The World Of Tendons

A tendon is a cord or band of dense, tough, inelastic, white, fibrous tissue, serving to connect a muscle with a bone. Think Achilles tendon, which attaches your calf muscle to the heel. Damage or injury to tendons is quite common. There is two different issues-tendinitis and tendinosis. One you’ve probably heard of before. The other, probably not. While they both sound the same, in reality they are worlds apart.

Tendinitis is, by definition, inflammation of a tendon.  Tendinosis on the other hand is defined as chronic tendinitis without inflammation and implies chronic tendon degeneration at the cellular level. Basically, one is short-term with inflammation, the other long-term, without inflammation, though both are caused typically by overuse. Repetitive strain injury (RSI) goes by a lot of names – it can also be called tenosynovitis or chronic tendinopathy by doctors. Don’t let their fancy jargon scare you! It’s kind of simple – tendinitis happens when you repeat a motion frequently on tight tissues and when the rate of damage exceeds your body’s natural rate of repair. 

NORMAL TENDON Uniform, Organized, & Parallel            

 

 

FRAYED TENDON (TENDINOSIS) Unorganized, Tangled, & Random

 

      

                         

Tendinitis, the most popular diagnosis of the two, usually presents with swelling and tenderness at the sight of pain, often accompanied by stiffness, and less often by weakness. Tendinosis presents most often with stiffness, tenderness to the touch, and weakness–almost identical to tendinitis. Recovery of tendinitis lasts anywhere from days to six weeks, a relatively “quick fix.” Tendinosis recovery can last a few short weeks to a couple months or more depending on the level of degeneration. If left untreated, tendinosis often leads to “tear” injuries

Tendinitis and tendinosis, both, occur most often in the Achilles tendon (ankle), patellar tendon (knee), proximal hamstring (high hamstring), common extensor tendon (elbow), and the supraspinatus tendon (shoulder). With both of these problems being so relatively close, while treatment is vastly different, proper diagnosis is vital to the recovery process! So which one do you have? Let’s go to the research.

While tendinitis is the wildly over-popular diagnosis among general practitioners, it may not be the case. Most research coming out on this topic is now showing that at a cellular level, once believed tendinitis actually is, in fact, tendinosis.

According to Almekinders and Temple, “Most currently practicing general practitioners were taught, and many still believe, that patients who present with overuse tendinitis have a largely inflammatory condition and will benefit from anti-inflammatory medication. Unfortunately this dogma is deeply entrenched. 10 of 11 readily available sports medicine texts specifically recommend non-steroidal anti-inflammatory drugs despite the lack of clinical evidence.”

In light of this, chances are that if you have been diagnosed with tendinitis the diagnosis was incorrect. Furthermore, traditional, conservative treatment, of such, with the use of anti-inflammatories, corticosteroid injections, and/or pain medication may have left you worse off long term even though pain may have dissipated short term. This is because these drugs inhibit collagen repair and are designed to eliminate inflammation, not regrow tendon. As mentioned above, treatment of tendinosis should be aimed at restoring tendon function and strength. Drugs will not help solve the problem! With all this said, while we cannot assume a tendinitis diagnosis was incorrect, lingering, worsening, or reoccurrence of pain would suggest that it may in fact be tendinosis. It is recommended that treatment plans geared toward tendinitis, in these cases, be re-evaluated.

Tendinitis is one of the most commonly diagnosed injuries and all too many struggle to find relief. With the proper diagnosis and treatment plan, it doesn’t have to be that way!

The next blog will discuss treatments for tendinitis/tendinosis. Stay tuned!

Dr. Stephen Kelly practices at Family First Chiropractic, 142 Erickson Drive, Red Deer, Alberta. 403-347-3261.www.family1stchiro.ca.