Tendinosis is a chronic condition characterized by the degeneration of a tendon’s collagen structure, resulting from long-term overuse or repetitive strain. This process involves the breakdown of the tendon tissue, leading to persistent pain and reduced function. Effective treatment requires actively stimulating the biological processes needed for tissue repair, moving beyond simple pain relief. This article details the steps for treating tendinosis, from targeted rehabilitation exercises to advanced medical interventions.
Understanding the Difference Between Tendinitis and Tendinosis
The distinction between tendinitis and tendinosis is foundational for proper treatment. Tendinitis is an acute condition involving inflammation, often caused by a sudden overload or injury, and may respond to rest and anti-inflammatory medications. Tendinosis, however, is a chronic degenerative state characterized by disorganized, damaged collagen fibers and an absence of inflammatory cells.
Misdiagnosing tendinosis as tendinitis can lead to ineffective treatment protocols. Traditional approaches like complete rest, ice, and anti-inflammatory drugs are often unhelpful because they fail to address the underlying structural deterioration. Some anti-inflammatory medications can even impair the body’s ability to synthesize new collagen, which is necessary for repair. Since tendinosis centers on collagen breakdown, therapy must focus on stimulating cellular activity and remodeling the damaged tissue.
Conservative Management: The Role of Load and Exercise
The primary treatment for tendinosis involves a carefully managed program of controlled mechanical loading. This approach uses specialized exercises to trigger a cellular response called mechanotransduction within the tendon. This process converts the mechanical force of exercise into a biological signal that stimulates the production of Type I collagen, the strong protein necessary for healthy tendon structure.
Eccentric exercise forms the cornerstone of conservative management, involving the controlled lengthening of the muscle-tendon unit while under tension. For example, slowly lowering the heel after a calf raise places specific stress on the Achilles tendon. This type of loading enhances the mechanical properties of the degenerative tendon by increasing the deposition of new collagen fibers. Eccentric protocols are performed with high repetitions and specific loads, often resulting in temporary discomfort, which is an expected part of the remodeling process.
Activity modification is equally important, focusing not on complete rest, but on reducing activities that cause compressive or high-impact strain on the tendon. Patients should identify and temporarily avoid the specific movements that originally triggered or aggravated the condition. This modification allows the tendon to begin healing without being subjected to further damaging forces. The rehabilitation program must be progressive, slowly increasing the load and complexity of the exercises as the tendon adapts and symptoms improve.
Advanced Clinical Interventions
When conservative loading programs fail to provide sufficient relief after several months, a physician may recommend advanced clinical interventions. These procedures are supplementary to, not replacements for, controlled exercise and loading. Extracorporeal Shockwave Therapy (SWT) is a non-invasive option that delivers high-energy acoustic waves to the injured site. This mechanical energy stimulates tissue regeneration, enhances blood flow, and promotes new blood vessel formation, facilitating healing.
Platelet-Rich Plasma (PRP) therapy involves drawing a small amount of the patient’s own blood, concentrating the platelets, and injecting the solution directly into the degenerative tendon. The concentrated platelets release growth factors that attract cells necessary for repair and accelerate the natural healing and remodeling process. While more invasive and costly than SWT, PRP has shown efficacy in stimulating tissue repair, especially in chronic injuries.
Corticosteroid injections are often discouraged for tendinosis, despite providing short-term pain relief. Corticosteroids act as strong anti-inflammatories, which is not the primary need in tendinosis, and they can inhibit necessary collagen repair and potentially weaken the tendon over time. Surgery remains a last resort for chronic, debilitating cases unresponsive to all other treatments, aiming to remove the damaged tissue and stimulate a healing response.
Long-Term Recovery and Preventing Recurrence
Achieving long-term recovery from tendinosis depends on establishing new habits and maintaining tendon health after pain subsides. Maintaining the strength and flexibility gained during rehabilitation is crucial for preventing a relapse. This involves continuing a modified, less intense version of the tendon-loading exercises multiple times per week.
Proper ergonomics and biomechanics are necessary, especially for tendinosis caused by work-related or repetitive activities. Adjusting workspaces, using supportive equipment, or modifying technique in sports reduces undue strain on the healed tendon. A comprehensive warm-up routine is essential before engaging in physical activity to prepare the muscle and tendon for the load.
Patients should avoid sudden increases in the intensity or duration of their activities, adhering to a gradual progression to allow the tendon time to adapt. Recognizing the earliest warning signs of pain or stiffness allows for immediate, temporary activity modification, preventing the degenerative cycle from restarting. A multidisciplinary approach, including physical therapy guidance, ensures a better functional outcome and reduced recurrence risk.