Tendinitis

Tendons are cord-like structures located where a muscle narrows down to attach to a bone. The tendon is more fibrous and dense than the elastic, fleshy muscle. A tendon transmits the pull of the muscle to the bone to cause movement. Tendinitis is often very tender to the touch.

Tendinitis (also tendonitis), meaning inflammation of a tendon, is a type of tendinopathy often confused with the more common tendinosis, which has similar symptoms but requires different treatment.

The term tendinitis should be reserved for tendon injuries that involve larger-scale acute injuries accompanied by inflammation. Generally tendinitis is referred to by the body part involved, such as Achilles tendinitis (affecting the Achilles tendon), or patellar tendinitis (jumper’s knee, affecting the patellar tendon).

   

Types of Tendinitis :

Tendinitis injuries are common in the upper and lower limbs (including the rotator cuff attachments), and are less common in the hips and torso. Individual variation in frequency and severity of tendinitis will vary depending on the type, frequency and severity of exercise or use; for example, rock climbers tend to develop tendinitis in their fingers or elbows, swimmers in their shoulders.Achilles tendinitis is a common injury, particularly in sports that involve lunging and jumping, while Patellar tendinitis is a common among basketball and volleyball players owing to the amount of jumping and landing.

Diagnosis :

Symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms. If the symptoms of tendinitis last for several months or longer it is probably tendinosis.

Signs:

  • pain,but often ubsides when tendon is warmed-up and returns when cooled down
  • swelling
  • warm to the touch
  • decreased motion
  • decreased function
  • crepitus – grating or cracking sound caused by the inflamed tendon struggling to move through its covering

Causes : 

  • overuse ( gradual onset of syptoms )
  • acute ( symptoms lasting less than two weeks )
  • sub acute ( symptoms lasting two to six weeks )
  • chronic ( symptoms lasting longer than six weeks )
  • repeated muscle contraction causing the tendon to slide over the bone

Treatment:

Treatment of tendon injuries is largely conservative. Use of non-steroidal anti-inflammatory drugs (NSAIDs), rest, and gradual return to exercise is a common therapy. Resting assists in the prevention of further damage to the tendon. Ice, compression and elevation are also frequently recommended.

Physical therapyOccupational therapy, orthotics or braces may also be useful. Initial recovery is typically within 2 to 3 days and full recovery is within 4 to 6 weeks.

Steroid injections have not been shown to have long term benefits but have been shown to be more effective than NSAIDs in the short term.

  • correct the cause
  • cryotherapy ( usually after activity )
  • heat therapy ( prior activity )
  • anti-inflammatory medication
  • iontophoresis
  • ultrasound
  • electrical muscle stimulation
  • massage to improve the blood flow
  • streching and ROM( range of motion) exercises
  • muscle strenghtening including proprioceptive and kinesthetic exercises
  • support with atheltic tape
  • cortisone injections
  • rest
  • gradual return to activity
  • in worst case : surgery

The goals of treatment for tendinitis are to restore movement to the joint without pain and to maintain strength in surrounding muscles while giving the tissues time to heal. Adequate rest is crucial.  Returning too soon to the activity that caused the injury can lead to chronic tendinitis or torn tendons.

As an immediate treatment for tendinitis, doctors and physical therapists recommend the RICE program: rest, ice, compression, and elevation of the injured tendon. They may also suggest aspirin, ibuprofen, or other anti-inflammatory drugs to help inflammation and pain. Ultrasound and whirlpool treatments are useful for relaxing muscles and tendons, improving circulation, and promoting healing. Occasionally, your doctor may discuss injecting corticosteroids (a stronger anti-inflammatory drug) around the tendon.

A physical therapist can propose an exercise plan that rests the tendon while strengthening nearby muscle groups and maintaining overall muscle tone. Only gradually will you begin to exercise the tendon itself. Your program may also include “eccentric” exercises, in which you gradually strengthen the muscle while stretching, stopping at the first sign of pain. You may also work into easy stretching exercises, done several times a day.

Surgery may be necessary to release or repair the involved tendon in chronic cases that don’t respond to other interventions.

                  

How can I prevent Tendinitis ?

Include warm-up and cool-down exercises and stretches in your exercise routine. As a general rule, a good warm-up is five minutes for every 30 minutes of planned exercise. So, one hour on the treadmill or elliptical trainer should be preceded by 10 minutes of warm-up. Vary your exercises and gently stretch all the muscles and tendons you are planning to exercise.

Overly ambitious exercise in an attempt to lose weight rapidly also can lead to tendinitis.

 

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