Tendinitis and tendinosis are similar conditions that affect the tendons. However. they present with slight variances that must be managed accordingly. Tendinitis is an acute condition where inflammation is caused by a direct injury or cumulative microtrauma to a tendon. Tendinosis, on the other hand, is a chronic non-inflammatory condition that leads to the degeneration of the tendon’s collagen as a result of repetitive trauma over an extended period of time or an injury that has never properly healed. In many cases, tendinitis evolves into tendinosis once it becomes chronic.
SYMPTOMS
Tendinitis indicates that inflammation is present and is characterized by swelling, redness, and warmth, while tendinosis causes minimal inflammation. While it can be painful, there is usually no redness or warmth in the surrounding soft tissue. Localized pain is characteristic of both conditions; however, in severe cases pain along the muscle and surrounding structures may be experienced. It is also common to experience discomfort with moving or loading the affected joint or limb. Pain is generally most severe after periods of inactivity and less pain is experienced once the tendon is warmed up.
RISK FACTORS AND CAUSES
Tendinitis and tendinosis usually occur as a result of repetitive stress to a tendon without appropriate rest. They may also develop following a sudden injury that has not healed properly. Any repetitive activity, such as sports, housework, and prolonged poor posture, can lead to tendinitis or tendinosis. Other risk factors for tendinitis include dysfunctional musculoskeletal mechanics (MSK) that can lead to increased joint stress, diseases affecting the MSK system (rheumatoid arthritis, gout, psoriatic arthritis, thyroid disorders), certain medication reactions[NW23] , and infections. Although people of all ages may suffer from these conditions, they are especially common in those over age 40, when aging tendons tolerate less stress, are less elastic, and are easier to tear.
PREVENTION
The first and most important line of defense is to stop any activity that aggravates the problem area. Other actions that may help prevent these types of injuries include avoiding repetitive tasks and movements, getting appropriate rest following periods of increased loading, limiting activities when your body is tired or you feel discomfort, focusing on maintaining proper posture and form, warming up and stretching the problem area before heavy use, and making sure you are using appropriate equipment or tools for the work you are doing. If you are doing something and feel pain, stop, and try again later. If pain persists, stop that activity for the rest of the day.
TREATMENT OPTIONS
In order to halt disease progression, it’s essential to modify your activities. Once the condition is under control, loading the injured structures within their tolerance can be very effective. Generally speaking, you want to begin with eccentric contractions, then isometric, and finally, concentric-type contractions (full range of movements).
Chiropractic techniques can help decrease muscle tension, minimize stress at the tendon’s insertions, and address poor body mechanics and any mechanical issue that may be limiting the body’s ability to heal. Photobiomodulation/laser therapy can also be exceptionally effective as it directly increases cellular turnover at the site of injury and overall tissue integrity, thereby decreasing pain and dysfunction. Instrument-assisted soft tissue therapy and acupuncture also yield positive results.
If the condition is presenting as tendinitis, controlling inflammation is paramount to decrease pain and disability associated with the condition. In the case of tendinosis, we may want to promote inflammation to re-establish the body’s own healing response. Other variances with regards to management will depend on a variety of other factors.
WHAT’S NEXT?
It’s important not only to manage the condition, but also to address its root cause. If you don’t, there is a risk it will return. Ongoing rehabilitation and treatments can help keep surrounding musculature and joints strong and stable, reducing the risk of re-exacerbation. Once the condition is under control, preventing further repetitive stress is paramount to minimize the risk of re-exacerbation. Tendinitis usually resolves within a few weeks, while tendinosis may take longer. It is important to note that if these conditions go unmanaged for some time, they can lead to calcific tendinopathy, where calcium deposits accumulate at the site of injury, leading to more intense and sudden pain. It may also result in an accumulation of microtraumas at the tendon, which can result in severe disability.
WHAT ARE THE AREAS MOST SUSCEPTIBLE TO TENDINITIS/TENDINOSIS?
Tendinitis can occur in any area of the body where a tendon connects the bone to a muscle, such as the shoulder, wrist, hand, hip and even the spine. However, three locations are generally affected more than any other.
Elbow (tennis elbow, golfer’s elbow): Tennis elbow (lateral epicondylitis) [NW24] causes pain at the bony bump on the outside of the elbow, while golfer’s elbow (medial epicondylitis) [NW25] causes pain at the inside bony bump of the elbow. These conditions usually cause localized pain where the tendons in your forearm muscles attach to a bony bump on the outside or inside of your elbow. The pain can also spread into your forearm and wrist. Pain is also common when moving or loading the wrist and finger, which may lead to weakness. It is also possible to suffer from both tennis and golfer’s elbow simultaneously, causing pain both inside and outside the elbow. People who have jobs that involve repetitive motions of the wrist and arm, such as plumbers, painters, carpenters, butchers, and cooks, are more likely to develop these conditions. Playing certain sports, especially racket sports, may increase your risk of developing tennis or golfer’s elbow, especially if your technique is poor and you do not rest enough.
Knee (jumper’s knee): Jumper’s knee, or patellar tendonitis[NW26] , is a condition characterized by inflammation of the patellar tendon. Pain and tenderness around your patellar tendon, swelling, pain experienced while jumping, running, walking, or while straightening your leg, and point tenderness at the lower part of the kneecap are common symptoms associated with this condition. Jumper’s knee is often related to sports or repetitive activities involving overuse of the knee joint, such as frequent jumping on hard surfaces and running.
Ankle (Achilles tendinopathy): Achilles tendinitis or tendinosis affects the tendon that attaches the calf to the heel. This usually results in localized pain and swelling and stiffness of the Achilles tendon. Repeated microtrauma caused by overuse (running, jumping), wearing inappropriate footwear, poor training or exercizing techniques, or exercizing on a hard or sloped surface, can be a risk factor in developing this condition. Achilles [NW27] and calf tightness can also contribute to the condition, particularly in older people. If this condition goes unmanaged, bone spurs may develop on the heel.
OTHER TENDON PATHOLOGIES
Tendinopathy. Broad term generally used to describe any type of tendon pathology. However, some scholars often use tendinopathy interchangeably with tendinosis.
Tenosynovitis. Inflammation of the fluid-filled (synovial) sheath that surrounds the tendon where tendons glide.
Paratenonitis. Inflammation of the thin sheath surrounding a tendon.
Strains. Tendons can be strained just like any other structure in the body. Symptoms are often similar to tendinitis; however, the mechanism of injury usually differs.
Tears. Tendon tears are not very common when compared to bone fractures and ligament tears. These usually occur when a load that exceeds tissue tolerance is applied slowly to a tendon. If applied quickly, the bone usually breaks first.