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The Difference Between Tendonitis and Tendinosis (and how this affects your treatment plan)

June 10, 2016

Here’s a common question we here in the clinic: “Do I have tendonitis or tendinosis?  And what does that mean?”

Since these 2 terms are used so frequently, and often interchangeably, I wanted to clear up what they both mean.

In addition, once we cover what they both mean, then we can discuss how understanding the difference can improve your success when designing a treatment plan.

(If you’d like to skip reading this post, I summarize everything in the video at the bottom of the page.)

So let’s start with tendonitis…

If you break the word down, it means inflammation of a muscle tendon (“-itis” stands for inflammation).

This means that the muscle is irritated where it tapers down into a tendon and attaches to the bone.

The 2 examples I use in the video and that I’ll use in this post are “rotator cuff tendonitis” and “Achilles tendonitis.”

So let’s say you decided to do a bunch of overhead activity this weekend, like chopping some wood, painting your ceiling or throwing the football around.

And come Monday morning, your shoulder is really sore.  In this case, it’s very likely that you have rotator cuff tendonitis, meaning that your rotator cuff muscles/tendons are inflamed.

You can imagine a similar scenario with your Achilles tendon after a long hike and a lot of walking.

Here are the basic characteristics of your issue (tendonitis):

  • The tendon is inflamed and irritated
  • Swelling and warmth are common, as your body is increasing blood flow to the tendon to help repair and heal it
  • At this point, if you don’t have any previous injuries, there shouldn’t be any structural damage

So as you can see, this is an “acute” or short-term issue that will hopefully resolve with things like rest and ice (although you probably know by know that rest and ice don’t always work…).

Now let’s look at someone with a longer-term, more chronic issue, which will lead to tendinosis…

Picture someone who has had multiple shoulder injuries over the years and who’s been having a low-moderate level of shoulder pain over the last 1-2 years.

Their pain is pretty much constant now and doesn’t vary much, and on a recent MRI they were found to have “moderate tendinosis” of the rotator cuff tendons.

So how do the 2 differ?

Here are the characteristics of the second person with “tendinosis”:

  • The tendons are irritated, but they’re no longer inflamed
  • Since there is no active inflammation, there is actually reduced blood flow to the tendons, which is limiting the healing potential
  • At this point, structural damage is starting to take place, and scar tissue/fatty tissue is starting to build (this can be shown on an MRI)

As you can see, there are some huge differences between the 2 scenarios.

And as you might also imagine, you really can’t expect to treat the 2 the same way (at least if you want quick results!).

For now, I’m not going to go into too many treatment details, but I hope this post helps you understand the importance of understanding the underlying cause of things like shoulder pain and Achilles pain.

Understanding the ROOT CAUSE of your pain is vital, BEFORE you dive into successful treatment options.

If you have any questions about pain that you’re experiencing, please don’t hesitate to call me at the clinic at (509) 892-5442 or send me an email at


– Luke Gordon (Doctor of Physical Therapy/Owner of Gordon Physical Therapy)

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