Tendonitis
Tendonitis vs. Tendinosis: Understanding Tendon Injuries
What is Tendonitis?
The term tendonitis comes from:
- Latin “tendo” = tendon (a structure that connects muscle to bone).
- Greek “-itis” = inflammation.
Tendonitis generally is an acute inflammatory condition of the tendon, typically caused by overuse, repetitive strain, or sudden injury. It is characterized by swelling, pain, and warmth around the affected tendon.
What is Tendinosis?
- Tendinosis is a degenerative condition of the tendon, not an inflammatory one.
- It occurs due to chronic overuse or failure to heal properly, leading to microtears, collagen breakdown, and poor blood supply.
- Unlike tendonitis, it does not involve inflammation, but rather structural damage and weakened tendon fibers.
Best Therapy for Tendonitis & Tendinosis
Tendonitis (Acute Inflammation)
- Rest & Activity Modification: Avoid aggravating movements.
- Ice & NSAIDs: Reduce inflammation (short-term use).
- Gentle Stretching & Massage: To relieve tightness.
Tendinosis (Chronic Degeneration)
- Progressive Loading (Isometric & Eccentric Exercises): Stimulates tendon remodeling.
- Shockwave Therapy: Stimulates healing and blood flow.
- Manual Therapy & Soft Tissue Work: Improves mobility.
- Nutrition (Collagen, Vitamin C, Magnesium, Omega-3s): Supports tendon repair.
How PhysioActive Uses Isometrics to Improve Tendon Quality & Strength
- Isometric exercises (holding a contraction without movement) help:
- Reduce pain by decreasing tendon strain sensitivity.
- Increase tendon stiffness & collagen production.
- Improve neuromuscular control around the affected joint.
Example:
For patellar tendinosis:
- Wall sit holds (30-45 sec)
- Isometric leg extension holds
For Achilles tendinosis:
- Heel raise holds (mid-range position)
Why PhysioActive uses Shockwave Therapy to assist your Tendinosis
Shockwave therapy (Extracorporeal Shock Wave Therapy – ESWT) is used when tendons fail to heal on their own.
- It delivers high-energy acoustic waves to the damaged tendon.
- Increases blood flow to the area.
- Breaks down calcifications & stimulates collagen production.
- Activates healing cells (fibroblasts).
Best for:
- Chronic Achilles tendinosis
- Tennis elbow (lateral epicondylitis)
- Rotator cuff tendinosis
- Patellar tendinosis
Final Thoughts
- Tendonitis is inflammation; tendinosis is degeneration.
- Tendonitis heals quickly with rest and anti-inflammatory treatments.
- Tendinosis requires mechanical loading (isometrics, eccentrics) & shockwave therapy to stimulate healing.
- Early intervention prevents chronic tendon degeneration.
Peritendinous Structures vs. Tendonus Structures: Understanding Their Differences and Why Isometrics Are a Better Starting Point in Therapy
To understand why isometric exercises are an effective starting point for tendon rehabilitation, it’s important to differentiate peri tendinous structures from the tendon itself and how each responds to mechanical loading.
A tendon is a dense, collagen-rich connective tissue that connects muscle to bone and transmits force. However, peritendinous structures surround the tendon and provide lubrication, support, and protection.
A. Tendon Structure (Load-Bearing Role)
- Composed primarily of Type I collagen, which gives it tensile strength.
- Functions as a shock absorber and force transmitter.
- Has poor blood supply, making healing slower.
B. Peritendinous Structures (Protective & Lubricating Role)
These include:
Key Difference:
- Tendons handle high-tension forces.
- Peritendinous structures allow for smooth movement and help distribute loads.
When injured, these structures respond differently:
- Tendon injuries (tendinosis) require gradual loading to promote collagen repair.
- Peritendinous inflammation (tenosynovitis or paratenonitis) often needs movement without excessive load to reduce adhesion formation.
