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Writer's pictureTerra Osteopathy

Is tendonitis an inflammation? Well, not exactly...

For many years, tendinitis was considered a condition primarily caused by inflammation. But recent research has turned that idea on its head. It turns out that tendinitis isn’t driven by inflammation as much as by pain and mechanical stress. Here’s what you need to know about modern approaches to treating tendinitis, and why certain methods, like stretching, might not be helping you heal.


1. What Is Tendinitis Really?


Tendinitis is a condition that develops due to repetitive motions that strain the same tissues over time. It’s commonly found in areas like the elbow, shoulder, and Achilles tendon. But unlike typical inflammation-driven conditions, tendinitis is more about changes in the tendon itself, which are triggered by overuse and mechanical stress.


It’s Not Inflammation: The term ‘tendinitis’ suggests inflammation, but modern studies reveal that what we’re often dealing with is tendon pain rather than a classic inflammatory process. The tendon’s structure undergoes degeneration, often without a significant inflammatory response.


2. Why Stretching Is Not the Answer


One common myth is that stretching the affected tendon can alleviate tendinitis. However, research shows that stretching an already irritated tendon can actually exacerbate the condition. Stretching applies further stress to the damaged tissues, which can worsen the pain and delay recovery.


Progressive Loading Is Key: Instead of stretching, the most effective treatment is progressive loading. This involves gradually increasing the load or resistance placed on the tendon over time, helping it adapt and strengthen. This approach helps rebuild the tendon’s capacity to handle stress without causing further damage.


3. Repetitive Motions and Tendinitis


Tendinitis is primarily a condition of overuse. Repetitive movements—whether from sports, work, or everyday activities—lead to microtrauma in the tendon. Over time, if the body doesn’t have adequate time to recover, this microtrauma accumulates and causes pain.


The Key Is Rest and Proper Rehabilitation: During the acute phase of tendinitis, rest is crucial. It allows the tendon to recover from the initial strain. However, rest alone is not enough. Following the acute phase, targeted exercises focusing on strengthening the tendon are necessary to prevent further injury.


4. Managing Acute Tendinitis in Modern Physiotherapy


In the acute phase, it’s important to reduce load and modify activities that aggravate the tendon. Ice and pain relief medications can help manage symptoms, but they don’t address the underlying problem. Modern physiotherapy focuses on adjusting movement patterns and introducing progressive loading as soon as the pain allows.


5. Preventing Chronic Pain


One of the greatest risks of untreated or improperly managed tendinitis is that it can evolve into chronic pain. Chronic tendinopathy is not only more difficult to treat but also disrupts daily life significantly. To avoid this, it’s essential to begin a proper rehabilitation program early, focusing on reducing pain, restoring movement, and gradually reintroducing activities without causing further strain.


References:


Malliaras P. Physiotherapy management of Achilles tendinopathy. J Physiother. 2022 Oct;68(4):221-237. doi: 10.1016/j.jphys.2022.09.010. Epub 2022 Oct 21. PMID: 36274038.


Millar NL, Silbernagel KG, Thorborg K, Kirwan PD, Galatz LM, Abrams GD, Murrell GAC, McInnes IB, Rodeo SA. Tendinopathy. Nat Rev Dis Primers. 2021 Jan 7;7(1):1. doi: 10.1038/s41572-020-00234-1. Erratum in: Nat Rev Dis Primers. 2021 Feb 3;7(1):10. doi: 10.1038/s41572-021-00251-8. PMID: 33414454.


Breda SJ, Oei EHG, Zwerver J, Visser E, Waarsing E, Krestin GP, de Vos RJ. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. Br J Sports Med. 2021 May;55(9):501-509. doi: 10.1136/bjsports-2020-103403. Epub 2020 Nov 20. PMID: 33219115; PMCID: PMC8070614.



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