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Writer's pictureNathaniel Edwards

Tendonitis Vs. Tendonosis - Know the difference!

Many of us are familiar with the feeling of a strain. This can be anything from what happens when you “pull a muscle” to when you trip and roll your ankle. Usually, there is pain and soreness for a few days as the body heals. But what happens when that pain persists?


To understand why pain lasts longer in following some injuries, we must first look at how the body’s soft tissue structures are organized. Soft tissue refers to things such as tendons, ligaments, and muscles. Each of these structures is made of different types of fibers, all oriented in a certain way. Think of them as a box of uncooked spaghetti, where each noodle is a fiber, all pointing in the same direction. This creates a strong, cohesive unit that is able to either produce power, or resist strain effectively.


When an injury occurs in a soft tissue structure, some of these fibers are broken. The body then goes through a healing process where new fibers are laid down in the area that was damaged. This process is natural and is how the first type of injury, tendonitis, is categorized.


Tendonitis - acute inflammation


When an injury occurs and some of the fibers of a soft tissue structure are broken, the first response is pain. Pain is the body signaling you to stop whatever is causing the damage to decrease the chance of accruing further injury to the area. Second, the body responds by sending in blood to provide the nutrients and building blocks for creating new, healthy tissue. The influx of blood also brings in white blood cells that clean out the area of damaged tissue. Finally, new fibers are laid down around the are to connect the soft tissue structure into a fully healed unity. This process usually takes between 10-14 days and is classified as an acute injury.


Managing your injury in this phase requires two key elements; providing a good healing environment for the body, and maintaining range of motion. A good healing environment can be achieved through plenty sleep, water, and relative rest. Relative rest is decreasing the movement or activity that caused the injury in the first place as much as possible, while not being completely sedentary. Walking, cycling, or other cardiovascular activities are fine to do as long as they are aggravating the injury site. Maintaining range of motion can be done by slowly moving the effected body part through its normal range with as little resistance as possible.


Tendonosis - disorganized tissue

An injury moves from tendonitis to tendonosis when the new fibers laid down after injury does not match the fibers that were initially injured. The most common issue is that the new tissue fibers are not oriented correctly, making the entire structure less able to deal with resistance. As stated before, a healthy tendon is structured like a box of uncooked spaghetti, with all the fibers facing the same way. After injury, the new fibers are laid down at random, creating a structure that looks like plate of cooked spaghetti. As you can imagine a plate of cooked spaghetti is less stable than lined up, uncooked spaghetti. Cooked spaghetti = tendonosis.

Having a tendon that is not organized appropriately leads to pain in the area during activities or even at rest. The pain may feel similar to when the injury was in the tendonitis stage, leading some to use tendonitis specific treatments. Unfortunately, relative rest and a good healing environment will not get a tendonosis injury better!

Disorganized tendon tissue :(

Tendonosis requires specific exercises and stretches to try and get the fibers rearranged in an appropriate orientation. There is a law with regards to the soft tissues in the human body called Davis’ Law, stating that a soft tissue structure will adapt to the forces put throughout it over time. For an injury in the tendonosis stage, progressive resistance and stretching exercises designed to add stress along a certain angle are necessary to regain maximum function. Always perform these exercises and stretches in a pain free state, if you feel that you are over doing it, you probably are! Talk to a rehab expert to get the exercises and stretches to do for your injury.



Organized, healthy tendon tissue!


In summary, knowing the difference between tendonitis and tedonosis is key to treating an injury successfuly and quickly. If you try to treat a tendonitis injury with progressive resistance and stretching, it could lead to longer healing times and overall more pain. If you try to treat a tendonosis injury with relative rest and anti inflammatories, you will not be able to effectively re arrange the tissue. Not every tendon injury will progress to tendonosis, and these tow categories are really on a spectrum rather than two individual buckets. The most basic way to knowing in which you land is time. If you have been dealing with a strain for more than a couple weeks, it is likely that you are dealing with a tendonosis injury. But don’t guess! Get assessed by a physical therapist to know for sure what to do and how to get functioning the best you can!

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