Tendonitis involves the inflammation of tendons. This painful condition is most commonly caused by repetitive tendon movement, such as typing, running, golfing, throwing balls or playing tennis. This condition can develop in the feet, knees, ankles, shoulders, hips, elbows and wrists. Common conditions include:
Tendons are different than ligaments and muscles. They connect muscles to bone. Ligaments, on the other hand, connect bone to bone in a joint. While muscles are constructed of actin and myosin (protein strands), tendons are constructed of connective tissue (collagen, elastin). Unlike muscles, tendons do not have contractile properties (although they can stretch under loads). The attachments of tendons to the bone are extremely strong. In fact, the attachment is so strong that when trauma occurs, rather than the tendon rupturing, it is common for a section of the bone to be pulled off instead. Some tendonitis forms actually involve the tendon pulling off the top layer of the bone’s cells (periosteum), resulting in an inflammatory response. Plantar fasciitis and shin splints are common examples of this occurrence.
When a muscle contracts, the tendon is pulled towards it. When this occurs, the tendon often slides against the bone. While protected within a sheath encasing, allowing smooth gliding across bone, ligaments and other tendons, repeated movements of tendons, particularly those under loads, can cause small tears in the tendon, resulting in is an inflammatory response. The body’s immune system controls this inflammatory response, producing many different biochemical compounds. While these biochemical compounds are critical to injury management, some, such as arachidonic acid, cause pain. Additionally, the body’s biochemical response can overcompensate for the injury, causing its own problems. As increased swelling takes place, this can lead to increased pressure in the injured area, leading to a hypoxic state, which only perpetuates the problem further. This occurrence is why tendonitis often becomes chronic, lasting up to several years.
The first defense against tendonitis is, upon recognizing the first signs of the onset of tendonitis, immediately stopping the triggering activity and resting the injury. Icing the injury for 20 minutes every 2 hours may also be beneficial (do not use heat during the early stages of tendonitis). Supportive wrist braces may be beneficial for wrist tendonitis. If the tendonitis persists, anti-inflammatories may be effective. If not a physician may recommend cortisone injections to ease the inflammation.
Alternatively, manual therapies like chiropractic along with physiotherapy modalities is often a good non-pharmaceutical option for treating tendonitis, both acute and chronic.