Tendinitis

Inflammation or irritation of a tendon is known as tendinitis. A tendon is any one of the thick, fibrous cords which attaches the muscles to bone. This medical condition can lead to pain and tenderness just outside of the joints. It is a common cause of pain and tenderness around the joint, and occurs around body parts such as:

• The shoulder
• Elbows
• Wrists
• Knees
• Hips
• The base of the thumb
• Achilles tendon
• Heels

It has many common names, like:

• Tennis elbow
• Golfer’s elbow
• Pitcher’s shoulder
• Swimmer’s shoulder
• Jumper’s knee

Surgical repair may be required in the case of a ruptured tendon, but in other cases, conservative treatment is enough. 

Tendinitis is most commonly seen in adults, however, anyone can get this condition. Adults, especially those above the age of forty, are more prone to tendinitis. As a person ages, the tendons age as well, so they tolerate less stress and gradually start losing their elasticity, becoming more prone to wear and tear. Tendinitis can affect people of all sizes, ages, and level of physical activity.

Signs and symptoms of tendinitis include pain while moving the affected joint, tenderness, and mild swelling.  One can experience pain at the site of the tendon and its surrounding area that gradually builds from moderate to severe. This especially happens if there are calcium deposits present. An individual can also experience loss of motion in the shoulder area, which is called “adhesive capsulitis” or “frozen shoulder.” One may also experience stiffness, trouble while sleeping due to the intense pain, or an increased level of pain while moving or carrying out any physical activity or exercise.

If one experiences the below symptoms, it is best to immediately consult a doctor:

• Swelling, warmth, and redness in the affected area
• Sudden fever above 100 degrees Fahrenheit
• Lack of movement in the affected area
• Multiple sites of pain

The above-mentioned signs need not be related to tendinitis, but they would still need to be checked to confirm there is no other medical condition associated with them.

Most often, tendinitis is caused by:

• Sudden injury of the joint
• Repeated movements overtime, especially overdoing any activities when the tendons are not used to a particular movement
• Improper movements while playing a sport. Tendinitis is quite common in people who play and exercise hard only on weekends; thus, they are called “weekend warriors.”
• Bone or joint being placed abnormally, which causes stress in the soft tissue structure. For example, the length difference in the legs or in the arthritis in the joint.
• Although rare, an infection can also be the cause of tendinitis. This mostly happens when the infection comes from a dog or cat bite on the hands or finger.
• Stress due to conditions such as thyroid diseases, gout, rheumatoid arthritis, psoriatic arthritis, or any other type of medical conditions

There are various activities that contribute to tendinitis, including:

• Carpentry
• Shoveling
• Baseball
• Gardening
• Tennis
• Scrubbing
• Painting
• Golf
• Raking
• Running or jogging, which can affect the heels
• House cleaning
• Sports that include throwing and pitching
• Carrying out sprints or high intensity workouts without proper warmups or enough rest in between
• Dancing

At times, incorrect sitting or standing posture at work or at home can also lead to tendinitis. Before starting any exercise or sports, if one performs incorrect stretching or conditioning, it also increases the risk of the person suffering from tendinitis.

One should note that these activities are not the only factors that can trigger tendinitis or cause the tendons to become inflamed. In elderly people, tendinitis can develop after a fall, which could again cause inflammation in the joint and tendons. Since tendons are nothing but chords of fibrous tissue, any type of stressful activity or movement or any internal infection can lead to swelling, thus causing strain to the point of injury.

There are hundreds of tendons that run throughout the body, but only a small number of specific tendons can be affected to cause the vast majority of tendinitis. This happens because those tendons are used the most in our everyday life and, at times, also receive less blood. A lower blood supply indirectly leads to a lack of nutrients for the tendons, which then leads to damage and inflammation in the tissues. Hence, it is very important to improve this blood circulation, ensure proper nutrient intake, maintain proper blood pressure levels, and avoid any inflammation in the body.

In most cases, a physical examination alone is used to diagnose tendinitis, but in other cases, X-rays and other imaging tests may be required to rule out other similar conditions.

There are various ways of treating tendinitis. It depends on where it is located in the body and how long it has been present there, as well as the individual’s level of physical activity.

Often, home remedies may resolve all symptoms of the disease, and a visit to the doctor is not needed. But in severe cases, the following treatments may be required:

• Medications: Pain relievers, corticosteroids (injections around the tendon), and platelet-rich plasma (the patient’s own blood sample is taken and platelets are separated out). This solution is injected into the area of irritation.
• Therapy: A physical therapist may recommend specific exercises to stretch and strengthen the muscle-tendon unit.
• Surgery and other procedures: If the tendon is ruptured, surgical repair is required.
• FAST: Focused aspiration of scar tissue (FAST) is a minimal-invasive tissue procedure that removes tendon scar tissue without disturbing the surrounding healthy tissue. It is guided by an ultrasound and is performed under local anesthesia. Most people return to daily activities within one to two months. 

The following are suggestions to prevent tendinitis:

• Avoid activities that put excessive pressure on the tendons for long periods.
• Perform different types of activities that mix up the impact of exercise.
• Improve one’s technique of the activity or exercise.
• Stretch the muscles after exercise to minimize repetitive trauma on tight tissues.
• Get ergonomic assessment of one’s work space.
• Stretch the muscles before playing any sport. 
• Take it one step at a time. If one is not used to carrying out any pressure activities, it is better to take it gradually. Slowly build up the activity level. If there is any unusual pain, stop carrying out the activity. Do something else and later try again by putting limited pressure. If the pain still continues, stop the activity.

R.I.C.E is the acronym used as an alternative remedy to treat tendinitis. Its components are:

• Rest: Avoid activities that increase the symptoms of tendinitis.
• Ice: To decrease pain, swelling, and to relax muscles, ice packs are applied for twenty minutes several times a day.
• Compression: Compressing the area reduces swelling, which is important because swelling can result in a loss of motion. Wraps or compressive elastic bandages can help.
• Elevation: Raising the affected leg above the level of the heart can help reduce swelling if tendinitis affects the knees.

After a few days of complete rest to the injured area, gentle movements are required to maintain joint flexibility. Also, over-the-counter pain relievers can reduce discomfort associated with tendinitis. 

Lifestyle changes after acquiring tendinitis include rest of the affected joint.

Also, be sure to rest, followed by gentle movements to maintain flexibility of the joints and specific exercises like eccentric strengthening, which emphasizes the contraction of the muscle while lengthening. 

• Rest: Take a break from exercise and rest. When one is impacted by tendinitis, a little bit of self-care can go a long way towards healing the condition. It is very important to sit and identify the type of activity that could have caused the tendinitis. Once you identify the root cause, you can temporarily stop the activity and rest. The time required for resting and keeping oneself away from the activity depends on the affected tendon and how severely it is inflamed. If one takes a longer rest, it can lead to stiffness in the tendons. You can check with your doctor and formulate an appropriate plan.
• Dietary changes: Inflammation can worsen the matter in the case of a chronic illness or injury. The food we eat has a major impact on the overall levels of inflammation. Some foods may help one recover quickly, while others can worsen the existing situation and thus delay the healing process. There are certain anti-inflammatory foods which can reduce the pain and swelling, including all types of green, leafy vegetables, which are loaded with antioxidants, and clean proteins, which repair the broken-down tissue. Bone broth is also good during such times. Avoid intake of alcohol, foods which contain too much salt or sodium, foods with too much sweetener or sugar, and fried foods.
• Wear a splint or brace: With tendinitis, it is beneficial to get additional support for the tendons by wearing a bandage or brace. These items will ensure you keep the affected area away from too much movement. This reduces inflammation, swelling, and speeds up the recovery process.

The following factors can significantly increase the risk of tendinitis:

• Age: Older people whose tendons are less flexible makes them easier to be injured.
• Occupation: Jobs that require repetitive motions, awkward positions, frequent overhead movements, vibrations, and forceful exertion lead to tendinitis.
• Sports: Participating in baseball, basketball, bowling, golf, running, swimming, and tennis, which require repetitive movements, also increases the risk of acquiring tendinitis.

Tendinitis is not a serious disease if treated properly. If tendon irritation continues for several months, tendinosis may develop, which involves the degeneration of tendons along with abnormal blood vessel growth and, in some cases, the affected tendon may rupture, requiring surgical repair.