Differentiating Tendonitis vs Tendonosis?
Critical Difference in Distinguishing Joint Pain
Tendinosis, the degenerative condition in a tendon, is far more severe and much less diagnosed than its cousin tendinitis, an inflammatory condition. Although tendinosis diagnoses are less common, the condition is actually more prevalent, especially among athletes. The more alarming fact is that popular treatments for tendonitis can actually have little-to-no success when treating tendinosis, which could delay or even terminate an athlete's career.
Patellar tendinosis is often referred to as "jumper's knee" or "runner's knee." It occurs mostly with athletes whose knees, specifically the tendon, are making rapid movements in multiple directions and being overused, like those in sports such as volleyball and basketball, or with strenuous activities like running and hiking.
Differentiating Tendinopathies
"The majority of athletes with patellar tendinopathies usually fall into two categories: high school basketball players, and runners of any age coming in at a close second.
This injury is most certainly not limited to athletes of sports that mainly require movements like jumping. It's like tennis elbow; only about 10 percent of people who have tennis elbow actually play tennis. However, patellar tendinosis specifically is found quite often in the athletic population, especially among basketball and volleyball athletes.
So, why is tendinosis in general more common yet less diagnosed than tendonitis? For starters, it's not always noted as being a different condition than tendonitis. People in general have a tendency to let things go. The medical community in general is not as well educated on the differences as they should be.
There are medical practitioners and physical therapists that see patients who are coming in with anterior knee pain, and get a diagnosis from a medical doctor or their family physician that says 'patellar tendonitis' and they treat it as such. They treat it with ice massage, rest, and other tendonitis treatments.
It's crucial for therapists to delve into the causes behind the symptoms of these conditions, rather than just going off what they think the patient has.
Therapists should be using a process of elimination when it comes to figuring out whether their patient has degeneration or inflammation. Since the patellar tendon is so close to the skin, they should be looking for obvious, visible symptoms of tendonitis to rule out tendinosis.
What you should see with tendonitis patients are the hallmark signs of inflammation, like swelling, redness, or palpable amounts of fluid in or around the tendon. And if you don't see these signs, the pain the patient is experiencing is most likely caused by the degenerative condition rather than the inflammatory. In the absence of those symptoms, the likelihood is that people don't have tendonitis -- but they have tendinosis, and this condition must be managed in a different way.
Role of Eccentric Training
Treatments for tendonitis are vastly different from those of tendinosis, and there is no room for overlap. In fact, tendonitis treatments can worsen the condition of a patient who actually has tendinosis.
It could worsen the condition if you're talking using anti-inflammatories, icing and resting with no physical activity. The most important thing is to understand the mechanism of tendonitis and tendinosis, and the pathomechanics happening in the tendon. Rest and modification of activity and increasing inflammation is the opposite of what you want to do in a tendinosis condition.
So what are the right ways to be treating this condition? Eccentric training has been studied and shown to be a positive and effective treatment for tendinosis patients for multiple parts of the body. Research is clear that eccentric activity and eccentric training are going to be the best way to treat tendinosis. It's been shown not only in the knee, but also the hamstring, Achilles, elbow, shoulder -- all over the body.
In fact, eccentric loading and training should be the preferred, primary treatment for any PT to utilize before considering an alternative like surgery, which comes with its own risks and recovery time. In a 2006 study published by The Journal of Bone and Joint Surgery, authors performed a randomized controlled trial in which one group with patellar tendinosis received a 12-week eccentric training program, while the other group with the same condition went in for an open tenotomy, followed by an exercise regimen slowly leading to eccentric training.
The authors concluded that there was no particular advantage to open tenotomy surgery over an eccentric training intervention period. They recommend any tendinosis patient receive a 12-week rehabilitation program with eccentric training before considering surgical operations.
There's no question that if we are not fully versed in the difference in conditions and treatments, we could be setting up our patients for long-term disability and re-injury.
If you are experiencing any of these types of injuries, please let us know how we can be of assistance in providing you a thorough PT evaluation.