Tendinosis

Tendinosis is a chronic tendon injury that typically occurs due to overuse of the tendon. It can cause symptoms such as swelling, burning pain, stiffness, and more. Tendinosis can occur in any tendon but is most common in the Achilles tendon, patellar tendon (knee), and the tendons of the elbow (tennis or golfer's elbow).

Tendinitis vs. Tendinosis: What's the Difference?

It's important to distinguish between tendinitis and tendinosis, as the treatment approaches differ significantly:

• Tendinitis is an acute condition involving inflammation of the tendon, usually resulting from a sudden injury or strain. It typically resolves within a few weeks with rest and anti-inflammatory measures.
• Tendinosis is a chronic condition characterized by the degeneration of the tendon's collagen fibers. It is a non-inflammatory process (or involves very low-grade inflammation) caused by repetitive stress and inadequate recovery time. The tendon structure breaks down, becoming thickened, weakened, and painful. Recovery can take months.

Symptoms of Tendinosis

• A dull, aching pain that may feel like a burning sensation.
• Localised swelling or a palpable lump (nodule) on the tendon.
• Stiffness, particularly in the morning or after periods of rest.
• Pain that worsens during or immediately after activity.
• Reduced strength and flexibility in the affected joint.

Treatment Strategies

Because tendinosis involves structural degeneration rather than simple inflammation, traditional treatments like ice and anti-inflammatory medications (NSAIDs) are often ineffective and may even slow down the healing process.

Effective management focuses on stimulating collagen production and remodeling the tendon:

• Load Management: Modifying activities to reduce stress on the tendon while maintaining some level of load to stimulate healing. Complete rest is usually not advised.
• Eccentric Exercises: Specific strengthening exercises that lengthen the muscle under tension (eccentric loading) have been shown to be highly effective in remodeling degenerated tendons.
• Soft Tissue Therapy: Techniques like cross-friction massage or instrument-assisted soft tissue mobilization (IASTM) can help break down scar tissue and stimulate blood flow to the area.
• Shockwave Therapy: Extracorporeal shockwave therapy (ESWT) uses acoustic waves to stimulate the healing process and reduce pain in chronic tendinopathy.