Understanding the Key Differences Between Tendinitis and Tendinosis

You've dealt with nagging tendon pain for a while now, maybe it's your Achilles, elbow, or shoulder, and you're calling it tendinitis because that's where your Google searches lead. But it might not be tendinitis at all. 

And, if you're treating the wrong condition, you could be spinning your wheels. 

At Active Rehab Clinics in Bucktown, Chicago, and Park Ridge, Illinois, Tony Zemlinsky, DC, specializes in diagnosing tendinitis and tendinosis. In this month's blog, he helps you understand the distinction and how it may affect your recovery.

Let's take a closer look at the key differences between tendinitis and tendinosis.

One is inflammation, and one isn't

Tendinitis (“-itis” is the key) is an inflammatory condition. Your tendon is irritated and inflamed, typically due to a sudden increase in activity or an accident that overloads it.

Tendinosis isn't primarily inflammation. Instead, it's a chronic degenerative condition that develops when wear-and-tear breaks down the collagen fibers in your tendon over time.

How long you've had it

Tendinitis comes on quickly, and with proper rest and care, it often resolves in a few weeks. Tendinosis develops slowly, often over months or even years of repetitive stress. With lingering tendon pain, tendinosis is probably the culprit.

Here's a quick way to think about it:

• Tendinitis: sudden onset; pain is sharp
• Tendinosis: gradual onset; pain feels chronic

The longer you've had to deal with it, the greater the likelihood that it's more than inflammation.

The pain feels different

With tendinitis, you may notice that pain flares up when you're active and calms down when you rest. There's typically some swelling and tenderness, too. 

Tendinosis produces a stiffer, duller pain, especially when you get up in the morning or after periods of inactivity. You might notice stiffness that loosens up once you get moving, only to ache again later.

This difference matters a lot when it comes to conditions like Achilles pain and tennis elbow, which can present as tendinitis or tendinosis, depending on how the injury occurred and how long you've gone without treatment.

Anti-inflammatory medications work for one, not the other

Since tendinosis isn't due to inflammation, anti-inflammatory medications (NSAIDs) and ice therapy won’t do much for it. Long-term reliance on NSAIDs (like ibuprofen) for tendinosis may interfere with the collagen remodeling that your tendon needs to heal.

Tendinosis requires an approach that focuses on regenerating healthy tissue. That's where targeted physical therapy, specific exercises, and hands-on treatment come in. Dr. Z's goal is to calm the irritation and help your tendon rebuild its structure.

Treatment timelines are different

Tendinitis, if caught early, can resolve in weeks, but tendinosis can take months of consistent rehabilitation to heal. A personalized treatment plan that accounts for your movement patterns, load tolerance, and activity level can make a difference.

Dr. Z incorporates tools such as motion capture analysis to assess how your body moves and aquatic therapy to help you load the tendon progressively without reaggravating it.

Schedule an evaluation by phone or online today at the Active Rehab Clinics location near you to determine if you're dealing with tendinitis or tendinosis.