“Tendonitis vs. Tendinosis” Overuse Injuries in Athletes

by John Smith MS, PT Cert. MDT

Hey sports fans, the school year has started and a new season of fall sports is underway.  Having been a collegiate and high school athlete myself, I understand the excitement and the pressure that our young athletes endure each week.  When I played high school sports at Sumner Academy, I remember having two and sometimes even three football practices a day in the 90 degree August weather. Although this practice hasn’t changed much, I have begun to see an increasing number of athletes participating in more than one sport, playing the same sport year round and having overlapping seasons, which takes a toll on the body.
As a physical therapist at Preferred Physical Therapy, in today’s youth sports I am beginning to see a higher incidence of overuse related injuries which in some cases can lead to worse injuries such as ACL tears. This increasing trend of overuse related injuries in my opinion is closely related to the increase in sport activity available to our young athletes, specifically those participating in the same sports year around.  Participating in same sport all year continues to stress the same muscle groups and never allow the muscles enough time recover.
When I played sports, there was always an off season, a time during which the athlete was allowed to recover and prepare for their next sport.  I don’t remember ever having a football game on Monday and then a fall baseball game on Tuesday.  However, in today’s world some athletes are playing the same sports year around and up to three or four sports simultaneously with no off season. For example, my nephew was telling me his schedule for the weekend, and it consisted of weight conditioning in the morning, football practice in the afternoon and a fall baseball tournament which could include up to six games.
My co-worker, who has four kids of her own, was talking about a football tournament for her son that could have multiple games in one weekend. This was unheard of in my days of playing sports. Although I don’t foresee a change in the increasing demand and trend to play multiple sports at one time and year around with overlapping seasons,  I do predict that we will continue to see a steady  increase in incidents for overuse related injuries in today’s young athletes.
What exactly is an overuse injury, you might ask? 
In the rehab world a high percentage of these injuries are referred to as tendonopathies.  There are two types of tendonpathies that we usually refer to, tendonitis and tendonosis. Tendonitis is the diagnosis most people are familiar with because it is used quite often.  However, we are learning that in many cases the injury has actually progressed further and should more accurately be diagnosed as tendonosis. There continues to be much confusion between the two injuries, and healthcare providers are just beginning to understand the process.
There are many factors that lead to these types of injuries including chronically tight muscles, poor biomechanics and alignment of a joint, activity levels, repetitive strain and many others. However, the most commonly accepted cause for these conditions are seen to be an overuse syndrome in a combination of factors leading to what may be seen as a progressive interference or the failing of the innate healing response.
Recognizing the symptoms for both diagnoses is extremely important and could mean the difference between returning to sports pain free within a week and suffering from a nagging injury all season long that could lead to something more serious.
I think it is important that the athlete, parent and even coach know the early signs and symptoms for both tendonitis and tendonsis. One reason it is important to know the difference between the two is because the treatment for both may vary. If the athlete is being treated inaccurately for tendonitis instead of tendinosis, then there is a good chance his symptoms will never improve. For example, an athlete who is being treated for tendonitis in the knee during basketball season will continue to suffer from the same problem late into track season because he hasn’t been doing the right exercise.
Tendonitis usually presents with pain at the affected area during movement or activity, swelling and tenderness to touch is common, and the pain is usually achy or sharp. This usually occurs when you have used a specific muscle too much over a short period of time. The classic example is Achilles tendinitis that occurs after a long or hilly run. It can also occur by playing too many sets of tennis or swimming excessively during one practice session.
Tendinosis has similar symptoms with pain at the affected area but often starts after the activity instead of during. The pain is often described as dull and sometimes radiates from the affected area. In addition, tendinosis is usually a chronic problem with a tendon that  has lasted at least 6-8 weeks. An example of this is the Achillies tendon that has been nagging you for months after every each football practice and doesn’t seem to be improving.
So where do we start when treating these problems?
First, you need to determine whether the problem came on quickly (for example, over a few practices or even from a single event) or if the problem was a slow progression and/or you can’t remember exactly when it started. Initially the treatment for both may be similar, but in the long run the treatment will be different.
A good place to start is to initiate rest, ice and over-the-counter pain relievers; your athletic trainer or primary doctor will most likely suggest these things as well.  Regarding ice, I much prefer ice massage using ice cups for treating tendonopathies. To do this, you can add water to a small Styrofoam cup and place it in the freezer until it is solidified. Once it has reached the frozen state, you peel away the top to expose the ice and then slowly massage the painful area for 5-8 min or until the area is numb. I believe an ice massage is much more effective than an ice pack, and furthermore it takes less time and isolates the problem much better.  
If problems persist after a few days, then you may need specific exercise to get you over the hump. This may include both gentle stretches and strengthening exercises to the affected area.  There is also an increasing amount of research and rapidly growing popularity for eccentric exercise to these types of injuries. Eccentric training is the lowering phase of an exercise.
For example; in a standing heel raise, the eccentric component is the part of the exercise where you lower your heels down slowly to the floor. Some other traditional treatments include corticosteroid injections from your doctor. This type of treatment in most cases is mainly effective for tendonitis.  It is also important to know that anti-inflammatory medications (NSAIDs) and/or corticosteroid injections can actually accelerate the degenerative process and therefore make the tendon more susceptible to further injury as well as a longer recovery and may increase the likelihood of rupture.
As mentioned above, there can be other factors that are contributing to your problem. In these circumstances, you may need to be evaluated by someone who specializes in musculoskeletal injuries such as an orthopedic physician or physical therapist.
Take Home Points

§  Overuse injuries include both tendonitis and tendonisis
§  Start with rest, ice and over-the-counter pain relievers
§  If problems persist for several weeks, you are most likely dealing with tendinosis
§  Seek a medical professional if symptoms persist

John Smith MS, PT Cert. MDT is a Physical Therapist and the clinic director at Preferred Physical Therapy (www.kcppt.com) located at 8437 State Ave KCK. He specializes in orthopedic injures and his professional interest include spine rehab, injuries of the shoulder and knee, sports injuries, running injuries and post operative rehab.