Tendinitis

Encyclopedia of Alternative Medicine, Apr 06, 2001 by Whitney Lowe

Tendinitis is the tearing of tendon fibers and the subsequent inflammation in the tendon. Tendons are the strong connective tissue that connect muscle to bone.

When a muscle contracts, it pulls on the tendon. The tendon then transmits that pulling force to the bone and moves the bone, producing movement. Tendinitis usually results from excessive demands placed on the tendon by the muscle. Tendinitis is not usually caused by a sudden injury; it is more commonly a result of a long period of overuse. Tendinitis occurs frequently with active individuals and those whose occupational tasks require repetitive motion.

Tendons that commonly become inflamed include:

• tendons of the hand
• tendons of the upper arm that affect the shoulder
• tendons of the forearm at the elbow
• the tendon of the quadriceps muscle group at the knee
• the Achilles tendon at the ankle

Repeated overuse of the tendon will cause small tears to develop in the tendon fibers. As a result, the body will initiate the injury repair process in the area and lay down scar tissue. Inflammation will develop in the area as part of the injury repair process. Inflammation increases the blood supply, bringing nutrients to the damaged tissues along with infection-fighting agents. The result is swelling, tenderness, pain, and heat. Redness may occur if the injury is close to the skin. Since many tendinitis conditions are chronic inflammatory conditions that develop from long periods of overuse, the inflammatory process is not as exaggerated as with an acute injury. Therefore swelling, heat, and redness are not always visible in a tendinitis complaint because the inflammation is really at a low level.

Some common tendon injuries are superficial and easy to identify. These include lateral epicondylitis (commonly referred to as tennis elbow ) and Achilles' tendinitis, which affects the tendon just above the heel of the foot. Tendinitis is most often diagnosed by evaluating factors in the patient's history that indicate muscular overuse. Tendinitis will often develop when an individual suddenly increases his or her level of activity without adequate training or conditioning. This occurs frequently in occupational and recreational settings.

In addition to evaluating factors in the patient's history that are likely to lead to tendinitis, the clinician may use several physical examination procedures. Most tendons are near the surface of the skin and therefore can be easily palpated (touched or pressed in order to make a diagnosis), especially by practitioners of manual therapy who have highly developed palpation skills. Pressure placed directly on these tendons is likely to cause discomfort. In addition, the practitioner may ask the patient to contract the muscle attached to the tendon, usually against resistance, to see if this causes pain.

Ice is often advocated for tendinitis when it is in an aggravated state. Ice is particularly useful for limiting inflammation in the tendon. Ice may be applied by placing a bag of ice on the skin. It may also be applied directly to the skin using an ice cube wrapped in a paper towel or ice frozen in a paper cup with the top portion of the cup peeled away to expose the ice. An ice massage--rubbing the skin and underlying tissue with ice in a slow, circular or back-and-forth motion--will cool the injured area quickly. If ice is applied to the skin without a barrier between the ice and the skin, the patient should be carefully monitored so that frostbite does not occur. Generally no more than about five minutes of treatment in one area is necessary with ice massage.

Compression wraps, such as elastic bandages, may be used to help provide mechanical support for the tendon during active movement. These compression wraps can be helpful, but they may also slow the healing process in the tendon if left on for long periods because they decrease blood supply in the area.

Various types of soft tissue manipulation are very effective for treating tendinitis and may be employed by a variety of practitioners, including chiropractors, massage therapists, physical therapists, and osteopaths. One of the most common methods of soft tissue treatment for tendinitis is a vigorous friction massage to the damaged tendon. This friction massage will stimulate the healing of tissue in the area. It is also thought to help produce a healthy and strong scar-tissue repair of the damaged tendon fibers. Practitioners of manual therapy are also likely to advocate a regular stretching program to help decrease tension in those muscles that may be pulling excessively on the tendon.

Acupuncture and traditional Chinese medicine are quite effective in treating tendinitis. Acupuncture may be used in the immediate vicinity of the tendinitis to help address muscular dysfunction. Acupuncture treatment may also use more distant points along the energy meridians to help address pain and reduce inflammation. Acupuncture may also have significant benefits in creating an optimum environment for healing of the tendon fiber to take place.