How to Work Through Tendonitis

Your Personal PT, Rachel Tavel, is a Doctor of Physical Therapy (DPT) and Certified Strength and Conditioning Specialist (CSCS), so she knows how to get your body back on track when it’s out of line. In this weekly series, she gives you tips on how to feel better, get stronger, and train smarter.

You’ve got a routine. You do the same exercises over and over again, or maybe your job requires you to repeat a movement all day. Whatever the reason, your body is repeatedly loading the same muscles and tendons, and this can lead to pain.

Tendonitis can occur just about anywhere in the body. Muscles attach to bone via tendons, and that tendinous junction between muscle and bone can become inflamed with repeated stress. It should be noted that tendonitis and tendinosis, or tendinopathy, are slightly different. Tendonitis is, by definition, an inflammation of the tendon due to microtears at the muscle-tendon junction. This usually occurs when the tendon is being overloaded by tensile forces that are too heavy or sudden. Tendinosis is a term that refers to degeneration of the collagen protein at the tendon, usually from repetitive straining of the tendon and lack of recovery time. Though slightly different, they both tend to present with similar symptoms.

Symptoms of tendonitis include pain and weakness or stiffness at a joint. Pain is usually worse with certain movements—particularly the movements that load the specific tendon most. The cause of your tendonitis is often identifiable by your symptoms, and how they are exacerbated. If the outside of your elbow hurts every time you use a hammer, maybe that’s what provoked it. If you feel pain in your heel or ankle during or after a run, you may have limitations in ankle mobility or stability that is affecting your foot strike pattern with each stride, repeatedly irritating the tendon. Pay attention to when you feel the pain and where, and that will be the best way to identify the cause of your symptoms.

Common sites of tendonitis include the ankle (peroneal, posterior tibialis or achilles tendonitis), shoulder (rotator cuff tendinitis), or elbow (lateral or medial epicondylitis). Often times these smaller joints at the extremities take on the brunt of larger forces when there is weakness in the bigger stabilizing muscles closer to your trunk that need the work.

The cause of tendonitis isn’t always at the site of pain. It requires a complete movement assessment by a physical therapist to identify where your weakness is in your movement and what pattern you are repeating that is causing the stress.

Your Move: While treatment is different for every body part (and every person), the general protocol is to temporarily offload the painful tendon to reduce pain, ice the inflamed tendon, perform soft tissue mobilization such as cross friction massage to stimulate circulation and cellular activity, and maintain mobility of the joint with active range of motion exercises.

Next, you’ll want to begin with gentle stretching and eccentric strengthening of the affected muscle, followed by graded concentric loading. Keep in mind that it is extremely important to look for other places of weakness in the body. Simply strengthening the muscles with the tendonitis may not address why the tendonitis developed in the first place. It usually is the result of weakness or instability elsewhere, for example hip weakness if there is an achilles or peroneal tendonitis, or scapular weakness if there is rotator cuff tendonitis.

Your best move is to see a physical therapist to get the individual assessment of your strength, mobility and body mechanics that you really need to properly treat your symptoms and get you back to optimal health and movement.

Finally, don’t forget sleep and nutrition! Getting enough Vitamin C and zinc are important for the synthesis of collagen, while sleep is often critical for proper healing.

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