Treating tendinitis: When over-the-counter medications won’t do

Tendinitis is a common condition that occurs when the tissue connecting your muscle to your bone becomes inflamed. It can be acute or chronic in nature, and causes pain, tenderness and sometimes swelling. Tendinitis is typically found in the elbow, shoulder and knee, as well as in the wrist and the Achilles tendon. If you’ve experienced it, you know tendinitis can be quite painful, preventing you from doing the things you love and making even the simplest activities of daily living—such as walking or lifting—difficult.

The first line of treatment for tendinitis is rest, ice and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, Motrin and Advil. But if these approaches don’t alleviate your symptoms within a few days, or if your symptoms return as soon as you resume regular activity, it’s time to see a physical therapist.

“Tendinitis can absolutely be cured with the proper treatment and it can be cured rather quickly,” says certified strength and conditioning specialist Ryan J. Algeo PT, MSPT, an outpatient physical therapist at Bryn Mawr Rehab, part of Main Line Health. “An experienced physical therapist can pinpoint the exact cause, ease the symptoms, and most importantly, prevent recurrence. We help patients build strength, increase flexibility, and correct faulty functional movements that are the underlying cause of tendinitis. It’s our goal to find the root of the problem and fix it, or the pain will come back.”

Algeo and his colleagues report that as many as half of the patients they work with arrive to physical therapy with a diagnosis of tendinitis.

Common types of tendinitis

There are several different types of tendinitis, including:

• Tennis elbow – an irritation of the tissue connecting the forearm muscle to the elbow
• Golfer's elbow – a condition that causes pain on the inner side of the elbow
• De Quervain's tenosynovitis – a painful condition affecting the tendons on the thumb side of the wrist
• Achilles tendinitis – an injury of the Achilles tendon, which connects the calf muscle to the heel bone
• Swimmer's shoulder – shoulder pain caused by connective tissue (a tendon) rubbing on a shoulder blade
• Patellar tendinitis – an injury to the tissue connecting the kneecap to the shin bone (patellar tendon)
• Tendinitis of the wrist – swelling of the tissues (tendons) connecting muscle to bone in the wrist

“The first thing we do is a thorough physical evaluation,” says Bryn Mawr Rehab physical therapist Sue Bradley, MPT, Cert MDT. “We assess the patient’s range of motion, strength and muscle tightness, and explore what activities are causing pain. It may be the way a person is sitting at their computer, running, throwing a baseball, swinging a golf club, or a host of other activities. We watch how a patient reaches, bends down to the ground, and even just walks. Sometimes we use video to break down movement into slow motion to reveal faulty mechanics. I once worked with a weightlifter who came to us with an elbow issue. I was able to determine that his elbow issue was actually caused by the way he squatted. Once we corrected his squatting motion, his elbow issue went away.”

“People tend to treat what hurts, but that may not be the problem,” adds Algeo. “A knee issue might be caused by hip weakness or ankle immobility. Elbow pain could be caused by a wrist problem. The reason for tendinitis can be found anywhere along the chain.”

Once the cause is pinpointed, physical therapists use hands-on techniques such as massage and stretching to decrease the pain, and then work closely with patients to build strength, increase flexibility and correct body mechanics. On average, the process takes four to six weeks, but can sometimes take as little as one week. Then, it’s up to the patient to continue practicing what he or she has learned.

“We teach patients proper mechanics—how to move in the most optimal way—as well as strengthening and stretching exercises that will prevent their tendinitis from returning,” explains physical therapist Laura Elko, PT, DPT, also with Bryn Mawr Rehab. “It takes ongoing work on the patient’s part—you cannot go back to your old mechanics or your tendinitis will return. But if you do your homework, it’s an easy fix. The patient has control.”

The team agrees that the sooner a patient with tendinitis receives physical therapy, the better the recovery will be.

“The more time that passes, the more something becomes chronic and the harder it is to fix,” says Bradley. “Typically, anti-inflammatory medications, and even cortisone shots, are just a short-term fix. If you’ve been diagnosed with tendinitis, don’t wait on it. Let us get to the root of the problem and correct it.”

If you have pain that lasts for a long period of time, pain that occurs without a trigger, or pain that continues to return, over-the-counter medications are not the answer. Ask your physician to prescribe physical therapy, and say goodbye to tendinitis pain for good.