One of the myths of the health and fitness industry is that of chronic tendinitis. From runners with bad knees and hips to tennis players with bad elbows or baseball pitchers with elbow and shoulder pain, the diagnosis is often tendinitis. But with an incorrect definition of the problem, treatments may be ineffective at best or even counterproductive at worst.
In reality, there is really no such thing as chronic tendinitis. Once a tendon is injured, the inflammation rapidly builds up as the body attempts to isolate the injury and prevent any further use or damage to the joint. This, of course, is tendinitis, as the joint swells and becomes inflamed, tender to the touch, and painful for the athlete to keep using.
But this kind of tendinitis caused by a blunt force trauma injury is not as common as the type of pain that most active people may experience throughout their lives. Much more common than twisting an ankle or falling from a ladder onto one's back is the repetitive stresses that lead to chronic pain in a joint. This may be from years of running leading to a chronically sore knee or the dreaded "tennis elbow."
In these cases, where the pain lasts for longer than a day or two, the issue is usually not tendinitis -- an inflammation of the soft tissues surrounding the joint. Instead, the issue is probably tendinosis -- an actual structural change in the soft tissues as a consequence of the demands placed on it. If someone spends hours a day hunched over a computer with a strained neck and a rounded lower back, it is not inflammation that is the problem; it is that the tendons are starting to change in response to that demand of sitting all day.
Furthermore, the treatments for tendinitis and tendinosis will be very different. Inflammation of the joint may respond well to anti-inflammatory medication, ice, and elevation. These treatments are used for the sole purpose of reducing the inflammatory response, reducing circulation to that area of the body, and giving the joint time to rest and repair itself.
But for tendinosis, there is usually no problem with inflammation at the area of pain. Instead of helping the joint repair, use of anti-inflammatory medicines may actually weaken the tendons and soft tissues of the joint, as well as contribute to further changes in the joint's structure. This will cause healing to take longer as the result of treating the problem with the wrong solution.
A more useful approach to helping reduce the pain of tendinosis is to begin to reeducate the joint and soft tissues through a combination of treatments. Foam rolling, massage therapy, or spinal decompression (for spinal issues) can help break down and stretch tissue. In addition, stretching to relax and reeducate a group of muscles and tendons can also help reduce pain, increase range of motion through a joint, and prevent future overuse injuries.
It is also important to reeducate the joint by practicing proper movement patters. Fixing one's running form, or practicing weight lifting movements in the proper manner with lighter weights and then progressing to heavier ones only once the form is excellent, can go a long way towards preventing tendinosis. Once a joint is no longer painful, it is important to fix any errors in movement patterns and address the causes that lead to the chronic pain.
It is important for everyone -- both active and sedentary -- to realize the difference between chronic painful tendinosis and local pain caused by tendinitis. Chronic pain in a joint that lasts longer than a few days and has no discernible cause like spraining an ankle or being struck by something is more likely to be a problem with the structure of the joint itself changing, and the treatment will be very different than resting and icing a twisted ankle.
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