If you are an Edmontonian (or are from the surrounding area) and you have been struggling with tendinitis, we want to help you.  The Unpain Clinic offers physiotherapy, chiropractic, shockwave therapy and massage therapy to help you reduce your pain and get back to what really matters – enjoying your life.

We love treating pain but we also love educating our patients and with that in mind, keep reading to learn more about tendinitis and how we might be able to help you move past it.

What is tendonitis?

Tendonitis occurs when the thick, fibrous tissue that connects muscle to bone, the tendon, becomes irritated or inflamed due to micro-tearing. Tendonitis can happen at any muscle tendon but is more common at:

• The Achilles tendon
• The patellar tendon (Jumpers knee)
• The rotator cuff tendons
• The forearm flexor and extensor tendons (Golfer’s Elbow and Tennis elbow, respectively)
• The tendons around the wrists (DeQuervain’s Syndrome)
• The biceps tendon

What causes tendonitis?

Tendonitis is usually due to trauma or stress on a tendon that exceeds its capacity for work, leading to changes in the health of the tendon. Generally these changes include degeneration of tendon collagen fibres and changes to the blood flow around the tendon. Additionally, the tendon may become thickened or calcified and bone spurs may form at tendon attachment sites. Tendon damage may occur rapidly or over a long period time, so symptom onset may be immediate or quite delayed.

Tendinosis vs. Tendinitis

Tendinosis is a chronic or recurrent condition caused by repetitive trauma or a non-healing injury. Tendonitis is usually an acute onset condition caused by direct injury to the tendon. Additionally, swelling and inflammation are usually present in tendonitis, but not in tendonosis. Most clinicians will simply term the condition a tendinopathy as in either case the treatments are similar and will always include advice and education related to activity and lifestyle modifications among other interventions.

Tendonitis symptoms

The symptoms of tendonitis can include:

• Pain at or around a joint or muscle tendon –usually worse with movement
• Gradual or sudden, severe pain at the affected area
• Stiffness or loss of motion in the affected joint
• Tenderness or pain when touching the affected area
• Mild swelling or thickening of the tendon

If you are experiencing these symptoms but they are accompanied by a fever, intense redness or severe swelling at the area or if your symptoms have been worsening over several days, seek immediate medical attention.

Can Anyone Get Tendonitis?

Yes, but it is more common in people who have certain risk factors. Some factors which can contribute to the development of tendinitis include:

• Poor technique or using ill-fitting equipment  at work or in sport
• Working in an occupation or having a hobby that has a lot of repetitive movement
• Playing a sport like baseball, swimming, golf, basketball, running, bowling or tennis
• Aging –as people get older tendons become weaker and less flexible
• Abnormal joint shape, position or stress at the joint (from previous trauma, injury, arthritis or other conditions)
• Being sedentary/rarely exercising
• Not stretching appropriately before or after physical activity
• Sitting or walking with poor posture
• Extreme or intense regular physical effort (e.g. over-training for a sport or event)
• Being obese
• Having an underlying condition that causes your tendons to be more vulnerable (e.g. a connective tissue disorder, diabetes

Tendinitis Treatment

The treatment for tendonopathy is generally the same, regardless of the affected area. Treatment for tendinitis can include:

• Self-care
  • Apply ice
  • Rest/avoid aggravating activities
  • Use compression and/or elevation to reduce swelling
  • Consult your pharmacist for appropriate over the counter medications to relieve pain and swelling
  • Stretch or perform gentle exercises at home to reduce pain
• Medication
  • As provided by a medical doctor to reduce more severe pain or swelling. Could be an oral medication or an injection like cortisone (or others).
• Physical therapy/chiropractic
  • Generally consists of advice and education regarding activity modification and lifestyle changes along with rehab exercise provision and the use of modalities (shockwave, ultrasound, laser, TENS) and/or manual joint and soft tissue therapy to relieve pain.
• Surgery
  • Usually the last option for treating tendonopathy but may be required for patients who do not respond to other less-invasive types of care.

Physical Therapy for Tendinitis

Physical therapy (or chiropractic) can be good for helping you relieve the pain of tendonitis and improve your overall function and quality of life. These treatment sessions generally consist of advice and education regarding activity modification and lifestyle changes along with rehab exercise provision and the use of modalities (shockwave, ultrasound, laser, TENS) and/or manual joint and soft tissue therapy to help relieve pain.

FAQ

Does Stretching Help Tendonitis?

Tendons are made of collagen which is much less elastic than muscle fibers. There is good evidence that stretching can be helpful to prevent tendonitis by relaxing the muscle and thus reducing strain at the tendon. In general static stretching AFTER activity is the most beneficial type of stretching but some athletes may get benefit from dynamic stretching before their sport as well.

If you already have tendonitis, the literature is less clear on the usefulness of stretching. In fact, some studies say that it might not be helpful at all and that targeted resistance training (especially eccentric exercise) and sport/activity specific training might be more useful.

What are the Best Exercises for Tendonitis?

It depends on the area of concern – a healthcare professional like a physiotherapist or chiropractor can create a rehab exercise program targeted to your unique needs, goals and overall level of fitness.

What are the Phases of Progression for My Tendonitis Recovery?

There are three basic, overlapping phases to tissue healing:

• The inflammatory phase (usually the first few days) in which erythrocytes, platelets and inflammatory migrate to the wound site and clean the site of necrotic materials. These cells will release special chemical that trigger fibroblast cells to synthesize and deposit collagen to repair the tendon. Sometimes patients can get stuck in this phase if they continue the cycle of repetitive strain with limited healing time.
• The repair phase (usually after a few days to weeks) -tendon fibroblasts synthesise abundant collagen and other extra cellular matrix components and deposit them at the wound site.
• The remodelling phase (usually after about 6 weeks) – during this period, the repair tissue changes to more fibrous tissue and covalent bonding between the collagen fibres increases resulting in repaired tissue with higher stiffness and tensile strength.

What is the best therapy for tendonitis?

In our opinion shockwave therapy is the best for tendonitis (but of course we are biased). We love shockwave for tendonitis because it is a regenerative healing therapy and because there are hundreds of studies linking extracorporeal shockwave to reduced pain and improved function for patients suffering from tendonitis, often in less than 5-6 sessions.

Of course our healthcare professionals will always assess you and are capable of providing a number of soft tissue therapy and rehabilitative exercise interventions beyond or in conjunction with shockwave therapy to get you back on your feet.

How do you rehab tendonitis?

The best way to start the rehab process for tendonitis is to make changes to your activities and lifestyle to reduce the strain on the tendon and provide an opportunity for healing to happen.  After this, working with a trusted healthcare professional is usually the best way to get a head start on recovery –they will be able to provide you with a treatment plan that meets your needs and will help you reach your health goals.