Tendonitis vs. Tendinosis vs. Tendinopathy: What do I have?
Tendon pathologies are a very common occurrence in the every day population. There is a lot of confusion surrounding the proper term to use as the diagnosis. The most common term is tendonitis; however, tendinosis and/or tendinopathy are also used.
Let’s first start off by defining some terms.
Definitions:
Tendons connect bone to muscle. Tendons are activated when we contract a muscle. They are made up of collagen which is a form of connective tissue. There are different types of collagen for different structures in the body. A healthy, mature tendon is made up of Type I collagen (Bass, 2012).
Tendinitis refers to inflammation of the tendon as ‘itis’ is the greek suffix for inflammation. It is questionable whether or not this is the proper term to use, since typically it’s not the tendon itself that is actually inflamed; rather, the tissue surrounding it. Bass (2012) states that tendonitis is caused by small tearing as a result of overuse and/or overload.
Tendinosis does not include inflammation of the tendon, often making this term more appropriate than tendonitis. Bass (2012) states that tendinosis is caused by repeated use of the associated movement of the tendon and that this overuse causes destruction/changes to the collagen. Type III immature collagen is seen in tendinosis (Bass, 2012).
Tendinopathy is the overall term used when there is pathology to the tendon due to repetitive use (Sharma & Mauffuli, 2005; Loppini & Maffuli, 2011; Woodley, Newsham-West, & Baxter, 2007) and the tendon has failed to heal (Loppini & Maffuli, 2011; Woodley, Newsham-West, & Baxter, 2007). Many studies show that the term most appropriate to use is tendinopathy, as a biopsy needs to be completed in order to see if inflammation is actually present (Loppini & Maffuli, 2011; Woodley, Newsham-West, & Baxter, 2007).
So what term will you be diagnosed with? It is hard to say, but to be safe, we will use the term tendinopathy.
How does tendinopathy present to a physiotherapist?
Many patients coming into STRIDE present with tendinopathy. Most common sites are the shoulder, elbow, wrist, knee and ankle. Common subjective complaints include pain, difficulty sleeping due to pain, tender to touch, reduced range and strength, and insidious onset; meaning no specific injury. Although there is no specific injury, as stated above, a common reason for tendon pathology is overuse and/or overload with repetitive movements. Most patients have been dealing with symptoms for weeks to months. Objectively, you may present with reduced range of motion, painful resisted testing when stressing the tendons, reduced strength, reduced flexibility/muscle length, tone/tightness to musculature, and tenderness to specific tendons.
A lot of tendinopathies are assessed and treated in the chronic stage ( > 3 months since onset). Patients feel they didn’t need to seek help when symptoms first started becasue the pain wasn’t debilitating; but symptoms progressed, and they now feel pain almost all the time.
Now let’s talk about what the physiotherapists at STRIDE can do to help you!
A treatment plan will be individualized based on presentation of symptoms and will likely include a combination of manual therapy/mobilizations, myofascial/trigger point release and stretching, deep tendon friction massage, strengthening with focus on eccentric movement, bracing/taping, ergonomic adjustments, and modalities (ex. ultrasound).
Specifically, what is eccentric strengthening?
Eccentric strengthening allows the muscle to be elongated/stretched as you slowly strengthen in the opposite direction of the muscle action.
For example: Wrist Extension
1. Place a dumbbell in the palm of your hand, elbow bent and palm facing to the ground.
2. Lift your wrist up with the opposite hand.
3. Slowly lower your wrist towards the ground.
Eccentric strengthening may begin to reverse the effects of tendinopathy and begin to heal the tendon (Woodley, Newsham-West, & Baxter, 2007). Strength of the tendon is said to improve as eccentric movements help to re-align and stimulate production of collagen (Bass, 2012). High positive clinical outcomes have been shown when incorporating eccentric exercise into a tendinopathy intervention program (Loppini & Maffuli, 2011).
How long until my symptoms are gone?
If your symptoms are acute, meaning symptoms have just begun, it can take anywhere from days to weeks (Bass, 2012). If the issue is chronic, it can take months for full recovery (Bass, 2012). This doesn’t mean you won’t get symptom relief, but the overall amount of healing time will increase.
If you feel you are experiencing any of these symptoms or believe you have tendinopathy, don’t hesitate, visit a STRIDE physiotherapist right away. The longer you wait, the longer it takes for symptoms to be eliminated.
References:
Bass, L. M. T. (2012). Tendinopathy: why the difference between tendinitis and
tendinosis matters. International Journal of Therapeutic Massage & Bodywork:
Research, Education, & Practice, 5(1), 14-17.
Loppini, M., & Maffulli, N. (2011). Conservative management of tendinopathy: an
evidence-based approach. MLTJ Muscles, Ligaments and Tendons Journal, 1(4),
134-137.
Sharma, P., & Maffulli, N. (2005). Tendon injury and tendinopathy: healing and
repair. The Journal of Bone & Joint Surgery, 87(1), 187-202.
Woodley, B. L., Newsham-West, R. J., & Baxter, G. D. (2007). Chronic
tendinopathy: effectiveness of eccentric exercise. British journal of sports medicine,
41(4), 188-198.