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Tendonitis versus Tendinosis: The Big Difference and Why it Matters

Tendonitis is a term you’re likely familiar with. You’ve probably even suffered from it at some point in your life. It’s 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. It involves deterioration of collagen, a structural protein in your tendon.  While the two conditions sound very similar, and are often used interchangeably, they couldn’t be more different. And the treatment for each condition should be different too.

Tendons are tight but flexible bands of fibrous tissue that connect your muscle to bone.

 

Without tendons, your muscles would be useless. Tendons are extremely organized, and the fibers are designed in a way to withstand and transmit high forces of tension so your muscle can function properly. 

With tendonitis, your tendon becomes inflamed and irritated, typically due to repetitive overuse.

 

Tendonitis causes pain when you try to move. The most common areas for tendonitis to occur are your elbows, rotator cuff (shoulder), patella (knee), and Achilles tendon (ankle). 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. Once you figure out and correct this pattern, it’s very easy to get rid of your tendonitis!

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

 

Tendinosis is a very different condition where the fibers in your tendon actually start to break down. An important 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 after an unresolved tendonitis issue. 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. 

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

 

They might help to relieve any pain you’re having from overdoing it or undertreating it — but the tendinosis will continue to progress. Unresolved tendinosis leads to progressive weakening of your tendon over time, making it easily susceptible to full blown tears. This is how so many folks tear their Achilles tendon 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. 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 many 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 not long enough to properly treat tendinosis.

The only way to re-organize those tendons is to put stress on them.

 

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.  This is literally the one time where “no pain no gain” is actually true. 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 that 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 instead, a breakdown of your tendon. Passive treatments will NOT work and could actually prolong your problem – so stop icing and resting. Getting rid of tendinosis requires carefully prescribed loading strategies (aka strengthening) that will properly re-organize your tendon so that it can be strong again! This is extremely challenging to do on your own, so it’s a good idea to talk to an expert about this. You can even schedule a FREE Discovery Session with one of our experts today!

 

Knee Pain while Running? Don’t Blame Arthritis

Is running bad for your knees? Does it cause arthritis?

We get asked these questions a lot, especially by clients who are in their 50s and 60’s and wondering if it’s safe to keep running.

The short answer is no — running is NOT bad for your knees! If you experience knee pain when you run, it’s not that you’ve “aged out” of the sport or that it’s causing arthritis in your knees. This is a very common misconception. In fact, research supports that running may actually be GOOD for your knees!

Staying strong, active, and mobile is your best defense always against osteoarthritis.

Therefore runners, because they are typically active and healthy individuals, often have healthier knees compared to non-runners.

Ok then — so if not arthritis — what really causes knee pain in runners?

In most cases, it’s simply a biomechanical issue that goes unaddressed over time. But the GOOD news is that once identified, these issues can actually be fixed with proper education and strengthening (best offered by movement specialists like us!).

Here are three of the most common factors we see that are often the true culprit of knee pain when you run (not arthritis):

1) Poor ankle mobility

Ankle mobility affects the way force hits your foot, which can impact your knee. If your ankle doesn’t move fully, freely, and adequately, excess forces will be shifted up to your knee. The knee may be forced to flex, rotate, and/or tilt more than it needs to. This, in turn, may result in unwanted loads that the tissues of the knee can’t handle. An expert in biomechanics and movement can not only help you identify if this is the true root of your “knee problem,” but can also help you improve your ankle mobility in order to prevent long term damage to the joints, tendons, and ligaments of your knees. We actually see this as a very common problem in those that have sprained or twisted their ankles in the past. If that’s you, this could be a reason why you’re suffering from knee pain while you run.

2) Weakness in your hips and thighs

There’s a widely perpetuated myth out there that runners don’t need to strength train. That’s simply not true! Adding strength training to your running regimen makes it way less likely that you’ll suffer an injury. When it comes to protecting your knees, developing good, balanced strength in your hips and thighs is critical. The hamstring and quadriceps muscles play a crucial role in stabilizing the patella, otherwise known as your kneecap. Since running is extremely repetitive on your joints, especially your knees, it requires they have good durability and endurance — something that is lost quickly when you neglect proper strength training. Often “wear and tear” in your knees (otherwise known as arthritis) will get blamed for your knee pain when in actuality, the loss of strength around your knees is what’s causing that wear and tear to feel worse than it needs to.

3) Unstable core

It may seem like running is all in the legs, but the stability of your pelvis and trunk have a huge influence on how your legs perform. You derive the majority of your power, speed, and stamina from your core muscles and glutes. Much like with ankle mobility, if your core is not performing adequately or efficiently – your legs will have to work harder. A stable core is key for developing and maintaining good balance and rhythm with any activity – but especially running. With a repetitive activity like running, efficiency and form is everything. Without a strong core, it’s impossible for your leg muscles and knee joints to work as efficiently as they were designed to, and it will be really difficult for you to maintain good and proper running form mile after mile. When your core strength is weak, and doesn’t have enough endurance to sustain the amount of miles you want to run, your knees will suffer.

What’s important for you to remember is that arthritis is NORMAL — everyone gets it as they age. 

What doesn’t have to be “normal” is for arthritis to stop you from running, or doing any other activity that you love. You can get surgery to fix the “wear and tear” in your knees, or injections to decrease the inflammation, but if you don’t check and address any underlying biomechanical issues, these fixes will be temporary and your knee pain will keep coming back. And worse… they could force you to stop running all together!

If you’re suffering from knee pain and it’s starting to impact your ability to run or do any other activity that you love, you might want to join us for our next live Zoom workshop: Preventing and Overcoming Knee Pain so you don’t have to stop activities you love! 

It’s FREE and happening on Tuesday, Aug 25th, from 6-7pm. Just follow this link to reserve your virtual seat.