Although tendon pain is all pretty much lumped into one catch-all term – tendonitis – the fact is that it comes in a variety of forms. How much could a misdiagnosis cost you?
Below is some information that I got from a woman who had knee pain for over ten years. She tried virtually all of the conventional therapies for tendonitis. These included icing, rest, taking NSAIDs like aspirin and ibuprofen, seeing a doctor (several times), seeing a gait specialist when her family doctor couldn’t make any headway with the problem, getting herself fitted with orthotics (recommended by the specialist), going back for adjustments, getting some custom-made orthotics, buying several pairs of special shoes so that the custom orthotics would fit correctly…
The list goes on and on. In the end, she spent well over a thousand dollars…and this woman has some very good insurance that covered the bulk of her costs. I don’t even want to think about how much the total would have been without it.
But that’s just the financial aspect. How much time was spent on those doctor and specialist visits, on shopping for shoes and different kinds of NSAIDs (hoping that a new brand would finally work), on getting the orthotics fitted, on all the follow-up visits when the problem wasn’t corrected the first time around? How exhausting and spirit-draining was it to try one thing after another, and have them all fail in the end?
All of this could have been avoided if this lady had just understood one simple fact: ninety-five percent of the time or more, tendon pain that lasts more than a couple of weeks–and doesn’t respond to icing and rest–is not tendonitis.
It’s a surprising thing to hear. Even people who have never had a problem with their tendons at all know the word tendonitis; in fact it’s so common that pretty much any kind of tendon problem seems to get lumped in under the same term. The ironic thing is, true cases of tendonitis are very rare, and generally resolve themselves within a week or two. Tendon pain that lasts longer than that can be a variety of things, but by far the most common condition is tendonosis.
I emphasize this point over and over again, but it can’t be repeated enough. Any kind of “itis” is a medically precise term that means “inflammation”. An “osis”, on the other hand, means an actual degeneration of some body tissue. So tendonitis is inflammation of a tendon; tendonosis – much more serious – means that the tendon is breaking down and can’t repair itself effectively.
Inflammation has been recognized and studied for centuries. It has four indicators – pain, heat, redness and swelling – that always accompany it. So it’s relatively easy to spot, and this makes it useful for people who think they might have tendonitis to decide for themselves and not rely 100% on a doctor’s diagnosis. (I have a free and very quick tendon test on this blog that can help out with this.)
Tendonosis, however, doesn’t have the same symptoms because it’s not the same problem. Usually it comes on more slowly, there is no redness or heat or swelling, and unlike tendonitis, which has a more or less constant level of pain, with tendonosis the pain gets worse and worse. Of course, if you rest the affected area – in other words, if you don’t use it – then the pain goes away. But if your tendon has suffered some degeneration, even if you completely rest it for a week or two, once you start using it again the pain will immediately come back. So unless you can afford to just not use that part of your body ever again, rest isn’t really a good solution to the problem.
Fortunately, there are specific exercises that can help damaged tendons to repair themselves. Tendons are composed of collagen fibers, and sometimes those fibers get tangled up into knots (a lot like what happens to your hair if you don’t comb it for a while). Once these knots develop, they prevent the tendon from functioning properly, and the result is pain. Left untreated, these knots generally get larger and larger, generating more pain, and in extreme cases can lead to a complete rupture of the tendon itself. At that point, exercises are no longer effective. The only option remaining is surgery.
If you have persistent tendon pain, it’s silly to let things get to that point just because some doctor tells you that it’s “tendonitis” and tries to prescribe cortisone shots and ibuprofen. There are other options, many of them surprisingly affordable and easy to implement, and you owe it to yourself to check them out.