Tendinitis, tendinosis, tendinopathy. Lets call the whole thing off

The older your therapist or trainer, the more likely they are to muddle up what to call your tendon pain. The younger your trainer or therapist, the more likely they are to waste your time with an obnoxious mini-lecture if you use the wrong word.

A few years ago the word “tendinitis” was widely employed to describe pain located at the tendon which was associated with inflammation (Maffulli et al., 2003).

By contrast, “tendinosis” has been employed to describe a degenerative tendon without inflammatory signs or correlation with clinical symptoms ( Maffulli et al., 2003).

More recently, this concept has evolved and the word “tendinopathy” has been proposed for the clinical diagnosis of pain accompanied by impaired performance, and sometimes swelling in the tendon (Khan K.M., Cook J.L., Kannus P., Maffulli N., Bonar S.F. (2002) Time to abandon the “tendinitis” myth. British Medical Journal 324, 626-627)

Currently, the most employed clinical and functional classification for tendinopathy remains the one proposed by Blazina, M.E., Kerlan, R.K., Jobe, F.W., Carter, V.S. and Carlson, G.J. (1973) Jumper’s knee. The Orthopedic Clinics of North America 4, 665-678.

This classification distinguishes 4 stages:

1) pain after sports activity;

2) pain at the beginning of sports activity, disappearing with warm-up and sometimes reappearing with fatigue;

3) pain at rest and during activity;

4) rupture of the tendon.

Maffulli, N., Wong, J. and Almekinders, L.C. (2003) Types and epidemiology of tendinopathy. Clinics in Sports Medicine22, 675-692. decided to classify the chronology of symptoms into 3 stages:

when symptoms have been present for 0 to 6 weeks, the tendinopathy is characterized as “acute”,

Between 6 to 12 weeks, it is regarded as “sub-acute

More than 3 months, it may be considered as chronic.

Nirschl, R.P. and Ashman, E.S. (2003) Elbow tendinopathy: tennis elbow. Clinics in Sports Medicine22, 813-836 developed another system

Pathologic stages:

Stage I: temporary irritation (chemical inflammation?)

Stage II: permanent tendinosis – less than 50% tendon cross-section

Stage III: permanent tendinosis – greater than 50% tendon cross-section

Stage IV: partial or total rupture of tendon

Phases of pain:

Phase I: mild pain after exercise activity, <24 hours

Phase II: pain after exercise activity, >48 hours, resolves with warm-up Phase III: pain with exercise activity, does not alter with activity

Phase IV: pain with exercise activity that alters activity

Phase V: pain caused by heavy activities of daily living

Phase VI: intermittent pain at rest that does not disturb sleep; pain caused by light activities of daily living

Phase VII: constant rest pain and pain that disturbs sleep

The chances are that for most people, these classifications are not essential for your treatment. Whilst inflammation may not have caused the initial pain, there will be some inflammation as it recovers. It’s sensible to adopt an anti-inflammatory diet!

Fixing tendons is a multi-layered process. The more stuff you chuck into your therapy the better. It may be an “itis” “osis” or an “opathy” but it still needs flexibility, strengthening, training, correct nutrition, and the effective timing and planning of exercise!

Drop me an email if you need me to fix your tendon pain (andrew@andrewstemler.com)

To keep up to date with fitness, physical therapy and mindfulness tips join my mailing list here:

Leave a Reply