We’re all familiar with that feeling: you’re exercising and you begin to get that nagging pain. Sometimes in your ankle, sometimes in your knee, sometimes in your shoulder, and you’re left to ask yourself whether to push through or back off.
There are clearly many types of overuse injuries one may experience during exercise and to cover them all in one blog post would be impossible. So for this post I am going to focus on 2 generic types of injuries: tendinitis and tendinosis.
As the names imply, both of these are injuries involving the tendon, or the strong connective tissue that connects your muscle to the bone. Some common locations that may become involved can be your Achilles tendon (behind the heel), tibialis posterior tendon (lower inside of the shin), patellar tendon (directly below the kneecap), biceps or rotator cuff tendons (front and outside of the shoulder), and the medial and lateral epicondyles (inside and outside of the elbow, known as golfers’ elbow and tennis elbow, respectively).
These injuries, while affecting many different areas of your body, have similar causes. As you continue to load tendons with both concentric (shortening) and eccentric (lengthening) contractions, an inflammation begins within your tendon. This is associated with swelling within the tendon itself, largely believed because the tendon is unable to heal entirely following extended bouts of exercise. As the condition progresses, inflammation and swelling will also surround the tendon, known as tenosynovitis. Finally, as the condition continues, tendinosis will form. Tendinosis is characterized by degeneration of the tendon, usually including weakening and disorganization of the fibers within the tendon, combined with a loss of elastin, or elasticity.
So what does this all mean? Well firstly, tendon problems, or tendinopathies, are typically atraumatic, meaning they will typically not be the result of an overstretching or compressing mechanism, but rather the result of extended exercise. Secondly, it tells us that tendinitis and tendinosis exist on a continuum, where the body will typically respond with symptoms of tendinitis, and if it goes untreated it can become tendinosis. They will both present with pain (often described as sharp) over the area of a tendon, typically with no noticeable onset. As the condition progresses, the pain may become dull, but you may notice some changes such as thickening of the tendon, or a “creaking” feeling as you move.
Now that we understand what tendinitis and tendinosis are, what can be done about it? One key is immediate recognition and treatment. If the pain is new, along a tendon, and is following long bouts of exercise, it is recommended to stop activity and rest. Anti-inflammatory medications (such as ibuprofen, aspirin, naproxen) may be taken, and ice and compression may be applied to the injured area. The key is to stop the inflammation before it progresses. Rest should be relative, last for approximately a week, and can include exercises that stress other areas of the body (such as swimming if you’re experiencing Achilles tendinitis or running if you have rotator cuff tendinitis). If the condition continues for 2 weeks or more, it is actually okay to continue exercising.
The keys to treating tendinosis includes strengthening the tendon using eccentric, or lengthening, contractions, as well as properly warming up prior to activity with heat packs or gentle exercises. Typically, continue to exercise will not damage the tendon further, but rather the continued stresses will help to strengthen the tendon.
- Tendinitis is an inflammation of the tendon that occurs following prolonged bouts of exercise or insufficient rest; tendinosis is a degeneration of the tendon that occurs following continued use and untreated tendinitis.
- When experiencing new pain while exercising in the location of a tendon, STOP and treat it with ice, compression, and if necessary anti-inflammatory medications.
- When pain has been consistent over 3 weeks or more, and includes creaking or thickening of the tendon, you do not need to stop exercising, but should warm-up and strengthen the tendon.
- As always, if you experience pain that affects your daily life, keeps you awake at night, or continues for weeks, please consult your personal physician immediately.
Alan R. Needle, MS, ATC, CSCS is a doctoral student in the Biomechanics and Movement Science program at the University of Delaware. He has more than 4 years of experience as a certified athletic trainer, and currently serves as an instructor for several Sports Medicine/Athletic Training classes at the University of Delaware. He can be contacted at firstname.lastname@example.org.