In my clinical experience, most of these elbow injuries and some of these shoulder injuries are likely tendinopathies.
Mention the word “tendinitis” to any climber who has been at it for a while and they will most likely be very familiar with the nagging pain it causes or will know someone who has.
It’s a common occurrence for climbers to come into my office and complain about “tendinitis” issues. What many of these athletes don’t realize though is that they don’t have tendinitis, they have tendinosis.
So…what is the difference between tendinitis and tendinosis?
Tendinitis is an inflammatory condition of the tendon that results from micro-tears that happen when the musculotendinous junction is acutely overloaded with a tensile force that is too heavy and/or too sudden.
Tendinosis is a degenerative condition of the tendon’s collagen in response to chronic overuse. When overuse is continued without giving the tendon time to heal and rest (think repetitive stress) tendinosis results.
The current thinking is that tendinitis occurs secondary to an underlying tendinosis. If you have a tendinitis going on then you probably had/have an underlying undiagnosed tendinosis.
Too often athletes get diagnosed (or in some cases self diagnosed) with tendinitis when their condition is actually more of a tendinosis.
Why is it important to know the difference?
The treatment approach, treatment goals and timelines for each of these conditions are quite different. If the difference between these two conditions is not differentially diagnosed and the appropriate treatment is not applied then the athlete will not improve and could suffer from chronic pain.
For example, if a climber thinks they have a tendinitis then they will likely ice, take NSAIDS and sometimes even get a corticosteroid injection from their doctor to reduce inflammation. This could be a problem if they actually have more of a tendinosis because some treatments to reduce inflammation are contraindicated with tendinosis. Ibuprofen, a nonsteroidal anti-inflammatory (NSAID), is associated with inhibited collagen repair and studies have shown that corticosteroid injections inhibited collagen repair prolonging healing times and were found to be a predictor of later tendon tears.
Treatment approaches can vary slightly depending on the specific injury. In general though most treatments will follow the guidelines below.
For tendinitis we want to reduce inflammation. Ice, NSAIDS, and rest are common treatment approaches.
The healing time for tendinitis is several days to 6 weeks, depending on whether treatment starts with early presentation or chronic presentation. If an athlete has a tendinitis it is important to treat the underlying tendinosis after the initial inflammatory phase.
For tendinosis we want to stimulate fibroblast activity and collagen production.Massage, Active Release techniques (ART), Graston/Gua Sha, Cup Therapy, eccentric loading of the tissue are common treatment approaches.
Treatment for tendinosis recognized at an early stage can be as brief as 6–10 weeks. However, once the tendinosis has become chronic treatment can take 3–6 months.
It is important to get an accurate diagnosis from a professional using assessment techniques and knowledge of the relevant condition in order to have the best possible outcome. Knowing the difference between these two conditions and their respective timelines is part of creating an effective treatment plan.
- Chronic tendon injury (tendinosis) is degenerative in nature and NOT inflammatory.
- Anti-inflammatory medications (NSAIDs) and/or corticosteroid injections can actually accelerate the degenerative process and make the tendon more susceptible to further injury, longer recovery time and may increase likelihood of rupture.
- Heavy load eccentric strength training helps to increase the tensile strength of the tendon and soft tissue treatment modalities increase collagen production and helping restore the health of the tendon.
I have said this a lot in previous posts and it’s worth repeating: Get a professional diagnosis! Know what you are dealing with before wasting time Googling symptoms and trying to self treat. Trust me. It will save you time, money and suffering in the long run.
“The body is extremely complex and it is rarely possible for a non-medic to confidently exclude possible diagnoses. An example of this is nerve compression syndromes of the back and neck which mimic exactly the symptoms of elbow tendon pain.”
Want to know more about how nerve impingement issues in your neck could be the cause of your elbow pain? READ HERE.
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*Featured image Tara Kerzhner
Khan KM, Cook JL, Kannus P, et al. Time to abandon the “tendinitis” myth: Painful, overuse tendon conditions have a non-inflammatory pathology [editorial] BMJ .http://www.bmj.com/content/324/7338/626.full. Published March 16, 2002.
Khan KM, Cook JL, Taunton JE, et al. Overuse tendinosis, not tendonitis—Part 1: A new paradigm for a difficult clinical problem. Physician Sportsmed. 2000 28(5) http://www.massagebyjoel.com/downloads/OveruseTendinosis-PhysSptsmed.pdf.
Heber M. Tendinosis vs. Tendinitis. Elite Sports Therapy. http://www.elitesportstherapy.com/tendinosis-vs–tendonitis.
Tsai WC, Tang FT, Hsu CC, et al. Ibuprofen inhibition of tendon cell proliferation and upregulation of the cyclin kinase inhibitor p21CIP1 [abstract] J Orthopedic Research. http://onlinelibrary.wiley.com/doi/10.1016/j.orthres.2003.10.014/abstract.