Tendonitis; myths, facts and how to get relief.
You have chronic pain near a joint that seems to be getting worse; what can you do to get the pain to go away? The pain may lessen with nsaids such as Nuprin but as you return to activity, so does the pain.
Many people are told their problem is tendonitis by their doctors, yet the diagnosis is so general, it is almost meaningless and they are almost always told to rest the area and take a medication, which may blunt the pain but never seems to resolve the problem. The next step most doctors take is to write a script to do rehabilitation the part in pain, which rarely works long term and sometimes aggravates the pain since it may use the same motions that created the problem in the first place.
The truth is, there is a reason for the pain and tendonitis infers that the muscle tendon is somehow inflamed. Technically, a true tendonitis occurs with trauma to an area, while tendonosis infers that a more chronic problem that has developed after a while. Some refer to it as tendonopathy because there is a pathology that causes the pain. Recently, the NY Times discussed tendonitis. You can read about it here.
Some visit an orthopedic who may suggest a cortisone injection, which can markedly reduce the pain, yet, when you return to activity, the likelihood of the pain returning is high, since the area of pain is rarely the cause. Others report that the area of pain felt better, but now they had pain somewhere else.
To resolve a tendonosis problem, there are a number of approaches that have been proven to work, since they break up the scarring along the painful tendon. They include massage, myofascial release, Active Release Techniques (a style of myofascial release), and instrument assisted soft tissue methods. Most of these methods are used by todays chiropractors, along with joint manipulation and exercise rehabilitation.
Typically, these methods work on the muscles, fascia and movement restrictions that are causing the pain in the tendon. Often people say these methods are effective however, to truly understand why you were hurting in the first place, a thorough healthcare practitioner should look beyond the area of pain for the best result.
An example of this is tennis elbow, which causes the tendon (s) on the lateral elbow to become inflamed. Most people have a physical therapist work on this with varying results. The approach is usually to work on the area of pain and often assumes that there is muscle weakness involved, but does anyone question why the area seems to be weak?
When we properly evaluate using active evaluation methods why the elbow is involved, we can often see problems with body form while playing tennis. These form problems often involve the fascia in the legs, back and shoulder which alter the way we use our body, loading the lateral elbow causing the pain. Golfers elbow is similar in that the tight fascia will cause a constant strain into the medial elbow, causing the pain. Attempting to massage the elbow, when the problem involves the rest of the body seems foolish, and it is, yet the most common approach is to treat the area of pain.
A better approach is to look at the patient, how they move, and look for the restrictions in the other parts of the body which is altering movement form and address those first, while strengthening and rehabilitating the movement patterns. As the movement patterns improve, strain is reduced on the area of pain, normal function is restored and the patient reports not only relief, but resolution of a problem that developed over years. It is also likely that other, less serious body aches will also resolve, since they are also symptoms of mechanical dysfunction.
Many other types of tendonosis pain in the shoulder, knees, hips and feet are best treated when the cause is fully understood, which requires the practitioner to look at you first, then the pain and to then resolve the mechanism first and then finally work on the area of pain last. While this seems counter intuitive, it is a more scientific approach that results in problem resolution, rather than temporary relief and a more chronic problem which is typical when the symptoms are approached with Nsaids and rehabilitation is applied to the area of pain, which is usually not the reason you are hurting.
Perhaps, this is why more people are turning to sports chiropractors to get the best results for problems such as tendonitis. Most of us want the problem to resolve, not just to feel better, but to do this properly, we need to find a healthcare provider who understands movement problems, and how to fix them. The chiropractic approach using manipulation, exercise and myofascial work is most appropriate since the holistic approach to care improves movement and function, resulting in pain free movement.