It is important to differentiate between tendonitis and tendinopathy. These conditions are often confused by patients as well as by health care providers. The pathophysiology and treatment for these conditions is very different.
Tendonitis refers to inflammation of the tendon. This is often an acute process due to overuse of the tendon. Tendonitis responds well to ice, anti-inflammatories and rest. Bracing or immobilization may be necessary to allow for complete rest of the tendon. Sometimes a corticosteroid injection, into the tendon sheath or the area around the tendon, may be necessary to provide temporary relief from the pain and inflammation. It is also important to correct the offending overuse activity that caused the tendonitis in the first place in order to prevent a recurrence. Physical therapy is helpful to control pain and inflammation by using therapeutic modalities. Physical therapy is also helpful to address and correct poor musculoskeletal mechanics which may have contributed to the injury as well.
Tendinopathy is a chronic tendon problem in which the tendon is degenerated and there may be small interstitial or partial tears as well as tendon fiber disorganization. The tendon becomes weaker, frayed and more disorganized over time and may even become calcified or nodular. When the tendon is weakened it may become painful during simple every-day use. It is also possible to develop an acute episode of tendonitis if the degenerated tendon is overused, but generally in tendinopathy there is very little inflammation. The typical treatments for pain and inflammation that apply for tendonitis are not helpful for tendinopathy. Anti-inflammatories and corticosteroid injections are typically not helpful in tendinopathy. In order to treat tendinopathy appropriately the underlying tendon degeneration must be addressed. A short period of bracing or immobilization may be necessary for pain control but then the tendon must be reconditioned. Physical therapy is essential to help break down scarred degenerated tissue and to provide appropriate stresses (such as eccentric strengthening) to help regenerate and remodel the tendon. If the physical therapy program involves only pain control modalities and simple ROM exercises then it is unlikely the patient will improve. It is extremely important that the patient participate in a structured home exercise program on a daily basis. Even with a properly structured physical therapy program it may take 3-4 months to completely regenerate and remodel the tendon. Patients who fail to improve with physical therapy would be candidates for more invasive and/or aggressive therapies such as Sonorex treatment, Platelet Rich Plasma (PRP) treatment or surgery.
