Most of us have heard the term “tendonitis,” usually when talking about conditions like tennis elbow, swimmer’s shoulder, or any of the many other overuse injuries we can develop. When we develop an overuse injury, our instinct for recovering is usually rest and ice. However, as we are now discovering, the best treatment is actually weight training. That’s because most of what we casually refer to as tendonitis is more accurately described as tendinopathy. The difference isn’t just a matter of semantics; it’s also a question of which treatments will be most effective.
There has been a paradigm shift in the past 10-15 years with respect to what we know about the cause of tendon pain and the best way to treat it. Given how recent this shift has been, there is still a fair amount of confusion in regards to terminology, as well as what is really happening to your tendon.
“As a medical community, we really shifted the framework for what we think is going on to a tendon, which has led to a change of the naming conventions, which is confusing to everybody,” said Jennifer Zellers, a faculty member at Washington University in St. Louis whose research focuses on tendons. Given how recent this shift has been, it’s still common to see the term tendonitis used in reference to overuse injuries, but this is no longer accurate.
What causes tendon pain?
True tendonitis, which is inflammation of the tendon, is less common than previously thought. In contrast, tendinopathy is a general term that refers to pain in the tendon. In addition to including cases of tendonitis, this also includes other causes, one of which is degeneration of the tendon.
When it comes to developing overuse injuries, such as tennis elbow or swimmer’s shoulder, what scientists have discovered in recent years is that this pain is due to the tendon starting to degenerate. In tendon degeneration, a tendon will develop small tears or the collagen fibres will become disorganized. When treated appropriately, the tendon has a limited ability to heal.
“There isn’t a really strong inflammatory response present in the tendon,” Zellers said. “What’s happening is more along the lines of degeneration of the tendon. The spring-like proteins that make up the tendon become pretty disorganized, along with some other changes in tendon composition. But it’s not inflammatory.”
Treatment options for tendon pain
The discovery that tendon pain is often resulting from degeneration, rather than inflammation, has led to a shift in treatment options. Previously, the prescribed treatment for overuse injuries was to rest and take anti-inflammatory medications, such as ibuprofen. Although this will reduce the pain, it won’t actually treat the cause of what is going on.
“One of the treatments with the best evidence is to gradually increase loads on a tendon,” Zellers said. “It’s much more about modifying someone’s activity, rather than resting completely, and it’s much more about showing the tendon higher and higher amounts of load, but in a way that the tendon can adapt and respond and be ready for higher loads.”
This treatment will often take place under the guidance of a physical therapist, who can offer advice on what exercises to do, how many reps, and at what weight. However, as Zellers notes, progressive tendon loading can be achieved without the use of specialised equipment. Instead, the most a person might need would be weights.
“Once somebody is feeling really comfortable with how to self-manage and self-progress, this is something that somebody should be able to manage on their own without having to go to the physical therapist for a long time,” Zeller said.