- Is it a tendonitis or tendon injury?
- Is it tendinitis or tendon damage?
Tendonitis is a frequently used word. Too frequent if you ask the research. So here we address an important question: Tendonitis or tendon damage?
Recent research has shown that many tendinitis erased are not inflammation (tendinitis), but rather an overuse injury in the tendon (tendinosis) - yet it is the case that many of these diagnoses are incorrectly called tendonitis. Why is it important to distinguish between tendinitis or tendon damage, you say? Yes, because the optimal treatment for the two is different from each other. So correct classification is essential to be able to provide the best possible treatment and ensure optimal functional progress. In many cases, it can be the solution to avoid a long-term and chronic problem.
"The article has been written in collaboration with, and quality checked by, publicly authorized health personnel. This includes both physiotherapists and chiropractors at Pain clinics Interdisciplinary Health (see clinic overview here). We always recommend having your pain assessed by knowledgeable healthcare personnel."
Tips: Scroll down to the bottom of the article to see a video with exercises against inflammation in the hip. Our YouTube channel also contains several free training programs for other types of tendinitis.
But, do I have tendonitis? Or?
Think of pain, a burning sensation in the area, decreased strength and mobility - all of which seem to be negatively affected by everyday activity. Must be symptoms of tendinitis, you say? Error. Several studies (Khan et al 2000 & 2002, Boyer et al 1999) have shown that these symptoms occur more often in tendinosis than in tendinitis. A common diagnosis that is often mistakenly called tendonitis is tennis elbow (lateral epicondylitis). It is a tendon injury. A systematic overview study has shown that in almost no studies (only 1) have concrete signs of acute or chronic inflammation been found during surgical interventions on patients who have been diagnosed with chronic tennis elbow / lateral epicondylitis (Boyer et al, 1999).
"The term epicondylitis suggests an inflammatory cause; however, in all but 1 publication examining pathologic specimens of patients operated on for this condition, no evidence of acute or chronic inflammation is found." - Boyer et al
- No inflammatory processes found in tennis elbow?
Another meta-analysis that considered histological, immunohistochemical findings and microscopic studies concluded that tennis elbow (lateral epicondylitis) is a tendon injury and not a tendonitis (Kraushaar et al, 1999). We remind you that systematic review studies and meta-analyses are the highest ranked research study forms.
- Tendinitis in the elbow is called tennis elbow or golfer's elbow (depending on whether it is on the inside or outside of the elbow)
What is the difference between tendonitis (tendinitis) and tendon injury (tendinosis)?
Here we will try to describe the difference between how a tendinitis and how a tendinosis occurs.
Tendinitis (tendinitis)
A tendinitis is an inflammation of the tendon itself and occurs due to micro tears that have occurred when the musculotendinous unit is acutely overloaded with a stretching force that is too strong or sudden. Yes, tendinitis is a diagnosis that can affect many people, but research has shown that this diagnosis is probably still overdiagnosed. One form of tendinitis is trochanter tendinitis (which is tendonitis in the hip).
Tendon damage (tendinosis)
A tendinosis (tendon injury) is a degeneration of the tendon's collagen fibers in response to chronic overuse – in other words, when the overuse continues even after the symptoms are there. This results in the tendon not having time to heal, and over time we have an overload injury in the tendon (tendinosis). It is best to take the symptoms seriously when they first appear. Most such ailments occur over time. Ask yourself: Did the damage happen suddenly or have you known it for a while?
Treatment of tendon problems
It is important to differentiate between tendinitis and tendinosis.
You have probably already begun to understand that tendinitis and tendinosis are treated in two different ways. In tendinitis, the main aim is to reduce the inflammation - and as we know, there is no such inflammation in tendinosis.
- No effect of anti-inflammatory when there is no inflammation
This means that forms of treatment that are effective against tendinitis are not necessarily effective against tendinosis. An example is ibuprofen. The latter will treat a tendinitis effectively, but will actually prevent the healing of a tendinosis (Tsai et al, 2004). This example could have long-term consequences if the person who actually had a tendinosis was recommended anti-inflammatory painkillers instead of receiving proper treatment.
– Cortisone for tendon pain?
Cortisone injection, a mixture of the anesthetic Xylocaine and a corticosteroid, has been shown in studies to stop natural collagen healing and is also an indirect cause of future tendon tears and tendon tears (Khan et al, 2000, & Boyer et al, 1999). In other words, you should really ask yourself the question - will this be beneficial? - before giving such an injection.
– Risk of tendon rupture and long-term deterioration
Cortisone can have a short-term good effect, but there is a risk of worsening the condition when you look at it long-term. So why did I feel better immediately after the injection? Well, one of the answers lies in the content: Xylocain. An effective anesthetic that will make it feel like the local pain is releasing immediately, but keep in mind that it may be too good to be true - at least in the long run.
Treatments that are good against both tendonitis and tendon injuries
Coincidentally, there are some forms of treatment that overlap when it comes to treating tendinitis and tendinosis. Deep friction massage or instrument-assisted massage (eg Graston) is actually beneficial for both conditions, but in two different ways. In the case of tendinitis, this form of treatment will reduce adhesions and generate functional scar tissue after the inflammation has subsided. In tendinosis injuries, the treatment will stimulate fibroblast activity and collagen production (Lowe, 2009). In addition, most tendinitis and tendon injuries will both have a positive effect from calming down a bit - here you can compression supports og cold packs be a good choice.
Tips: Use reusable cold packs to soothe the tendon
For the vast majority of people, it can be beneficial to have one reusable cold pack available in the freezer. This is a multipack (which can be used both as a cold pack and a heat pack). You can read more about it here or by clicking on the image above. The link opens in a new browser window.
Pain clinics: Please contact us if you have any questions
Our clinic departments at Vondtklinikkene (click here for a complete overview of our clinics), including in Oslo (Lambert seats) and Akershus (Eidsvoll Sound og Raw wood), has a distinctively high professional competence in the investigation, treatment and rehabilitation of pain in muscles, tendons, nerves and joints. Toe contact us if you want help from publicly authorized therapists with expertise in these fields.
1. Treatment of tendinitis (tendinitis)
- healing time: 6 to 16 weeks. Depending on when the diagnosis is made and treatment begins.
- purpose: Suppress the inflammation process.
- Tiltak: Rest, relaxation and anti-inflammatory drugs. Possible deep friction massage after the inflammation has subsided.
2. Treatment of tendon damage (tendinosis)
- healing time: 6-10 weeks (if the condition is detected at an early stage). 3-6 months (if the condition has become chronic).
- purpose: Stimulate healing and shorten healing time. Treatment can reduce tendon thickness after injury and optimize collagen production so that the tendon regains its normal strength.
- Tiltak: Rest, ergonomic measures, support, stretching and conservative movement, tendon tissue tools (IASTM), pressure wave therapy, nedicing, eccentric exercise. muscle work / physical therapy, joint mobilization and nutrition (we go through these in more detail in the article).
- 100 days to form new collagen
First and foremost, let's consider this statement from a larger study: "Later spends over 100 days laying down new collagen" (Khan et al, 2000). This means that treating a tendon injury, especially one you have had for a long time, can take time, but seek treatment from a publicly authorized clinician (physiotherapist, chiropractor or manual therapist) and get started with the right measures already today. You can do many of the measures yourself, but in certain more serious cases it can be beneficial to do so Shockwave Therapy, needle and physical therapy.
"Breaking down scar tissue and myofascial restrictions can contribute to faster and better healing. But, unlike muscles, it may take a few treatments (around 4-5) before you start to notice the positive effect."
Treatment and self-measures against tendon problems (tendinopathy)
Rest
The patient is advised to listen for the body's pain signals. If your body asks you to stop doing something, then you do well to listen. If the activity you perform gives you pain, then this is the body's way of telling you that you are doing "a little too much, a little fast" and that it does not have time to recover sufficiently between sessions. Micro-breaks at work can be extremely useful, for repetitive work you should take a 1-minute break every 15 minutes and a 5-minute break every 30 minutes. Yes, the boss will probably not love it, but it's better than being sick.
Take ergonomic measures
Small ergonomic investments can make a big difference. Eg. When working on the data, allow the wrist to rest in a neutral position. This results in significantly less strain on the wrist detectors.
Use support in the area (possibly taping)
When you have an injury, make sure that the area is not subjected to similar tensile forces that were the actual cause of the problem. Naturally. This is done by using support in the area where the tendon injury is located or alternatively, it can be used with sports tape or kinesio tape.
Example: Compression support for the knee (link opens in new window)
Stretch and keep moving
Regularly light stretching and movement of the affected area will ensure that the area maintains a normal movement pattern and prevents shortening of related muscle. It can also increase blood circulation in the area, which assists the natural healing process.
Use cooling
Icing can be symptom-relieving, but make sure you don't use ice cream more than recommended and also make sure you have a thin kitchen towel or similar around the ice pack. Clinical recommendation is usually 15 minutes in the affected area, up to 3-4 times a day.
Eccentric exercise
Eccentric strength training performed 1-2 times a day for 12 weeks has a clinically proven effect on tendinosis complaints. It has been seen that the effect is greatest if the movement is carried out calmly and in a controlled manner (Mafi et al, 2001).
Get treatment now - don't wait
Get help from a clinician to "get over the problem" so that it is easier for you to perform your own measures. A clinician can assist with pressure wave treatment, needle treatment, physical work and the like to provide both functional improvement and symptom relief.
Nutrition and diet
Vitamin C, manganese and zinc are all essential for collagen production – in fact, vitamin C forms the derivative of what develops into collagen. Vitamin B6 and vitamin E have also been linked directly to tendon health. So making sure you have a good, varied diet is important. Perhaps it may be necessary to take some supplements in the diet when the healing takes place? Feel free to consult with a nutritionist or similar.
VIDEO: 5 exercises against inflammation in the hip
In the video below shows chiropractor Alexander Andorff presented five adapted exercises adapted for both bursitis and tendinitis in the hip. Several exercises are performed with minibands. All links to training equipment and the like open in a new browser window.
Feel free to subscribe for free on our youtube channel (The link opens in a new browser window) for more free training programs (including programs against other types of tendinitis). And remember that we are always available for questions and input.
Summary: - Is it tendinitis or tendon damage?
En tendonitis is not always tendinitis. In fact, it is more common that the injury is a tendon injury. We hope you have understood the importance of the correct diagnosis and the consequences for the patient if the diagnosis decision is not made on the correct basis. Trying out conservative treatment and rehabilitation training should always be tried before resorting to more invasive measures (injections and surgery).
The pain clinics: Your choice for modern treatment
Our clinicians and clinic departments always aim to be among the elite in the investigation, treatment and rehabilitation of pain and injuries in muscles, tendons, nerves and joints. By pressing the button below, you can see an overview of our clinics - including in Oslo (incl Lambert seats) and Akershus (Raw wood og Eidsvoll Sound). Feel free to contact us if you have any questions or are wondering about anything.
Article: - Is it tendinitis or tendon damage?
Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene
Fact check: Our articles are always based on serious sources, research studies and research journals - such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.
Sources and research: Tendonitis or tendon damage?
- Khan Km, Cook JL, Kannus P, et al. Time to abandon the "tendinitis" Myth: Painful, Overuse Tendon Conditions Have A Non-Inflammatory Pathology [Editorial] BMJ. Published March 16, 2002.
- Heber M. Tendinosis vs. Tendinitis. Elite Sports Therapy.
- Khan KM, Cook JL, Taunton JE, Bonar F. Overuse tendinosis, not tendinitis part 1: a new paradigm for a difficult clinical problem.
- Boyer MI, Hastings H. Lateral tennis elbow: "Is there any science out there?".
- Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies.
J Orthop Res. 2004 May; 22 (3): 586-91.
- Rattray F, Ludwig L. Clinical Massage Therapy: Understanding, Assessing and Treating Over 70 Conditions. Elora, Ontario: Talus Inc; 2001.
- Lowe W. Orthopedic Massage Theory and Technique. Philadelphia, Pa: Mosby Elsevier; 2009.
- Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis.;Am J Sports Med. 1998. 26(3): 360-366.
- Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis; Knee Surgery Sports Traumatology Arthroscopy. 2001 9(1):42–7. doi: 10.1007/s001670000148.
