At either end of a muscle is an area referred to as the tendon. The tendon is the part of the muscle that attaches to the bone and when this part becomes inflamed, it is called tendonitis. Tendonitis is a commonly used term that many of our patients have heard of and it usually occurs when the tendon is placed under a tensile force that is too heavy or sudden for it to be able to cope with.
It was believed that due to the excessive forces being placed upon the tendon, micro-tears occur within the tendon resulting in inflammation. However, recent research shows that in most cases there is actually a lack of inflammation around the tendon, and the symptoms are being caused by degeneration is the tendons collagen. So instead of the term tendonitis, the more accurate term is tendinosis.
Causes of Tendonitis
As explained in the paragraph above, the understanding of what causes the symptoms of tendonitis has changed. The degeneration of the collagen in the tendon is now believed to be the cause of pain and symptoms rather than just inflammation surrounding the tendon.
The symptoms usually start after excessive loads are repeatedly placed on the tendon during activities. For example, in sports such as tennis and golf, repetitive loads being placed on the elbows can lead to golfers or tennis elbow (medial or lateral epicondylitis). Sports that involve jumping such as basketball, netball and volleyball can cause achilles tendinitis to occur. But tendinitis can be caused by repetitive movements in everyday life as well, such as using a computer or repetitive movements in manual jobs such as plasters, plumbers and carpet fitters. Possible risk factors for tendonitis are diabetes mellitus, smoking, being overweight as well as joint issues such as rheumatoid arthritis or osteoarthritis.
It is important to establish the cause of your symptoms as this can help prevent your symptoms from reoccurring in the future. Osteopathy can help you identify the cause of your symptoms, as well as provide you with specific exercises to help strengthen and stretch surrounding muscles, which would allow your body to function more harmoniously together.
Different Types of Tendonitis
Tendonitis or tendinosis can occur in any tendon in the body, but there are a few areas that are more commonly affected, some of which are listed below.
Tennis Elbow – Lateral Epicondylitis
Tennis elbow or lateral epicondylitis is when the extensor muscles in your forearm (the muscles that bend your hand back, such as in a tennis serve) become painful. The pain is commonly felt outside of your elbow or along the top of your forearm. Commonly this happens due to overuse or repetitive movements which could be because of sports such as playing tennis, or because of everyday overuse e.g. when typing, making a cup of tea, carrying items, driving etc.
The symptoms of tennis elbow often start gradually, usually beginning with a mild discomfort in the forearm, which then worsens over weeks or even months. Common symptoms are a pain or burning sensation in the forearm and/or around the elbow. You may have noticed some weakness in grip strength, making it difficult to grip small objects or turn door handles etc.
Golfers Elbow – Medial Epicondylitis
Golfers elbow or medial epicondylitis is when the flexor muscle group in the forearm becomes painful and symptomatic. Golfers elbow commonly produces pain in and around the inside of your elbow joint.
Your flexor muscles are the muscles that flex your wrists and fingers and when these muscles are overused, they can become symptomatic such as when playing golf, in manual jobs requiring repetitive movements and in desk/computer-based jobs.
Achilles Tendonitis
Your Achilles tendon is the tendon that attaches two of your calf muscles (gastrocnemius and soleus muscles) to your heel bone – the calcaneus. This is the thickest tendon in our bodies and it can withstand large tensile forces.
The Achilles tendon’s main function is to raise our heels off the floor, as well as lower our forefoot and this combination of movement and force transference is significant in activities such as walking, running and jumping.
The cause of Achilles tendonitis can be unclear, but as with other tendinopathies, the tendon has commonly been loaded excessively and/or repetitively.
Patella Tendinopathy
Patella Tendinopathy affects your patella tendon; the tendon that attaches your quadriceps muscle to your tibia. This tendon runs over the top of your kneecap (patella) and characteristically produces pain just below the patella. The symptoms often start gradually and the symptoms can be sporadic, usually aggravated by loading movements and movements that place more demand on the knee extensor muscles.
Sports that place repetitive loading on the patella tendon such as football, tennis and rugby are common causes of patella tendinopathy.
Common symptoms of patella tendinopathy are pain below the patella, especially after periods of prolonged sitting as well as pain with certain movements such as squatting and going up and down stairs.
Supraspinatus Tendonitis
This is a common cause of shoulder pain, especially as we get older. The supraspinatus muscle is a small muscle in our shoulder and is one of the four muscles that make up the rotator cuff.
This tendon, as in other tendonitis-type injuries becomes degenerated usually as a result of repetitive stresses and excessive overloading either because of day-to-day activities or sports.
The supraspinatus tendon passes between the acromion (part of the shoulder blade) and the humeral head and because of this anatomy, the tendon can become impinged and inflamed. The supraspinatus is an important muscle for the shoulder as it helps to stabilize, externally rotate and abduct the arm.
Common symptoms are pain when reaching, or with overhead movements such as brushing your hair, putting on a coat or a shirt and difficulty sleeping or lying on the affected shoulder.
Treatment of Tendonitis
There are several different options when treating tendonitis and the treatment approach can depend on how long your symptoms have been present for and the severity of them. This is not an exhaustive list of treatment options for tendonitis, but the most commonly used approaches.
NSAIDS
Nonsteroidal anti-inflammatory drugs have been shown to help with the pain and symptoms associated with tendonitis. NSAIDS have been used for a long time to treat pain associated with tendon injuries and the evidence suggests these medications can help relieve the pain and symptoms in the short term.
Osteopathy
The osteopathic approach to tendonitis is to look locally at the site of your symptoms but to also look more globally at how your body is moving and functioning. In some cases of tendonitis, the cause may be obvious and in other cases it might be less obvious, so understanding what led you to have these symptoms can be useful, especially in the long term. Osteopathy uses hands-on techniques, a combination of massage and joint articulations to help alleviate your symptoms and allow your body to work more harmoniously. Western Acupuncture (dry needling) is a technique our osteopaths use and its aim is to release myofascial trigger points helping muscles relax, be less painful and improve their range of movement which can be a useful approach with tendonitis especially helping surrounding areas function more optimally.
Stretching and Strengthening Exercises
Exercises have been shown to help with tendonitis symptoms, stretching and strengthening approaches are useful especially eccentric strengthening exercises. Eccentric exercises are when the muscle-tendon complex is forced to lengthen when the muscle is contracted. Why these particular exercises seem to help isn’t fully understood, but they appear to help with the feeling of stiffness.
Therapeutic Ultrasound
This has been shown to be effective in helping patients with tendonitis. The exact reason why isn’t yet fully understood, but ultrasound has been shown to stimulate cell migration and proliferation as well as collagen synthesis of the tendon cells and by doing this it helps the tendon repair and healing.
How Long Does Tendonitis Last?
Commonly a patient presents with fairly localised pain which is specific to the affected tendon. In the early stages of tendonitis, patients can be aware of pain and discomfort when they initially start an activity, the pain can then ease during the activity and be less noticeable, only to return during the cool down. The pain can be sharp & severe to begin with, but if the symptoms remain for a number of weeks, the pain can become duller and ache more. Acute tendinopathy commonly lasts for 2-3 weeks and by reducing the excessive loading on the tendon, the tissues are able to repair and heal. Tendonitis can become chronic and this is when the symptoms have been present for 12 weeks and longer.
If you are wondering whether osteopathy could help you with your tendonitis symptoms, then get in touch with us today. Don’t let these symptoms continue to affect your day-to-day activities!