Tendinitis vs. Tendinosis

Everyone has heard of tendinitis, but tendonosis is still mostly unheard of. For musicians, it seems to be a much more common condition, however. I say “seems to be” because tendinosis often gets misdiagnosed as tendinitis. My spell checker, for example, is right now putting wavy red lines underneath every instance of the word. While the symptoms of each are very similar, their cause is very different.

Tendonitis
A tendon is strong, fibrous band of tissue that connects a muscle to a bone. If a tendon gets irritated or inflamed, then it is called tendonitis. In drummers, tendons can get irritated when they are used too often. With healthy use, tendons are remarkably resilient. Misuse, such as moving from an awkward position or subjecting the tendon to constant tension, can exponentially increase the wear and tear and dramatically reduce the amount that you can use a tendon before it gets injured.

Another risk factor is how you hold the sticks. If you hold the sticks too tightly, then you will absorb the vibration on the stick into your hand instead of letting the stick ring out. This vibration can add wear and tear above and beyond the strain on the tendons.

Tendonitis can be difficult to heal because tendons have poor circulation. Because little blood gets to them, tendons don’t have the resources to heal themselves very quickly. The resources have to leak through the tendon’s tissue through diffusion. This is one reason why you should drink plenty of water at shows.

Because of the limited healing speed, it is important not to re-stress an injured tendon. Any additional injury will slow down recovery time. The most important thing you can do is to examine your technique. If the tendonitis came from drumming, you should find out what movements you are making that are stressing out your tendons, and how you can adjust your technique to avoid a recurrence of the problem. Without correcting the cause of the problem, you can expect tendonitis to come back even if you allow yourself time to heal completely.

Drummers are at risk for tendonitis in the elbow — often because someone told them not to allow their elbows to move in and out (see page 92). De Quervain’s tendonitis is also fairly common. De Quervain’s tendonitis is felt in the back of the wrist, often occurs when someone is gripping too tightly with their thumb.
Tendinosis
The symptoms of endonosis look a lot like tendonitis, but while tendonitis is an inflammation of the tendon, tendinosis is the degradation of the tendon due to insufficient blood. Circulation keeps the muscles and tendons healthy and functioning. When there isn’t enough blood, tendons degenerate inside your body. Doctors operating on tendinosis sufferers find gray, degraded tendons that just aren’t getting the resources they need. Tendinosis is not on most doctors’ radar, unfortunately, and may be extremely common in musicians.

Anything that reduces circulation, such as gripping too tightly, deadsticking, holding your elbow in or out artificially, and not incorporating moments of rest into your playing can contribute to tendinosis. Once blood flow is reduced, then the tendon and surrounding tissue starve and waste products begin to accumulate. These waste products signal the body to make scar tissue in order to strengthen the tendon. Creating scar tissue would be great if the tendon was actually damaged, but in tendinosis, the extra tissue just gets in the way and further constricts blood flow. Even worse, it may press on nerves and tendons, causing pinched nerves and inflamed tendons.

Tendinosis will not respond the way that tendonitis does. The scar tissue will not disappear by itself, so simply resting and letting the inflammation disappear won’t work. Luckily, tendinosis is much easier and quicker to treat. Once circulation is restored the blood heals the area and massage techniques such as cross fiber can help to reduce the scar tissue.