You say tendinitis and I say tendinosis.  Let's call the whole thing off and get to the bottom of this terminology debate.

The suffix "itis" implies a pathology of inflammation.  The suffix "osis" implies a pathology of chronic degeneration without inflammation.  Histological (tissue) studies have proven that most tendon injuries are non-inflammatory in nature, thus the medical community's relatively recent switch to the term tendinosis. 

Micro-trauma appears to be the most accepted cause of tendinosis.  Repetitive activities suchas swinging a hammer, playing tennis or golf, running, or even wearing high heeled shoes can cause the micro-trauma responsible for tendinosis.        

If there are no inflammatory cells in tendinosis, what is actually wrong with the tendon?  Studies have illustrated that tendons affected by this condition develop degenerative changes.  For those of you who are keeners or who are in the medical profession, the three key findings in tendinosis are; 1) disrupted fibers within the tendon 2) increased cellularity and 3) neovascularization.  One would think that the development of increased vascularity would actually aid in the healing process, but it is clear that this is not the case. 

This shift in knowledge and subsequent terminology has certainly affected the way in which we treat this condition. 

How Can We Remedy Tendinosis?

Eccentric training has been proven as a successful adjunct to conservative manual treatment for tendinosis.  Most studies have focused on Achilles tendinosis and patellar tendinosis, but this training has and can be been effective for other forms of tendinosis such as medial and lateral epicondylosis (Golfer's Elbow and Tennis Elbow respectively). 

Active Release Technique® (A.R.T.®) and Graston Technique® are two manual therapies that can assist in the management of tendinosis.  Increasing studies are proving Shockwave Therapy an effective tendinosis treatment; however, it is much more expensive and less accessible for most individuals. In my opinion, it is best to try techniques such as A.R.T.® and Graston® in conjunction with eccentric training first and if the case remains stubborn, Shockwave Therapy would be next in line. 

Take Home Points

Tendon injuries are non-inflammatory, thus the term tendin"osis"

Treatment options include A.R.T.®, Graston®, eccentric training and Shockwave Therapy.

Get diagnosed by a manual practitioner who can determine the cause of your injury as tendinosis most often results from muscular weakness during repetitive activities and sports.