TENDINITIS vs TENDINOSUS - what is the difference??

6 Feb 2018 12:00 PM -

Tendon issues generally from an overloading of the affected area. This can occur from a sudden increase in a particular type of activity (physical training or work activity related), from poor biomechanics (inefficient movement patterns) or from prolonged/repetitive stresses to an area. There are many terms given to tendon issues including those listed above - "tendinitis and tendinosus" - I will explain the differences between these terms below...

Common types of tendon conditions include:
Tennis elbow (outside aspect of the elbow)
Golfer's elbow (inside aspect of the elbow)
Jumpers knee (patellar tendinopathy - front of the knee)
Achilles tendinopathy (at the back of the ankle)
Rotator cuff issues in the shoulder

When a tendon is subjected to enough overloading stresses for a prolonged period of time it goes through different stages of pathology:

The initial phase can have an inflammatory component to it, in particular there can be signs of inflammation seen in the sheath around the tendon or in the tendon itself. In this phase the tendon problem can be referred to as a tendinitis (where the "itis" part refers to the tissue being in a state of inflammation). The inflammatory phase generally is only in the first 6 weeks or so from the onset of the issue.

Tendinosus is a term given to a tendon that has become degenerative in nature. If left untreated a tendinitis (an inflamed tendon) can progress to a state where it begins to go through degenerative changes. These changes include a breakdown of the tendon fibres (small tears start to appear in the tendon) and new blood vessels can infiltrate the tendon (something which are not generally present). As this progresses the tendon can begin to have an appearance a bit like a sponge with lots of holes and gaps appearing. This is much different to a very solid tendon with millions of intact collagen fibres. A tendon that has progressed to the stage of tendinosus is much less adept at handling normal loading levels and can be painful on a daily basis.

Due to the different stages of tendon pathology that exist Health/Medical Practitioners now give an umbrella term to tendon problems - that being "Tendinopathy" - which literally means pathology (or problem) in the tendon. This is due to the different stages of tendon health and breakdown that exist.

It is important to deal with developing tendon problems early to reduce the chance of the tissues progressing to the point where degenerative changes begin to appear in the tendon. Once this occurs it is not impossible but certainly more difficult to restore full tendon health and tolerance to loading.

By Matt Walls

Principal Physiotherapist