What Are TendonsTendons are tough, flexible bands of fibrous tissue throughout the body that attach muscles to bones. In sports, tendons can easily become irritated or inflamed from the stress of repeated movements, an acute injury such as a missed step or impacts from falls and collisions. When this happens, the smooth motion of tendons becomes painful and inflamed and tendinitis develops. [See Image]
Tendonitis or TendinopathyMore frequently, physicians are using the term tendinopathy to describe many tendon injuries, such as tennis elbow, golfer's elbow, Achilles tendon injuries, etc. Experts now recognize that typical tendon injuries are more often caused by long-term overuse that results in a deterioration of the tendon without any associated inflammation. Tendonitis, on the other hand, refers to an inflammation of the tendon. This distinction is important because the inflammation of tendinitis is treated differently than the deterioration of tendinopathy (tendonosis). Inflammation from acute tendonitis often respond quickly to medications and anti-inflammatory treatment. However, if the injury is due to tendon tissue degeneration, treatment may be quite lengthy and will be focused on improving the strength of the tendon and rebuilding tissues.
Common Causes of Tendonitis and TendinopathyThe most common cause of tendinitis in athletes is an acute injury that forces a tendon to stretch beyond its normal range of motion and causes pain, swelling and inflammation in the tendon. The most common cause of tendinopathy in athletes is from chronic overuse of a tendon (chronic repetitive stress and strain injury).
Overuse injuries are the result of repetitive use, stress and trauma to the soft tissues of the body (muscles, tendons, bones and joints) without proper time for healing. They are sometimes called cumulative trauma, or repetitive stress injuries.
Tendon injuries are common in beginning exercisers who do too much, too soon without enough rest. Repeated overuse will cause an inflammation and tendinitis. It’s important to start slow and increase your training time and intensity over time. Following the Ten Percent Rule is helpful in avoiding overuse injuries.
Sometimes tendinitis or tendinopathy can develop due to improper sports technique or biomechanical issues, in which case working with a coach or trainer is the best way to prevent a chronic problem from developing. Making sure to perform a proper warm-up and including enough cross-training is also helpful ti prevent tendon overuse injuries.
Treating Tendonitis and TendinopathyIf you have a sudden ache or pain in a tendon, and tendinitis is suspected the first thing to do is to stop activity and rest. Tendonitis will respond to the R.I.C.E. method for injury first aid (rest, ice, compression and elevation). This method helps decrease inflammation and swelling and bring temporary pain relief. Conservative treatment is generally all that is necessary to recover from a true tendonitis. Tendinitis usually resolves in a few days to a few weeks.
Unfortunately, it may take from two to six months to heal from a longterm tendinopathy. Many tendon injuries turn into chronic problems that gradually get worse because the athlete continues activity despite nagging pain.
If your tendon pain lasts more than a few days despite rest and conservative treatment, you should see a sports medicine specialist for an evaluation and work with a physical therapist to rehab the tendon.
Physical therapists may use ultrasound or other modalities to help heal tendinopathy. In some cases, splints or braces may be used to take pressure off the tendon as it heals. The general rehab protocol for tendinopathy will depend upon the specific diagnosis and cause of the injury however, common rehab methods include: ultrasound, medications, massage, bracing or splinting.
The final stage of rehab for tendinitis includes strengthening and flexibility exercises. There is some question regarding the benefit of stretching exercises for tendinopathy. Your PT will help determine the best rehab path for you, but it's important to understand that beginning any exercises before the tendon has healed may make the problem worse, so it's essential to follow your therapist or physician's recommendations.
If you can determine the cause of the tendon injury and make a correction, you can often avoid long-term problems. If your pain is from overuse, reduce or stop that activity and find a substitute activity. If the pain is from poor technique or poor ergonomics, consult a coach or trainer for skills training. If you can eliminate the offending factors, you have a much greater likelihood of a full recovery.
To prevent the return of tendon overuse injuries, athletes should maintain a training schedule that includes varied intensity and duration as well as type of activity.
Specific Types of Tendon InjuriesSome areas of the body that commonly develop tendon injuries include:
- Tennis Elbow (Lateral Epicondylitis)
- Golfer's Elbow (Medial Epicondylitis)
- Achilles Tendinitis
- Wrist Tendinitis
- Tendinitis (and Overuse Injuries) in Children
- Carpal Tunnel Syndrome
Coombes, et al. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. The Lancet, Volume 376, Issue 9754, Pages 1751 - 1767, 20 November 2010
Jobe, et al. "Lateral and Medial Epicondylitis of the Elbow" J. Am. Acad. Ortho. Surg., Jan 1994; 2: 1 - 8.
Regan, et al. Tendinopathies around the elbow. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2009. . Accessed Jan, 2011