Your Tendonitis Isn’t Tendonitis

Tendonitis, the medical term for inflammation of a tendon, is an all-too-common condition today. People suffer from many forms of tendonitis, ranging from runner’s knees, golfer’s elbows and tennis elbows, to Achilles’ tendonitis and plantar fasciitis. All of these conditions are forms of tendonitis, and people don’t have to be runners, golfers, or tennis players to be affected. In fact, the majority of people affected are not even athletes. Tendonitis is usually the first diagnosis to come to mind when something hurts and the most likely diagnosis patients will receive from their doctors when they point to a body part and say, “It hurts here.” It is also the reason that the use of anti-inflammatory medication is so prevalent in our country.

This data begs a question. If tendonitis is that common, and anti-inflammatory medication, the leading treatment for tendonitis, is readily available in most households, why are so many people still in pain? The reason is not the wrong treatment; it’s the wrong diagnosis.

The Right Diagnosis

When the medical community talks about inflammation, words like pain, swelling, redness, and heat come to mind. These normal signs of inflammation are triggered by one’s body to help a person recover from a recent injury. With tendonitis, pain and swelling occur to protect the injured area, and the increased blood flow that the body uses to heal injured tissue causes redness and heat. With any injury, these initial signs of inflammation are good; they mean that the tissue is alive, responding to stress and capable of healing.

Here’s the problem. Pain is also present with the absence of this inflammatory activity. Regardless of pain, if no swelling, redness, or heat occur, there is no inflammation present. Tendon pain is present in these conditions due to impaired blood flow and a deterioration of tendon tissue. The tissue is just not healthy and probably hasn’t been for some time. On a cellular level, this condition represents the opposite of tendonitis. The tissue is essentially dying, and the medical field calls this tendinosis.

This distinction between tendonitis and tendinosis is not just academic. It is the foundational difference between the right diagnosis and the wrong diagnosis, the right treatment and the wrong treatment. Since the right diagnosis affects how quickly a patient gets better, medical providers have to rely on more than the presence of pain to make that diagnosis. They have to consider the history of a patient’s pain and the stress on the body that contributes to that pain.

“It Just Started to Hurt”

The most common words medical providers hear when they ask patients with tendinosis about their pain are, “I don’t know what happened. It just started to hurt.” Patients rarely recall a specific incident or event that may have caused their injury, and most describe a gradual worsening of their symptoms over a period of weeks or months. Despite attempts at rest, ice, and the use of anti-inflammatory medication, many patients still find themselves trapped in a continuous cycle of pain. That description in itself is enough to make a diagnosis of tendinosis, but a physical examination usually reveals something more interesting.

“I Just Work Through the Pain”

Patients with tendinosis don’t usually look all that bad on paper.

Yes, they have pain, but they don’t typically have significant deficits with the strength or flexibility of an injured area. They can usually do many of the activities they want to do, although they suffer through pain while doing so. When pain levels are low to moderate, patients often will continue to work through pain, placing excessive stress on a tendon and causing breakdown of tissue that occurs more quickly than the body can repair itself. When pain levels are higher, patients will start to exhibit patterns of compensation, or “favoring” a body part that causes weakening of tissue as well.

Either way, tendinosis develops as a result of continued, excessive stress on tissue by harmful mechanics from certain movements or activities. In order to break this cycle and allow healing to begin, medical providers need to help patients eliminate harmful stress and create a healthy environment for the tendon.

The Right Treatment

The treatment of tendonitis is simple. Patients rest, take anti-inflammatory medication, and wait for their symptoms to go away.

Treatment is usually that simple and also the primary reason that physical therapists don’t see many patients in the clinic with painful conditions caused by acute inflammation. People know how to treat themselves. The treatment of tendinosis, however, is exactly the opposite. It encourages activity, stimulates inflammation, and educates patients on how to play an active role in managing their symptoms.

More Rest Is Not the Answer

While patients with tendonitis may rest to alleviate their symptoms, patients with tendinosis actually need to stress their tendons to become healthier. Physical therapists guide patients in this process by performing intentional, therapeutic exercise in order to introduce healthy stress to a painful tendon. This stress is applied gradually and with an intensity that the tendon can handle. As the tendon heals, pain levels decrease and activity tolerance of the tendon grows to a level where patients can resume their normal level of activity without pain.

Inflammation is Okay

Circulation needs to be addressed as well. While patients with tendonitis take medication to decrease inflammation and blood flow, physical therapists treat patients with tendinosis by actually performing interventions to increase inflammation. The resulting blood flow is essential to tissue healing and needs to be artificially produced if the body does not produce it on its own. Deep tissue massage is a start, but more aggressive techniques that use tools (i.e. ASTYM) are even more effective. Stretching exercises and movements to keep muscles and tendons “warmed-up” throughout the day also increase circulation and stimulate healing.

Use Good Mechanics

Finally, physical therapists help patients to break the cycle of pain by identifying movement patterns that place unhealthy stress on tendons during daily activity, exercise, or work. These movement patterns are then corrected or replaced with healthy ones.

Educating patients about the relationship between their mechanics and their pain helps them to understand the effects of stress on their bodies and allows them to avoid harmful stress during activity. Proper warm up, cool down, and better awareness of their form in the gym or at work help to create a healthy environment for tendons as well. For patients that can’t attribute their pain to a particular movement or activity, education about form and fatigue during therapeutic exercise in the clinic helps them to make good decisions outside the clinic.

Prevention is Key

With any medical condition, it is easier to prevent it than cure it. In the case of tendinosis, this statement has never been truer. Since stress on the body can be controlled to a great extent, those that listen to their body can easily manage symptoms. If tendinosis pain does develop, physical therapists can work with a person to introduce activities and healthy stress to promote healing. Although the difference between tendonitis and tendinosis is subtle, it makes all the difference in the world when someone is in pain.