Tendinitis vs. Tendinosis: Yes, There’s a Difference

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Yesterday I had the pleasure of attending the filming of Eric Cressey and  Mike Reinold’s next phase in their Functional Stability Training series, Functional Stability Training – Upper Body.

As an FYI:  the first two modalities, Functional Stability Training – Core, and Functional Stability Training – Lower Body, can be accessed HERE.

Think of the whole shebang as on par with The Dark Knight trilogy.  All stand alone pieces are equally badass in their own right, but as a whole……can be considered mindblowing.

Yesterday entailed the filming of the “hands-on” or lab portion, and Cressnold (as I like to call them) took volunteers from the audience and placed them through a few shoulder screens/assessments to demonstrate that not all shoulders are created equal.

More importantly, they took it as an opportunity to demonstrate to everyone that how “we” approach treating and addressing certain dysfunctions can drastically change from one shoulder to the next.

And, as it happened, I ended up being one of their guinea pigs, as seen below in a “behind the scenes” shot.

Basically, it went down like this:

Mike:  would anyone be willing to take their shirt off?

[dead sprint from my seat]

Me:  Can The Rock smell what’s cookin?  Does a bear shit in the woods?  Does Dolly Parton sleep on her back?  YOU WANT MY PANTS OFF TOO????

I suspect that my 20 minute shirtless cameo will be a huge selling point for Eric and Mike when they finally release this module.

Learn the secrets behind an effective shoulder screen/assessment.  

Find out how both Mike and Eric choose what treatment and corrective exercise progressions come into play based off a thorough shoulder assessment.

Watch Tony squeeze his pecs and turn a piece of coal into a diamond!

Okay, all facetiousness aside, it was a FANTASTIC event and it should come as no surprise that Mike and Eric helped make a lot of people a heckuva lot smarter.

One key point that I want to discuss today which Mike hit on briefly during one of his talks, is the notion of tendinitis and tendinosis.

Many people think the two are one in the same and that both should be lumped together (like Star Wars and Star Trek.  You know, cause both take place in space) with regards to how we go about assessing and addressing each.

This is wrong, and here’s why.

– itis = is the Greek suffix for inflammation.

– osis = is the Greek suffix which denotes actions, conditions, or states. In the context of this conversation it refers to degeneration.

Someone with acute elbow pain or discomfort for example has tendinITIS.  You can palpate the area, the person will say “ow,” tell them to apply ice, take some ibuprofen for a few days, lay low on things that exacerbate symptoms, and they should be fine within a few weeks, if not days.

Conversely, someone with a more chronic, insidious condition has tendinOSIS.  You can palpate the area, the person will probably want to punch you in the face (but it could just as easily be more acute discomfort like the example above), but in this case, despite icing, popping NSAIDS, and rest, the condition, even after six months hasn’t gotten any better.

The problem here is actual degeneration of the joint, and it’s in this scenario we need to look more outside the box.

In keeping with the elbow example, someone with tendinitis will typically – not always – respond well with dedicated manual therapy on the problem area itself alongside your standard ice/rest protocol.

If the issue doesn’t resolve and it continues for months on end (tendinosis), and as Mike pointed out, sometimes you need to look elsewhere along the kinetic chain to see what’s the TRUE culprit.

It’s something he’s routinely referred to as The Kinetic Chain Ripple Effect.

When dealing with a more chronic issue, you still need to look at the affected area (in this case the elbow), but you also need to look at other factors elsewhere.

You can treat the elbow all you want with manual therapy and corrective exercise, but if someone has atrocious T-spine mobility, is overly kyphotic, and has forward head posture, wouldn’t it make sense to address those “red flags?”

Interestingly, Mike worked with someone yesterday during his presentation who had elbow pain, and one of the first things he did was test her grip strength bilaterally.  It should come as no surprise that she was weaker on the side which hurt to squeeze.

After coaching her on her posture – getting the shoulders back and posteriorly tilted, learning to brace the abs and posteriorly tilt the pelvis, and to tuck the chin – he retested her grip and she immediately saw a 16% increase (and it was less painful!).

And all he did was place her into better alignment!

There’s no doubt that she would still need soft tissue work to address her elbow, but many of her symptoms were corrected by taking a closer look at her shoulder and head position!

All of this to say:  if you’re a personal trainer or strength coach and have a client with a nagging injury that hasn’t gotten better with traditional ice, rest, and NSAIDS, it’s a safe bet that it’s not just a simple case of tendinitis, and you’re dealing with something more chronic like a tendinosis (or, actual degeneration of a joint).

Step one would be to refer out to your network and have him or her work with a manual therapist.

Step two, and something which you can take more of the reigns on, would be to keep an eye out for other factors such as posture or any movement dysfunctions who may notice.

More often than we think an “elbow issue” isn’t just something that’s wrong with the elbow. Likewise, a “knee issue” could be something fishy going on elsewhere. We can’t assume it’s solely the knee.

I like to put all the blame on CrossFit….;o)  Just kidding.  Kinda.

What are you thoughts?  Agree?  Disagree?  Tomato? Tomahto?  I’d like to hear everyone else’s thoughts on the matter.

Did what you just read make your day? Ruin it? Either way, you should share it with your friends and/or comment below.

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Comments for This Entry

  • Christopher Tucker

    Great post, Tony! I have been dealing with Tendinosis in my foot for almost a year now. Not fun!

    April 9, 2014 at 10:21 am | Reply to this comment

  • Tim M

    Mahalo for going to the Greek. I will never again get the two mixed up.

    April 9, 2014 at 1:49 pm | Reply to this comment

  • Brandon Goulding

    100% agree. I especially like that you mentioned the kinetic chain ripple. I once treated a lady with thenar eminence wasting, weak grip string, and pain in her palm. She was (wrongly) diagnosed as having a tenosynovitis. After examination of T-spine and cervical spine, correcting for forward head posture and taping to unload the radian nerve, she immediately increased her grip strength. Looking at it as a purely "hand" issue she would never had found relief. Looking at the entire kinetic chain was key.

    April 9, 2014 at 9:26 pm | Reply to this comment

  • Tombo

    Thank you, Tony! Been diagnosed today with patellar tendinosis Tight quads and a tight psoas could be one of the reasons for my knee injury. So as you said, it's probably elsewhere in the kinetic chain. Therapist said it could take up from several months to a year! Wish it was tendinitis!

    April 11, 2014 at 12:11 pm | Reply to this comment

  • Joshua Reed

    Great article, Tony! I enjoyed your description and I agree with you. If the client is not recovering from your standard "RICE" treatment, then refer on. I am currently a PT Technician and moving into the Strength & Conditioning field. As a PT Tech for a few years now, I have seen many of the patients come in with acute pain be related to alignment/posture issues. Teaching the patient about correct posture, exercises and so forth, rarely do you see them return. Those who do return end up falling into the degenerative area. It is phenomenal to see how the body works and that you have to take a holistic approach to what is going on with relation to the kinetic chain. As a newbie entering the S&C field, thanks for also sharing Mike R's information. I will be headed over now to read his article on the ripple effect. Thanks!

    April 13, 2014 at 9:46 am | Reply to this comment

  • Shane Mclean

    I'm just imagining you sprinting up front to take part in demo. Your shameless.

    April 13, 2014 at 1:52 pm | Reply to this comment

  • stacey

    I couldn't agree more. I finally went to physio for a long-time nagging knee injury, but in treating my knee, discovered instability in my hip, which correlated directly to a long time nagging shoulder injury (yeah, I see the pattern - I just assume the body will heal itself - always... ahem, not the case). Bottom line, we found massive instability in my right shoulder and by shoulder, I mean shoulder and girdle. In working to improve and strengthen that I'm finding that I finally am gaining back lost proprioception in my entire right side and the strength in my right side is "miraculously" coming into balance with the left. It's amazing, truly. Take care of your aches and pains people!

    April 19, 2014 at 2:39 pm | Reply to this comment

  • Lisa Passante Coleman

    I have had elbow "tendonitis", so I have thought, for 9 weeks now, and have done all that I have been advised to do, still with little to no relief. This article gives me some new direction and perspective that I will be looking into to get my strength back and get back 'into my game'. The pain has radiated into the forearm, and tricep as well. What type of a professional do you recommend to deal with the treatment you have mentioned? Massage therapy has relieved that pain temporarily. Thanks Tony.

    April 19, 2014 at 8:22 pm | Reply to this comment

    • TonyGentilcore

      Lisa - glad this helped. SInce you're having radiating pain, I'd have someone take a look further up into the shoulder (brachial plexus). Chances are you're "gunked" up there, and the nerve is impinging.

      April 21, 2014 at 7:31 am | Reply to this comment

  • Dean Montague

    Great Article! I have been seriously strength training since Feb and just recently discovered a nagging ache on the outside of my elbow after doing a daily pull up challenge by a colleague. I stopped the pull ups and started researching and a couple of weeks later it is still there. Not only that but my other elbow seems to have developed the same problem! I have now stopped upper body work until I can figure out the problem but this article may just be the thing to help me nail it. I am working on my postural awareness as my shoulders and pelvis were a little out due to long hours at a desk but finding a manual therapist on the island I live is impossible. Do you have any other ideas/exercises on combating my elbow issues? it affects both arms at the moment and is nowhere near severe but I don't want to make it worse because I am spending virtually no time strength training upper body for fear of putting myself completely out of action. The internet has so many different exercises that 'may' work, I would be nice to get some that WILL work on solving this.

    May 8, 2014 at 2:42 pm | Reply to this comment

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