Karen had been putting in quality time at the driving range and was eager to demonstrate her new golfing skills to her friends. Then her elbow started acting up.
Whether you play a sport or just enjoy working out, you undoubtedly know the feeling. Just when you think you’re approaching a new level of fitness or competence, your body starts objecting, First, it’s a small pain that you try to ignore. But it continues to get bigger. Eventually, symptoms could include stiffness, swelling and redness around the joint, particularly during and after using the joint or muscle.
In most cases, what you’re experiencing is tendinitis. Literally, this means inflammation of a tendon, one of the thick rope-like cords of tissue that attach muscle to bone. Tendinitis can occur anywhere a tendon exists–most commonly in the vicinity of the shoulder, elbow, knee, wrist or fingers. You may recognize the sport specific names–tennis or golf elbow, swimmer’s shoulder, jumper’s knee, rock climber’s fingers.
Achilles tendinitis (at the back of the heel) frequently occurs to persons age 35 to 45 who are not particularly athletic. Older persons are also vulnerable because tendons become less flexible with age and injury can occur with minimal exertion.
In sports, the pain is nearly always associated with overuse–training a bit longer or with a bit more intensity than your tendon is able to accommodate at this particular time. Tendinitis can also occur because of repetitive motions in occupations such as carpentry or carpet laying. And it can occur any time you ask your muscles to move in new ways or do more than they are accustomed to doing.
For a high level athlete, a diagnosis of tendinitis may come as a relief because it indicates no structural damage to the joint. But it should not be taken lightly because, without attention, the problem will get worse and could lead to more serious problems.
Self Treatment with RICE
The most important thing you can do for tendinitis, or any soft tissue injury, is to rest the injured joint or muscle–something the competitive athlete does not want to think about.
After the first few days, though, rest means relative rest rather than complete immobilization, which can promote stiffness. The patient is advised, rather, to continue some kind of activity but at a lower level of intensity and with care taken to prevent damaging the most injured tissues. An alternate activity may also be advised–swimming to avoid stressing lower limb tendinitis, for example.
Ice is another basic part of self treatment. The ice or cold pack should be placed on the injured area to reduce swelling, pain and muscle spasm. It should be applied to the injured area for 20 minutes at a time several times a day while inflammation and swelling exist.
Later, for more chronic conditions, deep heat, such as from ultrasound, can ease pain and increase blood flow.
Compression (with wraps or compressive bandages) and elevation (keeping the affected limb above the level of the heart) are the other components of the traditional self treatment known as RICE (rest, ice, compression, elevation).
With prompt self treatment and a gradual return to former activities, the symptoms of tendinitis should clear fairly quickly. It’s important not to let the problem linger or recur, however, because it could lead to a more serious degenerative condition known as tendinosis.
Muscles and tendons become stronger through a gradual process of being broken down and then being rebuilt to adapt to a higher load. That is what training is all about. But when the process is rushed–when new injuries occur before old ones have a chance to heal, the result is a chronic degenerative injury of “failed healing.” That is tendinosis.
Based on research findings of the last 15 years, it’s now believed that failed healing rather than inflammation is the most frequent cause of tendon pain (even in cases commonly referred to as tendinitis). And, as a result, strategies for treatment are changing.
Many athletes pop aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen or naproxen at the first sign of tendon pain. That’s a practice that’s not very safe and, according to studies, not very effective, either, if failed healing rather than inflammation is causing the pain. Some studies, in fact, suggest that NSAIDs may even contribute to the development of tendinosis by shutting down inflammation in the early stages when it could be a positive factor in the healing process.
The same is true for cortisone injections. The injections are designed to reduce inflammation, but if no inflammation is present, there is no benefit, and repeat injections can weaken tissue. Cortisone is capable of dissolving scar tissue, however, so it is considered a useful option in some cases of tendon pain.
The best treatment for tendinosis is gentle stretching and strengthening, but patience is required since tendons heal more slowly than muscles. In most cases, it’s best to have the help of a physical therapist who has experience working with tendinosis.
Eccentric exercise may be helpful as part of the physical therapy program. This is exercise that forces a muscle to lengthen as it contracts. Walking downhill, for example, is eccentric, while walking uphill or riding a bike is concentric exercise.
Animal studies have found that lack of nitric oxide delays tendon healing. As a result, some experts have proposed the use of topical glyceryl trinitrate, a prodrug of nitric oxide. Some studies have found that patients using eccentric exercise plus glyceryl trinitrate had less pain and greater range of motion.
Blood platelets play a role in the healing process. As a result, some doctors advocate introducing platelets into the tendon–either by
• causing the tendon to bleed by needling or poking it or
• giving the tendon injections of blood or platelet-rich plasma taken from the patient.
The idea, in both cases, is to stimulate the body’s own healing mechanisms.
In the past, many athletes dealt with tendinitis by “toughing it out.” Pain, though, is never to be taken lightly. A better approach is correcting any problems of technique or gait that may have caused the problem, then having the patience to see that thorough healing takes place.
04/18/2012
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