Tendinitis versus tendinosis: ¿Cuál es la diferencia? Y 8 pasos para la recuperación
Las lesiones en los tendones no solo son dolorosas, sino que pueden resultar muy frustrantes por dos razones. Primero, tardan en curarse y segundo, a menudo se requiere un cambio de comportamiento para permitir que se lleve a cabo el proceso de curación. Muchas tendinopatías (que incluyen tendinitis, tendinosis y tenosinovitis) son el resultado del uso repetitivo, y si la actividad que causó la tendinopatía está relacionada con el trabajo o es recreativa, generalmente es difícil de evitar.
En esta publicación, analizaremos la diferencia entre tendinitis y tendinosis, y el enfoque de 8 pasos más eficaz para la recuperación.
¿Qué es un tendón?
Los tendones son un tipo de tejido conectivo que cumplen la importante función de conectar los músculos a los huesos. Están formados por fibras de colágeno densamente empaquetadas dispuestas en paralelo junto con una pequeña cantidad de una proteína llamada elastina, que permite que los tendones vuelvan a su longitud normal después de contraerse o estirarse.
In comparison to muscles, tendons are relatively poorly vascularized, meaning they have less blood flow. This means that injuries to tendons take longer to heal than injuries to muscles, and is a reason why tendon injuries are so frustrating. Research suggests that it can take anywhere from 6 weeks to 9 months for tendon injuries to fully heal.
La importante diferencia entre tendinitis y tendinosis
Tendon pain resulting from repetitive use has long been diagnosed as tendinitis, but research increasingly shows that these cases are most often actually tendinosis.
La tendinitis, designada por el sufijo "itis", es una afección inflamatoria aguda. La verdadera tendinitis generalmente ocurre cuando un tendón se sobrecarga por una fuerza repentina o fuerte, lo que resulta en microdesgarros en el tendón. El sistema inmunológico se activa para reparar el tejido dañado, y el tendón y los tejidos circundantes se inflaman y duelen.
La tendinosis, designada por el sufijo "osis", es una condición degenerativa crónica. En la tendinosis, el colágeno del tendón se degenera en respuesta al uso excesivo crónico. Incluso los movimientos pequeños, como hacer clic en el mouse de una computadora o enviar mensajes de texto, pueden provocar tendinosis con el tiempo. En la tendinosis, la inflamación no está presente y el tendón blanco brillante, firme se ha vuelto opaco, blando y marrón.
Researchers have learned about this important difference between tendinitis and tendinosis by examining surgical patients who are diagnosed with tendinitis. For example, in a study of people diagnosed with tennis elbow, no signs of inflammation were found, and thus the correct diagnosis for these patients was tendinosis.
Tendinitis is painful because inflammatory substances activate nociceptors (pain receptors), and because the swelling present in inflammation can cause painful pressure. But if inflammatory substances aren’t present in tendinosis, why is it painful? Research shows that degenerating tendons contain high levels of the amino acid glutamate, and it’s likely that this is at least partly responsible for the pain.
Another study examined patients with painful Achilles tendinosis and found neovascularization present in all of the painful tendinosis tendons, but in none of the pain-free controls. This finding suggests that the growth of new blood vessels in degenerative tendons plays a role in the pain felt in tendinosis.
If your tendon pain has come on gradually, and if it seems to be the result of repetitive use, it is most likely tendinosis. In the next section we’ll discuss a multifaceted approach to healing tendinosis based on proven methods.
El enfoque de 8 pasos más eficaz para curar su tendinosis
La tendinosis es una afección frustrante de tratar porque puede llevar mucho tiempo curarse por completo y, a menudo, se requieren modificaciones de comportamiento y estilo de vida para permitir que se cure. Por lo tanto, si bien es posible que se resista a hacer todo lo que se recomienda a continuación porque le parece demasiado trabajo, tenga en cuenta que los tendones degenerativos tienen un mayor riesgo de rotura, y eso es algo que definitivamente debe evitar.
Tómese el tiempo y el esfuerzo para dejar que el tendón doloroso se cure, y probablemente aprenderá algunas cosas valiosas sobre cómo cuidarse y evitar que se desarrollen problemas futuros en los tendones.
Tenga en cuenta que los medicamentos antiinflamatorios generalmente no se recomiendan para la tendinosis, ya que no hay inflamación.
1. Reduce or avoid the repetitive activity that caused the tendinosis. If the activity is required at your job, make sure to take frequent breaks, like a 5-minute break every 20-30 minutes. If possible, train yourself to do the task by using your body in a different way—like with your non-dominant hand—so that the injured tendon can rest.
Si la actividad es recreativa, recomiendo detenerla por completo hasta que desaparezca el dolor. Si eres un atleta, haz un tipo diferente de ejercicio que no agrave tu tendón doloroso y, mejor aún, aprovecha esto como una oportunidad para crear un régimen de entrenamiento cruzado para ti. Recomiendo alternar al menos 3 diferentes tipos de entrenamientos a lo largo de la semana que utilicen su cuerpo de diferentes maneras; esta es la mejor manera de evitar lesiones por uso excesivo mientras se mantiene un alto nivel de aptitud física.
2. Adjust ergonomics and biomechanics. If the repetitive activity that caused your tendinosis is performed at your job, then take the time to evaluate how your workstation is set up. Sometimes a small change, like moving your keyboard so that your wrists are in a neutral position when typing, can have a huge impact.
Whether your tendinosis was caused by a work-related or recreational activity, consider how you might be able to use your body differently in order to avoid straining the painful tendon. Tendinosis can occur not just from overuse but also from misuse—moving in an unnatural or imbalanced way, or with too much force. Clinical Somatics exercises are extremely effective for retraining habitual posture and movement. They also give you fine-tuned control of your body so that you can sense when your posture or movement is the slightest bit “off” and correct it before pain or damage occurs.
3. Support and splint the painful tendon. Limiting movement by taping or wearing a brace reduces the amount of harmful, repetitive movement that caused the injury. If you must continue to do the repetitive task at work, supportive tape or a brace is recommended.
4. Apply ice. Icing degenerative tendons is not intended to decrease inflammation, as there is none in tendinosis. Instead, ice is recommended for painful tendinosis because it has proved beneficial in clinical settings. The reasons why are not fully understood, but it may be because ice constricts blood vessels. Abnormal vascularization (growth of new blood vessels) is common in tendinosis, and as mentioned earlier, may contribute to the pain.
5. Massage the painful area. Massage has many benefits for healing connective tissue because:
- Estimula la circulacion
- Estimula la actividad de los fibroblastos, acelerando la generación de nuevo colágeno.
- Reduce la formación de tejido cicatricial.
- Relaja temporalmente el músculo adherido, reduciendo la tensión en el tendón.
- Disminuye temporalmente la sensación de dolor.
6. Get proper nutrition. Since the key to healing a degenerative tendon is allowing sufficient collagen to be produced—and not subsequently worn away by repetitive movement—it’s important to get enough of the vitamins and minerals that play a role in collagen synthesis and tissue repair. While more research is needed, a quick internet search will give you the basics: A diet rich in vegetables, fruits, legumes, nuts, seeds, and whole grains will provide you with the nutrients and antioxidants needed for optimal healing.
Una nota importante: el colágeno que se encuentra en los suplementos populares se descompone en aminoácidos en nuestro sistema digestivo, y luego nuestro cuerpo usa los aminoácidos donde sea que los necesite. Por lo tanto, siempre que obtenga proteínas de diversas fuentes en su dieta, los suplementos de colágeno probablemente sean una pérdida de dinero.
7. Release your muscles. Tight muscles pull on their tendons, creating excess strain on the tendons. This strain contributes to tendon degeneration and increases the risk of tendon rupture. An important part of both the healing and prevention process is reducing the baseline level of tension in your muscles.
While you might be inclined to focus on releasing just the muscle that’s attached to your painful tendon, keep in mind that one single muscle is never responsible for a dysfunctional movement pattern. You should reduce muscle tension throughout your body so that you can improve your posture and movement and prevent recurring and new problems. Don’t waste your time with static stretching—pandiculation is the most effective way to reduce your muscle tension.
8. Practice eccentric strengthening. An eccentric contraction is the action of a muscle lengthening while still contracting under load; an example is your biceps muscle slowly elongating as you lower a dumbbell. A number of studies have shown the effectiveness of eccentric strengthening as a treatment for tendinosis, and there are several likely reasons why. First, scientists believe that eccentric strengthening stimulates collagen production in tendons. Second, animal experiments have shown that eccentric strengthening can improve collagen alignment and stimulate collagen cross-linkage formation, improving the tensile strength of the tendon.
Lastly, scientists recognize that eccentric contraction actually lengthens muscle, thereby reducing muscle tension and strain on the attached tendon. Pandiculation is a specific type of eccentric contraction, the sole purpose of which is to reduce muscle tension rather than build strength. Yet another reason to incorporate Clinical Somatics into your regimen for tendinosis recovery!
Lectura recomendada:
The Pain Relief Secret: How to Retrain Your Nervous System, Heal Your Body, and Overcome Chronic Pain by Sarah Warren, CSE
Somatics: Reawakening the Mind’s Control of Movement, Flexibility and Health by Thomas Hanna
