Let’s Talk Tendinitis: What Treatments Work?

Elbow Pain

If you’ve participated in a sport or had to perform a repetitive activity in the past you have dealt with the dreaded tendinitis. Yes, it’s that achy elbow after you had to paint the living room or that sore knee your teenager keeps complaining of after basketball practice.

It’s the Dreaded Tendinitis. Or Is It?

The term tendinitis actually has many names that convey slightly different messages. Tendinitis refers to an inflamed tendon. Tendonosis refers to a degenerative state of a tendon without inflammation. Finally, tendonopathy is an umbrella term that has not been properly defined to date.

Tendon injuries occur because the tendon is not able to withstand the amount of work you just performed. This may be due to a sudden increase in the mileage you are running, a long list of chores that had to get done over the weekend, or a change in the way your body has been moving that puts extra stress on a tendon. Either way, the amount of load the tendon had to undergo was too much.

Typically, when you have an injury the tendon goes into a state of inflammation. This is the sharp pain, swelling, and soreness you feel typically for a few days to a week.  Sometimes tendons are able to get past this inflammation without any interventions, and you return to normal activities. All good there.

Sometimes tendons fail to get past this first stage and you continue to experience pain and periodic flare-ups of inflammation. Persistent inflammation over time leads to changes in the tendon. This makes it harder for the tendon to withstand repetitive or difficult tasks.  This can turn into a downward spiral with repetitive inflammation, further degeneration, and further cellular changes. Before you know it you have been complaining to your family about elbow pain for 6 months and they are just as tired of hearing about it as you are dealing with it. It’s this time that patients typically seek out care and I intervene.

How Does a Tendon Disorder Get Diagnosed?

Diagnosis of a tendon disorder is relatively simple. First, it’s a process of ruling out other conditions. Then, it’s ruling in a tendon disorder by finding pain with resisted testing (typically in a stretched position) and pain upon touch to the tendon area. There are also ‘special tests’ that can be used but typically these are not necessary for diagnosis.

So now you have a tendon problem that just won’t go away. A Google search will provide a lot of solutions but what really works? I’ll break down the different ways to treat a tendon problem that are tried and true through current research and clinical practice.

The Most Basic Form of Treatment

Activity modification is always the first line of treatment. This means altering or changing the activity that is leading to the tendon disorder. Surprisingly, as the most basic form of treatment, practitioners don’t often discuss activity modification. For example, reduce your running mileage if this is provoking your symptoms or switch to biking temporarily.

Temporary Fixes

Modalities include ice, heat, electrical stimulation (those shock-y things put on the skin), ultrasound (not the type to see a baby but the wand-like instrument used to spread cream over the site of pain), and iontophoresis (the patch with medicine) have all been used in the past. In very severe cases of pain, these modalities can calm symptoms. But, for the most part, research doesn’t show any long-term benefits of these treatments. I find that if you do your ‘activity modification’ correctly these treatment techniques rarely have to be used. They may feel good temporarily but they are not fixing the root of the problem.

Taping or splints can decrease pain through providing support or decreasing the load on the tendon. Taping helps diagnosis by changing the way your body is responding to a load. I will typically tape patients and have them repeat a painful movement after testing to see how effective this change was. Furthermore, tape can be used to unload or take away stress on a tendon when activity modification is difficult. It is a very cheap and easy short-term fix to help both guide diagnosis and alleviate pain. It is superior to modalities as it can be taught to the patient and exercises can then be used over time to mimic the effects of the tape. The downside to tapes and splinting is that you can become over-reliant on these quicker fixes and ignore more long-term solutions.

Physical Therapy Treatments

Manual Therapy is the use of hands on treatment to change the movement of a joint and the surrounding tissue (muscle, ligament, tendon, connective tissue). This includes joint manipulation (quick thrust), joint mobilization (oscillating movements), soft tissue mobilization (different forms of massage), and tool mediated soft tissue mobilization (the use of instruments on the tissue). It is very common for a stiff joint to have an effect on surrounding tissue and be contributing to the problem. In the case of a tendonosis, or degenerative tendon, manual therapy can be used to stimulate change in the tissue if the body is unable to do so on its own. The majority of my training is in this field and is one of the most successful ways to treat a lingering tendonopathy when combined with…

Exercise! The hallmark of the PT profession. Progressive exercise dosed at the right frequency promotes change in the body. Progressions of 5-10% load per week typically elicit a rate of change that the body can handle to improve strength in the tendon. Not enough loading through exercise and the body won’t respond. Too much loading through the tendon and you get a flare in your symptoms. Proper adherence to exercise is the most important part of treating a tendon disorder and the dose is incredibly important.

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