We all associate rest with pain relief. If you go out for a nice run start to feel knee pain, what do you do? Rest for a day, and try again. But what if it still hurts? Rest for a week, then try again. Maybe you also start taking some anti-inflammatories, ice it, and try and kinesiotape it. But what if it continues to hurt you? Is rest alone REALLY going to fix it?
Let’s start with the basics.
Tendonitis is inflammation of a tendon from overuse. Wear and tear of tendons occurs when we are using our muscles incorrectly due to weaknesses or imbalances. Let’s take running as an example. We see many runners come to our facility with pain at their patellar tendon also known as Jumpers Knee. This is caused by excessive use of the quad pulling at the tendon, causing small adhesions in the tendon which then have to heal. You rest, and they heal.
If rest heals then why do I still have pain when I run again?
Think of your tendon like a box of straws. When the straws are all standing upright and strong they can withstand light weight, such as a book, on top of them and the structure will remain strong.
Now visualize that some of those straws are bent and broken. The bent straws weaken the whole structure and now when you put a book on them the structure collapses. Your injured tendon has become a box of broken straws. Specific exercises and soft tissue work can restructure and rebuild the tendon into straight, strong straws. Correcting the way that you move through video analysis and sport specific drills will prevent the injury from recurring. If this key piece is avoided, the tendon will continue to break down, possibly to the point of rupture.
If not rest then what?
I performed an internet search for “treatment of tendonitis” and found some faulty information:
“Tendons require weeks of additional rest to heal. You may need to make long-term changes in the types of activities you do or how you do them. Apply ice or cold packs as soon as you notice pain and tenderness in your muscles or near a joint. Apply ice 10 to 15 minutes at a time, as often as twice an hour, for 72 hours”.
Be careful what you read as this is far from the scientific truth. Not only are tendons adversely affected by ice (see Kristin’s article next week) but rest simply reduces the blood flow and thus the healing process. The internet medical advice The one part of this internet statement that does ring true is “You may need to make long-term changes in the types of activities you do or how you do them”. And I don’t mean stop the activity you’re doing, but learn how to perform it with improved mechanics to reduce stress/strain at the injured site.
Now that we know what not to do, here are specific steps to effectively treat your tendonitis:
1.) Determine WHY your tendon has broken down through a medical evaluation
2.) Avoid the activity that is irritating the tendon (but continue with pain free activities)
3.) Correct the strength deficits or imbalances that contributed to the injury
4.) Restructure the tendon that is painful through soft tissue work
5.) Ease back into your activity with slow progression and correct mechanics (best to start with slow motion video analysis of the aggravating movements)
There is no reason to take excessive time away from the activity you love due to tendonitis. The faster you figure out the WHY behind your injury, the faster you can fix it!
Meg Pezzino, DPT