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Types of Tendon Pain

Tendons are composed of highly organized connective tissue which can resist high tensile stresses. The function of a tendon is to connect a muscle to a bone which allows for movement. Normal tendon is made up of primarily two connective tissue types:


The two main diagnoses of tendon pain are tendinitis and tendinosis. While tendonitis is commonly diagnosed in patients thought to have tendon-related pain, research suggests the problem is actually tendinosis. The difference is appreciated at the microscopic level.


Tendinitis is inflammation of the tendon which occurs secondary to microtears. These microtears happen due to the tendon being suddenly overstretched or overloaded with tensile forces.


Tendinosis is degeneration of the tendon’s collagen, due to chronic overuse. Even small movements can create tendinosis over time. The microscopic changes include:

  • The normal Type I collagen fibers are replaced with immature type III collagen fibers.
    • This disrupts the overall collagen continuity so that they are no longer aligned in a way that best facilitates load bearing.
  • There is an increase in ground substance (the material between collagen fibers).
  • Vascularization (development of blood vessels) becomes disorganized and does not contribute to the healing process. This is called neovascularization.
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Common Causes of Tendinopathy

Tendinopathy can be caused by an acute injury, but more commonly occurs with chronic overuse. Injury to a tendon can cause local pain and thickening of the tendon. Some of the more common locations of tendinopathy are:

  • The heel (Achilles tendinopathy)
  • Outside part of the elbow (tennis elbow)
  • Shoulder (rotator cuff)
  • Bottom of the foot (plantar fasciitis) – technically not a tendon, but same mechanism of disease

Treatment for Tendinosis

Treatment for tendinosis focuses on restoring the normal architecture of the tendon, thereby reducing pain and improving function and quality of life. Treatment includes a combination of the following:

After the procedure, there is typically a short duration of rest followed by a specialized physical therapy program tailored to the specific region of the body where the tendinosis has occurred.

Restoring a Pain-Free Life

Chronic tendinopathy can significantly impact the quality of your life, making it hard to perform routine daily tasks and participate in your favorite activities. Fortunately, you don’t have to live with this pain any longer. At the Denver Spine and Pain Institute, we offer the most advanced treatments to alleviate your pain, helping you enjoy life again.

We’re the only sports, back and pain specialists in the country providing a Connected Care Approach™ specifically designed to get you back to enjoying life faster. This approach involves:

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Please contact us today to schedule an appointment. The Denver Spine and Pain Institute serves patients in Denver and the surrounding areas of Colorado.

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