By Joshua Tucker
What is Tendonosis?
It's not a repetitive strain injury. It wasn't caused by repetitive strain or overuse. Use, and repetitive use, plays a role, of course, but are not direct causes of. There's much more too it.
Ten-don-oh-sis is the degradation of tendon tissue due to cell death due to insufficient nutrient delivery to the tendon cells.
This tendon damage primarily shows up as a significant problem in the Achilles tendon and the shoulder cuff tendons.
There seems to be a lot of confusion between Tendonitis versus Tendonosis, and doctors are just recently coming to know about and understand the process.
Remember, it's not DIRECTLY caused by repetitive strain and is not a repetitive strain injury.
Ultimately, Tendonosis is caused by lack of blood supply to the tendon. Less blood equals less nutrition to the cells.
Muscles have direct blood supply. Meaning, muscles are supplied with blood and nutrition by arteries that feed directly into muscle tissue.
Tendons do not have direct blood supply. So they only get circulation and nutrition from fluid floating around in the area, provided by nearby muscles and vascular structures of/near the bone.
Enhancing fluid movement by exercise, and osmotic pressure (basically) are the primary ways the body gets nutrition to a tendon.
Tendonosis happens like this:
1. We use our bodies.
2. Muscles get tight, and stay tight.
3. When muscles are chronically tight, they put constant tension on the tendons they attach to.
4. The tendon is stretched taut. This makes it harder to easily absorb nutrients in the surrounding fluid.
5. Due to other factors like age, activity levels, inflammation, etc, the tendon just doesn't get enough nutrition it needs to repair itself form normal catabolism and any microscopic wear and tear injury that may be happening.
6. Cells begin to starve. Cells die. Cells die faster than the body can replace them because there is not enough nutrition and protein building blocks being delivered to the location.
7. This happens for a long time before you ever feel any problems.
8. Eventually, the tendon degrades enough that it can no longer hold together under the stresses it is placed under.
9. Tendon rips apart to some degree.
What is the difference between Tendonosis versus Tendonitis?
There is not always a clear cut, obvious difference. You just have to start looking at the clues....
But in general:
Tendonitis is pain and symptoms due to wear and tear damage to a tendon that results in scar tissue build up and a dynamic that the body continually reads as 'injury'.
Tendonosis is degradation of a tendon due to cell death due to cell starvation.
They can both show up together. Scar tissue is the body's answer to injury, so it's going to throw scar tissue at tendonosis lesions, which effectively results in Tendonitis -and- Tendonosis, not just Tendonitis versus Tendonosis.
Due to a variety of factors, the Achilles tendon is the primary, most effected site for tendon degradation.
Shoulder tendons degrade also, for similar reasons.
A tendon's design is one of a tough inner core, and a spongier outer core. (technically there are three layers, or concentric bundles, depending on how you want to look at it, but for me it's easier to think about it as two layers, hard inner core melding into soft outer shell.
The Achilles Tendon is one of the biggest tendons in the body, and holds the most tensile strength.
Long story short, there a couple spots on the Achilles Tendon that are the weak points, getting the least amount of cirulation. Where the tendon meets the heel bone, and an approx 3" section sever inches above the heel.
Not enough blood supply, constant tension and impact load from running and such, cell starvation, weaker structure, continued use, damage.
The shoulder cuff tendons essentially work the same. Too much tension, wear and tear, not enough circulation, cell death, weaker structure, damage.
Tendonitis is bad enough, wear and tear damage building on itself into a bigger and bigger problem.
Add in cell starvation, death, and the process that makes the structure weaker and weaker while the body tries to protect you in ways that actually make it worse.....not such a good scenario.
Just the other day I was doing a phone consult with a man that had long term Achilles Tendonitis. The next day, as he was walking to work, *BAM* he felt like he got hit by a brick in the back of his leg. He actually had severe Tendonosis, and his tendon partially separated, just fell apart as he walked to work.
That just doesn't happen with true Tendonitis.
The Floroquinolone class of antibiotics that include Levaquin and Cipro can cause tendon damage.
Commonly called Levaquin Tendonitis, the cytotoxicity from these drugs actually cause Tendonosis.
Scientists aren't exaclty sure how this happens, but somehow the antibiotic kills fibroblasts in the tendons such that the tendon cells stop producing cell energy and die. And it seems that the tendon's DNA is damaged, such that when new cells are produced, they are faulty.
People with Levaquin Tendonitis get temporary and even permanent pain and disabling symptoms, including tendons rupturing under very normal conditions.
So what is a Tendonosis Treatment that works?
Corticosteroid Injections can actually damage tendons, and don't actually help a problem actually heal.
Rest just won't do it. Even while resting, the tendon is not getting enough blood to actually heal.
Physical Therapy likes Eccentric exercises, as this is seen to strengthen tendons by stimulating tenocytes metabolism.
Surgery shears off degraded tissue, and the body's healing response to being newly injured may stimulate the body to heal.
My favorite is the Ice Dip and Ice Massage techniques found on the How To Reduce Inflammation page.
Lack of new blood is the problem. Get new blood to the area.
Icing, when done right, gets waste product and irritant out, and helps the body push new blood and nutrition to the area.
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