A tendon is a cord of strong, flexible tissue, similar to a rope. Tendons connect your muscles to your bones. Tendons let us move our limbs and they also help prevent muscle injury by absorbing some of the impacts your muscles take when you run, jump, or do other movements. Generally, your body contains thousands of tendons. Therefore, you can find tendons from your head all the way down to your toes. The Achilles tendon, which connects your calf muscle to your heel bone, is the largest tendon in your body.
When you contract your muscle, your tendon pulls the attached bone, causing it to move. Tendons essentially work as levers to move your bones as your muscles contract and expand.
Tendonitis normally occurs after repeated injury to a specific area such as the wrist or ankle, thus causing pain and soreness around the joint. It also usually happens when an individual overuses a tendon, for instance, during a sport. It is typically accompanied by an acute injury with inflammation. In addition, tendonitis can occur almost anywhere in the human body whereas the tendons exist and are usually classified by their location.
Causes & Symptoms
Some common forms of tendonitis are named after the sports that increase the risk. A few of these names include the following:
- Tennis elbow – This is a common name for the elbow condition known as lateral epicondylitis. It is an overuse injury that causes inflammation and micro tears of the tendons that attach to the later epicondyle. Tennis elbow is a painful condition occurring from repeated muscle contractions at the forearm.
- Golfer’s elbow – A golfer’s elbow (medial epicondylitis) is a condition that develops when the tendons on the inside of the forearm become irritated, inflamed, and painful.
- Pitcher’s shoulder – Also known as thrower’s shoulder, is an injury that affects many baseball players. It is an overuse injury that is caused by an increased load placed upon the rotator cuff tendon. While the name suggests that this is a baseball injury, any athlete that participates in a sport where repetitive overhand motions are strongly required can sustain this type of injury.
- Swimmer’s shoulder – Swimmer’s shoulder (also known as shoulder impingement), is a condition where swimmers often aggravate their shoulders while they swim due to the constant joint rotation. Your shoulder is a very mobile joint, and due to this, it needs to be well supported by the ligaments and muscles surrounding the joint.
- Jumper’s knee – Jumper’s knee, also called patellar tendinopathy, is a common and potentially serious condition affecting the knee joint’s patellar tendon. Jumper’s knee is highly common in athletes whose sports require rapid jumping or stopping from high speed and is much more common in male athletes than in women.
Overall, tendonitis is caused due to lifestyle or exercise habits. It may also be caused by a general loss of flexibility in the tendon as part of the normal aging process. In rare cases, it can be caused by a serious underlying medical condition as well.
Other common areas where tendonitis can take effect include:
- Tendonitis in the wrist – Located in the wrist, tendonitis often appears in the form of De Quervain’s disease, a condition that causes pain in the back of the wrist at the base of the thumb. Although De Quervain’s disease normally occurs in people who repeatedly grasp or pinch with the thumb, it sometimes develops during pregnancy.
- Achilles tendonitis – This specific form of tendonitis affects the Achilles tendon. Achilles tendonitis typically is caused by overuse, especially in sports that require running or repeated jumping. Achilles tendonitis may also be related to faulty running technique or too poorly fitting shoes if the back of the shoe digs into the Achilles’ tendon above the heel.
Symptoms of tendonitis usually manifest around the affected joint. With proper treatment and rest, symptoms generally improve. However, you’re more likely to experience tendonitis symptoms daily within the first few days after onset. Symptoms can be continuous or recur just once in a while. It is recommended to allow some time for healing of your tendonitis, even if you are not experiencing any symptoms associated with this condition. At times any of these symptoms can become severe by the following below:
- Your joint pain suddenly increases with movement.
- Have redness, warmth, or swelling.
- Experience stiffness, tenderness, or thickening in the joint.
- Suddenly experience reduced joint range of motion.
Who gets Tendonitis?
Anyone can get tendonitis; however, it can be increased by certain risk factors:
- Labor-intensive occupation – Many occupational workers are required to use their strength to do certain things, thus increasing the chance of damaging their tendons. Some of these include gardening / landscaping, woodworking, building (construction workers).
- Poor posture – Having poor posture either at work or at home increases your risk of tendonitis, especially in your legs.
- Age – Patients older than 40 are more susceptible to developing tendonitis – as tendons age, they tolerate less stress, are less elastic, and tear more easily (degeneration).
- Medications – Some medications contain side effects that can cause tendons to tear. Certain medications include norfloxacin, fluoroquinolone antibiotics, and statins.
- Obesity – People who are overweight are more likely to damage their tendons anywhere in the lower body due to putting excessive stress.
How Does it Affect You? How Serious is it?
Tendonitis can normally be treated by following the correct steps within this type of injury. However, if tendonitis is left untreated, you could have a chance of developing chronic tendonitis, a tendon rupture (a complete tear of the affected tendon), or tendonosis (degeneration).
Chronic tendonitis can cause the tendon to degenerate and weaken over a period of time. As for a ruptured tendon, it can cause immediate sharp pain, weakness, immobility, and swelling in the affected area. You may also experience a popping or snapping sound when the injury occurs. Tendonosis involves degenerative changes, such as fraying, microtears, and abnormal new blood vessel growth in the tendon. Tendonosis often causes pain, stiffness, and restricted movement, and sometimes there may even be a visible lump.
Recommended Treatment & Rehabilitation
During a diagnosis regarding tendonitis, a physician will first ask about whether you have any underlying health conditions because an underlying condition frequently causes or radiates as pain. Your doctor will then ask you about when the pain began to take effect, what activity preceded the symptoms, and what the pain feels like. Afterward, he or she will ask about what treatments you have had in the past for similar symptoms, what you’ve been taking to treat the pain, and whether you have had an injury or surgery in the same area.
After a medical history has been done, the next process will be a physical examination. Your doctor will check for signs of infection, such as redness, and swelling. Your physician will use their hands to feel the skin at the painful area, check for physical symptoms, and determine whether the injury is limiting your range of motion in that joint. Next, your doctor will most likely ask you to move that joint so he or she can evaluate your ability to move it. In addition to this diagnosis, your doctor may request further testing, and the tests will depend on the symptoms you’re experiencing. The diagnostic imaging scan that is most often used is typically an X-ray. An X-ray is the fastest and easiest medical scan to perform, and it is performed in this case in order to rule out other possible causes, such as arthritis, stress fractures, or infection. If necessary, your doctor may also request a Magnetic Resonance Imaging (MRI) scan to confirm the extent of the injury.
Physiotherapy varies depending on the location and severity of the injury and whether you’re dealing with tendonitis or tendonosis. Therefore, below are a few physiotherapy treatments for each main location that are mostly affected by tendonitis:
Physiotherapy for tennis elbow
The ultimate goal for tennis elbow physiotherapy is to improve the strength and flexibility of your forearm muscles so you will not be bothered with tennis elbow again. Your physiotherapy may also teach you ways to change your tennis stroke or other activity that is causing your elbow troubles.
Physiotherapy for golfer’s elbow
It is always important to get treatment for a golfer’s elbow as soon as it occurs. As tendons do not have a good blood supply, an inflamed tendon that goes untreated can begin to tear. Therefore, your physiotherapist can help decrease the pain caused by medial epicondylitis and improve the affected elbow’s motion, strength, and function.
Physiotherapy for wrist tendonitis
Physiotherapy is a highly effective treatment for wrist tendonitis. Therefore, your therapist will help you reduce your pain, increase your wrist flexibility and strength, and return to your previous activities and sports. Some treatment programs for wrist tendonitis include pain management, hands-on techniques (manual therapy), and range-of-motion exercises in order to improve symptoms associated with this condition.
Physiotherapy for Achilles tendonitis
There are several treatment programs a physiotherapist can do to help boost your recovery for your Achilles tendonitis. One of the most common treatments is a hands-on myofascial release of the calf muscle and Achilles tendon to help prevent scar formation. Additionally, ultrasound, ice, and electrical stimulation are used to relieve soreness while the exercise promotes healing. Taping, orthotics, and footwear changes may also be needed.
Other treatments that are generally used throughout other locations where tendonitis is caused are:
- Rest – Especially if your injury is caused by repetitive motion, it’s a great method to avoid that motion while you recover.
- Supporting equipment – A splint, brace, or sling might be necessary for a short time.
- Strengthening exercises – possibly with elastic resistance tubing can help with injury recovery and prevention of future injuries.
- Patient education – Education and functional training can teach you how to avoid injuring yourself all over again once you return to your regular activities.
- Range of motion exercises – can help with recovery and help prevent the aggravation of a stiff or frozen joint.
- Manual therapy – Your physiotherapist may perform manual therapy such as gentle joint movements, soft tissue massage, and stretches.
Alternative & Homeopathic Treatment
You can try to treat your tendonitis homeopathically. Some of these alternative treatments include:
- Ice and heat application – Taking ibuprofen to relieve inflammation helps, but ice can be another form of medication. To help reduce swelling, apply an ice pack wrapped in a towel for 20 minutes, 2-3 times a day.
- Compression – A warm compress helps to increase blood flow. Compression alone helps to prevent the buildup of other fluids in your body and limits swelling getting rid of what is already surrounding the pain.
- Herbs – One of the common herbs that helps reduce inflammation comes from turmeric called curcumin.