Tendinitis, tendinosis are similar conditions that affect tendons. However. they do present with slight variances that must be managed accordingly. Tendinitis is an acute condition where inflammation is caused by a direct injury or cummulative 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.
Tendinitis indicates that inflammation is present and is characterized by swelling, redness, and warmth. Tendinosis on the other hand results in minimal inflammation. While it can be painful, there is usually no redness or warmth of 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. In addition, discomfort with moving or loading the affected joint or limb is also common. Pain is generally most severe after periods of inactivity and less pain is experienced once the tendon is warmed up.
Risk factors/ Causes
Tendinitis and tendinosis usually occurs as a result of repetitive stress to a tendon without appropriate rest or may develop following and sudden injury that has not healed properly. Any repetitive activity or overuse can lead to tendinitis/tendinosis such as playing sports, house work, and prolonged poor postures. Other risk factors for tendinitis include: dysfunctional musculoskeletal (MSK) mechanics that can lead to increased joint stress, diseases affecting the MSK system (rheumatoid arthritis, gout, psoriatic arthritis, thyroid disorders), certain medication reactions and infections. Individuals of all ages may suffer from these conditions, however it is especially common in those over age 40, when aging tendons tolerate less stress, are less elastic, and are easier to tear.
First and foremost stop any aggravating activities. Other things that may help prevent these types of injuries are to avoid repetitive tasks/movements, rest appropriately following periods of increased loading, limit activities when your body is tired or you feel discomfort, focus on maintaining proper posture and form, warmup/stretch the area before heavy use and make 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 returns, stop that activity for the day.
Activity modification is essential in order to halt the disease progression. Once the condition is under control loading the injured structures within their tolerance can be very effective. Generally you want to begin with eccentric contractions, then, isometric and finally concentric type contractions (completing full range of movements).
Chiropractic techniques can help decrease muscle tension, minimizing stress at the tendon’s insertions, as well as, 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 by directly increasing the cellular turnover at the site of injury and increasing the 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 a tendinitis, controlling inflammation is paramount to decrease pain and disability associated with the condition. While for 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.
It is important to not only manage the condition but to address the root cause of the condition, if not you risk it coming back. Continued 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 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 this can lead to calcific tendinopathy where calcium deposits accumulate at the site of injury leading to more intense and sudden pain or may result in an accumulation of microtrauma at the tendon leading to severe disability.
Where are the most common locations to experience tendinitis/ tendinosis?
Tendinitis can occur at any area of the body where a tendon connects a bone to a muscle such as at the shoulder, wrist, hand, hip and even the spine. However, three locations are generally affected more than any other.
Elbow (Tennis/ Golfers elbow)- Tennis elbow (lateral epicondylitis) causes pain at the bony bump on the outside of the elbow while golfer’s elbow (medial epicondylitis) causes pain at the inside bony bump of the elbow. These conditions usually cause local pain where the tendons of your forearm muscles attach to a bony bump on the outside/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 both pain at the inside and outside of the elbow. People who have jobs that involve repetitive motions of the wrist and arm are more likely to develop these types of conditions (i.e. plumbers, painters, carpenters, butchers and cooks). Participating in certain sports (racket sports) may increase your risk of tennis/golfer’s elbow, especially if you employ poor technique and do not rest enough.
Knee (Jumper’s knee)– Jumper’s knee or patellar tendonitis, is a condition characterized by inflammation of your patellar tendon. Pain and tenderness around your patellar tendon, swelling, pain with 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 your knee joint, such as frequent jumping on hard surfaces and running.
Ankle (Achilles tendinopathy)– Achilles tendinitis/ tendinosis affects the tendon that attaches the calf to the heel. This usually results in local pain, swelling and stiffness of the Achilles tendon. Repeated microtrauma caused by overuse (running/ jumping), wearing inappropriate footwear, poor training or exercising techniques, or exercising on hard or sloped surfaces can influence this condition. Achilles 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 fluid filled (synovial) sheath that surrounds the tendon where tendons glide.
Paratenonitis- Inflammation of thin sheath surrounding a tendon.
Strains- Tendon 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 fracture and ligament tears. These usually occur when a load that exceeds the tissue tolerance is applied slowly to a tendon (if applied fast the bone usually breaks first).