Misdiagnosis: Tendinitis
[From left to right: what a tendon is supposed to look like; one with tendinitis; one with tendinosis. Credit: Vicky Earle]
Did you know that most athletes who believe they’re plagued by tendinitis (also spelled tendonitis) actually have tendinosis (also spelled tendonosis)? Stupid athletes.
Just kidding — in many instances, a doctor or physical therapist misdiagnosed the problem, and that misdiagnosis can mean wasted treatment time, prolonged pain and lost sports seasons. Stupid doctors. (Kidding again!)
But there are some pretty important distinctions. Tendinitis involves inflammation of the tendon, doesn’t last longer than a couple weeks and heals just as fast, while tendinosis involves degeneration and can go on and on (and on), until you’re able to stimulate collagen regeneration in the injured area.
As far as treatment options go, while tendinitis responds well to ice, rest and anti-inflammatories to treat the inflammation, tendinosis does better with therapeutic exercises — mainly of the eccentric, or negative, variety.
Had I known that five years ago, I might have had a less irritating relationship with my knees. Some of the same strengthening therapies would have held true, but I wasted an awful lot of time treating inflammation that wasn’t there.
The differences between the conditions, as well as some of the best treatment options, are covered in more depth in the May Experience Life article “Tendon Trouble,” which, if you’ve ever struggled with a case of tennis elbow or runner’s knee that you can’t shake, is worth a read.
I also really like this article at Runnersweb.com. Some highlights:
- At least 25 percent of athletes treated for knee problems at major sports clinics are typically diagnosed with tendonitis, but there is strong evidence that the majority of athletes diagnosed with tendonitis are not really suffering from the disorder.
- The “tendonitis plague” may actually be a severe outbreak of tendonosis, not tendonitis.
- A reasonable course of therapy for tendonitis, an inflammatory condition, would involve the use of anti-inflammatory drugs; in fact, non-steroidal anti-inflammatory medications have become the mainstay of treatment for so-called “overuse” injuries to tendons. The trouble is that there is evidence that anti-inflammatory drugs can actually have a negative impact on the progress of tendonosis, in effect retarding the healing process.
- It is clear that a tendon [suffering from tendinosis] needs to be mechanically stimulated in order to begin the process of activating its fibroblasts and synthesizing significant quantities of new collagen fibers; complete rest would prevent this from happening.
- One tried-and-true treatment for tendinosis involves the deliberate, eccentric loading of a painful tendon and its muscle, a process which seems to accelerate strengthening of both the tendon and its associated sinew.
In other words, rather than endlessly icing, resting and popping anti-inflammatories, those of us with suspiciously long-lasting “tendinitis” might be better served by adjusting our routines and doing eccentric exercises to stimulate healing.
May 14th, 2008 at 7:03 am
Very interesting! I had no idea there was even a difference! Know any eccentric exercises for wrists??
May 14th, 2008 at 9:02 am
Hi, Charlotte,
I’m checking in with a few of the sources from the EL article, and I’ll let you know what I hear back.
In the meantime, I came across this video of an eccentric wrist exercise, and while it might be slightly more EK-centric than EE-centric (I think it’s the creepy living room), it has potential:
www.coopersguns.com/videos/rehab-exercises/elbow/eccentric-wrist-extension-kneeling
May 14th, 2008 at 2:49 pm
what exactly are eccentric exercises? and does glucosomine chondroitin help either tendonitis or tendonosis?
May 14th, 2008 at 3:10 pm
Eccentric exercises are described in depth in “Put the Weight Down!” but in general, you can think of them the lowering part of any exercise.
Example 1: In a pull-up (naturally we’ll talk about pull-ups), the concentric part of the exercise is when you pull yourself up. The eccentric part of the exercise is when you lower yourself down.
Example 2: In a bench press, the concentric part of the exercise is the push; the eccentric part is where you lower the bar to your chest.
When you do eccentric exercises, you place extra emphasis on this lowering phase, either by lowering weight more slowly than usual or by lowering more weight that you could lift concentrically.
These exercises tend to yield drastic results — and drastic delayed-onset muscle soreness, as they’re thought to tear up muscle fibers like nobody’s business. In a good way!
As for glucosamine and chondroitin’s effect on tendon health, good question, I’m not sure. But given that those substances reduce pain and swelling in joints, I wouldn’t think it’s out of the realm of possibility. (Even though I think their effect is mostly on cartilage? Does anyone know the answer to this?)
Regardless, it certainly doesn’t hurt to eat for joint health — that is, to include things like vitamins E, C, A, B5 and B6, as well as omega-3s, in your diet, but as to whether their impact on tendons have actually been studied? Unsure.
May 15th, 2008 at 2:58 am
Jen, I think you’re right about glucosamine/condroitin’s effect on the tendons. (Warning, big words ahead.) Tendonosis, for example, causes a decrease in the tendon’s collagen, but an increase on proteoglycans and glycosaminoglycans, such as chondroitin sulfate. Since glucosamine and chondroitin help build proteoglycans, you wouldn’t expecting adding more of these to your body to do much good.
Other studies may have shown something else, but I’m not aware of any. Anyone else?
May 15th, 2008 at 9:43 am
Monica to the rescue! Fabulous!