Tendinitis-What It Is & What To Do About It

Whether it involves your wrist, elbow, shoulder, hip, knee, or ankle, pretty much everyone who is involved in any exercise program has, at one time or another, been troubled with the pain of tendinitis. But very few, outside of the medical field, really understand what tendinitis is, or what correct treatment is.

Tendons are the cord-like, fibrous attachments of muscles to the bones that anchor them. It is through the tendons that the muscles exert their force and move our limbs. At the microscopic level, tendons are composed of multiple strands of fibrous tissue, made of the protein collagen. These strands are bundled together, like the wires in an electrical cable, to form the tendon. The outside of the tendon has a thin membrane around it, called the paratenon. This helps to allow the tendon to glide and carries tiny blood vessels, which penetrate the tendon to help nourish it.

At the insertion of the tendon, there are tiny little fibrils called Sharpey's Fibers, which penetrate the bone to firmly anchor the tendon, and therefore its attached muscle. The key thing about tendons is that they have a poor blood supply. They are mostly fibrous tissues, with only a few living cells here and there to maintain them, and relatively few blood vessels. For this reason, they take an extended period of time to heal from any injury.

In simplest terms, a tendinitis is an inflammation of the tendon itself, or the attachment of the tendon to a bone, or its muscle. This process results from microtears in the tendon, or a few Sharpey's fibers pulled out of the bone, caused by overloading or overstretching the tendon. The inflammation causes pain and tenderness on attempted use of the affected muscle. This is usually the result of an injury, either one single traumatic event, or a series of repetitive movements that provoke an inflammatory response.

A good example of a single injury might be a sudden onset of pain in your knee, if you attempt to lift too heavy a weight, or the pain at your shoulder/chest tie-in, from a too aggressive bench press. A repetitive injury, on the other hand, would be something like a "tennis elbow," (a lateral epicondylitis in medical jargon), where repeated pulls on the attachment of the forearm muscles, from swinging the tennis racket at the wrist, eventually cause this tendinous attachment to become inflamed and result in severe tenderness.

A tendinitis can be differentiated from other sources of pain around a joint, like bursitis (inflammation of a bursa, a fluid-filled sac, which permits smooth gliding of soft tissues over a bony protrusion) by motion. If active motion against resistance causes pain, then it's a tendinitis. If the area is only tender to touch, but is not aggravated by movement, then it's likely a bursitis.

Here's what to do:
1. First, STOP doing whatever is causing the pain and REST the limb.

2. Apply ICE or a cold pack, for the first 48 hours (20-30 minutes on, 30 minutes off, to prevent skin freezing) to the painful area.

3. After the initial 48 hours (this is approximate; could be up to 72 hours), begin applying moist heat for 20 minutes 4-6X/day.

4. Apply a compressive dressing around the tender area, like an ACE bandage. It should feel supportive, but not too tight.

5. OTC Anti-inflammatory medications, like Advil (2 tabs, 4X/day) or Aleve (2 tabs, 2X/day) WITH FOOD OR MILK, to protect your stomach from irritation, heartburn, ulcers or bleeding, can b very helpful. DO NOT TAKE ASPIRIN, when on these other drugs. Use Tylenol (2 tabs every 4-6 hours, as needed for pain or fever) only.

6. Avoid red meat. It contains arachadonic acid, which promotes inflammation.

7. Other dietary measures that can help include 2000-4000mg/day of FISH OIL (Omega 3 Free Fatty Acids reduce inflammation), and other sources of Omega-3's.

8. When the area is less tender, begin gentle passive stretching, preferably after the heat applications.

9. Finally, begin functional bodyweight exercises, and progress as tolerated. Continue the liberal use of heat and massage to promote local circulaton.

Above all, be patient. Tendons are slow to heal, often taking 6-8 weeks, or even longer. If you rush it, you can set yourself back and flare it up all over again. Make haste, slowly.

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