Tendonitis

What causes tendonitis?

• Tendonitis is an injury caused by an overuse and repetitive loading of the tendon. This continual stress on the tendon exceeds its ability to handle the load, resulting in a breakdown of tendinous tissue that causes pain, swelling and decreased functional ability of the associated joint.

What are the classifications of tendonitis?

• Mild tendonitis (Level 1 and 2) – This is associated with pain felt through extreme exertion, during long hours of repetitive loading through the tendon. The pain normally stops when activity stops. At this level, an individual can still function normally without any functional impact on his/ her ability to perform movements.
• Moderate tendonitis (Level 3 and 4) – This is usually associated with pain that lasts several hours after an activity of repetitive loading through the tendon. This level will start affecting functional ability to perform various movements.
• Severe tendonitis (Level 5 and 6) – This is usually associated with continuous pain, during day and night, after prolonged efforts through the tendon, and will affect everyday day movement constantly.

How to treat tendonitis?

• Reducing inflammation is key in the early treatment of tendonitis. While traditional rehabilitation protocols for most acute injuries focus on increasing the range of motion and strengthening the surrounding muscles, tendons and ligaments, initial treatment for tendonitis focuses on reducing inflammation.

Acute inflammation is initially treated using the P.R.I.C.E principle, which stands for Protection, Rest, Ice, Compression and Elevation.

Once the pain and swelling dissipate, exercise prescription can be introduced to work through the tendon’s range of motion and strength. This is a delicate part of the treatment, during which it is important for the therapist to closely monitor the symptoms that may appear so that the patient does not experience pain.

Strengthening exercises should focus on higher repetitions, at lower intensity and resistance, to avoid excessive stress on the tendon. Through research it has been shown that eccentric strengthening exercises (lengthening contraction) early in the rehabilitation process have proven beneficial, placing less stress on the tendons than the concentric exercises. An example of eccentric exercise is when the patient’s arm is in a flexed position and s/he tries to resist the force by extending the arm, but the said force is stopped before the arm is fully extended.

As the patient improves through the various exercises, the loads and intensities should be gradually increased.

Return to main activities – When strength exercises can be performed pain-free and equal in intensity to the uninjured side, the patient can engage in a sporting activity, performing the maximum of specific movements at increasing intensity, under close monitoring.