Tendonitis/Tendinosis

The advances in the understanding of tendon injury indicate that conditions that have been traditionally labelled as Achilles tendonitis, patella tendonitis, lateral Epicondylitis (tennis elbow), and rotator cuff tendonitis are in fact TENDINOSIS. Although the word “Tendonitis” is often still used, it is actually an out-dated term. The suffix “itis” in tendonitis means inflammation, however, research has shown that it is really a build up of scar tissue, and decrease in tissue collagen that is the problem, not inflammation. Therefore, the newer term that replaces tendonitis is “Tendinosis”, which denotes the scar tissue accumulation, and change in tendon tissue composition.

This condition is most common in athletes of jumping sports such as basketball and volleyball, but it also occurs in soccer, track, long distance running, cycling and tennis athletes. The symptoms of a tendinosis injury include pain at the tendon site which is worse with particular movements, reduced range of motion due to scar tissue accumulation and relative relief of pain with rest. The symptoms will depend on the severity of the injury and the length of time the injury has been present. Scar tissue accumulation can build up over a long period of time before symptoms appear. Once symptoms develop, they may come and go with time but the root problem will remain if left untreated. Those patients most at risk for re-injury are those that have symptoms of short duration and are still able to “warm up” the injury and engage in sports. They are the most likely to try to continue playing without undergoing appropriate treatment, and thus worsen the tendinosis.

Because tendinosis results from collagen degeneration and generally, mechanical overload, it is vital to establish why this occurred. Training errors are a common cause, but in some instances a more subtle mechanism underlies tendinosis. Thus, it is important to assess any equipment being used (eg. running shoes, tennis racquet, bike), examine movement biomechanics (eg. running, throwing motion, stroke pattern), and diagnose and treat any muscle imbalances. The importance of biomechanical correction cannot be overemphasized in treatment.

Effective treatment of any tendinosis injury requires an alteration in tissue structure to break up the cross-fibre adhesions. Targeted soft tissue therapy and Acupuncture can be used to restore normal function to the affected soft tissues, Physiotherapy and Chiropractic to restore normal motion and alignment to the involved joints. Functional Rehabilitation, emphasizing eccentric strengthening will be necessary to restore the long strength to the involved tissues