tendinitis or tendinosis?

My first patient on Friday arrived promptly at 6 am.  She had traveled a distance to see me because of various issues —- mostly having to do with HIP FLEXOR TENDINOSIS / possible PIRIFORMIS SYNDROME and TENNIS ELBOW.  Needless to say, she had been riding the MEDICAL MERRY-GO-ROUND for quite some time and was ready for some answers.  She had been dealing with her problems medically, and nothing they had tried was working.  She was finally ready to step outside the box. 

In the nearly two hours I spent figuring out / treating her problems, we talked.  One thing that she said sort of perked my ears.  She had read my TENDINITIS -vs- TENDINOSIS webpage and was fairly amazed at how much research I quoted saying that it is doubtful that Tendinitis even exists.  According to the current science on the subject, virtually all Tendinopathies are Tendinosis — not Tendinitis.  Despite the fact that most of their ICD-9 diagnosis and billing practices have it correct (Tendinosis), I have said for years that not one doctor in a hundred knows the difference between Tendinitis and Tendinosis — despite the fact that Tendinopathies account for significant numbers of doctor visits.

This woman had recently visited an Orthopedic Specialist’s office and did something that I tell my patients suffering with Tendinopathies to do.  In one of my Blog Posts I suggested that people ask their doctor the difference between Tendinitis and Tendinosis.  She did.  Can you possibly guess what she was told?  I knew what he would say before she even told me what his answer was.  Her orthopedic ‘specialist’ told her that, “There is no difference between Tendinitis and Tendinosis.  They are one and the same —- two different names for the same problem.“  She knew then and there that she was in the wrong place.  You see; she had been on my TENDINOSIS page, and had one up on her doctor.  She had seen the snippets I have posted from numerous scientific studies and position papers on the subject — all saying the same thing.  Tendinitis is an old and outdated diagnosis — virtually all Tendinopathies are actually Tendinosis.

I realize that if you have never struggled with chronic Tendinosis, you think that this is splitting hairs — a matter of semantics.  ‘Au contraire mon frere‘.  Allow me to explain why by asking a simple question.  How do doctors treat ‘itis” (INFLAMMATION)?  We all know the answer to this.  They prescribe anti-inflammatory medications, including CORTICOSTEROIDS.   Unfortunately this does not help people with Tendinopathies (Tendinosis) heal their tendon. Why not?  Because just like the name implies, these people are struggling with an “osis” (Tissue Derangement) instead of an “itis“ (Tissue Inflammation).  Not only are the drugs that doctors commonly use to treat what they mistakenly call ‘Tendinitis’ not effective for this problem, they are downright dangerous and degenerative!

Oh, and by the way.  My patient — the one I was speaking of at the beginning of the post — was dumbfounded because she could frog leg her hips without pain or restriction when she left my office — for the first time in 25 years!  Her problem was a combination of Tendinosis and FASCIAL ADHESIONS most likely brought on by extremely high arches in her feet.  She may have also fallen into THIS category as well.