By Dr. Loretta Lanphier, ND, CN, HHP, CH

If you play sports or have an occupation that involves certain repetitive motions, chances are you are familiar with tendinitis, either through personal experience or from the experiences of your peers. It goes by various names, including tennis elbow, pitcher’s shoulder, golfer’s elbow, and jumper’s knee. It can affect just about anyone at any age, and is found in both acute and chronic forms. Tendinitis can be very debilitating, but the good news is that is easily treatable and preventable in most cases.

What Is Tendinitis?

Tendinitis is the fibrous tearing and subsequent irritation of the strong connective tissues or thick fibrous chords called tendons that connect muscle to bone. Tendinitis is not usually the result of a sudden trauma or injury, but rather is the culmination of long periods of overuse. Tendinitis can affect any area of the body, but the most common tendons impacted are those of the:

  • Hand
  • Upper arm (affecting the shoulder)
  • Knee (related to the quadriceps muscle group)
  • Ankle (Achilles tendon)
  • Elbow (tendons of the forearm)

What Are the Symptoms of Tendinitis?

Tendinitis usually causes pain and tenderness just outside the affiliated joints. Different types of tendinitis cause pain in certain areas. Swelling is also a factor in some cases of tendinitis. The following specific types of tendinitis are associated with certain distinct symptoms:

  • Achilles tendinitis:  Known for pain just above your heel.
  • Patellar tendinitis:  This form is characterized by pain just below the kneecap.
  • Rotator cuff tendinitis:  Pain with this type is found in the shoulder. This is a very common problem for professional baseball pitchers.
  • Adductor tendinitis:  Leads to pain in the groin area.
  • Tennis elbow:  Folks with this type experience pain near the elbow on the outside surface of the forearm, especially when twisting the forearm or trying to grip and object.
  • Trigger finger is a form of tendinitis associated with smaller joints, such as in the fingers. When these areas become scarred and therefore narrowed, the tendon can “lock up,” and mobility in the area, such as a finger, becomes extremely difficult or impossible.

Most tendinitis is acute, and can be turned around with rest and proper treatment. However, continued abuse of tendons that are affected by tendinitis can lead to chronic forms of tendinintis that can be much more difficult to treat. Tendons can actually rupture and result in permament damage to the tendon that may take an extended amount of time to heal, or they may never heal on their own without surgery to repair them. This condition is called tendonosis or tendinopathy, and in some cases the tissues themselves that make up the tendon are changed into a weaker, more fibrous type. Complications such as these can be avoided by not ignoring tendinitis and not continuing to engage in the same activities that caused the problem in the first place. Behaviors like this will only make a bad situation worse, and make recovery much more difficult.

What Are the Causes of Tendinitis?

Most tendinitis originates from repeated movements or use of certain muscles and the attached tendons. That’s why athletes are so susceptible to tendinitis. For example, individuals who use their arms and shoulders a lot in repeated movements, such as swimmers, golfers, and tennis players, are prime targets for tendinitis in their arms, shoulders, and elbows. Other sports or activities, such as soccer, basketball, and volleyball, can often lead to the development of tendinitis in the legs and feet. Age is also a factor. The older we get, the more wear and tear the tendons experience, especially with heavy usage. Certain inflammatory diseases, such as rheumatoid arthritis, can also contribute to the development of tendinitis.

Most of the body’s tendons are covered by a tunnel of tissue that is composed of material that is similar to that which lines our joints (synovium). When this sheath of protective tissue wears down through overuse and aging, the tendons themselves become subject to tears and subsequent inflammation. One of the ironic things about tendinitis is that is partly the result of the body’s attempt to heal itself. As the tendons develop tears, the body lays down scar tissue as a natural part of the repair process. This thickens the tendons, and causes more friction and inflammation as they attempt to move freely when doing their job of manipulating the bones and muscles. Inflammation is also a natural response of the body in an attempt to heal the damaged tissues. But the inflammation can also cause tenderness, swelling, heat, and inevitably pain.

One of the problems with diagnosing tendinitis is that since the condition is usually one that slowly develops over time, the inflammation is relatively minor, and outward signs such as swelling, heat, and redness are often not observable. The pain may be significant, but at least from the victim’s perspective, there are typically no obvious signs that point to the cause, especially in the early stages of tendinitis. That is why many patients will not stop the aggravating activities immediately, which would usually bring about quick healing with no further intervention.

To go beyond theory, and learn a bit more about how tendinitis affects sufferers on a daily basis, I would like to take a more in depth look at two of the most common types of tendinitis: Patellar tendinitis and Achilles tendinitis.

Patellar Tendinitis

Patellar tendinitis specifically affects the patellar tendon, which connects the tibia (shinbone) to the patella (kneecap). This pivotal tendon is responsible for movement of the lower leg, below the knee, and makes possible such activities as jumping, pedaling a bicycle, or kicking a soccer ball. Patellar tendinitis is sometimes called “jumper’s knee,” and is one of the more common sports injuries, especially for softball or baseball, volleyball, and soccer players. It often rears its ugly head if you suddenly increase the intensity or frequency of your workouts or activities, especially if not taking the time to train, warm up, and cool off properly. Ongoing repeated use of the patellar tendon can cause a gradual build up of tears and resulting scar tissue, but often an individual will not become aware of it until a sudden increase in usage.

Intermittent pain in the shin area is usually the first sign of patellar tendinitis, and is often confused with “shin splints” or other muscle pain in the area. While exercising, the pain may be sharp in nature, and after the workout, it may change to a dull ache. The key with patellar tendinitis, and actually any form of tendinitis, is to  catch it early, and ease off from the offending activities for a while.  This is the good news about tendinitis. Often stopping use of the affected tendon is all that is needed to bring fast and complete healing. However, if the pain is ignored, it can worsen and become a dull ache that is experienced constantly. In advanced cases, it becomes difficult for patients to climb or descend stairs, and may make sleeping difficult due to the constant pain.

Other than overuse, there are some other factors that can cause patellar tendinitis for some folks:

  • Tight leg muscles, that are not properly stretched and limber, can put undue stress on the patellar tendon. The hamstring, which runs up the back of the thigh, is a likely culprit.
  • Misalignment:  Some individuals have a variance in the way their leg bones line up, and this can be a stressor for the patellar tendon, as well as others.
  • Muscular imbalance:  If some muscles in your legs are stronger than others, it can also cause pressure on the patellar tendon. When you workout your leg muscles, try to strengthen and stretch them all fairly equally.
  • Patella alta:  This is a condition whereby the kneecap is placed abnormally high on your knee joint, and this can also cause strain on the tendon.

It is particularly important to not ignore pain from patellar tendinitis. If you continue to overuse it, it can cause permament weakness of your leg muscles and possibly a torn patellar tendon. Both of these can become chronic conditions that will haunt you for life.

Achilles Tendinitis

This is another very common form of tendinitis, but it is often short-lived and responds very well to such common sense steps as rest from activities that aggravate it. It is found in folks who engage in repetitive movements that put a lot of strain on the calf muscle. The Achilles tendon runs between the muscles of your calf to your heel bone. Achilles tendinitis is very common amongst basketball players. It can also develop in folks who start a new exercise or increase their level of activity suddenly, without proper stretching or training.

Typical symptoms of Achilles tendinitis include:

  • Pain or achiness when rising onto your toes
  • Mild swelling and/or tenderness on the tendon, usually near the heel
  • A creaking or crackling sound while using or touching the Achilles tendon.
  • Soreness after rest (upon rising), that lessens after moving around, and may worsen when the tendon use is increased.
  • If you experience significant pain or swelling near the heel, or find it nearly impossible to rise up on your toes, you may have ruptured the Achilles tendon. Surgical repair is usually necessary.

Improper conditioning is the most common cause for a bout with Achilles tendinitis, but other risk factors include:

  • Trauma, such as an injury or infection in the area of the tendon.
  • Flat feet, also known as fallen arches or excessive pronation, can also put undue strain on the Achilles tendon, and cause tendinitis. Wearing shoes with ample arch support can often correct or avoid this problem.

How Can I Prevent or Treat Tendinitis?

The great thing about most cases of tendinitis is that, especially if they are caught early, simple rest and avoidance of the activities that caused the problem in the first place are very affective measures. Being aware of the warning signs that we have discussed is key. The worst thing you can do is push through them and continue to stress the tendons. Some other helpful steps include:

  • Massage
  • Hydrotherapy (soak in a warm bath)
  • Good mechanics when working out or playing sports. Always warm up your muscles by gently stretching, and do the same after the workout to cool down.
  • Physical therapy can be very helpful in some cases. Exercises can be practiced which will actually strengthen the tendons and thus avoid many problems.
  • Keep hydrated:  Plenty of good water helps the muscles and tendons work properly and most efficiently.

While tendinitis can be very painful and disabling at times, especially if left untreated, it also responds very well to common sense treatments that usually don’t involve surgery or drugs. Even better than that, it can be avoided most of the time by treating your body well and listening to it when it gives you messages to slow down. If you treat yourself well, your body will most often return the favor in kind. This is wellness at its best.

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