Tendinitis or Tendinosis? or Why Am I Not Getting Better?

Most of us have had the misfortune of encountering tendinitis. Whether in the arm, shoulder, knee, or foot, tendinitis seems to strike most athletes at some time in their career. As with most maladies, “it’s easier to get than to get rid of”. So what causes tendinitis, how do we treat it, and how can we prevent it?
Unfortunately, researchers have yet to completely determine the cellular and molecular basis of tendon injury. In fact, they argue the term ‘tendinitis’ should be supplanted by the more accurate ‘tendinosis’ or ‘tendinopathy’ highlighting the absence of an inflammatory process underlying the injury. Most athletes dealing with tendon injury would agree that anti-inflammatory medication does little to ameliorate the pain and discomfort associated with this malady.
Researchers, however, are slowly unfolding the complex process of tendon injury and repair. Unlike the previous understanding of tendon injury as an acute process leading to inflammation and pain, the new concept paints a picture of a dynamic environment constantly changing and adapting to stress. Chronic, micro-injuries lead to a disruption of tendinous homeostasis favoring repair and a disorganization of normal architecture. Enzymes called metalloproteinases decrease and blood vessels proliferate within the tendon. The tendon becomes less able to deal with physical stress and decompensates. At this point either pain limits activity or the tendon ruptures.
The best way to treat tendinosis is to avoid injury. Common sense and the advice of trainers dictates increasing exercise effort and intensity gradually. This will allow a more normal turnover process within the tendon allowing it to adapt to the new stresses. When an athlete does begin to have tendinous pain they should immediately discontinue the offending activity. Rest, ice, compression, and elevation (R.I.C.E.) seem reasonable initial measures. Onset of discomfort, however, usually indicates the tendon has already been injured for some time. Consultation with a physician, trainer, or physical therapist can help the athlete elucidate the cause of the pain and suspend or modify their training allowing for healing of the affected tendon.
Unfortunately, no single treatment has been shown to accelerate tendinous healing. Studies, however, indicate modalities such as eccentric exercise therapy, shock wave therapy, and sclerosant injections, have some beneficial effect. Generally, adequate rest away from the provoking activity and therapy addressing the underlying cause of the injury results in recovery. Newer approaches such as gene therapy show promise but need more research before they can be used in humans.


Riley, Graham, 2008,
Tendinopathy, From Basic Science to Treatment
Nature Clinical Practice Rheumatology