Question
What are the key differences between Achilles tendinitis and tendinosis, and how do they impact treatment?
Answer
Achilles tendinitis and tendinosis are two distinct conditions that fall under the broader category of Achilles tendinopathy, but they differ in pathology, symptoms, and recovery time. Achilles tendinitis is an acute inflammatory condition that develops due to sudden increases in activity or excessive strain on the tendon. It is characterized by localized pain, swelling, and warmth, and typically resolves within a few weeks with activity modification, ice, and anti-inflammatory treatments. Because inflammation is present, corticosteroid injections may sometimes provide short-term relief, but they come with an increased risk of tendon rupture.
In contrast, Achilles tendinosis is a chronic, degenerative condition marked by structural changes in the tendon, including collagen disorganization, neovascularization, and thickening. Unlike tendinitis, tendinosis is not primarily driven by inflammation but rather by repeated microtrauma and failed healing responses over time. Symptoms develop gradually and can persist for months, requiring a longer and more structured rehabilitation approach. Treatment focuses on progressive tendon loading exercises, such as eccentric strengthening, to stimulate tissue remodeling. Patient education is crucial, as recovery is slower than with tendinitis, often requiring at least 12 weeks of consistent intervention. Understanding these distinctions ensures that clinicians select the appropriate treatment strategies for optimal patient outcomes.
This Ask the Expert is an edited excerpt from the course, "Management of Achilles Tendinopathy," presented by David Nolan, PT, DPT, MS, OCS, SCS, CSCS.
