Ask the Expert: Tendonitis versus tendinosis

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Q: I have done martial arts training for 12 years and last summer in preparation for my black belt exam I significantly increased my training volume. I quickly developed tennis elbow and many activities suddenly became painful. I have tried everything to make this go away, including anti-inflammatory drugs, corticosteroid injections, rest, and countless hours of physiotherapy. Because I wasn’t improving, an ultrasound was ordered which shows I have tendinosis. What is tendinosis and is this the same thing as tendonitis?

— Frustrated

A: Dear Frustrated:

Tendinosis and tendonitis are not the same thing. Tendinosis is a chronic problem, where tendons develop microscopic tears and progressively degenerate without inflammation. Tendonitis is an acute condition where tendons become inflamed, but if treated correctly will not experience any structural damage. Regrettably, many cases of tendonitis are not treated properly and they eventually deteriorate into tendinosis. Tendinosis is a very common problem and it frequently affects the Achilles, patellar, elbow and rotator cuff tendons.

The symptoms of tendinosis include pain, stiffness, and reduced strength, and in some cases a tender lump develops within the tendon. Unlike tendonitis, tendinosis does not cause the affected tendon to become red or warm to the touch. People with tendinosis often experience discomfort and stiffness with activity, but these symptoms are worse after they finish their workout and are inactive for a while.

Tendinosis is extremely discouraging as it can take many months and occasionally several years to resolve even if treated correctly. This prolonged healing time occurs because the affected tendon must be rebuilt at the cellular level and because tendons have a limited blood supply.  Since tendinosis is not an inflammatory problem you will not get sustained benefit from anti-inflammatory medications or corticosteroid injections. Research shows that tendinosis responds to a limited number of treatment approaches. Carefully progressed eccentric strengthening exercises are very helpful, as they seem to stimulate the microscopic structure of the tendon to change and become stronger. Nitroglycerine patches can help by improving the blood flow to the damaged tendon. Staying sensibly active doing non-explosive activities, such as swimming, walking, or cycling, also seems to stimulate tendon healing.

The bottom line: tendinosis is very common and it can be extremely challenging because it takes so long to heal. Fortunately for you there are many aspects of martial arts that you can focus on while you give your tennis elbow adequate time to properly heal. Good luck on your exam. Exercise is medicine!

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