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Understanding Tendinopathy: Tendinitis vs Tendinosis

Updated: Feb 28

Tendons are the connective tissue from muscle to bone. They are considered active tissue because they can contribute to muscle contraction.

Tendinopathy means pathology (a condition) of the tendon. Tendinitis and tendinosis are both tendinopathies. The most common muscles that have tendon issues among active people are: Bicep, Iliopsoas (a hip flexor), quadriceps (patellar tendon), and achilles.

Tendon pain can be pinpoint or radiate to areas around the tendon. That pain can also decrease muscle activation and negatively effect athletic performance. Anyone with tendinitis or tendinosis knows how much they feel limited in their daily lives.

TendinITIS is an acute tendon injury/condition. Acute means an injury occurred followed by inflammation and most often pain. An acute episode can last anywhere between 24 hours to 3 months. Acute episodes are marked by sharp pain and further activity can make it worse. If an acute episode lasts longer than 3 months we then classify it as tendinOSIS. In some cases tendinitis does not progress to tendinosis.

TendinOSIS can happen following an acute episode of tendinitis or can happen as an overuse injury, basically wear and tear on the tendon. Tendonosis is marked by decreased tendon tolerance, scarring, and possibly limited range of motion. Pain with tendinosis is commonly achy or dull and improves with further activity.

The common theme among tendon conditions is that pain can be brought on by resisting the motion of the muscle it attaches to. For example someone with achilles tendinopathy might have pain with calf raises, running, and jumping.

The biggest difference between the two is that with Tendinitis pushing through pain can be more injurious to the tendon, while in a tendinosis pushing through some low level pain can help rebuild the tendon.

The good news is tendinopathies are HIGHLY treatable with physical therapy and the vast majority of people don't need to have surgery.

Rehab for tendinitis is focused on corrective exercise, activity modification, stretching, anti-inflammatories, light exercise for the tendon. (Ex: low resistance cycling for patellar tendinitis)

Rehab for tendinosis is focused on stimulating strength adaptation in the muscle and tendon through the progression through isometrics, eccentrics and concentric exercise. Isometrics is holding a position for a specific time. An example of eccentrics is the lowering phase of a squat, and an example of concentric is the rising phase of a squat.

Medical Disclaimer:

This website does not provide medical advice and does not direct that you undertake any specific exercise or training/rehabilitation regimen. All information on this website is intended for instruction and informational purposes only. The authors are not responsible for any harm or injury that may result. Significant injury risk is possible if you do not follow due diligence and seek suitable professional advice about your injury. No guarantees of specific results are expressly made or implied on this website.

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