We often hear the term ‘tendinopathy’ these days, which is an umbrella term that describes all tendon problems. But there are various types and stages of tendon damage, where different things are happening in the tendon. Treatment needs to address the right situation. Find out about the difference between tendonitis and tendinosis, and how treatments such as physiotherapy, osteopathy and shockwave can help.

Tendons

Tendons are really tough.

They are a blending of the connective tissue that surrounds each muscle fibre. This tissue comes together to form a strong band that connects muscle to bone. Every muscle in your body has tendons.

But they’re not inert. Although they’re not stretchy, they are flexible. They are continually changing and renewing in response to the forces they must cope with.

That means you can train your tendons. Just as muscles build up when you regularly load them with work, so tendons get stronger in response to load.

So what goes wrong with tendons?

Although tendons can strengthen like muscle, they can also injure like muscle.

Just as overusing or overstretching muscle can lead to inflammation and tearing, the same can happen in tendons. Inflammation in tendons is known as ‘tendonitis’ (also spelled ‘tendinitis’).

In a more chronic situation, tendons can degrade with repeated overuse – a condition known as ‘tendinosis’.

If you looked at such a tendon through a microscope, you would see a change in the type of collagen that makes up most of the tendon, poor collagen fibre alignment, a greater proportion of the jelly-like substance between fibres, and tiny, new blood vessels growing into the tendon.

These changes mean the tendon becomes thicker, but weaker and more prone to tearing.

Tendonitis

Tendonitis is a response to a sudden increase in demand that is beyond the tendon’s ability to cope with in the short term.

The tendon becomes inflamed, and symptoms include:

• Pain that worsens with movement
• Stiffness when moving the joint
• Possible swelling, heat and redness
• A crackling sensation during movement

Tendonitis usually settles down over a few weeks if it is looked after appropriately. That means reducing load on the tendon by limiting your activity – but not by too much!

It’s important to maintain some activity, progressively increasing the load on your recovering tendon to ensure it repairs well and fully.

Tendon loading – getting it right

Researchers have analysed performance in sportspeople, and have shown the risk of soft tissue injuries, such as tendonitis, is related to the level of training.

But, interestingly, it’s not just overload that raises the risk. Players who are less active or have greater length between training sessions also appear to be at greater risk of injury. It seems likely that too significant a reduction in workload fails to maintain the protective qualities that training provides.

Exercise physiologist, Dr Tim Gabbett, suggests that there is a ‘sweet spot’ between underload and overload where injury risk decreases, and this varies between individuals.

This ideal level of load means training enough to prepare the body for the demands of sport or activity, and training in the right way (i.e. balancing volume, intensity and frequency).

Of course, finding this ‘sweet spot’ can be difficult when you’re recovering from injury.

That’s where the help of a qualified physiotherapist or osteopath comes in.

Physiotherapists and osteopaths understand the principles of tendon loading. They know how to progressively load a repairing tendon to maximise its strength and resilience, protecting you from future injury.

Tendinosis

Tendinosis is a more long-term condition than tendonitis. According to an article published in 2000, producing new collagen fibres takes a long time – somewhere in the region of 100 days.

This means the gradual renewal and healing of a degenerative tendon is a process of several months. However, it can be a matter of weeks if the problem is caught in its early stages.

The symptoms of tendinosis include:

• Burning pain
• Stiffness
• Swelling
• Lack of strength

The symptoms of tendinosis, then, can be hard to tell apart from those of tendonitis. If your symptoms have come on gradually with minor repetitive use, rather than a sudden increase in activity, tendinosis is the likely culprit.

Tendonitis or tendinosis – why does it matter?

Although these two conditions present in a similar way, their underlying mechanisms are different.

As our understanding of tendon conditions increases, it seems that tendinosis is much more common than first thought.

In fact, some experts now think that tendonitis mainly occurs in tendons that have already been undergoing a degenerative process. Tendinosis might be predisposing tendons to the more acute, inflammatory tendonitis.

Getting a good understanding of what’s happening in a painful tendon is helpful, so we know what to expect in terms of healing time.

In addition, treatments can be different – for example, ibuprofen, which can be useful in reducing the inflammation of tendonitis, can also inhibit collagen repair.

What should you do if you have tendon pain?

Tendon problems, then, are complicated. If you have pain and you’re unsure of the cause, get it checked by a professional.

At Woodside Clinic, we have a team of physiotherapists and osteopaths who are skilled at diagnosing and treating tendon problems.

Here are some of our top tips for dealing with your tendon pain.

Rest – in the first few days, ease back on those activities that aggravate your pain, if possible.

Apply ice – use an ice pack for 15–20-minute periods, regularly through the day and especially after aggravating activities. This will reduce inflammation in cases of tendonitis, and it will reduce new blood vessel growth in tendinosis, which is associated with pain.

Support – use an appropriate support or brace to provide your tendon with some extra help. This is especially useful if you can’t entirely avoid exacerbating activities – at work, for example.

Ergonomics – small changes, such as using a wrist support when typing, can reduce biomechanical stress on your tendon.

Movement – gentle stretching and movement keeps the muscle supple and prevents stiffness building up. It will also promote good circulation, which is necessary for healing.

The best treatments for tendonitis and tendinosis

Both short-term and chronic tendon problems need careful rehabilitation.

Seeing an osteopath or physiotherapist can be a rapid route to getting the diagnosis and treatment you need. As skilled primary health care practitioners, they can assess and diagnose your tendon pain.

Evaluation goes beyond determining the type and stage of the tendon issue. Tendons and muscles work as part of a kinetic chain to produce movement, and weakness in one part of that chain can lead to overload in another.

Osteopaths and physiotherapists understand biomechanics. Your rehabilitation plan will include:

• Manual treatment that promotes healing and reduces pain
• Guided, progressive exercises to return the tendon to full strength and health
• Targeted strengthening and mobility to other areas in the relevant kinetic chain
• Advice and guidance for self-management

Shockwave and EMTT for tendonitis and tendinosis

 

Both Extracorporeal Magnetotransduction Therapy (EMTT) and Shockwave Therapy are proving excellent treatment for acute and chronic tendon problems.

EMTT reduces pain in tendinopathy by applying pulsed magnetic fields to the painful area via a handheld device. These work to reduce inflammation and pain and stimulate cell growth.

Shockwave works in a similar manner. A device passes sound waves through the body, promoting tissue healing and easing pain.

In 2018, research into the use of Shockwave Therapy for tendinopathies showed that it ‘significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life’.

Both these therapies are safe and non-invasive. They can even be combined for maximum effectiveness.

Here at Woodside Clinic, we can offer these state-of-the-art technologies as standalones or together with physiotherapy or osteopathy treatments.

Great treatment for your tendonitis or tendinosis

If you have tendonitis, tendinosis, or other musculoskeletal pain, we can help you. Book now with our team to have your pain dealt with effectively and efficiently, and get back to doing the things you love.