Tendinitis versus tendonosis

Tennis elbow is a common complaint that we treat, and it doesn't always happen playing tennis! Some patients present with pain in their forearm and elbow after an increase in a certain activity like home renovations or gardening; others find that it is a result of increased computer work. Whatever the cause, the aim of treatment is to reduce muscle tension and guarding and restore circulation to the area.

For more information about the specific differences of tendinitis versus tendonosis, this article has great information. 
Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters

"Tendinitis is the inflammation of the tendon and results from micro-tears that happen when the musculotendinous unit is acutely overloaded with a tensile force that is too heavy and/or too sudden... Tendinosis is a degeneration of the tendon’s collagen in response to chronic overuse; when overuse is continued without giving the tendon time to heal and rest, such as with repetitive strain injury, tendinosis results. Even tiny movements, such as clicking a mouse, can cause tendinosis, when done repeatedly."

In English? Basically what they are saying is that that tendinitis is is small tears that happen when you overload the area where the muscle and tendon attach to a bone. These injuries are likely to happen suddenly, like when you lift something that is too heavy.

In tendinosis the damage to the collagen fibres in the tendon (the bit at the end of the muscle which attaches to bone) happens over a longer time, due to overuse. These movements can be small but are repeated time and time again.

You may be asking yourself why doe it matter? It matters because treatment goals will be different depending on which condition you have. There is no point taking drugs to get rid of inflammation, like is present in tendonitis, when there is no inflammation causing issues, as with tendinosis!

Or to put it in the terms of the study results: "The most important reason to distinguish between tendinitis and tendinosis is the differing treatment goals and timelines. The most prominent treatment goal for tendinitis is to reduce inflammation, a condition that isn’t present in tendinosis. In fact, some treatments to reduce inflammation are contraindicated with tendinosis. Ibuprofen, a nonsteroidal anti-inflammatory, is associated with inhibited collagen repair(9). Corticosteroid injections inhibited collagen repair in one study, and were found to be a predictor of later tendon tears(3,4,10)".

Interestingly the healing times of each injury are very different too. Tendinitis may heal in a matter of days or up to six weeks depending on how soon someone seeks treatment. Whereas building new collagen fibres, in the case of tendinosis, could take one hundred days or more!

The study also states that some treatments overlap for the two complaints but may work for different reasons. "For example, deep-friction treatments are beneficial for both conditions, but for very different reasons. In the case of tendinitis, deep friction serves to reduce adhesions and create functional scar tissue once inflammation has subsided. In the case of tendinosis, deep-friction treatments serve to stimulate fibroblast activity and collagen production".

All the more reason to tolerate that pesky load of questions a good osteopath will hit you with when you come in for treatment. We can learn so much from taking a thorough case history about the onset of your injury and in the case of tendinitis versus tendinosis an accurate diagnosis could not only change your treatment options but your prognosis too!

If you would like more information on common tendinitis, and tendinosis) sites please have a look at our page dedicated to osteopathy for tendinitis or give the clinic a call on 03 94999456