What Is The Physio Treatment & Self Management
Tendonitis vs Tendinosis
What Is A Tendon?
A tendon is a dense and strong connective tissue that connects our muscles to our bone, it transmits force from muscles to the bone resulting in movement.
The Difference Between Tendonitis & Tendinosis?
Now that we have outlined what a tendon is and its role in the human body, let us discuss the difference between tendonitis and tendinosis. The suffix “itis” is inflammation and “osis” indicates degeneration. It’s important to know the difference between both due to varying treatment goals and diagnoses.
Tendonitis is acute inflammation in the tendon, it is usually caused by micro-tears in the tendon when it has been overloaded. Tendonitis is normally acute and is accompanied by other signs and symptoms of inflammation such as stiffness in the morning, thickening of the tendon, tenderness, and swelling that may become worse during the day and after exercising.
There are two main types of achilles tendonitis depending on which part of the tendon is affected.
Non-insertional & insertional tendonitis
Non-insertional tendonitis refers to inflammation and breakdown of the middle portion of the tendon, whereas insertional achilles tendonitis involves the lower portion of the heel where the tendon inserts into the heel bone.
Contributing factors to achilles tendonitis include:
A sudden increase in the intensity or frequency of activity, for example, an increased running frequency or distance everyday without giving your tendons a chance to recover and adjust to the new distance or load.
Tight or overactive calf muscles can contribute to putting extra load on the achilles tendon, especially when there is a change in baseline activity level. For example, suddenly starting a running or exercise program without first easing into it.
Bony spur refers to extra bone growth where the achilles tendon attaches to the heel. This bone spur can be sharp and can rub against the tendon causing pain.
Tendinosis is the chronic degeneration of a tendon related to an overuse injury, when tendinosis occurs, the collagen fibers and cross-section of a tendon become more fragile and disrupted. We often see tendinosis in people that exercise heavily and don’t allow enough rest between exercise sessions.
This type of overuse injury can be managed by identifying training errors such as exercise form, dose, frequency, duration, and intensity. Tendinosis can also occur when highly repetitive work tasks are undertaken and the tendon is loaded repeatedly beyond its threshold due to compensatory movement patterns or weakness.
Achilles tendinopathy more often than not occurs due to repetitive microtrauma. People with this often present with pain behind the heel, some swelling, and calf stiffness that is worse in the morning and goes away after it is warmed up. They usually have limitations when walking, running, and jumping.
What Is The Treatment From Physio & What Can You Do To Self-Manage The Problem?
In tendinitis, the goal is to essentially reduce inflammation, early interventions include ice and appropriate rest. Early Physiotherapy education regarding activity modifications and appropriate movement is vital to help with pain relief and prevent reaggravation.
In contrast, the aim in successful rehabilitation of tendinosis is to appropriately load the tendon in a way that promotes tissue remodelling to reduce pain and improve function. This can be a slow process which can take up to 3-6 months as tendons have less blood supply compared to other tissues and bones. Understanding this will enable you to work better with your Physiotherapist along your rehabilitation journey.
The type of treatment offered and rehabilitation program varies depending on your goals and type of tendon injury. Please visit your nearest local core physiotherapy clinic for further assessment and individualised programs.
This blog post was written by Jasmin from the Gawler Place Physio practice.
Elnaggar, S. (2020). Tendinitis vs. Tendinosis: Important differences for rehab and treatment. Retrieved from https://theprehabguys.com/tendinitis-versus-tendinosis-important-differences-for-rehab-and-treatment/
Orthoinfo. (2010). Achilles Tendinitis. Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendinitis/
Physiopedia. (2020). Achilles Tendinopathy. Retrieved from https://www.physio-pedia.com/Achilles_Tendinopathy
Physiopedia. (2020). Tendon Biomechanics. Retrieved from https://www.physio-pedia.com/Tendon_Biomechanics