TENDONITIS / BURSITIS

How Tendonitis Occurs

A tendon is the end part of a muscle that attaches the muscle to the bone. The normally very elastic and soft muscle tapers off at the end to form the much more dense and stiff tendon. While this density makes the tendons stronger, the lack of elasticity of the tendon and the constant pulling on its attachment to the bone with movement, makes it much more susceptible to a low level of tearing at a microscopic level. This tearing will produce the inflammation and irritation known as tendinitis. Often spelled tendonitis, either spelling is correct for this condition. Tendinitis is usually seen after excessive repetitive movement with which the tendon gradually becomes tighter until the fibers start to tear. For example, a person who plays tennis may over-use the muscles of the elbow through hitting the ball repetitively and cause tendonitis to the area.

Tendonitis -- inflammation of a tendon -- is a very common condition. Any word ending in “itis” means inflammation. Example: arthritis means inflammation of a joint (arthro = joint, and itis = inflammation), myositis = inflammation of muscle, and bursitis = inflammation of a bursa.

There are many locations that develop tendonitis and are diagnosed correctly. Other locations, however, are diagnosed incorrectly. Tendonitis of the elbow (tennis elbow), shoulder, and wrist are often correctly cited. Tendonitis of the knee and lower extremities is also often correctly diagnosed.

However, some locations of tendonitis are overlooked. For example, many people are incorrectly told that they have carpal tunnel syndrome (CTS) when they really have wrist tendonitis. With wrist tendonitis there is inflammation of the tendons that are next to the median nerve (the nerve affected with CTS – see chapter 9). There are additional locations where the tendonitis diagnosis is also missed. Also, while many doctors may diagnose tendonitis correctly, they still don’t have an effective treatment program.

Additionally, there is one huge problem with the diagnosis of tendonitis. It’s only half of the diagnosis! What do I mean? Look at the muscle in this photo ®. The red tissue is muscle. The white tissues on the muscle’s two ends are tendons. Muscles turn into tendons. In other words, muscles have a tendon on each end and this tendon then attaches to the bone. Any muscle with its associated tendons is a whole or complete unit. This is important because the second half of the diagnosis is muscle spasm. Muscles go into spasm as a defense mechanism. When we get hurt, our bodies automatically send the muscles in the area into spasm -- a sustained muscle contraction. Thus, the muscle stays in the shortened (or contracted) position. When the muscle constantly contracts in spasm, it pulls on its two tendons which leads to inflammation of the tendon. It works the other ways as well. If we overuse our tendons they inflame, and the muscle responds by going into spasm. The spasm then keeps the inflamed tendon tight, and the tendon can’t heal.

So most cases of tendonitis are really a combination of muscle spasms and tendonitis. This concept is missed by many medical offices. If you try to heal the tendonitis without addressing the muscle spasm you may heal, but it will take a lot longer. Additionally, these muscle spasms and tendonitis injuries develop as a result of overuse. The treatments offered in this chapter are aimed at reversing the overuse components of these injuries. To heal, you need a comprehensive home treatment program that you will use multiple times each day to help your body overcome the daily overuse of the affected area. This treatment is a shotgun approach. Just as shotgun pellets spread out over a target, so, too, will your variety of treatment spread out over your condition.

BURSITIS

Bursitis means inflammation of a bursa, which is a fluid filled sac near a joint that helps the joint with its mobility. Common bursas that inflame are the shoulder bursa, hip bursa and knee bursa. Treatment for bursitis is similar to tendinitis and covered in the same chapter.

So what do you do if you have tendonitis or bursitis? The chapter on Tendonitis / Bursitis covers the whole “muscle spasm / tendinitis complex”. It includes what types of tendonitis treatment you should expect from medical office. It also includes an exhaustive list of home treatments as well.

Common Areas of Tendon inflammation

The most common tendon areas that become inflamed are the elbow, wrist, biceps, shoulder (including rotator cuff attachments), leg, knee (patellar), ankle, hip, and Achilles. Of course, tendonitis can will vary with each person, as it strikes the areas you use most.

Tendonitis Symptoms

Symptoms can vary from an achy pain and stiffness to the local area of the tendon, to a burning that surrounds the whole joint around the inflamed tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day.

Tendonitis Treatment

With proper care for the area, the pain in the tendon should lessen over three weeks, but it should be noted that the healing of the area continues and doesn't even peak until at least six weeks following the initial injury. This is due to scar tissue formation, which initially acts like the glue to bond the tissue back together. Scar tissue will continue to form past six weeks in some cases and as long as a year in severe cases. After 6 months this condition is considered chronic and much more difficult to treat. The initial approach to treating tendonitis is to support and protect the tendons by bracing any areas of the tendon that are being pulled on during use. It is important to loosen up the tendon, lessen the pain, and minimize any inflammation.

This can be done topically if a pain reliever has the ability to penetrate the skin barrier and contains anti-inflammatory agents. A topical formula that contains natural menthol will not only relieve pain, but dilate the blood vessels. This allows for relief of the tendonitis, without causing any stiffening of the tissue. MSM, also known as Methyl Sulfonyl Methane is a natural supplement that is getting a lot of attention due to its role in tissue healing at a cellular level. It is a natural organic sulfur that comes from rain fall and is found naturally in the human body. It has been shown to have anti-inflammatory effects on the tissues. See all about Glucosamine and MSM for more information this supplement. Ice can relieve inflammation, but will constrict the blood vessels and further stiffen the tendon. Cortisone injections can reduce inflammation, but unfortunately are very caustic and can cause a weakening of the tendon structure and a create more scar tissue.

After the scar tissue has begun to accumulate, it will be important to perform procedures which help break down the scar tissue in the tendon tissue, so as to let the tendon and muscle regain it's normal flexibility and lessen the chance of further injury. While exercise is appropriate for breaking down scar tissue once the area has healed, it may further irritate the area during the initial stages. Therefore, other methods that can be performed by your healthcare provider, such as ultrasound and massage, may be safely used to accomplish this early on in the injury. Ultrasound uses sound waves that vibrate a such a fast level, that it cannot be felt with normal use. Ultrasound will cause an increase in circulation to the tissue and soften the scar tissue to allow it to further break down. Ultrasound can also be used as phonophoresis to help topical pain and nutrient solutions reach further down into the tissues by transporting them with the sound waves. Light stretches may also be performed if they do not cause any further irritation to the area during the acute phase. During the sub-acute and chronic phases of Tendonitis, more aggressive stretches can be performed, however, it should be noted that stretches should focus on the muscle belly and not attempt to lengthen the affected tendon. Additionally, you should not feel any irritation in the tendon during these muscle stretches.