Inflammation of the tendon and/or tendon sheath is referred to as tendinitis. Small tears can develop as a result of overuse, gravity (traction stress), posture (rounded shoulders), and muscle imbalance. The inflammation and resulting formation of scar tissue (adhesions) prevent the tendon from gliding smoothly within the tendon sheath. A cycle of swelling and irritation occurs causing chronic tendon problems. Tendinitis most often occurs in tendons that are tight and/or weak. The patella (kneecap), achilles (heel), biceps, and rotator cuff (shoulder) tendons are especially prone to irritation in sports. Inflexible and weak, the patella and achilles tendons, can be overstressed by repeated running and jumping activities. Rotator Cuff tendons are usually overstressed when an athlete throws with a weak and inflexible shoulder.
Signs and Symptoms
- Point tenderness to touch.
- Pain on activity.
- A grating sound (crepitus) is often heard, and can be felt on palpation.
- Sometimes swelling or thickening of the tendon is evident.
P.R.I.C.E. PROTECT the area from further injury (i.e. evaluate proper body mechanics and body alignment). REST does not imply halting all activity, and the injured athlete can be running in deep water, cycling, etc. to maintain and/or increase fitness. ICE massage before and after activity can be helpful. COMPRESS the area to move inflammation away. ELEVATE the area to increase circulation towards the heart.
Refer for a Correct Diagnosis. It is important, as with all overuse injuries, that a correct diagnosis be determined before the cycle of pain becomes established. A sports medicine practitioner will take a history of the injury and conduct a physical examination of the injured area. Physicians will often prescribe anti-inflammatory medication.
Rehabilitation. Physiotherapists can apply various electrical modalities to assist in controlling inflammation.
Promote Healing. Invariably with overuse injuries, when the athlete's pain is relieved s/he prematurely returns to activity and is reinjured. Rest and anti-inflammatory medication alone do not lead to healing. Healing occurs with a combination of progressive site-specific strength and conditioning exercises and overall body conditioning. Active and passive exercises assist in strengthening the surrounding muscles (i.e. scapular and rotator cuff muscles for shoulder) as needed. Address movements creating impingement for proper motion and posture.
Control Abuse. The potential for tissue overload must be adequately controlled prior to returning the athlete to activity. A heel lift, for example, will take the stress off an achilles tendon injury. Persistent achilles tendinitis may be caused by a foot imbalance such as excessive pronation of the foot on landing. Shoe inserts (Orthotics) may be required to alleviate the problem.
Return to Activity. When the athlete returns to activity, pain should be used as a guide, and the intensity of the activity should not be increased too quickly.
- Avoid too much too soon. Gradually work your way back up to speed.
- Proper equipment (i.e. supportive footwear, a properly strung racket).
- Avoid excessive running on sloping surfaces or hills.
- Proper warm-up and stretching exercises.
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