When you’re committing to working out and take time off for illness or injury, you naturally worry about losing your fitness gains. The reality is you won’t notice a significant decline in your fitness level for several weeks. Plus, your muscles have a certain degree of “memory,” so it’s easier to get back into shape than it was to get there in the first place. With overuse injuries, you don’t necessarily have to stop working out. The key is to modify your routine to put less stress on the affected area. One of the most common types of overuse syndromes active people experience is tendonitis and it can make working out very uncomfortable.
What is Tendonitis?
A better term for the pain and stiffness most people feel when they overuse a tendon is tendinosis. Tendinosis refers to degeneration of the collagen protein that makes up the tendon. This usually occurs as a result of repetitive stress on the tendon. Tendonitis, in contrast to tendinosis, is active inflammation in a tendon. It comes from overloading the tendon with excessive force and is an acute injury whereas tendinosis comes from chronic overuse. Both of these entities are referred to as tendinopathies.
Tendinitis is a relatively uncommon condition compared to tendinosis but sometimes an injury starts out as tendinitis and becomes the more chronic condition of tendinosis. Most people who experience tendon discomfort actually have tendinosis.
Understanding Your Anatomy
What are tendons anyway? They’re strong bands of fibrous tissue that connect muscles to bones. It’s these bands that make movement possible. For movement to occur, muscles pull on tendons which attach to the bone. Even though tendons are strong and flexible, they’re still susceptible to overuse injuries. Certain tendons are more injury prone than others because they have less blood supply feeding into them. Some of the most common types of tendonitis are rotator cuff tendonitis in the shoulder, Achilles tendonitis in the calf and tennis elbow. As mentioned, in most cases, these are tendinosis and not true tendonitis.
Tendinosis is usually not related to a specific injury or trauma but a result of chronic overuse. It’s more common for it to appear after increasing the frequency or intensity of a workout or doing the same repetitive motions over and over. It frequently starts out with mild pain and stiffness that improves with exercise or movement, but the pain typically comes back after stopping. Gradually, the discomfort can worsen to the point where it’s difficult to exercise the area at all. In severe cases, you can experience swelling, popping and even weakness in the affected tendon.
Is It Okay to Exercise with Tendinosis?
Contrary to popular belief, tendinosis doesn’t usually clear up in a week or two. If you catch it early and treat it, you can expect to recover in 5 to 10 weeks. If you don’t treat it and it becomes chronic you may be stuck with it for months. If you have tendinitis due to an acute injury, the recovery period is usually shorter – from a few days to a week or two unless it becomes chronic.
You don’t have to stay on the sidelines if you have tendinopathy, but you will need to modify your exercise routine so you’re not placing added stress on that tendon. If you don’t, you run the risk of it becoming a chronic problem that persists for months. In severe cases of tendonitis, the tendon can rupture or tear. That’s why it’s important to rest the area. This is one time you don’t want to “push through the pain” unless you want to end up with a chronic problem.
Modifying Your Exercise Routine
If you have tendinopathy in your shoulder or elbow, you can still use the muscles in your lower body to get a good workout and maintain your fitness level, although it’s best to lighten up for a week or two on upper body resistance training and focus on stretching the muscles instead. Once the pain subsides, start back slowly, using a lighter weight, and gradually work up to heavier weight as long as you’re not experiencing pain. After working out, apply ice to the affected area. Ice the area throughout the day too, not just after a workout.
If you’re unfortunate enough to have tendinosis in a tendon in your lower body like Achilles tendinosis, getting a good workout becomes a little more challenging. Stop all high-impact exercise and switch to low-impact options like cycling and swimming until the pain subsides. Even when the pain starts to decrease, the healing process won’t be complete, so it’s important to listen to your body and not overdo it.
When you restart high-impact exercise, stop if you feel pain or discomfort and temporarily return to low-impact exercise until you’re no longer experiencing pain. Modified kickboxing using only your upper body is another way to work out without aggravating Achilles tendinosis. Strength-training is still okay as long as you don’t do exercise that causes pain in the area and you don’t do exercises that put stress on your Achilles. Always ice the area afterward.
Should You Take Non-Steroidal Anti-Inflammatory Medications?
Some people reach for a bottle of ibuprofen when they have an injured tendon. It’s best to avoid it. There’s some evidence that NSAID slow down the healing process. Plus, these medications have side effects, especially if you use them for long periods of time. NSAID can irritate your digestive tract, cause intestinal bleeding, increase blood pressure and, in rare cases, lead to kidney failure.
Other Ways to Treat and Prevent Tendinopathies
Strengthening the muscles that connect to the tendon and stretching them after they’re warmed up helps to reduce the risk of tendon injury and irritation. Always warm up before working out to ensure your muscles and tendons are warm and ready to work. Warming up and stretching becomes even more important as you age since tendons become more prone towards injury and degeneration as you get older. In addition, it’s important to cross-train so you’re not doing the same repetitive motions over and over.
If you don’t get relief from rest and conservative therapy, see your doctor. There are other treatments like cortisone injections and ultrasound therapy that may help in some cases.
References:
The Physician and Sports Medicine. Vol. 28 – No. 5 – May 2000.
Medscape. “Tendonitis: Treatment and Management”
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