Tendinosis

Understanding tendinosis is crucial for anyone experiencing persistent tendon pain and seeking an effective treatment plan. While often confused with tendinitis, tendinosis is a different condition that requires specific approaches for diagnosis and management.

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What is Tendinosis?

Tendinosis refers to the degeneration of a tendon’s collagen in response to chronic overuse without adequate time for recovery. Unlike tendinitis, which is characterized by inflammation, tendinosis is marked by the absence of inflammatory cells and the presence of degenerative changes. This distinction is vital because it affects the approach to treatment and management.

Tendinosis vs Tendinitis

Tendinitis and tendinosis are often mistakenly used interchangeably, but they represent different pathological processes. Tendinitis involves acute inflammation of the tendon, typically resulting from a sudden injury. In contrast, tendinosis is a chronic condition characterized by the breakdown of collagen within the tendon due to repetitive strain or overuse.

The primary difference lies in the presence of inflammation: tendinitis involves inflammation, while tendinosis does not. This distinction influences the treatment strategy, as anti-inflammatory medications may be effective for tendinitis but not for tendinosis.

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Causes of Tendinosis

Tendinosis is primarily caused by repetitive stress and overuse of a tendon without sufficient recovery time. Several factors can contribute to the development of tendinosis:

Repetitive Strain

Activities that involve repetitive motions, such as running, swimming, or typing, can put continuous stress on tendons, leading to microtears and subsequent degeneration over time. Occupations that require repetitive movements are also at higher risk.

Age and Degeneration

As individuals age, the tendons naturally lose elasticity and become more prone to injury. The collagen within the tendons deteriorates, making them more susceptible to tendinosis. Age-related changes in blood supply to the tendons can also contribute to degeneration.

Poor Biomechanics

Improper technique or biomechanics during physical activities can place undue stress on tendons, increasing the likelihood of tendinosis. For instance, runners with improper gait mechanics may experience tendinosis in the Achilles tendon.

Inadequate Recovery

Insufficient rest and recovery between periods of intense physical activity can prevent tendons from healing properly, leading to cumulative damage and tendinosis.

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Symptoms of Tendinosis

The symptoms of tendinosis can vary depending on the affected tendon but generally include:

Persistent Pain

Chronic pain at the site of the affected tendon is the hallmark symptom of tendinosis. The pain is typically localized and may worsen with activity.

Stiffness and Reduced Range of Motion

Tendinosis often leads to stiffness and a reduced range of motion in the affected area. This can impact daily activities and overall mobility.

Swelling and Thickening

Although inflammation is not a primary feature of tendinosis, localized swelling and thickening of the tendon may occur. This can sometimes be mistaken for tendinitis.

Weakness

Weakness in the affected tendon and surrounding muscles is common in tendinosis, which can lead to decreased performance in physical activities.

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Tendinosis Treatment

Effective treatment of tendinosis requires a multifaceted approach aimed at promoting tendon healing, reducing pain, and preventing further degeneration. Here are some of the primary treatment strategies for tendinosis:

Rest and Activity Modification

Giving the affected tendon adequate rest is crucial for healing. Modifying activities to avoid repetitive strain and overuse is essential. This may involve reducing the intensity and frequency of physical activities or switching to low-impact exercises.

Physical Therapy

Physical therapy plays a significant role in tendinosis treatment. A physical therapist can design a tailored exercise program to strengthen the tendon and surrounding muscles, improve flexibility, and correct biomechanical issues. Eccentric exercises, in particular, have shown promise in promoting tendon healing.

Pain Management

Pain management strategies for tendinosis may include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), although their effectiveness may be limited due to the lack of inflammation. Other options include acetaminophen and topical analgesics.

Extracorporeal Shockwave Therapy (ESWT)

ESWT involves the application of high-energy shockwaves to the affected tendon to stimulate healing and reduce pain. This non-invasive treatment has shown positive results in some cases of tendinosis.

Platelet-Rich Plasma (PRP) Therapy

PRP therapy involves injecting a concentrated solution of the patient’s own platelets into the affected tendon. The growth factors in PRP are believed to promote healing and tissue regeneration. While research on PRP for tendinosis is ongoing, some studies suggest it may be beneficial.

Surgery

In severe cases of tendinosis that do not respond to conservative treatments, surgical intervention may be necessary. Surgery typically involves removing the damaged tissue and stimulating healing.

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Tendinosis Recovery Time

The recovery time for tendinosis can vary widely depending on the severity of the condition, the tendon involved, and the individual’s overall health. Generally, tendinosis requires a longer recovery period compared to tendinitis due to the chronic nature of the condition.

Short-Term Recovery

In mild cases, with appropriate treatment and activity modification, symptoms may improve within a few weeks to a couple of months. However, it is essential to continue with rehabilitation exercises to prevent recurrence.

Long-Term Recovery

For more severe cases, recovery can take several months to a year or longer. Persistent adherence to physical therapy and activity modification is crucial for long-term recovery and tendon health.