Staying with the theme of new year’s resolutions, there may be some new injuries you run into while working out. A common one that likes to show its ugly self is tendonitis. Tendonitis by definition, is an inflammation of the tendon. Tendinosis is an intratendinous (within the tendon itself) degeneration commonly due to aging, microtrauma or vascular compromise.
Now, to give you some background information. Tendons are the physical links between muscles and bones. They are specially designed to transmit mechanical energy. Most tendons are cordlike or strap-like structures of different length and cross sectional profile. Their thickness is proportional to the size of muscles from which they originate and to the degree of tension applied to them. They are made up of different types of collagen, of which 95% is type I collagen, the strongest fiber in the body, elastin and proteoglycans.
An appreciation of the structural organization of the tendon, including the surrounding connective tissue sheaths, is important in understanding tendon injuries and their classification. With the use of a light microscope and an electron microscope, depending on the location of the tendon, there are ten different parts of a tendon, from the external paratenon sheath to the individual microfibril strands.
Tendons are able to withstand an incredible amount of tension. To be exact, the tensile strength of a tendon is approximately 620 to 1050 kg/cm. The absolute strength of tendons is difficult to measure. Nevertheless, tendons are strong enough to withstand several times the tension that their attached muscles can generate. This and the ability of tendons to resist stretch appear to be due to their chemical composition and structural organization.
A tendon with tendinosis shows a loss of collagen and an absence of inflammatory cells. Therefore, treatment of tendinosis needs to combat collagen breakdown rather than inflammation. It may require a period of rest and attention to strengthening with the aim at breaking the tendinosis cycle. Once this is done, modalities that optimize collagen production and maturation are used.
Patients who have a short duration of symptoms but are stil able to “warm up” the injury and engage in sports are the ones who need the most education. They are likely to continue in sports without undergoing appropriate treatment, and thus worsen the tendinosis.
In order to address tendinosis we must first consider a few areas with the diagnosis.
- Training errors are a common cause of tendinosis. Assess any equipment being used, examine movement biomechanics and diagnose and treat of any muscle imbalances.
- Patients who have a short duration of symptoms but are stil able to “warm up” the injury and engage in sports are the ones who need the most education. They are likely to continue in sports without undergoing appropriate treatment, and thus worsen the tendinosis.
- The pathology of tendinopathies show abnormal neovascularization, patients will benefit more from cryotherepy due to ice having a vasoconstrictive role. NSAIDs and corticosteroids show little evidence of being helpful. Since tendinopathies are not an inflammation and corticosteroid injections inhibit collagen repair around the tendon.
- Braces and supports that decrease load through the tendon may benefit the patient since tendinosis results from excessive load on collagen.
- Short duration tendon symptoms could take an average of 2-3 months of treatment; chronic symptoms may require a longer period of time to achieve a similar outcome, depending on the condition and the patients response to treatment.
- With the appropriate strengthening home program, clinical effectiveness has been shown with eccentric strengthening exercises. Strengthening stimulates mechanoreceptors in tenocytes to produce collagen and help reverse the tendinosis cycle.
Tendinopathies have proved to be frustrating to both the patient and to the healthcare providers. This may be due to attributing the pathology to tendinitis rather than tendinosis. At Premier Sports and Spine Center
we acknowledge that the cause is most often due to tendinosis not tendonitis. Our treatment style offers a different approach to treat the problem and can help you recover more quickly and avoid unnecessary or ineffective treatment.