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Tendonitis, tendinosis and tendinopathy? What’s the difference and when will I get better?

There is a lot of misunderstanding when it comes to tendon injuries, with many confusing terms and sometimes contradicting advice on how best to treat them.

What do tendons do and how do they work?

We often think of tendons as merely a connection a muscle has to the bone, to allow it to transfer a pulling force, much like pulling on a string or rope. We have since discovered tendons to be a lot more complex! Their primary role is actually to store and release energy, much like a spring, to allow us to propel ourselves. This is particularly obvious with the Achilles tendon at the ankle when we are sprinting. It is responsible for much of the forward propulsion, and allows us move efficiently with less metabolic energy expenditure.

What happens when a tendon is injured?

A tendon is injured when there is a force exerted on it that exceeds what it is capable of withstanding. What we have found is that when there is damage to tendon tissue, that area of the tendon does not heal. Even when re-scanned long after the injury and once pain has settled and tendon function has restored, the tendon will still look the same on ultrasound.

Tendinopathy  This is a broad term to describe any pathology of a tendon.

Tendonitis Refers to inflammation of the tendon, which is actually a less common cause of tendon pain than you might think! However the term is loosely used out of habit to described any tendon pain or pathology.
Tendinosis This is non-inflammatory degeneration of collagen fibers in the tendon due to repetitive overloading and is a much more common cause of tendinopathy or tendon pain. As a result, they typically don’t respond that well to anti-inflammatories, and are best treated with rehabilitation exercises to strengthen the intact tendon tissue.

How are tendon injuries treated?

Studies have shown scans on individuals with even quite extensive tendon tissue damage, go on to be relative pain-free and high functioning with appropriate non-surgical treatment and rehabilitation. The key is, that even when there has been significant damage to part of the tendon, there is generally still a lot of good quality, functioning tendon tissue around it, and it is this part of the tendon that we are looking at strengthening and conditioning with our exercises, to allow it to operate at capacity.
It is not just a case of ‘stretching it out’ – in fact, in some cases this could actually cause further tissue damage and prolong your road to recovery. We need to use gradual strength and loading exercises to recondition the function of the tendon. Everyone’s injury will be slightly different, and require a tailored approach, so it’s best to see a health professional for proper advice and management.
In the case of a complete tendon rupture, then surgical intervention is required.
Our goal with rehabilitation exercises is to improve the capacity of the tendon to store and release energy, well above the daily demands that will be exerted upon it, thus reducing the risk of re-injury.
We see a lot of tendon injuries through the clinic, most commonly of the shoulder and hip region. A thorough physical examination is often enough for us diagnose the nature and severity of tendon injury, and develop a treatment plan to get you back to full function. In some cases we may decide to get an ultrasound or MRI to further assess the degree of tendon injury and rule out any other pathology. Treatment generally comprises gradual progression through a program of exercises designed to increase the load tolerance of the tendon, in combination with hands-on manual therapy to maintain pain-free range of motion through the region.
Feel free to contact us if you would like more information on tendon injuries, or if you would like to book a consultation, you can use our online bookings or phone on 9581 3331.

Check out the short video below on how tendons work!

2 Simple Exercises to Keep Your Shoulders Strong and Pain-Free

Following on from our blog last week on subacromial bursitis and shoulder impingement, I thought it would be useful to provide some information on two exercises I have found to be very helpful for my patients with various forms of shoulder pain.

Stretches are beneficial to keep soft tissue structures flexible, but strengthening is really the key to enabling the shoulder to move correctly and be stabilised. Strengthening increases the capacity of the muscles to perform the tasks we demand of them, in a pain-free manner.


1. Resisted External Rotation

This is an excellent and very popular exercise to strengthen the rotator cuff muscles, and will generally form part of the initial rehabilitation phase in most clinics.

With your elbows by your side at 90 degrees, hold a length or resistance band between both hands. Keep one arm still as an anchor point, and slowly rotate the opposite arm away from your body. Alternatively, you can tie the band onto a pole or hook. It is important to keep your elbow up tight against your body with the movement, to ensure the rotator cuff muscles are doing the work and not the torso trying to help out. Also ensure that the wrist stays straight, as it too can try to compensate for a weakness in the rotator cuff. The body will look for ways to cheat and avoid using the shoulder if it is painful, so keep an eye on your form!

2. Seated Rows

This exercise helps to strengthen the muscles of the upper back that help support the scapula(shoulder blade). The scapula forms the base of support from which the upper limb operates, so it important that we have a strong, stable foundation here. Issues with scapular control and stability, can often have a significant flow-on effect down the chain.

It is best to start with this exercises in a seated position, with your arms slightly elevated out to your sides. With the resistance band in each hand, have it looped around a pole or a hook in front of you. Focus on squeezing the shoulder blades together in the middle of your back, without shrugging your shoulders. Try to focus most of the strength and movement at the shoulder blades, and not the arms/elbows. Also, be careful not to jut the neck/chin forward!


These exercises are meant as a guide only. It is recommended that you consult with your usual healthcare practitioner prior to commencing exercises, to rule out any contraindications or underlying pathology that may need to be addressed.

Is My Sleep Position Aggravating My Shoulder Pain?

I see a lot of patient’s in the clinic for treatment and rehabilitation of shoulder pain and this is a question I am often asked. In a lot of people, shoulder pain can arise from the rotator cuff, which is a group of muscles around the shoulder, that stabilise the ball and socket joint in a ‘cuff’.

If you are always laying on the same side (which we often do), then this constant pressure of the muscle tendons against the underlying bone can cause fraying and inflammation. This is known as rotator cuff tendonitis and can lead to impingement syndrome.

Symptoms often start off as pain in the front of the shoulder that can refer down as far as the elbow. Over time this can progress to weakness in the shoulder and difficulty perform tasks above 90 degrees.

Thankfully, in most cases, it can be treated quite effectively with a combination of manual soft tissue therapy, joint mobilisation and rehabilitation exercises to restrengthen the rotator cuff.

If you have shoulder pain that is not resolving, feel free to book an appointment at the clinic for a full assessment and treatment.

Winter Exercise Tips

It’s easy to let the exercise go by the wayside over winter. Here are some tips for keeping active over the cooler months…

1. Make the most of daylight hours – With limited daylight hours before and after work, look at ways to incorporate exercise into your daily routine. This might include a brisk lunch-time walk or a midday exercise class.

2. Plan an active winter holiday – A winter escape to a warmer location is a good way to avoid the worst of the weather, and to also plan some outdoor activities like hiking, cycling, kayaking and surfing.

3. Get an exercise partner – It can take a lot of determination to get out of bed on those cold, dark mornings. Having an exercise buddy is a great way to commit to an exercise plan.