Tendons are highly organized connective tissue which connects muscle to bone and can resist high tensile stresses. Normal tendon is made up of primarily collagen (mostly Type I) and elastin. Collagen makes up 60-80% of the dry mass of the tendon while elastin accounts for 1-2%. Collagen and elastin are produced by cells called tenoblasts and tenocytes which are embedded within the collagen fibers.
Tendinitis is inflammation of the tendon which occurs secondary to microtears when it is suddenly overstretched or overloaded with tensile forces. While tendinitis is commonly diagnosed in patients thought to have tendon-related pain, research suggests the problem is tendinosis. The difference between tendinitis and tendinosis is appreciated at the microscopic level. In tendinosis the normal Type I collagen fibers are replaced with immature type III collagen fibers. There is a loss of collagen continuity so that collagen fibers are no longer aligned in a way that best facilitates load-bearing. There is an increase in the ground substance (material between the collagen) and disorganized vascularization (neovascularization) that has no role in the healing process. The result is a large and painful tendon that is no longer able to transmit normal forces from the muscle to the bone.
Treatment for tendinosis focuses on restoring the normal architecture of the tendon and thereby reduce pain and improve function and quality of life. The providers at Denver Back Pain Specialists offer regenerative medicine therapies, including stem cells and platelet rich plasma (PRP) which are thought to promote healing and reduce pain. These treatments are often done in combination with a procedure called Tenex. Tenex is a tenotomy (also called Focused Aspiration of Scar Tissue) procedure that is a minimally invasive, non-surgical approach for eliminating abnormal tendon. Once the abnormal tendon is removed, either stem cells or PRP are injected in the void to facilitate the healing process. 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.