Tendon and Joint Pain: What to Try Before an Injection

Tendon pain that has lasted more than a few weeks is usually not inflammation. It is tendinosis, a change in the tendon tissue itself, and it answers to different treatment from short lived tendonitis. Getting that distinction right changes what you should try first, and what you should be slow to try at all.

What is the difference between tendonitis and tendinosis?

Tendonitis is inflammation of a tendon. It follows a sudden overload, it is painful for days to a couple of weeks, and anti inflammatory treatment helps it.

Tendinosis is a change in the collagen inside the tendon, with little inflammation present. It builds over a long stretch of repeated load.

Under a microscope the two look nothing alike. The American Academy of Orthopaedic Surgeons describes the long standing form as degeneration of the tendon fibers.

Why does the difference change the treatment?

If there is no inflammation to reduce, an anti inflammatory approach has little to work on. That is the common story behind a tendon that has been iced, rested and medicated for months with no progress.

Tendinosis responds to load. The tendon has to be given work it can tolerate, then a little more, on a schedule. Rest alone lets it get weaker, which is why the pain often returns the week someone goes back to their sport.

How long does a stubborn tendon take?

Published guidance does not put a date on it, and any clinic that gives you one is guessing. Tendon tissue adapts slowly.

Progress is measured in how much load the tendon accepts without flaring the next day. A calendar is the wrong instrument for this.

What helps a stubborn tendon?

• Load it on purpose. Progressive, controlled loading has the most support behind it for long standing tendon pain.
• Reduce the load that flares it, then add it back in steps.
• Track one number weekly, such as pain the morning after, so progress is visible.
• Look above and below the sore spot. A painful elbow or knee often reflects how the shoulder, hip or ankle moves.
• Sleep, protein and hormone health all feed tendon recovery, and they are the part most people skip.

When is an injection the right call?

A steroid injection can reduce pain in the short term. Published reviews of tennis elbow report that the early advantage fades, and that by a year a loading program has caught up or done better.

That makes an injection a tool with a place, and a poor first move for a tendon that has hurt for months. It is a conversation for the doctor examining you, not a decision to take from a blog post.

When should you get it looked at?

Book an appointment if any of these apply.

• The joint locks or gives way.
• Swelling does not settle.
• You cannot put weight through it.
• Three months of sensible self management has changed nothing.

Sudden pain with a pop during effort is different again. A tendon can rupture, and that one wants same week attention.

What we do at Towsen Clinic, and what we do not

Dr. Adrienne Towsen is a board certified orthopedic surgeon with a sports medicine fellowship from Thomas Jefferson University Hospital. She no longer performs surgery, and we do not do injections or physical therapy here.

The clinic works on the layer that decides how well a tendon copes. That means movement quality, graded loading, sleep, and the hormone and metabolic health behind recovery. Her own published focus, written when the clinic opened, is “maximizing musculoskeletal potential and injury prevention”.

Who we see with this

Golfers, tennis players, runners and lifters across Chester County, plus people whose elbow or knee started complaining after a house project. They arrive from West Chester, Malvern, Exton and Glen Mills, usually after several months of hoping it would settle on its own.

What to do next

If the tendon has been sore for months, one appointment is worth booking. It looks at the load going through the tendon and at how well you recover between sessions.

Our page on injury prevention and performance medicine in West Chester describes what that program covers.

A first visit is 60 to 90 minutes and costs $295. Our page on how the first visit works lists the steps.

Call (484) 803-5448 to book.