Many people are told by their doctor that they have tendinitis and have no idea exactly what tendinitis is. The suffix –itis is a Greek word meaning inflammation and tendinitis is inflammation of the tendon. Actually the inflammation can involve the tendon insertion into the bone, the tendon connection to the muscle and the muscle connection to the bone. The majority of tendinitis that is seen in the United States is caused by over-use, usually by the so called WEEKEND WARRIORS, who try to do more than their unconditioned bodies will allow them to do.
When the muscle tendon is overused, cells die and need to be replaced and during this replacement process the entire muscle-tendon unite gets inflamed and swells, causing pain. The pain, believe it or not is good because it prevents the individual from continuing to use the muscle tendon unite and allows the muscle tendon unite to repair itself.
There fore, the first treatment of tendinitis is to listen to one’s boy and if the part hurts don’t use it. My first recommendation then is immobilization. Depending on the part of the body involved, immobilization can take the form of a short arm cast, a long arm cast or an arm sling. In the first 48 hours, after the injury, I recommend ice to cut down the swelling. Also, I recommend aspirin, as many as 10 to 12 a day, to control excessive inflammation. Occasionally, in very severe cases I will recommend injection of the painful area with a diluted steroid medication to reduce inflammation or with a long-acting pain medication similar to Novocain injection into the area to relieve some of the pain.
After the part has been immobilized for enough time where there is no pain at rest, the muscle-tendon unit will have had enough time to repair and replace the dead cells. During this time however, the muscle tendon unit tends to shorten, and when the pain becomes severe during stretching exercises, they should be stopped immediately and immobilization should be resumed.
I strongly recommend applying heat to the involved part before stretching exercise are carried out. As I am often fond of pointing out to patients, muscle-tendon units more likely to tear or crack, but if they are stretched when cold they are more likely to tear or crack, but if they are stretch when warm they are much more pliant and less apt to be injured.
By far the best method I have found to heat the injured part is to apply warm water, approximately 106 degrees Fahrenheit, preferably with a pulsating action, to the involved part. A hot shower or a Jacuzzi is an ideal method that most people have access to. Also, applying a hot towel to the area for several minutes is effective.
The actual stretching of the involved part should be slow and deliberate, much as one pushes a boat away from a dock. Short, convulsive stretching actions are to be avoided. Stretching activities should be carried out, at least on a daily basis, if not more often and when full return of motion without pain is obtained then the next phase of rehabilitation can be carried out.
The third phase of rehabilitation involves regaining strength of the involved muscle tendon unit. During a period of immobilization and during a period of stretching the muscle-tendon unit has not been used and when any muscle-tendon unit is not used it loses strength. Strengthening a muscle tendon unit simply involves using the unit against increasing amounts of resistance. In the early phase of rehabilitation strengthening exercise must be done very carefully, as the muscle tendon unit can be re-injured very easily if too much resistance or weight is used too soon.
Strengthening exercise tend to shorten the muscle-tendon unit and make it stiffer. Therefore, I always recommend stretching exercise to be done before any strengthening exercises are carried out. Also strengthening exercises should not be done on a daily basis, as they can re-aggravate the initial injury. I usually recommend whatever type of strengthening exercises to be done two days out of three with the third day being used for rest to allow the muscle-tendon unit to recuperate. During strengthening exercise, if pain returns to the muscle-tendon unit while the exercising is being done they should be stopped immediately and the individual should go back to gentle stretching exercise until the pain is gone. Pain after the strengthening exercise have been done is not worrisome and usually is the normal achy type of pain.
After strengthening exercise have been done to a sufficient degree were the individual feels comfortable resuming his normal activities, be at their employment or sports exercise should be carried out under a controlled situation so that re-injury does not occur. For instance, with racket sports I usually recommend the patients practice hitting the ball against a wall by themselves for the first couple of weeks and monitor whether they have any recurrence of pain in the involved area.
Also, I recommend that a large handle racket be used if possible and that the racket be loosely strung during the initial recuperative phases, so that less force is transmitted to the muscle-tendon units. If the patients is able to manage that for another two weeks, only then will I recommend he return back to his regular activities.
Of course, the most important thing in any rehabilitation program is common sense. Much judgment must be used during the rehabilitation phase and there is the constant temptation especially when one is feeling better to go all out or work through the pain or get back in the groove. Many people simply are not patient enough to go through a prolonged rehabilitation program to get them back to their usual level of activity and try to take shortcuts which more often than not result in re-aggravation of the original injury of the muscle tendon unit. Depending on severity of the injury rehabilitation of a tendinitis of the upper extremity can take from three weeks to three months. Some can take even longer.
The most important thing in treating tendinitis is to educate the individual so he know how to prevent getting tendinitis in the first place. As we get older we are more prone to develop tendinitis because our bodies become stiffer and less pliable. Also, our reparative properties are not as good as when we were children.
Therefore, it is of paramount importance for anyone doing any sort of repetitive activity, whether it involves his job or recreation, to understand what muscles tendon units are involved and to know how to care for them so that injury does not develop.
The first step in avoiding any injury during vigorous activity is to make sure that the muscle-tendon unit has been warmed sufficiently, so that it is pliable and not stiff. This can be done as mentioned above or simply using a warm-up suit with gentle warm-up exercises.
The second step in preventing injury is to stretch the involved muscle-tendon unit so it does not become injured during the vigorous activity. Our office or any competent gymnast and physical therapist can do strengthening exercises.
Finally when one undertakes vigorous physical activity, one should be realistic in the level of activity that he reasonably can do. The 45 year old Grade C level tennis player who plays for four hours for the first time in three months against the club pro is inviting a severe tendinitis of his upper arm, because he simple doesn’t have the conditioning in the involved muscle-tendon units to allow the intense A level of activity.
It is useful to remember that 60% of all exercise programs undertaken in the United States are interrupted or terminated because of some sort of injury, encountered during the exercise program. If these simple measures are followed, many of the injuries, encountered during the exercise program. If these simple measures are followed, many of these injuries can be prevented.
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