Physical therapy for tendonitis injuries are one of the more common diagnoses that people seek our help. In fact, tendon injuries account for about 30-50% of all injuries in sports; more specifically chronic overuse tendon injuries have resulted in 30% of all running related injuries and be as high as 40% in tennis players.(1) These injuries typically present to an individual with pain in an area with the onset of movement that will increase quickly but if the person continues the activity frequently the pain will lessen or subside completely. Only to be followed with even more pain if you continue to perform the aggravating activity too long or, which is more typical, after you have stopped the aggravating activity, rested, and now are attempting to get moving again. In the clinic some of the more common diagnosis we see are Achilles tendinitis, patella tendinitis (sometimes called Jumper’s knee), and both lateral and medial epicondylitis (tennis elbow and golfer’s elbow).
Tendonitis vs Tendonosis
Unfortunately, tendonitis is somewhat of a misnomer. The prefix “tendon” represents what one would expect the tendon but the suffix “itis” actually means inflammation.(2) Therefore the word tendonitis literally means inflammation of the tendon. However, as anyone who has suffered one of these injuries can attest, after the initial injury there typically is little to no swelling in the painful area. Even under imaging examination (MRI, CT Scan) and histological studies there is little to no evidence that inflammation is present. These injuries are now more prevalently being termed tendonosis. The suffix “osis” implies a degenerative process is occurring which is more consistent with numerous studies on tendon injuries.(2) Nowadays the term tendonitis reflects more the acute stage (the first 12-24 hours) of a tendon injury while a tendonosis reflects more of the chronic stage of a tendon injury.
The Role of Eccentric Exercises
Regardless of what you call it, it still hurts so how do you get relief? Actually there is little evidence that supports getting cortisone injections or using anti-inflammatories to improve tendonosis. However, there have been a number of studies over the years that have shown the positive benefits of Physical Therapy for tendinitis when incorporating eccentric exercises as the primary treatment. In what may be the first study to do so in 1998 Alfredson et al in the American Journal of Sports Medicine performed a study that focused on the effectiveness of eccentric exercises on tendinitis/tendonosis.(3) The protocol developed through that study has been one of the main driving forces for the use of eccentric exercises since. A research article by Dr Lorenz found in the April 2010 issue of Strength and Conditioning Journal discussed applying those principles developed by Alfredson et al to the treatment of Achilles tendinitis, patella tendinitis, and to tennis elbow specifically. (1) Finally, in 2014 A Frizziero et al performed a meta-analysis of current research articles comparing the use of eccentric exercise compared to other conservative treatment methods and concluded that compared to other treatment eccentric exercise demonstrated a successful outcome in the treatment of patella tendinitis and Achilles tendinitis specifically but also represented promising results in the management of other locations as well as lower leg muscle and ligament strains.(4)
What does this mean for you?
Tendonitis, or more accurately tendonosis, is a common injury that can affect the majority of us at some point in our life. The nature of the injury means that it will become a chronic condition limiting not only or athletic performance and exercising ability, but will also negatively impact our every day mobility. When you are having some type of tendon issue, or suspect you might have tendonitis, specific eccentric exercises provided by your Physical Therapist can successfully abolish your pain to get you back to your everyday life and help make you stay that way!
For more information give us a call at either of our two convenient locations: Bridgewater NJ 908.203.5200 Chester NJ 908.879.5700.
Lorenz, D. Eccentric Exercise Interventions for Tendinopathies. The Strength and Conditioning Journal, Vol 32 No2: 90-98, 2010, April.
Ledbetter WB. Cell-Matric Response in Tendon Injury. Clinical Sports Medicine 11:533-578, 1992
Alfredson H, et al. Heavy -Load Eccentric Calf Muscle Training for Treatment of Chronic Achilles Tendinosis. American Journal of Sports Medicine 26:360-366, 1998
Frizziero A, et al. The Role of Eccentric Exercise in Sport Injuries Rehabilitation. The British Medical Bulletin 110:47-75, 2014.