What’s the Difference Between Tendinosis and Tendinitis
Our therapists at Bodyharmonix fitness centre are frequently asked about differing between pain from tendinosis and that of tendinitis.
As people in the health rehabilitation industry it’s not unusual for us to see tendinosis being diagnosed as tendinitis. Much of the difficulty is to do with the similarity of symptoms: burning pain, weakness of the muscles and pain brought about by day to day tasks. Differentiating between these two forms of tendinopathy are critical to determine the correct choice of treatment.
The following post is a summary of the peer-review article of Bass E (2012), Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. International Journal of Therapeutic Massage & Bodywork, 5(1), 14-17.
When the tendon is inflamed due to very small tears in the fibre, it is usually due to too much or too abrupt load and tensile force (Bass, 2012). In contrast, when the collagen within a tendon’s fibres breaks down due to repetitive overuse, from even the minute movements, tendonosis is the cause.
Assessing Tendinosis and Tendinitis
Our therapists can help you to distinguish if your tennis elbow is tendinosis rather than tendonitis, given that the latter condition does not present as inflammation. The fibres of those experiencing tendinosis have been found to have a higher level of immature type III collagen. Alternatively, type I fibres are collagen that is in its mature form in a tendon that is functioning in a healthy way.
Tendinosis also presents as misalignment of the collagen fibres so linkage problems occur that contribute to weakness during load-bearing tasks. The ground substance between each of the cells in the body has been found to be higher in inflamed tendons as compared to healthy tissue. Irregular vascularisation increases are not unusual either, however they do not function to transport blood and appear to not play a part in the healing processes. Due to these histological changes in the dysfunctional tissue, the tendon no longer maintains a shiny and reflective surface, rather it becomes dull and softens as it takes on a brown appearance.
As the tendon continues to lose strength it also conversely bulks in size due to increases in ground substance, and the swelling caused by the inflammation. Both symptoms can rapidly cause secondary issues, such as the development of tendinitis or even the impingement of nerves as the tendon compresses them between the tendon and surrounding bony processes.
As inflammation is not a factor in tendinosis, it is not a treatment goal. Misdiagnosis can cause aggravation of tendinosis symptoms. One example is using a non steroidal anti-inflammatory medication that hinders the repair of collagen. Treating tendinosis can take 6-10 weeks in acute conditions. However in its chronic form it may take 3-6 months to heal tendinosis. Whereas tendinitis may only take a few days to 6 weeks. Time-frames are important to healing goals of tendons, as collagen production may take over 100 days.
Understanding Collagen and Inflammation
Interestingly, the methods for treating either condition is of benefit to both. Bodyharmonix therapists can provide deep-friction massage which will decrease cell changes that result in stickiness that clog healing processes in tendinitis. The goal is to cal scar-tissue from inflammation so that it can become more functional. For tendinosis, a deep-friction massage will activate fibro-blasts that stimulate collagen production.
Treatment from our therapists will include education for self-care. For example, rest is incredibly important. People tend to forget this critical healing element when their symptoms are lessening or are low-pain tendon injuries. Taking breaks are important, Brass suggests a minimum of 1-minute rest time for every 15 minutes of activity. Ice is an excellent vasoconstrictor and can also calm the nerves feeding the afflicted tendon. For 15-20 minutes daily, use of ice can help the person with tendinopathy to regain use of their tendons.
Changing Movement Patterns
Attending to the ergonomics of your workspace and daily functioning at home can massively change your biomechanical patterns. Sometimes you need support, especially for your lower back when you’re sitting and your knees when you’re sleeping.
A therapist may also use taping (e.g., at Bodyharmonix we use Kinesio tape). Stretching is vital, though it will need to be light. It’s equally important for you to use your range of motion (ROM) in the affected area and aid your flexibility and mobility.
These two self-care tasks will also aid your circulation to clear toxins, and decrease tension of the tendon when it’s under load.
Our therapists recommend that you perform eccentric strengthening twice daily for tendinosis. That’s because strengthening lengthens muscles when they are under load and contracted. You can activate your collagen production and attenuate your collagen fibre alignment as well.
You can stimulate the cross-linkage of your collagen fibres to enhance tendon strength. It also appears that eccentric strengthening can decrease production of ground substance and so can reduce the thickening of tendons.
Massage for Healing
Remedial and Swedish massage are beneficial for stimulating circulation, clearing toxins from lymph and stimulating cell functioning. Importantly deep-friction massage of tendons stimulates fibroblast functioning and collagen production. Even just 10 minutes of this style of massage can alleviate pain and increase strength and ROM in an afflicted area. Myofascial trigger point therapy can release tension in the tendon and reduce scar tissue. Combined or on their own, these various manual therapies can alleviate pain and activate healing processes.
Nutrition and Recovery
Nutrition is essential to the self-care management of your tendinopathy symptoms. Especially if directed to improve nutrition by your therapist. You may need to increase the intake of:
- vitamin C
- B6 and vitamin E
These vitamins aid collagen production and tendon health respectively.
As injury is more likely to happen when a person is experiencing tendinopathy. Therefore it is important for you to seek a diagnosis of the form it is taking. Early treatment plans tailored to your lifestyle and biomechanical patterns will enable more rapid healing. By following this you will have less disruption to your quality of life.
Charmayne Paul, Bodyharmonix Associate, of Psych and Stats Tutor ~ Chart your course to success~