Introduction

Physical Therapy for Tendonitis

Long-term tendon issues are extremely common. A tendon issue is even more common among specific sports participants. These injuries mainly occur among runners and tennis players with tendonitis accounting for 30 percent of running issues and 40 percent of injuries among tennis players.

Here at Hicksville Physical Therapy, the term “tendonitis,” whose medical definition is “inflammation of the tendon,” is used in reference to common, long-term tendon issues. Physicians, after years of study, know that the tendon does not always become inflamed when injured, as other injuries can damage the tendon and cause pain, so tendonitis is the most widely used term.

This guide we have constructed will help you:

Understand how conditions such as tendonitis develop.
Understand how medical physicians come to a diagnosis.
Understand courses of treatment for tendonitis.

Anatomy

Where does tendonitis develop?

Tendons, made of a material known as collagen, help to connect muscle and bone together. This collagen, a connective tissue, is a key component in the body. It is known as a connective tissue thanks to its construction similar to the strands present in rope. Much like those rope strands, strands of collagen form together. The more strands of collagen present, the more able they are to form together and, in turn, the stronger they are. The tendon and collagen are paired together and enveloped in a thin, slick material known as the tendon sheath. This tendon sheath gives the tendon the ability to slide against other tissues without friction.

Since large portions of the body contain tendons, tendons can be injured in a variety of ways. The injury can be where the tendon attaches to the bone, to the tendon sheath, or to the actual tissues of the tendon itself. Since they can widely vary, medical professionals will use varying terminology to refer to different tendon injuries based on the injury itself and where it is in the body.

Although these injuries can present themselves almost anywhere in the body, medical professionals most often see tendonitis in a few specific regions, which we can discuss further.

Achilles Tendonitis

Achilles tendonitis forms as a result of injury to the Achilles tendon. All three parts of the tendon (the sheath, the actual tissue of the tendon, and where it attaches to the bone) can all be damaged by injury to the Achilles Tendon.

Damage to the Achilles tendon, found within the lower portion of the leg, is a significant injury. Injured Achilles tendons have a much more severe risk of rupturing due to weight that is mistakenly placed on it by an injured individual while walking.

Posterior Tibial Tendonitis

The form of tendonitis caused by injury to the inside edge of the ankle, expanding into the instep of the foot, is known as posterior tibial tendonitis.

This is most often caused by deterioration to the area, frequently because of age. When this particular tendon breaks, the arch of the foot can become flattened and quite painful.

Patellar and Quadriceps Tendonitis

Issues within the tendons of the knee most frequently happen in people who have an exercise regimen involving either jumping or running. Patellar tendonitis can also be referred to as jumper’s knee.

De Quervain's Disease and Trigger Finger

Because the hand and wrist are so frequently used, tendon injuries are frequent in both of these areas. A form of injury, De Quervain’s Disease, causes pain in the area between the wrist and the thumb.

Trigger Finger typically causes discomfort and pain in the palm of the hand in the area between the wrist and the knuckles. Over time, this can lead to issues with hand movement.

Lateral Epicondylitis

Also referred to as tennis elbow, lateral epicondylitis generally affects the outside tendons of the elbow that attach to the bone. These injured tendons cause pain when utilizing either the wrist or the hand.

Medial Epicondylitis

Also referred to as golfer’s elbow, medial epicondylitis generally affects the inside tendons of the elbow that attach to the bone. These injured tendons cause pain when utilizing either the wrist or the hand.

Rotator Cuff Tendonitis

Rotator cuff issues span a wide range of severity from mild damage to complete tears. With a complete tear, pain is much more severe and can cause issues even while resting the rotator cuff. More often than not, the area around the injured joint becomes tight, potentially misaligned, or even weak. Despite a rotator cuff injury, some of the pain may be due to the surrounding tissues and not the damaged tendon itself.

Causes

Why do I have this problem?

Medical practitioners are not entirely sure what the root of most tendon issues are. The most prevailing thought is that constant stress on a particular tendon is the most likely cause. As tendons can be injured by repetitive motions such as running, jumping, lifting, and pounding, it stands to reason that this is the cause. Tendonitis itself typically increases over the course of weeks or even months.

When tendons are severely damaged or not given the proper amount of time to heal, the tendonitis tends to become long-term. A good rule of thumb is that the more repetitive stress placed on a tendon, the more likely it is that the tendon will be damaged and that tendonitis will develop.

Stress on a particular tendon can increase due to a number of factors. Things such as a lack of flexibility or general muscle weakness can contribute to a case of tendonitis. Other things such as ill-fitting shoes, insufficient exercise equipment, or incorrect movements can also greatly increase the chance that a tendon injury occurs. The biggest takeaway is upgrading your exercise equipment is a great way to reduce injury. The improved design of tennis shoes has seemingly contributed to a decrease in tendon injuries among runners.

For a less controllable factor, aging appears to be a significant cause of tendon damage in a few cases. As individuals age, tendon tissue has a tendency to deteriorate. The good news is that tendon issues caused by old age don’t seem to lead to cases of inflammation. The tendon itself is most often more affected and not the surrounding tissues so some medical professionals refer to this variety of tendon issue as tendonosis.

There is a theory among some medical researchers that a lower-than-normal blood flow to a particular tendon leads to an increased risk of tendon damage and, subsequently, tendonosis. This lower-than-normal blood flow does not allow a tendon to receive enough oxygen. Because of this, the tendon seems to deteriorate. The aforementioned collagen that helps to make the tendons loses strength and its rope-like appearance. This type of deterioration has been seen in areas such as the rotator cuff, the Achilles tendon, and around the elbow.

A variety of factors can contribute to a case of tendonitis. As an example, a middle-aged woman who begins to run for exercise may develop a case of tendonitis due to both the deterioration of her tendons as well as stress on those tendons from running.

Symptoms

What does tendonitis feel like?

Simply put, a case of tendonitis leads to pain. Pain is the most common symptom of both tendonitis and tendonosis. With this condition, the injured tendons are swollen from time to time. On occasion, the swelling occurs from a thickening of the actual tendon, and in other cases, the swelling occurs due to a thickening or additional swelling of the tendon sheath. Issues with a tendon tend to cause pain after rest such as when you first wake up each day. This pain has a tendency to go away rather quickly.

With increased swelling and pain in a tendon, it may make it more difficult to move an affected joint. During these times, an issue called crepitus arises. Crepitus is a cracking feeling when an affected joint is moved. In rare cases, the tendon that is weakened has the potential to rupture rather suddenly. On occasion, this may require surgical intervention to repair.

Diagnosis

How do health care providers identify tendonitis?

Upon your initial visit with us at Hicksville Physical Therapy, our licensed physical therapists will evaluate your medical history, including a variety of questions concerning not only any physical activities you may perform, but your career and your general symptoms as well. After this, our therapists will examine the affected area. This may cause discomfort, but it is important for us to understand the extent of your pain and the exact location that the pain emanates from.

On occasion, an individual affected with a tendon issue will be referred to a physician for an additional diagnosis. Once completed, our physical therapists here at Hicksville Physical Therapy will provide you with a variety of treatment options to quickly assist in your recovery and return you back to your active lifestyle.

Our Treatment

What can be done for the problem?

Injuries to a tendon can sometimes be difficult to care for effectively. Even with the proper care, an injured tendon can linger for months or even years. On average, it is common to expect any form of treatment to last six to nine months. Even if your rehabilitation is successful, there is potential for the pain to come back. Any treatment recommendations by our staff will be based upon the severity of your injury as well as which tendon has been injured.

If signs of inflammation our present, our still will prescribe a regime of nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen to help reduce the inflammation and pain. These types of medications are used for a short period of time in combination with either ice or heat to the affected area.

The important thing is to rest and heal. If a sport such as tennis caused your tendon injury, do not play again until it has completely healed. During this time, only participate in activities that do not risk further injuring the tendon.

Upon beginning your physical therapy regimen with us, our physical therapist will help you learn a variety of stretches and exercises that will help your tendon to heal properly and regain any lost strength. Additionally, our team can assess both your job and workout equipment to determine if any changes should be made to your day-to-day routine. Based on the severity of injury, special equipment such as arch supports, splints, or heel lifts may be utilized.

The good news is that even if the pain does not subside entirely, a majority of individuals with long-term tendon issues find ways to reduce their overall pain level and live a normal life. In some cases, individuals still experience lingering pain after six months. For these individuals, surgical intervention may be required to help alleviate the pain.

Hicksville Physical Therapy helps to provide a wide variety of physical therapy services in Hicksville, New York and the surrounding area.