If you’ve ever had a bout of tennis elbow, swimmer’s shoulder, or jumper’s knee, you know that professional athleticism is not a pre-req for developing pain and stiffness in these joints and others such as the hips and ankles. In fact, any repetitive motion or sudden trauma can bring with it a classic case of tendinitis. But did you know that there is another—and more likely—culprit responsible for your tendon pain? Studies have shown that in many cases suspected tendinitis is actually tendinosis.
Although they sound similar and both affect the fibrous tendons that connect muscle to bone, there are distinct differences in their symptoms which can help you identify what you are experiencing. Their underlying causes and, more importantly, their treatments are also different. Let’s start with an overview of the two conditions:
Tendinitis—tendinitis occurs when repetitive movement, injury, or strain (such as carrying a heavy object) causes microtears in your tendon, resulting in inflammation and pain.
Tendinosis—tendinosis occurs when overuse of a tendon causes the collagen (the substance tendons are made of) to break down. This compromises the structural integrity of the tendon and causes pain.
Which is it? Check your symptoms!
If both conditions result in tendon pain and decreased strength and stamina, how can you know which one you are experiencing? Your biggest clue will be the presence or absence of inflammation. If the injured area is reddish, warm to the touch, or swollen, you are likely experiencing an inflammatory response which only occurs with tendinitis. (The suffix -itis literally means inflammation.)
Your recovery time will also be an indicator because tendinitis typically resolves within 1 to 6 weeks with proper rest, while tendinosis can take 6 to 10 weeks if caught early, or 3 to 6 months if it has developed into a chronic condition.
However, if you are unsure if you are experiencing swelling or suspect you may have tendinosis, don’t wait several weeks—see your doctor! They can confirm whether it is tendinitis or tendinosis through a simple ultrasound and set you up with the proper treatment plan.
For recovery, a correct diagnosis is key
Having a correct diagnosis is crucial before beginning treatment because what works for one condition may actually hinder recovery for the other. There is some treatment overlap, with both cases benefitting from resting the injured tendon and receiving massage therapy, but that is usually where the similarities end.
With tendinitis, the inflammation is often treated with ice and nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or a stronger corticosteroid injection. As we mentioned before, tendinosis is not accompanied by inflammation. Thus, the goal in treating tendinosis is not to reduce inflammation but to boost collagen production to allow the tendon to heal itself. NSAIDs have been shown to inhibit collagen production, effectively slowing the healing process for tendinosis. This makes a proper diagnosis so important.
Rather than benefitting from anti-inflammatories, tendinosis could require physical therapy to strengthen the surrounding muscles, a brace to reduce stress on the tendon, and collagen-promoting nutrition or platelet-rich plasma injections to encourage healing. Regenerative medicine, like the stem cell injections or prolotherapy offered at In2it Medical, is also used to treat tendinosis, including cases where the tendinosis did not respond to physical therapy.
What does the future hold?
With proper treatment, those experiencing both tendinitis and tendinosis can expect to reduce their pain, improve their strength and range of motion, and return to normal activities. Tendinosis recovery may vary on a case-by-case basis since it involves damage on the cellular level. If you’re experiencing tendinosis, your main recovery goal may be to prevent further deterioration and surgical intervention, and you could be prone to re-injury in the future. Always discuss your specific treatment plan and goals with your doctor.
How can these injuries be prevented?
If you have a job or participate in activities or sports that leave you at risk for tendon strain or overuse, be sure to take preventative action. Warming up properly before engaging in physical activity, using the correct body mechanics and technique when both active and sedentary, taking regular breaks, and resting at the first signs of discomfort can all contribute to keeping you safe and free of pain.
Experiencing tendon, joint, or muscle pain? Come see us at In2it Medical so we can get you started on the road to recovery!
Bass E. (2012). Tendinopathy: why the difference between tendinitis and tendinosis matters. International journal of therapeutic massage & bodywork, 5(1), 14-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/