Tendonitis vs Tendonosis

When someone is experiencing an issue with their tendons, many may assume it is tendonitis such as Achilles tendonitis, patellar tendonitis, tennis elbow (lateral epicondylitis), or rotator cuff tendonitis. A tendonitis is inflammation of the tendon caused by too much load often associated with an episode of lifting too heavy or a sudden strenuous event.¹ For many people with tendon injuries, there is no specific event that can contribute to their symptoms and in fact occur gradually over a long period of time. There also may not be the presence of inflammation and swelling.^1,2 This is why symptoms can continue to persist despite doing things like icing the area and/or taking anti-inflammatory medications. If there is no inflammation and swelling, then these will be ineffective treatment options.

If it is not tendonitis, then what is it?

Tendinopathy is the term used to describe all issues pertaining to tendons such as tendonitis and tendinosis.² Tendinosis is the term used to describe issues with the tendon as a result of overuse, usually occurring over longer periods of time.² A number of different activities can fit this description, but the main contributor is the repetitive nature of the activity. Examples can include running, repeated use of a screwdriver, typing, swinging a tennis racket, etc. The main driver is that the level of activity exceeds our ability to recover from the task.

Why is it important to know the difference?

The treatment for tendonitis vs tendinosis varies greatly. For example, tendonitis includes swelling and inflammation and may benefit from treatments focused on reducing this swelling.² This includes anti-inflammatory medications or the well-known treatment option of RICE (rest, ice, compression, elevation). But if the issue is tendinosis, then inflammation is not the major driving contributor to pain, and these treatments will not resolve symptoms. Tendinosis will benefit more from gradual strengthening to improve the tendon’s ability to handle the demands placed upon it.^3,4,5

How will your Physical Therapist treat tendinosis?

This depends on a number of different factors. For instance, the early stages of the condition can heal in just a few weeks or months while more chronic issues can take up to a year or more in duration.^1,2,3 Also, the location of symptoms may play an important role where the treatment approach to Achilles tendinosis could look different from Patellar tendinosis.^4,5 It is our job, to determine the best treatment route, work strategies, and progression in order to resolve your issue.

Some potential interventions Your Physical Therapy may use include:^2,4,5

• Work and daily activity modifications
• Manual therapy
• Gradual strengthening

Disclaimer: There are a number of different causes of symptoms that may present as tendon-related issues. A Physical Therapist is trained to determine the cause and how to resolve your symptoms.

1. Thomopoulos S, Parks WC, Rifkin DB, Derwin KA. Mechanisms of tendon injury and repair. J Orthop Res. 2015;33(6):832-839. doi:10.1002/jor.22806
2. Bass E. Tendinopathy: why the difference between tendinitis and tendinosis matters. Int J Ther Massage Bodywork. 2012;5(1):14-17. doi:10.3822/ijtmb.v5i1.153
3. Cook JL, Rio E, Purdam CR, Docking SI. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?. Br J Sports Med. 2016;50(19):1187-1191. doi:10.1136/bjsports-2015-095422
4. Figueroa D, Figueroa F, Calvo R. Patellar Tendinopathy: Diagnosis and Treatment. J Am Acad Orthop Surg. 2016;24(12):e184-e192. doi:10.5435/JAAOS-D-15-00703
5. Silbernagel KG, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. J Athl Train. 2020;55(5):438-447. doi:10.4085/1062-6050-356-19
6. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies.