Talking Tendons
This week I wanted to cover some terminology differences commonly talked about. In graduate school, I had a professor that used to profoundly say “words mean things” which seems simple but the implication is that in order to transmit the right message, the right words need to be used. Essentially if people use different definitions for different words, communication fails. In the spirit of accurate communication, I wanted to talk tendons today.
First up is the word tendinopathy. The suffix opathy means “disease” so tendinopathy means there is a disease of a tendon. This is a broad, all inclusive category basically telling you that you have a problem with a tendon. Since there are other diagnoses under the umbrella of tendinopathy, it does not indicate a specific pathology. Now the terminology is ever evolving as researchers learn more and more, about 5 years ago, the word tendinopathy was a more specific diagnosis, which has now been replaced with the word tendinosis.
The word tendinosis means a disease process of a tendon which refers to the degeneration of that tendon. This is a process where a tendon is repeatedly damaged, then not given proper time to heal or something cuts the healing cascade short. This then leads to disorganization of the tendon matrix, and even the death of some of the tendon cells. This can slowly lead to muscle weakness, and an increased risk for tears. Tendinosis is something that develops over a period of time and does not come from a single insult, although sometimes a singular insult can bring pain to an already degenerating tendon. Pain can be present at any point in the continuum of degeneration.
Most of what people used to call tendinitis is really tendinosis. Tendinitis refers to acute inflammation of a tendon. This is when you do a repeated movement too much or with poor technique in a single session and the tendon becomes irritated and inflamed. Tendinitis is usually self resolving and will go away within a week. If you irritate a tendon multiple times in a row, now you progress into a tendinosis.
Now why is the distinction between them important? This matters because the treatment is different between the two. For tendonitis, rest and compression are the top treatments. We tend to want to avoid anti-inflammatory things because they cut the healing cascade short and can actually impair proper healing. For a tendinosis, we want to load the tendon. Typically we start with an isometric load (not moving). This is because tendons only know load or no load and we can use load to force them to heal, provided it's the right amount and we give adequate time to rest.
Hopefully this clears up some of the confusion around tendons.
