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Open Mon-Sat · (03) 9859 5059 · BOOK online OR call Reception

Dr Tristan Joss

A quick anatomy lesson… (skip this if you know it already) 

A tendinopathy refers to a tendon which may be painful, weak, swollen or inflamed. It’s a broad term describing any tendon pain. We can narrow this down into two main categories which are tendonitis and tendinosis.  

What is tendonitis?  

“ITIS” means inflammation, so whenever ITIS is thrown onto the end of a word, it means that anatomical structure is inflamed, E.G tonsillitis is inflammation of the tonsils. Tendonitis is the inflammation of a tendon.  

What is tendinosis? 

It’s the degeneration (breaking down) of the tendon’s collagen in response to overuse. It happens when we persistently overuse a joint without giving the tendon time to rest and heal. This happens with repetitive strain injury or chronic overuse. In theory any movement done repetitively enough can cause tendinosis but this doesn’t always happen.  

We hear so much about tendonitis, it seems to be an overly diagnosed umbrella term compared with tendinosis. Everyone’s been told at some point they have tendonitis in the knee or elbow, haven’t they?  The outcome of long-term bouts can result in loss of strength through the tendon which can result in a cycle of not healing completely. This can increase the chances of having secondary conditions such as nerve impingement or bursitis.   

What do we do differently?

Practitioners are usually satisfied with diagnosing a tendonitis and treating it, but here at Boroondara Osteopathy we are much more intrigued with why they occur in the first place.   

We all, in our daytoday lives, at work, at home or exercising do a lot of the same repetitive movements and most people don’t have a tendinopathy   

Its estimated we have around 1300 tendons in the body. If in theory tendinitis can affect any tendon in the body, why are there only 4 or 5 that seem to cop it?  

The common areas of tendinopathy are all around major joints In the body: 

  • the ankle (achilles) 
  • knee (quads or hamstrings) 
  • hips (glutes) 
  • shoulders (rotator cuff/biceps) 
  • elbow (tennis/golfers elbow) 
  • wrist (De Quervains tenosynovitis)

If a joint is moving too little (we might call it stiffness), or a joint is moving too much (we might call this hypermobility), the tendon is only able to work with the movement that is available at the joint it crosses over.  So the question is, WHY is the joint not moving efficiently 

The thing is these joints are related and rely on each other to spread the load. If one isn’t doing the job the best it can, another will take up the slack taking on more movement than it should. This can mean there is more pressure on a specific joint to carrying a bigger load, the muscles around it tighten up, and this may end up with tendinopathy.  

To overcome the tendinopathy forever, especially if its reoccurring, we need to find the joint that doesn’t move effectively that’s impacting on the joint with the tendonitis in the body, not just the tendon that has the symptoms. We can treat the sore tendon and get some symptomatic relief all we like but the cause of the problem hasn’t disappeared.  

If we can get the joints moving efficiently through manual therapy and movement practices, then there won’t be any good reason for a tendon to become inflamed or to break down.  



E.Bass. Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. Int J Ther Massage Bodywork. 2012; 5(1): 14–17 

F.Abat et al. Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part I: biology, biomechanics, anatomy and an exercise-based approach. J Exp Orthop. 2017 Dec; 4: 18. 

A.Puri. Tendon fatigue in response to mechanical loading. J Musculoskeletal Neuronal Interact. 2011 Jun;11(2):106-14 

R.Mellor. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ 2018; 361