Tendon pain is often traced to tendonosis, a condition representing the long-term breakdown of the tendon structure. Unlike an acute injury, tendonosis involves a degenerative process that resists simple rest and anti-inflammatory measures. Successfully resolving this chronic condition requires a targeted approach focused on stimulating tissue repair and rebuilding the tendon’s load-bearing capacity. This guide outlines the strategies, from initial self-care to advanced medical procedures, necessary to manage chronic tendon pain.
Understanding Tendonosis Versus Tendonitis
The distinction between tendonosis and tendonitis is foundational for effective treatment. Tendonitis is an acute condition characterized by inflammation, typically resulting from a sudden injury, and usually resolves quickly with rest.
Tendonosis, conversely, is a chronic degenerative condition that lacks significant inflammation and is marked by the breakdown of the tendon’s collagen fibers. This degeneration results from chronic overuse where the rate of collagen breakdown exceeds the rate of repair.
This difference explains why traditional treatments often fail for chronic tendon pain. NSAIDs and corticosteroid injections target inflammation, which is largely absent in tendonosis. The treatment strategy must therefore shift away from reducing inflammation and focus instead on regenerating the damaged tissue.
Immediate At-Home Management
The first step in managing tendonosis is implementing relative rest and activity modification to halt chronic irritation. Complete immobilization is discouraged, as it can lead to muscle and tendon atrophy. Specific movements that aggravate the tendon must be identified and stopped to reduce repetitive strain before active rehabilitation begins.
Using a supportive brace or strap can temporarily offload the tendon during necessary daily activities. Unlike acute tendonitis, ice is not the primary treatment. Applying heat may be beneficial by increasing local blood flow, which helps bring necessary nutrients to the poorly vascularized tendon tissue to promote healing.
Structured Rehabilitation Through Exercise
Active, targeted exercise is the most important treatment for reversing the degenerative changes of tendonosis. Rehabilitation focuses on progressive loading, which systematically increases mechanical stress on the tendon to stimulate collagen production and realign the structure. This process requires working closely with a physical therapist to ensure the load promotes change without causing further injury.
The gold standard for this rehabilitation is eccentric exercise, where the muscle is lengthened while contracting under load. For example, treating Achilles tendonosis involves slowly lowering the heel from an elevated step, focusing on the controlled descent. This specific loading creates mechanical tension that encourages the production of stronger, organized Type I collagen fibers, remodeling the degenerative tissue.
A common protocol involves high-volume training, such as three sets of 15 repetitions, performed twice daily for 12 weeks. Exercises are often performed into a level of tolerable pain, indicating the load is adequate to stimulate structural change. Consistency is necessary to drive the biological changes required for long-term recovery.
Advanced Medical Interventions
When conservative measures fail to resolve symptoms after several months, advanced medical interventions may be considered. Injection therapies are utilized to restart the healing process in the degenerative tendon.
Injection Therapies
Platelet-Rich Plasma (PRP) involves concentrating a patient’s own platelets, which contain growth factors, and injecting this solution into the damaged area. This aims to mimic the body’s initial healing response and promote collagen synthesis. Prolotherapy, using a solution like hypertonic dextrose, is another technique intended to create a localized irritation to stimulate a regenerative healing cascade. Both PRP and prolotherapy focus on stimulating tissue repair rather than suppressing symptoms.
Other Procedures
Other procedures include percutaneous tenotomy, where a specialized needle is used under ultrasound guidance to break up scar tissue and stimulate blood flow within the tendon. Corticosteroid injections are generally avoided for chronic tendonosis due to the risk of tendon weakening and inhibiting collagen repair. Surgery is reserved as a last resort for chronic cases, typically involving the removal of degenerative tissue and repair of the remaining healthy structure.