Ask the c.Ped – What are the Differences between Tendinitis, Tendinosis, and Tendinopathy?

Helen Russell

Helen Russell is the owner of Metro Run and Walk with her husband Mark. She is a certified pedorthist and has completed several marathons!

Tendinopathy refers to a disease of a tendon and can refer to either “Tendinitis” or “Tendinosis.”

Tendinitis

Tendinitis simply means inflammation of a tendon (the suffix “-itis” denotes diseases characterized by inflammation.)   Generally tendinitis is referred to by the body part involved, such as Achilles tendinitis (affecting the Achilles tendon), or patellar tendinitis (jumper’s knee, affecting the patellar tendon).

Tendinitis injuries are common in the arms and legs and are less common in the hips and torso.  Differences in the frequency and severity of tendinitis will depend on the type, frequency and severity of exercise or use.  For runners, the three most common tendinitis diagnoses include:  Achilles tendinitis, Patellar tendinitis (runner’s knee), and tibial tendinitis where pain is mostly common felt in the arch of the foot.

Symptoms can vary from aches or pains and local stiffness, to a burning that surrounds the whole area around the inflamed tendon. Swelling may happen along with heat and redness.  With this condition, the pain is usually worse during and after activity, and the tendon can become stiffer the following day as muscles tighten from the movement of the tendon.  If the symptoms of tendinitis last for several months or longer it is probably tendinosis.

Treatment of tendon injuries is largely conservative. Use of non-steroidal anti-inflammatory drugs (NSAIDs), rest, and gradual return to exercise is a common therapy. Resting assists in the prevention of further damage to the tendon. Ice, compression and elevation are also frequently recommended. Physical therapy, orthotics or braces may also be useful. Initial recovery is typically within 2 to 3 days and full recovery is within 4 to 6 weeks.  As tendinosis is more common than tendinitis, and has similar symptoms, tendinitis is often initially treated the same as tendinosis. This helps reduce some of the chronic long-term risks of tendinosis, which takes longer to heal.

Tendinosis

Tendinosis, sometimes called chronic tendinitis, tendinosus, chronic tendinopathy or chronic tendon injury, is damage to a tendon at a cellular level (the suffix “osis” implies a pathology of chronic degeneration without inflammation). It is believed to be caused by microtears in the connective tissue in and around the tendon, leading to an increase in tendon repair cells. This may lead to a reduced tensile strength, thus increasing the chance of tendon rupture. Tendinosis is often misdiagnosed as tendinitis due to the limited understanding of tendinopathies by the medical community.

Swelling in a region of micro damage or partial tear can be detected visually or by touch. Increased water content and disorganized collagen matrix in tendon lesions may be detected by ultrasound or magnetic resonance imaging.

Symptoms can vary from an ache or pain and stiffness to the local area of the tendon, or a burning that surrounds the whole joint around the inflamed tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day as swelling impinges on the movement of the tendon.

Tendons are very slow to heal if injured, and rarely regain their original strength and recurrence of injury in the damaged region of tendon is common.

Standard treatment of tendon injuries is largely palliative. Use of non-steroidal anti-inflammatory drugs combined with Physical Therapy, rest and gradual return to exercise is a common therapy, although there is evidence to suggest that tendinosis is not an inflammatory disorder, and that anti-inflammatory drugs are not an effective treatment[2] and that inflammation does not cause tendon dysfunction.[3] There are a variety of treatment options, but more research is necessary to determine their effectiveness. Initial recovery is usually within 2 to 3 months and full recovery is within 3 to 6 months. About 80% of patients will fully recover.

Remember, pain is our body’s way of communicating that something is not right.  If you experience chronic pain, go see a medical professional.  They will work with you to reach a diagnosis and treatment plan.

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2 Responses to Ask the c.Ped – What are the Differences between Tendinitis, Tendinosis, and Tendinopathy?

  1. I agree with your post absolutely and I am now interested in reading some more of your posts on your blog and see what you have to say. I just bookmarked this one and do you mind if I tweet your blog post out to my followers on twitter? I think they would also enjoy the blog post.

    • metrorunwalkspringfield says:

      Thanks for your comment. Several of us posters have been traveling, so if we failed to respond, sorry! You can feel free to tweet or forward any of our posts out. Thanks!

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