Tendinosis vs. Tendinitis: What’s the Difference and How to Treat Them

If you’ve ever dealt with stubborn tendon pain—whether in your elbow, shoulder, hip, or Achilles—you may have heard the terms tendinitis and tendinosis used interchangeably. While they sound similar, they’re actually different conditions, and understanding which one you’re dealing with can make all the difference in your recovery.

The good news? Both are treatable. But the best treatment depends on what’s happening inside the tendon itself.

Tendinitis: The “Hot and Irritated” Tendon

Tendinitis is an acute inflammation of the tendon. It usually develops after a sudden increase

in activity, repetitive strain, or overuse. Think of it as the “angry” phase of a tendon injury.

Key signs of tendinitis:

• Recent onset of pain

• Swelling or warmth around the tendon

• Pain that worsens with activity and improves with rest

Treatment for Tendinitis

The focus here is calming things down:

• Manual therapy (soft tissue work, joint mobilization, or dry needling) can reduce tension in surrounding muscles and improve blood flow.

• Relative rest & activity modification—avoid movements that irritate the tendon, but don’t completely immobilize it.

• Gentle mobility and light loading can be introduced as symptoms improve.

  
  

Tendinosis: The “Stubborn and Degenerative” Tendon

Tendinosis is a chronic condition that happens when a tendon doesn’t heal properly over time. Instead of being inflamed, the tendon fibers start to break down, losing strength and elasticity.

Key signs of tendinosis:

• Pain that lingers for months

• Achiness or stiffness, often worse in the morning

• No obvious swelling or warmth

• Pain may flare with activity but often doesn’t improve much with rest

  
  

Treatment for Tendinosis

The goal here is rebuilding and reconditioning the tendon:

• Manual therapy is still key for improving mobility and reducing compensations.

• Progressive loading and strength training are critical. Tendons heal by being stressed appropriately—starting with isometric holds, then progressing to eccentric (slow lengthening) and concentric strengthening.

• Patience is required—tendon remodeling takes weeks to months, but with consistency, outcomes are excellent.

  
  

Why Knowing the Difference Matters

While both conditions benefit from hands-on care and smart training, the approach differs:

• Tendinitis → calm down inflammation, gradually reintroduce loading.

• Tendinosis → load the tendon progressively to stimulate healing and strength.

Treating tendinosis like tendinitis (rest only) often leads to lingering pain. And treating tendinitis like tendinosis (aggressive loading too soon) can make it worse.

Final Thoughts

Whether it’s tendinitis or tendinosis, you don’t have to live with tendon pain. With the right combination of manual therapy, activity modifications, and progressive loading, tendons can heal and return to full strength.

At The Body Remedy, I help active adults and athletes recover from tendon injuries with a personalized plan that combines hands-on treatment, mobility work, and tailored strength training.