Tendinitis

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Now, I don’t know how many of you have had this experience, or one close to it. I had a pain in my shoulder for a while, I suspected it was tendonitis, so I booked in to see my GP. I went, and yes, she suspected it was tendonitis of the biceps brachii (long head) as well - basically agreeing with me. So, what can be done? Stop doing what you are doing. And…? That’s it. The thing that was causing the issue was actually my work - so a slight impossibility… what if I carry on doing it? Well, eventually the tendon will fray and snap.

Wow. That’s pretty harsh… Oh but don’t worry, many people only have one tendon attached to their biceps, and it doesn’t affect them in their day to day life.

I was pretty much speechless. It was almost as if she was saying, yes it hurts, and yes, you might lose a tendon in your arm/shoulder, but hey, I have more pressing things to do today, off you go.

Nice.

So.

Tendonitis. What is it and why does it happen, and what can you do about it? If I answer all of these here, it may be a bit of a long one, so lets start, see where we get to and carry on in another post if need be.

What are tendons?

They attach muscle to bone, transmitting the effort of the muscles to create movement in the bones - so they are pretty important. They are made from collagen have a pretty poor blood supply (in comparison with muscles - which is part of the reason they can take so long to heal) and can withstand quite staggering amounts of force - but not on a shear or compression basis… they are structures which work on a pulling basis.

Normal stresses of day to day living increase collagen synthesis in the tendons and strengthen connective tissue. Immobilisation or lack of use decreases collagen production leading to atrophy in connective tissue and bone. Without movement, connective tissue is laid down in random orientation, packing fibres close together and forming micro adhesions. This creates weakness, and instability. Without movement, collagen reabsorption occurs, and it also happens in the early period of sports conditioning. During reabsorption collagenous layers are weakened and susceptible to injury - which is why you need to build up slowly!

However, on the other side of things, overuse can also cause inflammation. This inflammation signals the formation of connective tissue which can interfere with movement and cause the tendons to adhere to surrounding tissue. In tendons without a sheath this is tendonitis. Friction techniques (something massage therapists do) help these conditions, and tight tendons are normalised when resting muscle length is normalised.

Tendonitis (or tendinitis, depending on which spellchecker you have) can be divided up into a number of types. This is just a very brief bit to give you information to know that there are different forms of it - they are:

Tendinitis - an inflammation and scarring of the tendon,

Tenosynovitis - a lesion of the gliding surfaces of the tendon and sheath,

Tenovaginitis - a chronic inflammation and thickening of the tendon sheath.
Peritendonitis is tenovaginitis when it occurs to tendons without a sheath (like the Achilles tendon).

Why does it happen?

Tendonitis tends to build up slowly, gradual in onset and diffuse in pain - because of repeated micro traumas. There is also swelling and pain - generally around a specific joint. The tendonitis generally gets named after the structure it affects - tennis elbow, runners knee, Achilles tendonitis etc.

The most common cause of injury is overuse, the second most common is bad sporting movement. If you do a certain movement hundreds of times a week, or even every day, and that movement is ergonomically sub-optimal, the tendons and muscles are going to feel it. If you keep doing the same thing, in a way that causes your body to move in a way which it is uncomfortable doing, or if the tendons are not quite doing the right thing to make them work optimally, these structures are slowly going to break down.

The good news is Tendinitis can be treated in a matter of weeks if appropriate rest and ice is applied. If the affected area is continually used, this will take much, much longer to heal, it is also more likely to progress to a chronic condition called tendonosis. This condition involves a change in the structure of the tendon to a weaker and more fiberous tissue.

Usually rest and medication to reduce pain and inflammation are the treatment required, but massage can help support healing.

If you go back to the same thing as before the tendonitis flared up, it will come back. Unless you retrain your body to do the same thing in a more efficient way, those tendons that have become inflamed, will do so again.

Doing the same thing over and over again expecting a different result is madness, and that is what you will be guilty of.

If you want to get better, and have this tendon work optimally again, do your exercises. We get 1 hour a week with your bodies, if we are lucky, you get the other 167 in which to either take care of it, or let it go back to its previous movement patterns, which got to you to where you are at the moment.

I think that’s enough for the while, next time I’ll go into the kind of things a massage therapist may do to help with tendinopathies, why they do them and why they work.