Tendonitis is inflammation of a tendon, the fibrous tissue that connects muscles to bones. The most common tendons affected include the Achilles (heel), elbow (tennis elbow or lateral epicondylitis), and wrist (DeQuervain’s tenosynovitis). The most common cause of tendonitis is repetitive use of the tendon, but disease and injuries also can cause tendon inflammation. Most tendonitis is self-limited, lasting only a few weeks. However, it can last from six weeks to a few years, especially if you keep reirritating the tendon by continued use. In some cases of chronic tendonitis, calcium deposits will occur in the tendon.
- Tenderness where the tendon inserts into a bone
- Decreased range of motion
- Occasional swelling
Exercise: Stretching properly before sports activities or exercise is the primary method of preventing tendonitis.
Your balanced healing action plan for Tendonitis
If tendonitis has been present for more than two weeks, or is chronic, go to Step 3.
Step 1: Use the RICE Method
If you have recent onset of your pain, or your symptoms are mild, start with the RICE program:
Ice (not more than 20 minutes per hour)
Compress the joint (elastic bandage such as ACE wrap)
Elevate the limb
You should notice improvement in your inflammation and pain within a few days to a week.
Step 2: Take Over-the-Counter Ibuprofen or Naproxen
Along with Step 1, take over-the-counter NSAIDs (ibuprofen, naproxen), which are helpful short term to reduce inflammation and pain, and allow your body to heal itself. If your symptoms persist after a few weeks, proceed with the following steps.
Step 3: Undergo Acupuncture
For persistent tendonitis, the most effective and fastest resolution is from acupuncture. Usually only three or four sessions are required to obtain substantial relief, although more treatments may be necessary for long-lasting resolution. Principal points depend on the particular tendon involved. The Liver-Gall Bladder channels are important to treat because they control the tendons and sinews of the body. Acupuncture can work even if you are still using the tendon in various activities. Always seek evaluation and treatment from a practitioner certified in acupuncture.
Step 4: Undergo Low-Level Energy Laser Therapy
If your symptoms continue, I recommend using low-level energy lasers because, in my studies, the laser appears to help heal the tissue, reduce the inflammatory response, and give long-lasting relief. I commonly use the laser in conjunction with acupuncture for better and faster results. These lasers are called “cold” lasers, because they do not produce heat like the hot lasers used in surgical procedures do. You should notice improvement within six to nine treatments (two to three weeks). Because this is currently a research device unavailable to most doctors, see Appendix C for a reference source.
Step 5: Undergo Physical Therapy Modalities
If your symptoms persist, your doctor can refer you for physical therapy modalities, including electrical stimulation (both direct current and alternating current can be applied to the painful areas; I prefer alternating, which can project deeper into the tissues without burning the skin), ultrasound (high-frequency sound that produces heat deep in the tissues), and iontophoresis (injection of steroids through the skin into the tendon). A physical therapy modality that I also highly recommend is infrasound, or low-frequency sound. Infrasound works by increasing the local circulation of blood and lymph to accelerate the healing process. It not only can reduce pain, but it can decrease swelling as well. Numerous chiropractors, naturopaths, acupuncturists, and a few doctors use infrasound.
You can receive physical therapy along with the previous steps, and you should feel improvement in your pain within six to eight treatments.
Step 6: Take Bromelain, Curcumin, and Citrus Flavonoids
If the previous steps have not helped or have been only partially beneficial, take supplements of bromelain (250mg to 750mg three times per day between meals) and curcumin (200mg to 400mg three times per day between meals). These supplements can decrease inflammation, as well as bruising. To decrease healing time by half, you can add citrus flavonoids (5,600mg to 1,000mg three times daily) to these two supplements.
Step 7: Learn and Practice Counterstrain
If your tendonitis has not been resolved yet, I suggest trying an osteopathic technique called counterstrain. In tendonitis, your nerves may be overstimulating your tendons in certain positions, causing your pain. Counterstrain is used to “re-wire” your nerve-tendon communications to reduce the stimulation. This is done by first finding the area that has the most tenderness and the position that causes the most pain. Then you use your other surrounding muscles to find a position that immediately relieves the pain. You then repeat that position as often as you can, thus establishing a different pattern of nerve firing, which doesn’t cause pain. You can be taught this technique by an osteopathic physician and perform it at home.
Step 8: Undergo Corticosteroid Injections
If nothing else has worked, your doctor can give you a local injection of corticosteroids. Steroids can help some people, but they should not be repeated often because they can cause softening of your bone and long-term damage to your tendon. If one injection is not helpful, repeat injections won’t be helpful and are not recommended.
Step 9: Undergo Surgery
Some physicians perform surgery for chronic tendonitis, especially in the elbow or wrist. I have found surgery to help only a small percentage of people, and it can cause permanent problems such as decreased strength and limited range of motion. Surgery should be your last resort and be done only if you have severe unrelenting pain or cannot use the affected limb.