Treating Tendonitis – Early Intervention is Key

Tendonitis can be successfully treated but it is important to note that the treatment protocol for tendonitis is unique and different than treating other acute injuries. The wrong treatment can exacerbate the condition increasing the time for recovery and getting back to sport.

Tendonitis can affect many body segments.  Understanding the basic structure and function of a tendon will give the athlete a better understanding of why the treatment protocol for tendonitis is different than other types of acute injuries.

What is the structure and function of a tendon? 

The purpose of a tendon is to connect muscle to bone.  A tendon is primarily made up of collagen fibers, water, and ground substance. As with muscle tissue, a tendon has a structural breaking point. Initially, when stress is applied to the tendon, the tendon will elongate. If the force continues beyond what the tensile strength of the tendon can handle, the tendon will eventually rupture.

What are the classifications of tendonitis? 

There are six classifications of tendonitis ranging from mild to severe. Each classification is based on the amount of pain the athlete experiences before, during, and after exercise and is correlated to the athlete’s functional ability.

Mild tendonitis (levels 1 and 2) is usually associated with pain with extreme exertion that stops when activity stops.

Moderate tendonitis (levels 3 and 4) is usually associated with pain with extreme exertion that lasts several hours after the activity. Moderate tendonitis may begin to affect the athlete’s ability to perform at high levels.

Severe tendonitis (levels 5 and 6) is usually associated with pain during the activity that may continue to last throughout the day and night.

What causes tendonitis? 

Tendonitis is considered an overuse injury caused by repetitive loading of a tendon exceeding the ability of the tendon to handle the load. Repetitive loading of a tendon can breakdown otherwise normal tissue resulting in pain, swelling, and decreased functional ability of the associated joint.

Common causes of tendonitis include the following:

• Excessive increases in training load, distances, and speed
• Mechanical errors from improper technique
• Structural abnormalities
• Inappropriate equipment, play or work conditions
• Training surfaces (surfaces that do not give)
• Muscle imbalances
• Inadequate time for tendon recovery

How to treat tendonitis? – Most Important Step

The first step in how to treat tendonitis is to identify the cause. This step cannot be overemphasized because even if you treat the tendonitis, the condition will return if the cause has not been identified and dealt with.

Identifying the possible causes of tendonitis begins with a detailed history of the athlete specifically looking at specific load increases. These may include significant increases in the amount of activity (number of repetitions), distance (mileage) increases, and/or speed increases.

If there is not an obvious increase in the athlete’s history that triggered the tendonitis, an analysis of the athlete’s mechanics may be in order.  In order to ensure that the tendonitis does not return, the causative factors must be identified and changed prior to the athlete returning to sport.

How to treat tendonitis

The initial phase in how to treat tendonitis is to get the inflammation under control. If the tendon is acutely inflamed (tender to the touch, swollen, and painful with movement), the treatment needs to focus on reducing the inflammation. Acute inflammation can be treated using the P.R.I.C.E. principle of Protection, Rest, Ice, Compression, and Elevation with the focus on rest and ice. Rest is absolutely crucial in treating tendonitis and is the most difficult component to get an athlete to adhere to. However, athletes who continue to push through pain risk moving their injury from the acute inflammation phase to a chronic tendonitis which is much harder to treat. 

Once again, the longer an athlete plays with tendonitis, the more structural changes and damage there will be to the tendon. As the tendon worsens, the time frame for healing the tendon significantly increases.

If complete rest from the activity is not possible, the athlete needs to accommodate his/her activities to reduce the amount of stress on the tendon. For example, the pitcher can also reduce the number and intensity of pitches thrown focusing more on mechanics than speed.

During early tendonitis treatment, the sports medicine professional may also prescribe anti-inflammatory medication to help reduce the inflammation. Rest, ice, and anti-inflammatory medications are the primary treatment protocol during early rehabilitation for tendonitis.

When can I proceed to range of motion and strengthening exercises? 

As pain and swelling dissipate, the athlete can then move carefully into a progression of exercises to improve the range of motion of the affected tendon and strengthen the tendon. However, because of the delicate nature of the tendon, these exercises need to be carefully monitored to ensure that the athlete does not digress in his/her symptoms.

Flexibility exercises should focus on gradually elongating the tendon without causing an increase in pain. If adhesions are noted in the tendon by the sports medicine professional, he/she may apply one or more soft tissue techniques to help release the adhesions that may be interfering with the tendon’s ability to elongate.  Strengthening exercises should focus on light intensity and higher repetitions so as not to place too much stress on the tendon.

When can I begin functional sports training? 

When strength exercises can be performed pain free and equal in intensity to the uninjured side, then the athlete can begin agility and functional sports specific training exercises.  These exercises should be carefully selected to match the demands of the athlete’s sport.

When can I return to sports? 

The athlete can return to participation in sport when he/she has been released to participate by his/her sports medicine professional and is pain-free during full activity.

Chronic tendonitis is very difficult to treat. The goal for the athlete is to catch the tendonitis and treat it early before it becomes a chronic problem.

For more details on learning about and treating tendonitis please visit How To Treat Tendonitis.

Reference 

Houglum, P.A. (2005). Therapeutic Exercise for Musculoskeletal Injuries (2nd Ed.). Human Kinetics: Champaign, IL.

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