Tendon strains are one of the most common overuse injuries, usually caused by improper training or biomechanical errors from strength or flexibility impairments. While many people are familiar with the RICE protocol (rest/ ice/ compression/ elevation) used to address tendonitis and tend to gravitate towards this treatment option for injuries, most are unfamiliar with another prevalent type of tendon injury called tendonosis. In fact, by the time most athletes seek medical care for a tendon injury, the condition has progressed out of an acute inflammatory response to a more chronic condition called tendonosis. Tendonitis and tendonosis are treated differently, and to best address an athlete's injury and provide a plan of care, it is important to understand the difference between the two.

Tendonitis refers to an inflammatory reaction at the involved tendon. This term implies that there is micro tearing and inflammation present. Often times redness, swelling, and warmth are present at the tendon. In contrast, tendonosis refers to a more chronic condition, where the involved tendon's collagen begins to degenerate from chronic overuse. According to histology studies, inflammation is not present in tendonosis.

Tendonitis (the inflammatory condition) can progress into tendonosis (chronic degeneration) if the injured tendon is not given time to heal and the repetitive stress on the tendon persists. If treated in the early phases of inflammation, tendonitis typically heals within 6 weeks or less. After 6 weeks, the injury transitions out of tendonitis into tendonosis, which can take 3 months to heal if caught in the early phase of degeneration, and up to 9 months if not.

The treatment goal for tendonitis is to reduce the inflammation, commonly achieved through ice, nonsteroidal anti-inflammatory medications, and corticosteroid injections. Rest is also prescribed, as well as gentle cross friction to break up scar tissue and adhesion. The treatments for tendonitis are contraindicated for tendonosis, as the above interventions prevent the degenerated collagen from repairing. Hence, a correct diagnosis is a key element in helping an athlete recover. The treatment goal for tendonosis focuses on stimulating collagen production, alignment, and cross link formation so the injured tendon can improve tensile strength. Research suggests that it can take 100 days to make new collagen. Tendonosis is treated with heat, deep friction massage, and eccentric exercise. Modification of activity is recommended, as complete rest can stall tissue recovery.

For both conditions, consideration of ergonomics, shoe wear, and analysis of current a training plan to prevent future injury can be valuable. A physical therapist or qualified wellness coach can help revise your training plan, as well as identify strength and flexibility impairments that may be contributing to injury. Your physician can assist in diagnosing and order imaging if symptoms persist. Contact a medical professional before beginning self treatment.

Carla Pryor PT, DPT, OCS, RYT 200. Co Owner of Redefine Health and Fitness located in North County San Diego. Redefine is a wellness based company focused on providing excellent comprehensive and research driven care to assist clients in meeting their fitness and nutrition goals. Contact carla@redefinehealthandfitness.com for further inquiry.