Tendon problems are among the most common musculoskeletal conditions, yet the terms "tendinitis" and "tendinosis" are often confused or used interchangeably. Understanding the difference is crucial because these conditions require different treatment approaches. At M.O. Therapy in Markham, we accurately diagnose tendon problems and provide evidence-based treatment for optimal recovery.
Understanding Tendon Problems
What Is a Tendon?
Tendons are tough, fibrous connective tissues that connect muscles to bones. They:
- Transmit muscle force to create movement
- Are composed primarily of collagen fibers
- Have relatively poor blood supply
- Require mechanical loading for health
The Terminology
Traditional Term: Tendinitis
- "-itis" implies inflammation
- Historically assumed all tendon pain was inflammatory
- Term still commonly used
Modern Understanding: Tendinopathy
- Umbrella term for tendon problems
- Acknowledges various pathological processes
- More accurate terminology
Tendinitis: Acute Inflammation
What Is Tendinitis?
True tendinitis involves acute inflammation of the tendon, usually in response to sudden injury or overload.
Characteristics:
- Acute onset (sudden)
- Inflammatory process present
- Usually follows overload or trauma
- Short duration (days to weeks)
- Responds to anti-inflammatory treatment
When Tendinitis Occurs
Common Scenarios:
- Sudden increase in activity
- New or unaccustomed exercise
- Return to sport after time off
- Acute injury or strain
- Early stages of overuse
Symptoms of Tendinitis
- Pain with activity
- Swelling (may be visible)
- Warmth at tendon
- Redness (sometimes)
- Pain that may worsen over first few days
- Usually improves with rest
Treatment for Tendinitis
RICE Protocol:
- Rest from aggravating activities
- Ice for pain and swelling
- Compression if applicable
- Elevation when possible
Anti-inflammatory Measures:
- NSAIDs may help
- Ice application
- Rest from loading
Recovery:
- Usually resolves in 2-6 weeks
- Gradual return to activity
- Address contributing factors
Tendinosis: Chronic Degeneration
What Is Tendinosis?
Tendinosis is a chronic, degenerative condition where the tendon structure deteriorates due to failed healing responses.
Characteristics:
- Chronic condition (lasting months)
- Degenerative changes, NOT inflammation
- Collagen fiber disorganization
- Increased cell activity (but not inflammatory cells)
- Increased ground substance
- Possible neovascularization (new blood vessels)
How Tendinosis Develops
Pathological Process:
- Repetitive microtrauma to tendon
- Inadequate recovery between loads
- Failed healing response
- Collagen breakdown exceeds repair
- Disorganized tendon structure
- Continued degeneration
Common Sites
Frequently Affected:
- Achilles tendon
- Patellar tendon (jumper's knee)
- Rotator cuff tendons
- Lateral elbow (tennis elbow)
- Wrist extensors
- Gluteal tendons
Symptoms of Tendinosis
- Gradual onset of pain
- Pain with activity (may warm up initially)
- Stiffness after rest
- Possible thickening of tendon
- No significant swelling or warmth
- Chronic, persistent symptoms
Key Differences
Comparison Table
| Feature | Tendinitis | Tendinosis | |---------|-----------|------------| | Onset | Acute | Gradual/Chronic | | Duration | Days to weeks | Months to years | | Pathology | Inflammation | Degeneration | | Swelling | Often present | Usually absent | | Anti-inflammatories | Helpful | Limited benefit | | Main treatment | Rest, ice, NSAIDs | Loading exercises | | Recovery time | 2-6 weeks | 3-6+ months |
Why the Distinction Matters
Treatment Implications:
Treating tendinosis like tendinitis often fails because:
- Anti-inflammatory approaches don't address degeneration
- Rest alone doesn't stimulate healing
- Injection therapies may weaken tendon
- Loading is actually needed for repair
Tendinosis Treatment
The Loading Approach
Modern treatment for tendinosis focuses on progressive loading to stimulate tendon healing and remodeling.
Isometric Exercise
Early Stage:
- Heavy, sustained contractions
- 45-60 second holds
- 4-5 repetitions
- Reduces pain
- Maintains strength
Example:
- Wall sit for patellar tendon
- Calf raise hold for Achilles
- Wrist extension hold for tennis elbow
Eccentric Exercise
What It Is:
- Lengthening the muscle-tendon unit under load
- Traditionally the gold standard for tendinosis
Protocol:
- Slow, controlled lowering
- Moderate to heavy load
- 3 sets of 15 repetitions
- Twice daily
- 12-week program typical
Examples:
- Heel drops for Achilles
- Decline squats for patellar
- Wrist lowering for elbow
Heavy Slow Resistance (HSR)
Modern Approach:
- Both concentric and eccentric loading
- Heavy loads (high resistance)
- Slow movements (3-4 seconds each way)
- Lower volume than eccentric protocols
- Often equally or more effective
Protocol:
- 3-4 sets of 6-15 repetitions
- 3 times per week
- Progressive loading
- 12-week minimum
Progressive Loading Principles
Key Concepts:
- Start at tolerable level
- Progress gradually
- Pain should be manageable (4/10 or less)
- Symptoms should settle within 24 hours
- Consistency is key
Managing Load
Activity Modification
Not Complete Rest:
- Reduce aggravating activities
- Continue appropriate loading
- Avoid complete cessation
- Maintain tendon capacity
Finding the Balance:
- Load enough to stimulate healing
- Not so much to cause setback
- Gradual progression
- Monitor symptoms
Return to Sport
Staged Approach:
- Continue loading program
- Gradually add sport-specific activities
- Monitor symptom response
- Progress when tolerable
Other Treatment Modalities
Shockwave Therapy
May Help When:
- Exercise therapy plateaus
- Chronic, resistant cases
- Used alongside loading program
Injection Therapies
Considerations:
- Corticosteroid injections may weaken tendon
- PRP (platelet-rich plasma) has mixed evidence
- Should not replace loading therapy
Manual Therapy
Supportive Role:
- Address related muscle tightness
- Improve joint mobility
- May reduce symptoms
- Not primary treatment
Prevention
Training Principles
- Gradual progression (10% rule)
- Adequate recovery between sessions
- Vary training activities
- Address technique issues
- Include strength training
Early Recognition
- Don't ignore early symptoms
- Address problems when minor
- Modify activity early
- Prevent progression to tendinosis
Treatment at M.O. Therapy
Physiotherapy
Our physiotherapists provide:
Assessment:
- Accurate diagnosis
- Stage identification
- Contributing factor analysis
Treatment:
- Appropriate loading program
- Exercise progression guidance
- Manual therapy as indicated
- Activity modification advice
Massage Therapy
Our RMTs help with:
- Muscle tension around tendon
- Improved circulation
- Pain management
- Recovery support
Chiropractic Care
May include:
- Joint assessment
- Mobility optimization
- Movement pattern correction
- Complementary care
Frequently Asked Questions
How do I know if I have tendinitis or tendinosis? Duration is a key factor. If symptoms have been present for more than 6-8 weeks, it's likely tendinosis. Acute onset with swelling suggests tendinitis. Professional assessment provides accurate diagnosis.
Why didn't anti-inflammatory medications help my tendon pain? If you have tendinosis (chronic tendon degeneration), anti-inflammatory medications address the wrong problem. Tendinosis requires loading therapy to stimulate tendon repair.
How long does tendinosis take to heal? Tendinosis typically requires 3-6 months of consistent loading therapy for significant improvement. Some cases take longer. Patience and consistency are essential.
Can tendinosis become tendinitis again? Yes, acute flares can occur on top of underlying tendinosis. These acute-on-chronic situations may temporarily benefit from anti-inflammatory measures before resuming loading therapy.
Book Your Assessment
If you're dealing with tendon pain, M.O. Therapy in Markham can help determine whether you have tendinitis or tendinosis and develop an appropriate treatment plan.
Call (905) 201-5827 or book online for your assessment. We offer direct billing and same-day appointments.