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Tendonitis is the inflammation or irritation of a tendon, causing it to swell and leading to pain and soreness around the affected joint. It is often caused by repetitive strain or overuse injury and can occur at any site in the body where a tendon connects a bone to a muscle. Treatment for tendonitis typically involves the RICE protocol: Rest, Ice, Compression, and Elevation. In addition, over-the-counter anti-inflammatory medications can be taken to reduce inflammation and pain. If symptoms persist beyond three weeks, further treatment options include corticosteroid injections or physical therapy.
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What You'll Learn
Rest, ice, compression and elevation
Tendonitis is the inflammation or irritation of a tendon that makes it swell. It is usually caused by repetitive strain or overuse injury and is common in the shoulders, elbows, and knees. If you have tendonitis, you will feel pain and soreness around the affected joint, usually near where the tendon attaches to the bone.
Doctors recommend the RICE method to treat tendonitis, which involves rest, ice, compression, and elevation. This treatment can prevent the injury from worsening and promote healing. Here is a detailed breakdown of the RICE method:
Rest
Rest involves immobilizing the injured area to prevent further injury and give the body time to recover. Avoid any activities that cause symptoms and try to keep weight off the injured area. Use splints, braces, canes, or crutches when available.
Ice
Apply ice packs or bags of frozen vegetables to the injured area to reduce pain and swelling. Do not apply ice directly to the skin. Place a towel between the ice pack and your skin. Apply ice for 10 to 20 minutes, four to eight times a day, especially within the first three days.
Compression
Wrap the injured area with an elastic bandage to provide support, reduce blood flow, and limit swelling. Ensure the bandage is not too tight, as this can cause more swelling below the affected area. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage. Compression is effective for up to one week.
Elevation
Keep the injured area raised above the level of the heart to reduce swelling and associated pain and discomfort. Prop up the injured area on pillows while applying ice and anytime you are sitting or lying down. Aim to elevate the area for 2-3 hours a day.
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Over-the-counter anti-inflammatory medicines
Non-steroidal anti-inflammatory drugs (NSAIDs) are a common treatment for tendonitis. NSAIDs are easily accessible over the counter and can help to reduce inflammation and alleviate pain. Ibuprofen is one of the most popular and effective NSAIDs for tendonitis. It is available in tablet form and as a gel that can be applied directly to the skin over the affected area.
Ibuprofen tablets are a convenient way to benefit from the anti-inflammatory properties of ibuprofen. The recommended dosage for adults is 200-400 mg every 4 to 6 hours, not exceeding 1200 mg per day. It is important to take the tablets with food to avoid an upset stomach.
Ibuprofen gel is another option for those who prefer a more targeted approach or want to avoid ingesting the medication. The gel is applied directly to the skin over the affected tendon, and the active ingredient is absorbed through the skin. This method is particularly useful for treating tendonitis in areas with thin skin, such as the hand or wrist. The gel should be gently massaged into the skin, ensuring complete absorption.
In addition to ibuprofen, other NSAIDs such as naproxen and aspirin can also be effective in treating tendonitis. These medications work by blocking the production of prostaglandins, which are chemicals in the body that cause inflammation and pain. By reducing inflammation, NSAIDs can help alleviate the pain and discomfort associated with tendonitis.
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Corticosteroid injections
Cortisone is injected directly into the inflamed area, delivering the corticosteroid where it is needed. The steroid then circulates through the bloodstream and can affect other areas of the body, although these systemic effects are usually minimal. Steroid injections usually last between a few weeks and a few months, and can be effective in treating inflammation after an injury, allowing the body to heal fully. However, for those with chronic inflammation, symptoms may return over time.
In a multicentre pragmatic randomised controlled trial, Hay et al. compared local corticosteroid injections, oral non-steroidal anti-inflammatory drugs, and simple analgesics in 164 subjects with lateral epicondylitis. After four weeks, 82% of patients in the corticosteroid group reported improvement, compared to 48-50% in the other groups. However, at the one-year mark, outcomes were similar across all groups.
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Physical therapy
The first step in treating tendonitis is to follow the RICE protocol: Rest, Ice, Compression, and Elevation. It is important to rest the tendon and give it time to heal. Returning too soon can lead to chronic tendonitis and even cause tendons to tear.
A physical therapist can suggest an exercise plan that rests the tendon while strengthening the nearby muscle groups and maintaining overall muscle tone. They may recommend eccentric exercises, where you slowly strengthen the muscle while stretching, stopping at the first sign of pain. Easy stretching exercises may also be recommended for you to do several times a day. Ultrasound and whirlpool treatments can also be used to relax muscles and tendons, improve circulation, and promote healing.
For chronic tendonitis, options include open surgery and FAST (focused aspiration of scar tissue), a minimally invasive procedure guided by ultrasound. Surgery is rarely needed and is only recommended for severe symptoms that do not respond to other treatments.
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Surgery
Surgical procedures for tendonitis aim to address the underlying causes and repair damaged tendons. One such procedure is a gastrocnemius recession, which lengthens the calf muscle to relieve stress on the Achilles tendon. Tenosynovectomy, another surgical option, involves cleaning and removing damaged tissue from a tendon before stitching healthy tissues together. In cases of severe tendon injury, a tendon transfer may be necessary. This procedure involves removing most of the damaged tendon and replacing it with a healthy tendon from elsewhere in the body.
Ultrasound-Guided Hydroresection (TenJet) is a procedure used to treat tendonitis without tearing the tendon. It is used to remove degenerative material called tendinosis. This procedure is often performed in an office setting.
In more severe cases, surgery may be required to realign tendons, remove bone spurs causing pressure on tendons, or eliminate calcium buildup. The specific surgical procedure depends on the location of the affected tendon. For example, posterior tibial tendonitis affects the tendon connecting the calf muscle to the bones on the inside of the foot, while swimmer's shoulder involves tendon inflammation in the rotator cuff at the top of the shoulder.
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Frequently asked questions
Tendonitis is the inflammation or irritation of a tendon, which causes it to swell. Tendons are strands of connective tissue between muscles and bones that help the body move.
The most common symptom of tendonitis is pain at the site of the injured tendon, especially during use. Other symptoms include swelling, warmth, tenderness, and redness.
The first step to treating tendonitis is the "RICE" protocol, which stands for "Rest, Ice, Compression and Elevation". If the condition does not improve within a few weeks, a healthcare provider may recommend additional treatment, such as corticosteroid injections or physical therapy.
Tendonitis is not always preventable, but you can reduce the chances of a tendon injury by warming up before exercising and gently stretching afterward.
