Tendinitis is a common term used to describe pain resulting from stresses on tendons, often where they insert into the bone. Since there is often not inflammation the problem might better be termed tendinopathy as the -itis ending implies an inflammatory process. There is a group of typical places which suffer from this kind of condition and examples are: supraspinatus tendinitis and biceps problems; Achilles tendinitis; tennis and golfer''s elbow at the elbow and various knee tendon problems. Many muscles narrow down near their ends into tendons, through which the forces exerted by the muscles are transmitted to the bone, sometimes repetitively over long periods.
Inflammation of the tendon can occur in the early stages, with small tears developing and increased fibrosis but overall the development of this condition is not completely understood. It occurs most often in adults of middle age and in severe cases the tendon can weaken and progress to rupture. The most typical cause of tendinopathy is overuse of a particular part and this more difficult if the work is repeated and strenuous and does not allow enough rest time. Physiotherapy management initially involves getting the patient to reduce the their relevant activity level or stop doing the aggravating activity altogether
In the acute phase cryotherapy, using ice, is useful during the first few days when inflammation may be a problem, along with anti-inflammatory drugs and some form of immobilisation such as splinting or bracing. Gentle range of movements may be recommended to keep some stresses through the tendon as it heals. When the pain starts to settle the physio will increase the exercises to include graded stretching and strengthening, progressing to eccentric muscle training which has been shown to have efficacy in managing this kind of problem. Eccentric training involves putting forces through the tendon whilst the muscle is lengthening rather than shortening.
Injections with an anaesthetic and a corticosteroid can be considered in cases in which conservative treatment has failed. However, injections into some tendons, such as the Achilles, are known to be associated with rupture of the tendon which is a significantly disabling trauma. With rest and physiotherapy most tendinopathy problems will settle or reduce in severity, but in some cases patients may require surgery to alleviate a resistant problem, with protocol based physiotherapy following the operation.
Author: Jonathan Blood-Smyth