Tendinitis, tendinosis or tendinopathy?

Tendinopathy pain is a common condition that is present in many areas of the body and can be a long-term and restricting condition.

In addition to this, the seemingly interchangeable terms used by doctors, specialists and physios can make what is already complicated and frustrating condition confusing for patients.

Common tendinopathies include plantar fasciitis, Achilles, patella (jumper’s knee), gluteal (hip bursitis), tennis/golfers elbow and rotator cuff.

In the late 1990’s there was a push to change the terminology of describing pain/swelling in an injured tendon from tendinitis to tendinopathy.

Tendinopathy is an umbrella term used to indicate injury to a tendon (excluding ruptures) that is exacerbated by loading the tendon.

Tendinopathy describes the same conditions that was previously called tendinitis, however, the term tendinitis suggests inflammation of the tendon is the primary cause of pain, which is often not the case.

Tendinosis is often used by some instead of tendinitis to shift the focus away from inflammation, with specific terms such as paratendinitis or tenosynovitis used to identify other structures surrounding the tendon that may become inflamed and present in conjunction with a tendinosis.

As these conditions often occur simultaneously, the term tendinopathy is a more generic term for tendon pain associated with loading, without trying to suggest an underlying pathology.

It rather indicates that all is not well within the tendon.

Tendinopathy can then be classified according to the Cook and Purdam continuum model.

There are 3 stages of tendinopathy:

  1. Reactive tendinopathy is a short-term response to tendon overload that thickens the tendon, with the potential to return to normal if the increased strain is reduced
  2. Tendon dysrepair occurs when there is an attempt at tendon healing, resulting in greater structural breakdown of the tendon
  3. Degenerative tendinopathy is a progression of tendon structure change with areas of cell death and little chance of reversibility of pathological change

Classifying the tendon according to the model in conjunction with your clinical history and physical tests allows your physio to develop a rehab program that is effective and specific to your needs.