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Treating Tendinitis

Achilles tendinitis, tennis elbow, rotator cuff tendinitis, these tendon conditions are all common causes of pain that we see in our practice with much frequency.

What many of us usually understand about tendinitis is that it is a condition involving inflammation of the tendon resulting from overuse and repetition. This usually leads us to respond with treatments involving rest, ice, and other attempts to reduce inflammation. Traditionally, we then come to think that progression of tendinitis results in changes to the tendon structure itself if left too long.

However, what we know now about tendinitis may surprise you. Inflammation, in fact, is typically not seen in tendons until very late in the development of the condition.

The Real Cause Of Tendon Pain
When the tendon is under improper loads (usually due to stressful movement habits) the tendon will actually develop a neurological intolerance first. What this means is that the nervous system can begin telling us that there’s pain before there’s even any true structural difference present.

The next stage of the condition is changes to the fibers of the tendon. Irregular healing and fiber direction will result from that improper loading as the tendon tries to heal and align itself to the activity demand.

So How Do We Treat It?
This all indicates that, instead of rest and ice, movement is actually the most-beneficial treatment method for tendon pain. By gradually reapplying load to the tendon using the movements that would otherwise cause pain, we can recondition the structure to be more tolerant and less reactive to load. Past that, addressing whatever movement habit resulted in excessive loading to the tendon will also be crucial.

The implications of this don’t impact the prognosis of the condition; outcomes are still very positive with proper treatment. There is always a safe and effective way to move and load the structure to eventually train the tendon out of its pain.

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