Rehabbing Not Resting Painful Tendons
Physical Therapy for Tendonitis
Tackling Tendon Pain Once and For all
Muscles get most of the attention when it comes to strength and conditioning. We work hard to build those muscles up so that we can lift heavier objects, run faster, jump higher, and look good while doing it. But while our muscles display all of our hard work, our tendons are in the background working just as diligently with little of the glory. Tendons are a type of fibrous connective tissue that connect muscles to bones. Far from simply fasteners of muscle to bone, tendons play a pivotal role in the effects that muscles have on the skeleton. First, tendons help to move our bones and amplify the effect of muscle contractions . Second, they play an important role in attenuating and absorbing shock that is transmitted from bone into muscle.
Tendons are strong but they are not designed to stretch or deform easily. They can also become weaker or stronger/stiffer in response to a training stimulus. Depending on the training and the activity, a tendon can become more prone to or more resilient against injury. Tendons are built to withstand a lot of force but repetitive stress which exceeds the tolerance of the tendon can lead to injury. The overloading of the tendon may be caused by ramping up the volume of a new activity too quickly, or due to muscle strength or length impairments, movement pattern inefficiencies and biomechanical errors in and around the involved tendon.
One type of tendon injury that can affect tendons throughout the body is tendonitis. This condition is commonly treated by physical therapists. While other joint conditions can mimic tendonitis, signs and symptoms suggestive of tendonitis include:
Pain over the involved tendon when the muscle is contracted
Pain over the involved tendon when the muscle/tendon is stretched
Swelling or inflammation over the injured tendon
Stiffness when moving the joint near the involved tendon
A feeling of weakness when contracting the involved muscle
Technically any tendon in the body could experience tendonitis, however, certain tendons seem to be more susceptible to this condition than others. Common types of tendonitis include:
Patellar tendonitis (aka jumper’s knee)
Rotator cuff tendonitis
Lateral epicondylitis (aka tennis elbow)
Medial epicondylitis (aka golfer’s elbow)
Achilles tendonitis
Thumb tendonitis (aka De Quervain's tenosynovitis)
Hip flexor tendonitis
Posterior tibialis tendonitis
Hamstring tendonitis
A CASE OF MISTAKEN IDENTITY?
The term “tendonitis” is commonly used to describe pain and irritation of a tendon, but are we using this term incorrectly? It turns out, in many cases, yes. The suffix “itis” denotes the presence of inflammation. In the case of tendonitis, the term suggests the tendon is inflamed, and in the early stages of tendon injury, inflammation is likely present. Except in mild cases of tendonitis which heal quickly, however, the symptoms of a chronic or prolonged case of tendonitis likely have little to do with inflammation and more to do with degeneration that can develop in an injured tendon. This is why it is often more appropriate to refer to a case of persistent tendonitis as a tendinopathy which means “disease or disorder of the tendon.”
Are we splitting hairs here? It may seem that way but understanding what is happening at the level of the injured tissue helps us to select the appropriate treatment interventions. A tendon that is inflamed benefits from treatments aimed at reducing inflammation. A tendon that is degenerating needs a different type of treatment. This is why a tendon that is allowed to rest and treated with ice or anti-inflammatories may recover quickly if caught early. These treatments, however, become less effective over time, and a case of persistent tendinopathy is much more responsive to treatments that improve the stiffness and strength of the tendon rather than simply trying to manage symptoms by reducing inflammation. Similarly, reducing the offending activity can be a good choice early on to allow inflammation to subside and the body’s natural healing process to take over, but prolonged rest may do more harm than good.
Hopefully by now you understand a bit more about the pathophysiology of tendonitis/tendinopathy but you may be wondering how you would know which treatment approach to take. The good news is, you don’t have to figure that out on your own. Physical therapists are experts at musculoskeletal injuries like the one we are describing and are there to tell you which type of treatment or exercise you need. If they believe your tendon injury is in the inflammatory stage they will teach you how to rest and protect the tendon while applying interventions to minimize pain and inflammation. When the tendon has moved beyond the inflammatory stage, your therapist will prescribe treatments and exercises to help increase the stiffness of the tendon so that it becomes more resilient to the repetitive forces of your work tasks and favorite sports. Resting the tendon will not contribute to this process and will predispose you to experience recurrence of these symptoms when you resume your previous level of activities. There is a right way and a wrong way to go about this process of applying graded stress to the tendon and it is a good idea to work with a PT who can help you progress without setbacks.
Tendonitis can seem like a big hurdle to overcome, but with the right treatment plan and the keen eye of a skilled physical therapist, you can get long lasting results that will allow you to return to the activities you love and need to do without worrying that your symptoms will come back as soon as you do. If you are experiencing tendonitis or tendinopathy, let our team of physical therapists at Evolve show you how to recover more quickly and completely.
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About EvolveNY-
Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better! First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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