an encompassing term used to broadly describe most tendon problems. The tendon conditions under this umbrella have different characteristics and underlying causes.

Tendinitis and tendinosis are distinctly different tendon problems, each requiring different treatments, that are grouped under the term “tendinopathy.”

Tendinopathy is often referred to by location or the specific tendon it affects. It also may be referenced by related athletic activity. Common variants include:

• Achilles tendinitis,
• Jumper’s knee,
• Golfer’s elbow,
• Tennis elbow,
• Swimmer’s shoulder,
• De Quervain’s tenosynovitis,
• and others.

Tendons vs Ligaments

Tendons are thick cords of tissue that connect muscles to bones. In contrast, ligaments connect bone to bone. Tendons, ligaments, and muscles are all soft tissue.

People have tendons all over their bodies, varying in size, structure, and function. Tendon injuries are common among the general public and athletes of every level.

Pain or restricted movement from these tendon injuries can significantly impact individuals’ lives. The appropriate treatment path will vary considerably according to whether the tendinopathy disorder is tendinitis or tendinosis.

Tendinitis is the inflammation of a tendon, normally accompanied by pain and reduced functional abilities. It occurs when a tendon experiences excessive strain from sudden or repetitive movements or from bearing too much weight. It can be an acute (short-term) or chronic (long-term) injury.

Tendinosis is a chronic (long-term) injury where a tendon’s collagen breaks down (degenerates) from overuse. This condition is also known as “chronic tendon disease.” It normally happens slowly over time and is frequently the result of tendon overuse.

While tendinitis is the inflammation of a tendon, tendinosis is a chronic injury where a tendon’s collagen breaks down. Very basic self-care may be appropriate for tendinitis. However, tendinosis treatment requires attention to arresting and reversing the tendon’s collagen deterioration.

Correctly distinguishing between these two disorders is critical, as it informs how to treat the injury and predict the treatment outcomes.

Tendinitis involves inflammation of tendon cells, called tenocytes. It is normally painful, accompanied by swelling, redness, and warmth in the surrounding soft tissues.

When examined by ultrasound, inflammatory cells will be present, but the tendon microtears typical of tendinosis will not.

Tendinosis is primarily a degeneration of tendon tissue, usually without inflammation. It is a breakdown of a tendon’s collagen, the primary structural protein of skin, tendons, and other connective tissue. Tendinosis may or may not include pain. The surrounding soft tissues are usually not red or warm.

When examined by ultrasound, tiny tears, called microtears, will be present, but there will be no evidence of inflammatory cells.

Tendinitis is most normally caused by repetitive minor stress or a sudden, forceful strain on a tendon.

Tendinitis can occur anywhere in the body. It is more common, however, in the knee, wrist, hip, elbow, shoulder, base of the thumb, or Achilles tendon at the heel. It may also occur in other places. Tendonitis of the back is just such an example, also known as spinal tendonitis.

As tendons age, they will tolerate less stress and become less flexible. Thus, adults become more susceptible to tendinitis as they grow older.

The exact cause of tendinosis isn’t always clear. It is often related to multiple factors, including:

• Repetitive tasks such as typing, lifting, sports, gardening, shoveling, or painting.
• Minor, ongoing tendon injuries that haven’t been given time to heal correctly.
• Failing to maintain good posture.
• Participating in athletic activities without preparing with flexibility and strength training.
• Poor circulation in a tendon from a sedentary lifestyle that is followed by a sudden increase in activity.
• Certain medical conditions that can weaken muscles or, although rare, certain medications can cause tendons to tear.

Sprains and strains are common in our daily lives. We are all used to self-treatment in the early stages of these injuries. However, it is crucial that you do not neglect persistent tendinopathy that doesn’t improve in a few days.

Note that we are using the broader term “tendinopathy” because you may not know without proper medical evaluation whether your issues are related to tendinitis or tendinosis.

Continuing symptoms may indicate the degeneration of a tendon, known as tendinosis. A weakened tendon from tendinosis can be at risk for tearing or rupture. If tendon pain is persistent, you should see a specialist in physiatry, sports medicine, or orthopedics. They can properly diagnose and treat your pain.

The medical community at large does not uniformly agree on all aspects of diagnosing tendinopathy. There are several unresolved controversies, including the cellular changes that accompany tendinopathy and the role of inflammation.

Nevertheless, most healthcare providers will begin diagnosis by reviewing a patient’s medical history and performing a medical examination. They’ll request a microscopic tendon examination through an MRI or ultrasound imaging assessment if more information is needed. When using imaging, tendinitis will reveal inflammatory cells, while tendinosis will show microtears in the tendon.

One of a healthcare provider’s goals will be to clarify if a tendon’s condition is tendinitis or tendinosis. Imaging will clarify the injury’s detailed condition and the most appropriate treatment approaches.

Tendonitis usually responds to nonsurgical care. Typically, you can recover in two to three weeks, but it can take months with severe injuries.

There are two schools of thought on the first line of treatment for tendonitis. The first involves the “RICE” protocol. “RICE” stands for rest, ice, compression, and elevation. It’s a simple self-care technique that helps reduce swelling, ease pain, and speed healing.

A second alternative is based on more recent research on sprains and strains. With this approach:

• Ice is used sparingly so that the healing processes of inflammation aren’t overly inhibited.
• Gentle movement is used, instead of strict rest, to avoid muscle shortening.
• Gentle movement also encourages healing blood flow to the injury location.

A major key to this second approach is to use common sense. The level of pain sustained is used as a guide on how far you should push an injury.

This second alternative is frequently used by athletes and individuals where speed to recovery is critical. However, it is most safely used under the supervision of a physiatrist, sports medicine doctor, orthopedist, or physical therapist.

Additional treatments for recurring tendonitis will differ depending on the tendon’s location. These may include:

• Nonsteroidal anti-inflammatories (NSAIDs). Aspirin (Bayer), Ibuprofen (Motrin and Advil), and Naproxen Sodium (Aleve) are common pain relievers. However, they should be used with caution. Studies show NSAIDs may inhibit the pro-inflammatory prostaglandins that play key roles in tendon healing.
• Physical therapy. Physical therapists are experts in exercises to strengthen the tendons and related muscles. They also are experienced in preserving the joint’s range of motion.
• Orthotics, splints, and braces. Orthotics and braces can protect tendons from further injury and lessen loads.
• Deep tissue massage. Deep tissue massage introduces healthy collagen to the injured area to promote healing. It also can help reduce pain and increase strength and range of motion in the affected joint.
• Corticosteroids. Corticosteroids can decrease inflammation and get pain down to tolerable levels. However, as with NSAIDs, they should be used with caution. Studies have shown that corticosteroids may inhibit the pro-inflammatory prostaglandins that play key roles in tendon healing.
• Platelet-rich plasma (PRP). Platelet-rich plasma therapy uses injections of a concentration of a patient’s own platelets to accelerate the healing of injured tendons. However, most health insurance providers do not cover this therapy’s cost. Currently, PRP is considered an experimental treatment by the Food & Drug Administration (FDA).

The treatments for tendinosis depend on which tendon is bothering an individual. These treatments are different from those used for tendinitis.

Tendinosis treatments and self-care recommendations include:

• Rest. If an activity an individual is engaged in causes pain, they are probably doing too much. If a person is involved in repetitive work tasks, they should take regular breaks.
• Use taping and bracing. Taping and bracing, as commonly used by trainers in sports activities, can reduce tensile stress on the injured tendon.
• Stretch and keep moving with caution. Light stretching and movement can increase circulation, which will help the healing process. It will also elongate and preserve the range of motion and flexibility of the tendon and related muscles.
• Eccentric strengthening. Eccentric strengthening involves slow contractions with a specific muscle while holding something heavy. Performing this exercise enhances tendon durability and boosts the generation of collagen.
• Modify Ergonomics and Biomechanics. Small adjustments in repetitive activities can make a big difference. An ergonomically optimized workspace, while considering each individual’s unique biomechanics, can mean more comfort and less pain.
• Massage. Applying a deep-friction massage to the tendon can promote the production of fresh collagen, alleviate pain, and build flexibility and power.
• Nutrition and Supplements. Vitamin C, manganese, and zinc are all key for collagen production. Vitamin B6 and Vitamin E have also been linked to tendon health. However, always consult your doctor before taking any supplements to ensure they are safe for your overall health.

Tendinopathy is frequently caused by sudden, sharp movements or repetitive exercise, such as running, jumping, or throwing. It can also be caused by repetitive movements, poor posture, or improper technique at work or when playing a sport.

To help reduce your risk of tendinopathy:

• Warm up before starting to exercise and stretch afterward. Start with light activity before beginning intense exercise, which will loosen up tendons and increase blood flow. Never stretch to the point of pain.
• Wear athletic shoes designed for your specific sport. Today’s athletic shoes are designed with specific activities in mind. They can improve comfort and performance and, most importantly, prevent injuries.
• Take regular breaks from repetitive exercises. Balance cardio exercise, strength training, and flexibility. Keeping your body moving in a variety of ways can prevent you from overtaxing your tendons. Regular breaks should be taken by individuals who perform repetitive tasks at work.
• Don’t overexercise tired muscles or continue if pain occurs. Take it easy if your body lets you know it’s tired or stressed. And if you experience pain during an activity, stop and regroup.
• Schedule rest days. Taking regular days off can lessen the chances of overstressing your tendons.
• Learn new sports or tasks before starting them. Don’t start new activities without some training or practice.

The outlook for individuals with tendinopathy is usually excellent. It normally responds to nonsurgical care.

The tendon degeneration of tendinosis is mostly permanent. But the symptoms can be stopped, and individuals and athletes can return to normal activities. However, the symptoms can sometimes return with another injury or a resumption of repetitive tasks.