Tendonitis vs. Tendinosis

Why won’t that tendinitis heal?

At some time in our life we all face or know someone who has faced some injury labeled as an “-itis”. Thereare a few common maladies that seem to creep into our everyday vocabulary. These are usually labeled along with an accompanying sport such as; Runner’s knee, Tennis elbow, golfer’s elbow, or swimmer’s shoulder. A couple of these seem to defy the sport naming rule and stand alone, such as Achilles tendonitis and plantar fasciitis. These will strike a resonant cord with you who have felt the sting of these particular pains as they are often difficult to resolve. This difficulty has often been due to the fact that the pain we are experiencing may not in fact be an “itis” at all. It may  in fact be something not as simple as a structure that is simply inflamed or irritated but has actually become weakened and intolerant of activity. We now are experiencing the effects of an “osis”. How can you tell and what exactly is different? Most of the time pain is experienced after a single bout of over exertion or a rapid increase in volume of activity. This situation will irritate tissue and the classic “itis” is experienced.  We don’t give this too much thought because it usually last about 2 weeks and then resolves. Once this pain continues beyond two weeks the body takes notice and we see tissue changes start to occur. The change is basically a failure of the body to build connective tissue faster than it is breaking down.

For those of you familiar with old TV shows, I like to think of Lucille Ball in the candy factory episode. She is supposed to be wrapping candy as it comes down the conveyor belt. The belt speeds up and she loses control so the candy is going everywhere except where it is supposed to be going. The system is not working so something has to change in order for poor Lucy to get back on track.   Classic treatment for an “itis” is Rest, Ice, Compression, and Elevation. Your doctor may also recommend anti-inflammatory medication. If this is done the tissue will calm down and activity can be re-introduced.   Classic treatments for an “osis” are a little more complex. The trick is to re-fortify the tissue to make it more tolerant of activity. The problem is that the tissue is weakened and will often react with a painful response. This response is often NOT a result of inflammation but instead because of the changes in the tissue. One of the characteristics of an “osis” is that it is recalcitrant to treatment. Discussion with your health care providershould include the different options available for your individual diagnosis. The role of a physical therapy program is to provide specific systematic progressive overload, muscular endurance, and speed of exercise to improve muscular power. These exercises should be performed in sound biomechanical patterns to avoid secondary stresses (i.e. avoid “my ankle feels better but my knee sure hurts now”).

Call your health care provider and get the help you need to treat these “all-too-common” ache and pains. Move Well!

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