Tendinitis is not tendinitis

Tennis elbow, golfer’s elbow, Achilles tendinopathy, and rotator cuff pathology are different types of tendon pain or tendinopathy. It used to be called tendinitis. Tendinitis refers to discomfort in the tissue that connects muscle to bone. The term tendonitis comes from the Latin “tendo” for tendon (any tissue connecting muscle to bone) and “itis” meaning inflammation. Technically, a diagnosis of tendinitis means inflammation of the tendon. In the previous century, healthcare professionals commonly believed these conditions were inflammatory in nature.

Tendon pain (tendinopathy) Typically Does Not Involve Inflammation

We know better, now. Examination of the cells in these painful scenarios show us that after the first week, inflammatory cells are not part of the problem.¹ Nevertheless, if you do an internet search for the term “tendinitis,” even to this day you are likely to see several definitions that still refer to inflammation. More importantly, some traditional ways of thinking about tendinitis lead to concepts that are counterproductive to overcoming it.  

Old Concepts Lead to Counterproductive Concepts

A common self-management approach is to try anti-inflammatories and rest until the pain reduces and then resume normal activities, but this frequently does not fix the problem^2,3 Some anti-inflammatory treatments create short-term pain relief but may make the tendinitis worse in the long term.⁴ More importantly, thinking of the problem as an inflammatory disorder leads to the false perception that beating the inflammation means beating the problem. Inflammation does occur, but only at the initial stage.

How to Beat Chronic Tendinitis

Rest is a good strategy for allowing the tendon to heal from a current painful episode. Ice is also helpful, but probably from its blood-flow-enhancing effect when timed properly. True rehab and recovery may require modifications to posture, athletic technique, strength, range of motion, activity choices and muscle balance. Each of these directly affect the level of stress put on tendons during activity. It is likely that pre-existing deficits in one or more of these variables predispose some workers and athletes to tendinopathies. A number of studies show that therapeutic exercise programs focusing on these factors improve both short-term and long-term outcomes in various types of tendinosis.^6-14

Conclusion

The term tendinitis is long-standing, and most people know what it means. For that reason, it is likely that people will keep using it for many years to come. It would be nice if people switch to a term such as tendinosis, which is less of a misnomer, but vocabulary is not the main issue. The main issue is to not use approaches based on the idea that tendinosis is about inflammation. Tendinosis is about an ongoing mismatch between the recurring demands imposed on a tendon and the tendon’s ability to recover from those strains. Improving our preparation for those demands allows us to continue our activities with less chance of pain and injury.

References:

1. Kahn K, Cook J, Kannus P, et al. Time to abandon the “tendinitis” myth. Painful overuse tendon conditions have a non-inflammatory pathology. BMJ 2002; 324: 626-627.
2. Rees J, Wilson A, Wolman R. Current concepts in the management of tendon disorders. Rheumatology (Oxford). 2006 May; 45 (5): 508-21.
3. Cosca D, Navazio F. Common problems in endurance athletes. Am Fam Physician 2007; 76: 237-44.
4. Coombes B, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010; 376: 1751-67.
5. Rees J, Maffulli N, Cook J. Management of tendinopathy. Am J Sports Med 2009; 37: 1855-67.
6. Wilson, Sevier Helfst R, et al. Comparison of rehabilitation methods in the treatment of patellar tendinitis. Journal of Sport Rehabilitation. 2000; 9 (4).
7. Jonsson P, Alfredson H. Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomised study. British Journal of Sports Medicine. 2005; 39 (11): 847-50.
8. Chen P, Hong W, Lin C, et al. Biomechanics effects of Kinesio taping for persons with patelllofemoral pain syndrome during stair climbing. In 4th Kuala Lumpur International Conference on Biomedical Engineering 2008. Springer Berlin Heidelberg. 2008: 395-397.
9.  Linschoten R, van Middelkoop M, Berger M, et al. Supervised exercise therapy versus usual care for patellofemoral pain syndrome: An open label randomised controlled trial. BMJ (Clinical research ed). 2009; 339: b4074.
10. Tonks J, Pai S, Murali S. Steroid injection therapy is the best conservative treatment for lateral epicondylitis: A prospective randomised controlled trial. Int J Clin Pract. 2007; 61 (2): 240-216.
11. Cleland J, Flynn T, Palmer J. Incorporation of manual therapy directed at the cervicothoracic spine in patients with lateral epicondylalgia: a pilot trial. The Journal of Manual & Manipulative Therapy. 2005; 13 (3): 143-151.
12. Croisier J, Foidart-Dessalle M, Tinant F, et al. An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy. Br J Sports Med. 2007; 41: 269-275.
13. Liu Y, Shen S, Liin C, et al. Motion tracking on elbow tissue from ultrasonic image sequence for patients with lateral epicondylitis. Conf Proc IEEE Eng Med Biol Soc. 2007: 95-8.

Alfredson H, Peitila T, Jonsson P, et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. The American Journal of Sports Medicine. 1998; 26 (3): 360-366