Tendonitis: Management

When it comes to tendonitis management, treatments aim to help you gain movement of the affected joints without pain and at the same time build strength in the muscles that surround those joints as the tissues heal. Treatment for tendonitis includes resting the affected joints. Rest is very important. According to the American College of Rheumatology, failure to rest the affected area is the most common delay in complete healing. If you resume the activities that led to your injury too quickly, you put yourself at risk of developing chronic tendonitis or torn tendons. A common, painful example is a torn rotator cuff. As you recover, try to be mindful about using limited force and limited repetitions in your day-to-day activities.

The RICE Program

One treatment doctors, physical therapists and physiotherapists recommend for tendonitis is the RICE program (this program is similar to the P-R-I-C-E-M-M method for treating bursitis): rest, ice, compression and elevation of the affected tendon. The American College of Rheumatology advises icing the affected area for 10 to 15 minutes once or twice a day. According to the Arthritis Foundation, a cold compress can help reduce your initial swelling and pain. This is especially effective during the first 48 hours after overuse, injury or swelling. After 48 hours, or for chronic (long-term) pain, the switch to dry or moist heat (like a warm bath) may be more helpful.

Exercise and Stretching Programs

Your physical therapist or physiotherapist can create an exercise program that promotes range of motion and allows your tendon to rest while strengthening the muscle groups that surround it. You gradually would begin to exercise the affected tendon. Your program would include stretching exercises and those that slowly strengthen the surrounding muscle while stretching. It also will help prevent future injury. You will be advised to stop exercises that cause any pain. An occupational therapist can recommend exercises and changes to your daily activities and work habits to prevent re-injury.

Support Equipment

Splinting might be recommended by your therapist as well. Splinting is a method that prevents a body part from moving, to help facilitate better healing. Splinting for tendonitis generally involves a flexible fabric. If necessary, a splint can be applied to the knee or hand. A brace can be applied to the ankle or foot, and an elbow band can be applied to the elbow.

Other Treatments

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, other available treatments include “an electrical current that pushes a corticosteroid drug through the skin directly over the swollen bursa or tendon, gentle stretching and strengthening exercises and massage of the soft tissue.” Ultrasound and whirlpool treatments can be helpful to relax your tendons and muscles, improve circulation and promote the healing process. In some cases, acupuncture has been found to be helpful with pain management. Massage therapy also can help some people, as it can loosen tight muscles and aid with circulation.

 Medication

In some cases, your doctor may recommend that you take aspirin, ibuprofen (such as Advil), another anti-inflammatory drug or topical anti-inflammatory gels for a short-term period to help manage your pain and the associated inflammation. This may be recommended in addition to the RICE program. Sometimes cortisone shots are recommended. Cortisone is a corticosteroid hormone (glucocorticoid) and an anti-inflammatory medication that is injected to help relieve your pain and inflammation in a specific area. Cortisone shots usually are injected into joints.

“I’ve had cortisone injections into my tendons,” said Matthew, 51. “I had golfer’s elbow and tennis elbow from hammering, pulling nails and too much construction work. The cortisone shots helped me a lot. I had it again about four to five months later, and then I was good on my own. The injections were a miracle solution for me.”

In some cases, doctors recommend injecting corticosteroids (anti-inflammatory drugs) around the tendon for an acute injury, but they are not used in chronic tendonitis due to potential harmful effects if used too often. Corticosteroids work quickly to reduce pain and inflammation.

Surgery

If your tendon is completely torn surgery may be needed to repair the damage. Surgery may be necessary to release or repair your affected tendon in chronic cases that do not respond to other interventions/treatments. The National Institute of Arthritis and Musculoskeletal and Skin Diseases advises that if your joint does not improve after six to 12 months, your doctor may recommend surgery to repair damage and relieve the pressure on the tendons.

To prevent more common forms of tendonitis, the American College of Rheumatology offers the following tips:

 Shoulders      

  • When reaching for an object, face it rather than reaching sideways or backward.
  • Rise from a chair by pushing off with your thigh muscles instead ofyour shoulders or hands.
  • Do pushups from the wall, not the floor.
  • When reaching for a heavy object overhead, keep the load centered in front of you and use both hands.

 Elbows and wrists    

  • Recognize and avoid hand clenching or gripping tools or other objects too strongly. Use power tools. In the kitchen, use aids such as jar openers. Pad your car steering wheel.
  • Use your stomach muscles to help roll over when getting out of bed.
  • Avoid carrying heavy items in one hand or at the side of your body.

Knees and ankles

  • Avoid sitting with a leg folded under.
  • Wear shoes that provide support and comfort, with room for the toes to extend fully.
  • Check shoes often for signs of wear and replace them when worn.
  • If you walk or stand on concrete, cushion the inside bottom of your shoes with pads or wear walking or running shoes with cushioned soles.
  • Keep leg muscles strong. Do leg lifts with ankle weights (five to 20 pounds) while seated.

Lisa Cantkier, CHN is a certified holistic nutritionist and a health and wellness editor.

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