Do’s and Do Not’s for Tendinitis (and why the term is a misnomer)
There are a lot of mixed messages out there on how to manage a tendinitis injury. My hope is that this article clears the air a bit and gives you the confidence that you need to recover optimally.
First things first, let’s outline exactly what a “tendinitis” is, what it is not, and why the term is a misnomer.
Historically tendinitis has been defined as a tendon that exhibits inflammation due to various causes. However, studies actually show that there are no traditional cellular markers of inflammation. Instead there are other degenerative changes in the complex tendon tissue that result in pain and dysfunction. So the suffix “-itis” does not technically apply as it indicates inflammation. As such, the term “tendinopathy” has become the more clinically accepted term to describe the condition. Whether the tendinopathy is acute, subacute, or chronic dictates that treatment approach. Here I will be addressing the “do’s” and “do not’s” of the acute and subacute tendinopathies.
Now that we are clear on what we are discussing, let’s get on with the actionable steps you can take (or avoid) to get better.
DO NOT:
-Totally rest
It’s incredibly important to your recovery that you stay active. Do activities with which you do not feel your symptoms. This may mean you need to modify your regular exercise routine and integrate things that you don’t normally do such as biking, swimming, or walking. If you do strength training, keep it up by simply avoiding the exercises that use the affected area. Exercise promotes improved circulation, keeps mood and mental health in the positive direction, and prevents the rest of your body from becoming deconditioned as you give the injured area TLC.
-Stretch the tendinopathy
Acute and subacute tendinopathies do not like to be stretched! There is nothing to be gained by doing so, it will only irritate the tendon further. If the tendon/muscle needs better mobility, this should be done once acute symptoms are mostly resolved and you have moved onto reconditioning phase of rehab. You can stretch other tendons/muscles if you’d like, just be sure to leave the affected tendon alone.
-Use a mobilization ball on the tendon
While there are instances in which direct mobilization to a tendon is indicated, it’s typically for the more chronic tendinopathy’s. So put the ball or theragun down for now. This type of intervention should be used only when advised by an expert physical therapist who can train the proper technique and dosage.
DO:
-Ice or heat
Choose whichever feels best to you! Truly! Everyone is a bit different and the evidence on this is not as clear as many claim it to be. I have found that choosing the temperature that feels best to the client has the greatest therapeutic benefit. Once you figure out which is more ideal for you, do it for 10-20 minutes twice/day.
-Relatively rest
This ties back up to the first “don’t.” Rest the affected tendon by avoiding or limiting activities that illicit pain. This is important in allowing the area to heal. If you never remove the aggravating activities adequately, the tendon never has the time or space to recover. For some tendinitis’, this may mean there is a huge limitation on what you can do. If you need help modifying or finding replacement activities, ask an expert PT.
-Consult with an expert PT right away
There are specific ways in which you should begin to activate the affected tendon and muscle early on. Doing so can improve the rate of healing and help minimize future issues. Furthermore, beginning to chip away at the biomechanical cause of the tendinitis is critical in preventing reoccurrence. A skilled PT will be able to help you on both of these fronts so that your recovery is as optimal as possible.
As you care for your injured tendon, keep in mind that it WILL get better. Tendinopathies have an excellent prognosis so keep your chin up. While it can be very frustrating to have your life and fitness routine interrupted, sometimes an injury gives you an opportunity to strengthen and mobilize areas that need extra attention. Follow the guidelines above and then hire an expert PT to help you rehab back to optimal health.