There is wide spread confusion between the two terms and some health practitioners tend to throw these two words interchangeably. However there is a marked difference between the two and the approach that we use to treat it is vastly different. A tendinitis, with the prefix 'itis' infers that there is some inflammation within the tendon itself, whereas a tendinopathy occurs due to an overload of the tendon, where it cannot adapt and it becomes irritated and painful.
Tendinitis is the inflammation of the tendon, usually from an acute or sudden tensile force which causes micro tears within the musculotendinous junction (where the muscle meets the tendon) causing inflammatory cells to rush to the area, whereas tendinosis/tendinopathy is a degeneration of the tendon due to chronic overuse, without allowing the tendon to heal adequately.
The most important thing to take away from this is that most of the time when we experience what we think as an “inflammation” of the tendon, it is not, it is more likely that you agitated it by working harder and longer than usual causing a tendinopathy. Many of us fall in that trap hole of using non-steroidal anti-inflammatory drugs for our tendon pains. This can have the opposite effect in fact since NSAIDS have been shown to inhibit collagen repair making it worse.
So does that mean we need to rest the muscle?
Intuitively resting seems like the best response to an acute injury, however, going against what is logical we actually need to load the tendon more. Well not more, but with the correct load. According to research when we exercise, with the correct load, we promote collagen restructuring. What is collagen restructuring you ask? well, imagine a healthy tendon like a piece of rope, all of the fibers are all in line with each other running parallel, in an angry and unhappy tendon these fibers sometimes crisscross and go in all different directions, in turn making the tendon weak. With exercise, we can rearrange the fibers and make it more optimal to withstand loads.
But it hurts when I do my exercises? Won't it get worse?
Yes that is a very good question, it is true that pain is our body’s way of telling us something odd is going on however in the case of tendinopathy’s having a little bit of pain when we do the correct exercises. In fact with certain exercises with the correct, dose and repetition it can actually reduce pain. Current research shows that phase 1 exercises such as isometric exercises have shown to reliably reduce pain.
So what should I be avoiding when I start having these pains?
· Resting completely
o Like I spoke earlier resting or just praying that the pain may go away is not the best course of action, by resting you reduce the tendons ability to take load, meaning when you go back to do the task it is no weaker.
· Having passive treatments
o Treatments that do not address the need to progressively increase the tendons ability to take load, are generally, useless, it may give short term pain relief but will not address the underlying issue. Treatments like ice and eletro-therapy are band-aid solutions.
· Injection therapies
o Current literature do not heavily support the idea of injection therapy such as PRP into the tendon. It is always best to try and have non-invasive treatments first before jumping straight to injections. Injections do not address the tendon weakness, it merely masks the pain.
· Stretching your tendons
o By stretching tendons we can actually add compressive loads that we know are harmful to the tendon, an alternative if your muscles are tight is to massage to loosen them up
· Massaging directly on the tendon
o Like I mentioned above massaging an already irritated and angry tendon does not serve to make it better
· Getting unnecessary scans for your tendons
o The pictures of your tendons with ultrasound or MRI can frighten you. The words used by doctors such as degeneration and tears can make you second guess if you should be loading the tendon at all. However there is a mountain of evidence to suggest that degenerated tendons, or partially torn tendons can tolerate loads, and can adapt.
The take home message is that an exercise based rehabilitation is the best treatment for tendon pain. Whenever in doubt go visit your local qualified health professional expert such as a physiotherapist to guide your rehabilitation and point you on the right track.