Tendonitis is a common diagnosis for many people. Tendonitis means that the tendon structure has been altered in some way resulting in weakness in the structure. There are different degrees of severity of tendonitis.
What are tendons?
Tendons are found at the end of the muscle and act like a flexible cord. Tendons connect muscles to other body parts, usually bones. The function of the tendon is to pull on the structure that they are attached to when the muscle is working. For example:
- When you do a biceps curl, the biceps tendon pulls the forearm bones up, bending your elbow.
- As you are walking, the Achilles tendon pulls the heel bone up which moves the foot downwards.
- When you raise your arm, the rotator cuff muscles pull on the shoulder bone and move your arm up
Therefore, the main function of tendons is to carry load and produce movement. As a result, if tendons become injured, then the impact to movement and overall function can be significant.
How do tendons get injured?
Firstly, injury to the tendon can occur when there is a direct trauma to the structure, such as with a fall, a direct blow to the area or an overstretching of the area. In some more serious circumstances, traumatic injuries can lead to a complete rupture of the tendon. This usually occurs when the force applied to the tendon is more than what it can tolerate causing it to tear. A complete rupture of the tendon can be a more serious injury and may require surgery for the patient to regain their function.
Secondly, and more commonly, tendons get injured over time with repetitive activity or movements. Tendons are made to carry a certain load. The structure of the tendon can get changed over time with the repetitive or prolonged stressors of home, work or activity. These loads will impact the tendons ability to work properly and alter their structural make up.
How do injured tendons become painful?
Different tendons can carry different amounts of load. When the tendon is overloaded, injury can occur. For example, if a person at the gym has been lifting 50 lbs for several weeks and then one day they decide to lift 80 lbs, the rotator cuff tendons may not be ready to tolerate the sudden increase in weight. Similarly, if someone is usually at the office typing for about 4 hours and then they had to do 10 hours of typing one day, the wrist tendons may get overloaded with the increased activity. In both these scenarios, the tendons may become irritated and painful as a result of the overload.
For some people, the structural changes of the tendon may have happened several years in the past. The body learns to compensate for such changes keeping the involved area pain free despite the changes in the tendon. If the person then overdoes an activity or gets an injury, it may make that once pain-free tendon now painful. Although it may seem related to the most recent activity or injury itself, the actual symptoms may be coming from the pre-existing structural changes to the tendon.
Where does tendonitis usually occur?
Tendonitis can occur anywhere in the body where there are tendons. However, some tendons tend to be more susceptible to injury compared to others due to increased work or stress to those joints. Some of the most commonly occurring types of tendonitis are:
- Rotator Cuff Tendonitis (Shoulder)
- Lateral epicondylitis or Tennis Elbow
- Medial epicondylitis or Golfer’s Elbow
- Tendonitis of the wrist
- Patellar Tendonitis (Knee)
- Achilles Tendonitis (Heel)
What are the signs and symptoms of tendonitis?
- Usually described as a dull ache
- Usually occurs when moving the affected joint
- Decreased strength of muscles of the affected joint
- Pain when the affected muscles have to carry load
What are the stages of tendonitis?
Treating tendonitis effectively involves identifying the correct stage of the injury process of the affected tendon. Tendonitis injuries can present in the acute, sub-acute and chronic stages.
- Acute Stage
- Very early stages of the injury (ie. First few days after a fall or overstretching incident)
- Pain can be very sharp and there may be a lot of movement loss through the joint
- There may also be signs of inflammation
- Subacute/Chronic Stage
- A few weeks/months/years after the start of pain
- Pain may be duller and is dependent on specific activities
- The patient may have made many different compensations to deal with the symptoms
What is the treatment for tendonitis?
The treatment options will be different for the different stages of the injury. The specific stage of the injury will be identified during the assessment by the Registered Physiotherapist. If the physiotherapist suspects that there is something more serious going on like a fracture or complete tear, then they may make a referral to the doctor for further investigation.
In the acute stage, the goals of management is to reduce pain and regain mobility of the affected area. Pain can be significant and sharp at this stage. The physiotherapist may therefore use some pain-relieving modalities like IFC or Ultrasound to help reduce the acute discomfort. They may also provide some gentle soft tissue work as well some gentle exercises to keep the area mobile. The physiotherapist may also make recommendations for activity modifications at home and work to help with the recovery process.
Subacute and Chronic Stage
The management will change in the subacute and chronic stage of the injury as the area settles down and healing of the tendon occurs. Treatment at this stage is geared toward strengthening the tendon structure so that it can carry load appropriately. The exercises must remodel the tissues of the tendon so that they can learn to do the work correctly. The strengthening should be progressive in nature so that the affected tendon can tolerate increasing mechanical loads.
Most tendon injuries improve in approximately 8-12 weeks but there are some more complex cases that could take longer to resolve. With tendons that have structural changes that started several years ago, the remodelling of the fibres may take longer to accomplish. As with many other injuries, early treatment for these types of injures produces overall better results and helps improve a patient’s quality of life sooner than later.
At PhysioNow, our physiotherapists work with the patient to identify their specific limitations and help them recover. Call PhysioNow today to book your appointment for tendonitis!
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