Tendonosis is a condition affecting tendons, which are strong, flexible cords of connective tissue connecting muscles to bones. These structures are made primarily of collagen fibers, providing strength and transmitting force from muscle contractions, allowing for movement. Tendons also absorb impact and prevent muscle injury. Tendonosis leads to pain and dysfunction in these tissues.
Defining Tendonosis: Beyond Inflammation
Tendonosis represents a chronic degenerative process within a tendon, distinct from acute inflammation. Unlike tendinitis, which involves an inflammatory response, tendonosis is characterized by a gradual breakdown of collagen fibers and cellular changes, showing little to no significant inflammation. This distinction is important because the underlying pathology guides the treatment approach.
In tendonosis, the tendon’s primary component, collagen, begins to break down, leading to disorganization of its normally parallel fibers. This structural change weakens the tissue, making it less resilient and stiffer.
The progression of tendonosis involves a failure in the tendon’s natural healing process, where micro-injuries occur faster than the body can repair them. This leads to changes in the tendon’s composition, sometimes resulting in a thickened, scarred, or rubbery texture. While tendinitis can be an acute, short-term issue that often resolves with rest, tendonosis is a more persistent condition that can worsen if left unaddressed.
Recognizing Tendonosis: Causes and Signs
Tendonosis commonly develops from factors that place repetitive stress or inadequate healing demands on the tendons. Chronic overuse, repetitive strain, and poor biomechanics can create tiny tears that do not receive sufficient time to heal.
Age-related wear and tear also contributes, as tendons may become less flexible and more susceptible to damage. Insufficient recovery time between activities that stress the tendons prevents proper tissue repair, accelerating the degenerative process. Certain medical conditions, such as arthritis, can also increase the risk.
Individuals with tendonosis typically experience persistent pain that often worsens with activity. Stiffness, particularly after periods of rest, is a common symptom. The affected tendon may also be tender to the touch, and a palpable nodule or thickening of the tendon might be present. Common locations include the Achilles tendon, the patellar tendon (jumper’s knee), the rotator cuff tendons, and the common extensor tendons of the elbow (tennis elbow).
Pathways to Recovery: Diagnosis and Management
Diagnosing tendonosis typically begins with a thorough clinical evaluation, which includes a detailed patient history and a physical examination. The physical exam assesses range of motion, identifies areas of tenderness, and evaluates the tendon’s integrity. In some cases, imaging studies like ultrasound or magnetic resonance imaging (MRI) may be used to visualize the degenerative changes within the tendon, such as disorganization of collagen fibers or thickening.
Management of tendonosis primarily focuses on non-surgical interventions to promote healing and restore tendon function. Initial steps often involve rest and activity modification to reduce stress on the affected tendon, allowing the healing process to begin. Eccentric exercise programs, which involve lengthening the muscle while it is contracting, are a cornerstone of physical therapy for tendonosis, helping to remodel and strengthen collagen fibers.
Physical therapy also incorporates stretching to improve flexibility and circulation, and strengthening exercises for the muscles surrounding the tendon. In some situations, specific injection therapies may be considered. Platelet-rich plasma (PRP) injections utilize the patient’s own blood components to deliver growth factors. Dry needling involves inserting thin needles into the tendon to stimulate a healing response. Surgical intervention is generally a last resort for chronic cases unresponsive to non-surgical management.