Don’t get Caught in Tendon-Confusion! The Difference Between Tendonitis and Tendonosis Explained



Many have either suffered from tendinitis or at least heard of it.

But have you ever heard of TENDINOSIS?

If you’ve ever suffered from tendonitis – then you know that it can last anywhere from a few weeks to several months!

What is the difference between Tendonitis and Tendonosis?

Tendonitis is an acute, short-term, inflammatory condition typically caused by repetitive overuse of your tendon.

Tendinosis, on the other hand, is a chronic, degenerative condition of your tendon that involves the deterioration of collagen, a structural protein in your tendon.

While the two conditions sound very similar and are often used interchangeably – they are very different.

When tendonitis isn’t caught early enough or treated properly (meaning, not ignored thinking it will just go away on its own) – it can turn into tendinosis.

The treatment for acute tendonitis is very different from chronic tendinosis.

How do you treat Tendonitis?

Tendonitis is an acute condition, and the best treatment is to rest, apply ice, and sometimes take anti-inflammatories to control pain. From there, you want to figure out what caused the tendonitis to occur in the first place and address that.

Typically, it’s due to some sort of mismatch between muscle strength and the activity you need to perform, leading your body to compensate and put unwanted stress on your tendon. Often it’s some sort of too much too soon.

Once you figure out and correct this pattern, it’s very easy to get rid of your tendonitis!

The most common areas for tendonitis to occur are your elbows, rotator cuff (shoulder), patella (knee), Achilles tendon (ankle), and glutes (hip, just about every hip pain located over the side near the hip bone).

Confusingly, many doctors will diagnose these conditions as bursitis. Another -itis that doesn’t clearly identify the root cause of the pain and this confusion contributes to the mismanagement of tendonitis.

How do you treat Tendonosis?

When you don’t manage tendonitis properly, and it goes on longer than a few months, it results in tendinosis.

Tendinosis is a very different condition where the fibers in your tendon actually start to break down.

The first thing to note is that tendinosis no longer involves inflammation of your tendon.

So using ice every day, resting it, and taking anti-inflammatories will not help you.

I can’t tell you how many times I’ve spoken to people still doing this 6-8 months later…

Second, since tendinosis involves disorganization and degeneration of the fibers that make up your tendon, you have to “re-organize” those fibers in order to resolve tendinosis and get your tendon functioning properly again without pain and without the fear of causing bigger tears in the tendon.

Passive treatments like ice, rest, and medicine will not help tendinosis.

They might help to temporarily relieve the pain you’re having from overdoing it or under-treating it… but the tendinosis will continue to progress.

Unresolved tendinosis leads to the progressive weakening of your tendon over time – making it easily susceptible to full-blown tears. This is how so many folks tear their Achilles or rotator cuff, for example, “out of nowhere”.

Once I speak with them, they often report that over the years they had recurring bouts of tendonitis in that area.

Why you must know the difference between Tendonitis and Tendonosis

In other words, their tendonitis wasn’t managed properly and it led to chronic tendinosis, making them an easy target for a torn tendon.

So how do you treat tendinosis and prevent more serious problems from happening down the line?

You have to re-organize those fibers so your tendon can work properly again!

Sounds easy, right?

Well technically it is, but the biggest problem is that this process takes time – up to 9 months in some cases. And most patients I come across simply don’t have the patience for this – or they simply aren’t told.

The other issue is that if you’re expecting an insurance company to cover your treatment – they typically don’t want you in physical therapy for more than 6-12 weeks at a time. (This is why many people join Preferred Fitness, individualized exercise to help keep you active, young, and free from pills, injections, or surgery)

This is not long enough to properly treat tendinosis.

The only way to re-organize those tendons is to put stress on them – and over a period of time.

You have to put just the right amount of stress to cause a little bit of pain – but not so much that your tendon gets inflamed again. A properly trained physical therapist who is well-versed in tendinosis will know how to do this.

You basically have to retrain the fibers to withstand force again – and this process takes time.

The good news, however, is that if you rehab your tendinosis properly, you can get back to all the activities you love as if nothing ever happened!

If you’re confused after reading this don’t worry – so is half the medical community…

The take-home points to remember are these…

Tendonitis involves pain and inflammation, there is no damage to your tendon, and it only lasts about 4-6 weeks.

Treatment for this should involve passive modalities like ice and rest, and the focus should be on what caused your tendon to get irritated in the first place.

But if problems in your tendon have gone on longer than 3 months, you MUST suspect tendinosis, which no longer involves inflammation but a breakdown of your tendon.

Passive treatments will NOT work and could actually prolong your problem – so stop icing and resting.

To get rid of tendinosis, it requires carefully prescribed loading strategies that will properly re-organize your tendon so that it can be strong again!

This is extremely challenging to do on your own, so we recommend working with an expert who is well-versed in this diagnosis.

With the right approach, we can restore tendon health and reduce our risk of repeated injury to help you to stay active, independent, and confident well into your later years.

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Nick Hunter, PT, DPT

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