Table of Contents

• The skinny on tendon injuries-it’s NOT tendinitis …

• Hillary Topper-Businesswoman turned coach and auth …

• Episode takeaways:

  • References used for the MMB

The skinny on tendon injuries-it’s NOT tendinitis but rather tendinosis that ails you

Exploring the intersection of nutrition and athletic performance, the podcast begins with an engaging discussion about quercetin, a natural flavonoid known for its potential health benefits. The hosts delve into the claims surrounding quercetin's ability to prevent respiratory illnesses, particularly during the cold and flu season. They scrutinize various studies, highlighting how quercetin may inhibit viral entry into cells and its implications for endurance athletes, who often face a dip in immune function after intense training sessions. The conversation emphasizes the importance of realistic goal-setting for athletes and how supplementation can play a role in achieving those goals without compromising health. The hosts wrap up this segment by inviting listeners to consider how they might incorporate quercetin into their training regimens, all while maintaining a light and relatable tone that encourages personal experimentation and discussion within the community. This segment is peppered with practical advice, encouraging athletes to consider how supplements like quercetin might fit into their overall training strategy while emphasizing the need for achievable goals that push personal limits without risking health.

Hillary Topper-Businesswoman turned coach and author

About Hillary according to Hillary: I'm the author of From Couch Potato to Endurance Athlete, which is a memoir/self help book, where I share my 10+ year journey from a workaholic to an endurance athlete. I currently have a book coming out in January 2026, Unlocking the Triathlon: A Beginner's Guide to Triathlon Training. Following that, I have another book coming out next year on swimming in the open water. I am a USA Triathlon coach, USMS swim coach, RRCA run coach and a WOWSA swim coach. I am a blogger with ATriathletesDiary.com where I review products and write about experiences. I also blog for HilaryTopper.com, a NY Lifestyle Blog and I have a podcast, Hilary Topper on Air. I am an adjunct professor at a local university teaching digital marketing.

Diving into the depths of endurance sports and the wild ride of transformation, this episode takes us on a journey through the life of Hillary Topper—a former couch potato turned triathlon dynamo. Hillary's infectious enthusiasm is palpable as she recounts her leap from a grueling corporate grind to the exhilarating world of multisport. With her recent books, including 'From Couch Potato to Endurance Athlete' and the upcoming 'Unlocking Triathlon', she shares not just tips but relatable chaos that comes with competing in triathlons. We get the scoop on her somewhat disastrous first half marathon—think late-night Shake Shack and a heavy dose of regret—and how that moment became a catalyst for her endurance journey. Oh, and let’s not forget the laughable first attempts at swimming, where she hilariously fumbles through lessons, proving that you don’t need to be perfect to start. It’s a reminder that everyone starts somewhere, and sometimes, the best stories come from the most absurd beginnings. The conversation doesn’t stop there! Jeff engages Hillary in a discussion about the nuances of triathlon training and the various hurdles athletes face.

Episode takeaways:

• Our guest, Hillary Topper, shares her vibrant story of endurance coaching, emphasizing the importance of finding joy in the process rather than stressing about performance or others' opinions.

• We tackle the not-so-funny reality of tendonitis, revealing that most of us are dealing with tendinosis instead, which is way less fun and involves a long recovery process, leading to surgery for some.

• One key takeaway is that fear and self-doubt can be major hurdles, but as Hillary points out, just getting out there and doing it is half the battle—so let’s stop overthinking and start doing!

References used for the MMB

"Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters" by Evelyn Bass (published in the International Journal of Therapeutic Massage and Bodywork, 2012) highlights the critical distinction between tendinitis and tendinosis, emphasizing why accurate diagnosis matters for effective treatment.

Key Points:

1. Definitions and Misconceptions

• Tendinitis refers to inflammation of a tendon due to acute overload or trauma. It's still commonly diagnosed, but recent research suggests this is often incorrect.

• Tendinosis is a degenerative condition caused by chronic overuse without sufficient healing time. It involves structural changes in the tendon without inflammation.

2. Clinical Misdiagnosis

• Many conditions commonly labeled as tendinitis (e.g., tennis elbow) are, in fact, tendinosis.

• Histological studies show that what appears to be tendinitis lacks inflammatory markers and instead shows degenerative features like disorganized collagen, excess ground substance, and abnormal vascularization.

3. Progression and Pathophysiology

• It was once believed that tendinitis precedes tendinosis, but evidence shows tendinosis often occurs independently and may lead to secondary inflammation, not the other way around.

• Tendons are usually stronger than muscle, so injury to the tendon body typically requires prior degeneration.

4. Treatment Implications

• Tendinitis treatment focuses on reducing inflammation (e.g., NSAIDs, rest).

• Tendinosis requires strategies to repair degenerative damage and stimulate healthy collagen production, including:

  • Rest and ergonomic adjustments

  • Stretching and conservative movement

  • Ice application

  • Eccentric strengthening exercises

  • Massage techniques (e.g., deep-friction, myofascial release)

  • Nutritional support (vitamin C, manganese, zinc, etc.)

• Some anti-inflammatory treatments (e.g., corticosteroids, ibuprofen) may actually impair healing in tendinosis.

5. Massage Therapy Role

• Massage can aid by stimulating circulation, fibroblast activity, and collagen formation. Techniques must be carefully applied based on the condition being treated.

• Therapists should recognize their limits and refer patients to medical providers or physical therapists as appropriate.

6. Healing Timelines

• Tendinitis typically heals in weeks.

• Tendinosis, especially chronic cases, can take several months (up to 9 months) due to the slow process of collagen regeneration.

7. Long-Term Care

• Once symptoms subside, ongoing self-care (stretching, strengthening, massage, proper ergonomics) is essential to prevent re-injury.

Conclusion:

Understanding the difference between tendinitis and tendinosis is crucial for selecting appropriate treatments. Mislabeling these conditions can lead to ineffective or even harmful interventions. Practitioners must use accurate assessment techniques and customize care plans accordingly to promote optimal healing.

“Overuse Tendinosis, Not Tendinitis: Part 1 – A New Paradigm for a Difficult Clinical Problem” by Khan, Cook, Taunton, and Bonar (2000) challenges the conventional view that common overuse tendon injuries are inflammatory (i.e., tendinitis), asserting instead that they are degenerative conditions known as tendinosis.

Key Points:

1. Misdiagnosis of Tendon Injuries

• Conditions traditionally labeled as Achilles tendinitis, patellar tendinitis, tennis elbow, and rotator cuff tendinitisare more accurately tendinosis.

• Tendinosis is a non-inflammatory, degenerative condition marked by collagen breakdown, not by the presence of inflammatory cells.

2. Pathological Features

• Tendinosis is characterized by:

  • Disorganized and fragmented collagen fibers.

  • Increased ground substance (gel-like tissue between cells).

  • Increased cellularity (mostly fibroblasts and myofibroblasts, not inflammatory cells).

  • Neovascularization (new blood vessels that are not beneficial).

• Tendons with tendinosis appear dull, soft, and brown, in contrast to the white, glistening, and firm appearance of healthy tendon tissue.

3. Implications for Diagnosis and Treatment

The recognition of tendinosis has major clinical consequences in eight key areas:

1. Imaging: MRI and ultrasound can help confirm the diagnosis, showing structural degeneration, but are not predictive of prognosis.

2. Patient Education: Patients must understand that symptoms are due to chronic degeneration, not acute inflammation, and that recovery is slow (often 3–6 months).

3. Biomechanical Assessment: Identifying and correcting overuse, poor technique, or equipment issues is critical.

4. Anti-inflammatory Therapy Limitations:

   • NSAIDs and corticosteroids are ineffective or even harmful in tendinosis because they don't address the underlying degeneration and may impair collagen repair.

   • Cryotherapy may still help by reducing abnormal blood vessel growth.

5. Support Devices: Braces, orthotics, or heel lifts can offload stress on the tendon and assist healing.

6. Coordination with Physical Therapy: Clinicians and therapists should align expectations—treatment takes time, and early return to sport can lead to reinjury.

7. Eccentric Strengthening: Slow, controlled eccentric exercises are clinically proven to stimulate collagen production and restore tendon strength. This is a cornerstone of tendinosis rehabilitation.

8. Surgery: Reserved for chronic, treatment-resistant cases. It involves excising damaged tissue but requires long recovery (4–6 months). Surgery does not directly restore collagen health.

4. Clinical Relevance

• Tendinosis is common but often misunderstood.

• Tendinitis (true inflammation) is rare in overuse conditions.

• Recovery from tendinosis requires patience and structured, collagen-focused therapy.

• Mislabeling tendinosis as tendinitis leads to inappropriate treatment and prolonged symptoms.

Conclusion

This article calls for a shift in the clinical paradigm from viewing overuse tendon injuries as inflammatory (tendinitis) to understanding them as degenerative (tendinosis). Proper diagnosis and treatment rooted in this understanding are essential for effective recovery, reduced reliance on anti-inflammatory drugs, and improved long-term outcomes.

“Current Understanding of the Diagnosis and Management of Tendinopathy: An Update from the Lab to the Clinical Practice” published in Disease-a-Month:

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 Overview

Tendinopathy is a prevalent musculoskeletal condition accounting for up to 30% of sports medicine consultations. The term encompasses various non-rupture tendon injuries that worsen with mechanical loading. Despite extensive research, its exact definition and etiology remain unclear.

 Pathophysiology & Tendon Structure

- Tendons connect muscles to bones, transmitting force and storing elastic energy.

- They have high tensile strength but low flexibility due to densely packed collagen fibers.

- Tendinopathy progression includes:

  - Reactive phase: Early cellular response to overload

  - Tendon dysrepair: Disorganized matrix and neovascularization

  - Degenerative phase: Cell death and matrix breakdown

 Epidemiology

- Varies by age, sport, and anatomical site:

  - Children: Osgood-Schlatter, Sever's disease

  - Adults: Rotator cuff, Achilles, patellar, and gluteal tendinopathies

  - Common in runners, jumpers, and overhead athletes

 Diagnosis

- Based on clinical symptoms rather than imaging

- MRI and ultrasound may not correlate with pain

- Diagnostic tests include patient history, symptom reproduction, and functional assessments (e.g., VISA questionnaires)

 Biomechanics & Risk Factors

- Overuse, poor biomechanics, aging, metabolic disorders (e.g., diabetes, obesity), and specific medications (e.g., fluoroquinolones, statins) are key contributors

- Intrinsic: age, genetics, biomechanics

- Extrinsic: training load, surfaces, footwear

 Assessment Tools

- Physical exams (e.g., impingement tests for rotator cuff)

- Imaging (MRI, USI, Doppler for vascular changes)

- Functional evaluations (e.g., kinetic chain, scapular dyskinesis)

Management Strategies

- Conservative Treatment: First-line and includes:

  - Load management

  - Exercise therapy (isometrics, eccentrics, HSR—heavy slow resistance)

  - Manual therapy

  - Education on biomechanics and pain science

- Adjunct Therapies:

  - Shockwave therapy (ESWT)

  - Platelet-rich plasma (PRP)

  - Electrolysis and dry needling

  - Limited role for corticosteroid injections

- Surgical Intervention: Reserved for recalcitrant cases after ≥6–12 months

Drug-Induced Tendinopathy

Certain drugs can induce tendon pathology:

| Fluoroquinolones, Statins  | Glucocorticoids, Isotretinoin | Aromatase Inhibitors, Antiretrovirals |

Key Takeaways

- Tendinopathy is a spectrum disorder requiring individualized care

- Clinical diagnosis is more reliable than imaging

- Load management and progressive exercise remain the gold standard

- Surgical and pharmacologic options are adjuncts, not primary interventions

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