Have you ever had a bad case of tendonitis? Hurts, doesn’t it? It also makes it harder to work out. If tendonitis affects your Achilles tendon, you might find it uncomfortable to run or even walk. If it impacts a tendon in your elbow, you may find it painful to lift or grip an object or even shake someone’s hand. No matter what tendon is affected, tendonitis usually takes a long time to heal. If it becomes chronic, it can hang around for 6 months or longer. That’s inconvenient, especially if you ‘re an active person. Why do tendon injuries take so long to heal?
Tendonitis Isn’t Really Tendonitis
We have called tendonitis by its name for years, but it’s not an accurate term. The term tendonitis suggests an ongoing inflammatory state and experts don’t believe that inflammation is a component of tendonitis after the early stages. You may experience a period where the tendon is inflamed right after it’s injured. This can last up to 6 weeks. If you’re fortunate, the inflamed tendon will heal, and you won’t progress to a chronic tendon injury called tendonosis.
When tendonitis becomes chronic, it’s called tendonosis. The ongoing pain is typically related to tissue breakdown and degeneration rather than an active inflammatory process. That’s why most health care professionals call chronic tendonitis by the more accurate name of tendonosis. Both are under the category of tendinopathies. What is initially tendonitis, assuming it doesn’t heal promptly, turns into tendonosis.
Tendonitis and tendonosis are caused by the repetitive use of a tendon. Chronic overuse leads to microscopic tears in the tendon that initially cause inflammation and when it becomes tendonosis, tissue breakdown. When the initial inflammation of tendonitis becomes tendonosis, healing is often slow. If you’re still experiencing discomfort in a tendon after 4-6 weeks, you likely have tendonosis and may have symptoms for weeks to months.
Why Tendon Overuse Takes a Long Time to Heal
What is this entity called a tendon and why do we need them? A tendon is a thick band of connective tissue that connects muscle to bone. The tendon transmits force from muscle to bone. The fibers of a tendon have to be strong to hold up to force and they are. Tendons have the highest tensile strength of all the soft tissues in the body. They also store energy and release that energy when a muscle contracts.
Unfortunately, tendons don’t have a good blood supply. Instead, they get nourishment from the synovial fluid inside the joint. This lack of blood supply makes healing an injured tendon slower.
What’s happening at the microscopic level when you sustain a tendon injury? If you change your exercise routine in a way that places more stress on a tendon, the cells within that tendon have to work harder to repair and generate new tendon tissue. For efficient repair, cells need a good blood supply and they don’t have it. That’s why tendon overuse injuries are so common and why they take so long to heal. Healing will often take longer in older people and those with other health conditions like diabetes, as these factors further impact blood flow to the tendon.
Some tendons are more susceptible to injury than others. For example, Achilles tendonitis and tendonitis involving the elbows, shoulders, and wrists are the most common. The tendons that are most prone toward tendonitis are ones that have the least blood supply. Tendonitis can also arise from a direct injury to a tendon, like a blunt force, but this is less common than tendonitis due to overuse.
Can You Speed the Healing of Tendonitis or Tendonosis?
A common practice to ease the pain is to take non-steroidal, anti-inflammatory medications, like Ibuprofen, for tendonitis. Since the early phase of a tendon injury involves inflammation, NSAID may help initially. But, after the initial inflammation has subsided, tendon tissue breakdown is the main reason tendons still hurt, so an anti-inflammatory doesn’t always help the discomfort. Some studies suggest that taking NSAID during this stage may actually slow healing by interfering with collagen synthesis. One of the components of the connective tissue that makes up a tendon is collagen. Plus, NSAID, even ibuprofen, has a variety of potentially serious side effects if you take them for a long period of time.
Should you stop exercising? Exercise increases blood flow to the injured tendon and that can aid in healing. But you shouldn’t continue to apply stress to an injured tendon. Physical therapists often use a type of training called eccentric training for those with tendonosis. Eccentric training is strength training where you emphasize the eccentric, or lengthening portion of the movement. For example, you contract a muscle to lift a weight but lengthen the muscle slowly as you hold the tension to slow the movement. Studies show this type of training may help, especially for Achilles tendonitis. However, it’s a good idea to do this under the guidance of a physical therapist. Before you start strengthening, you should be able to stretch the muscles that connect to the tendon passive and actively without pain.
Sometimes, these approaches aren’t enough. Other treatments that help some tendonosis sufferers include massage to increase circulation to the tendon. More advanced treatments include extracorporeal shockwave therapy, a treatment that zaps the tendon with shock waves to activate healing and platelet-rich injections. This is where stem cells are injected around the tendon to jumpstart healing. Sometimes, orthopedists use corticosteroid injections into the area, but this has a significant downside. It increases the risk of a future tendon rupture.
Preventing Tendonitis and Tendonosis
The best way to avoid the discomfort and inconvenience of tendonitis and tendonosis is to not develop it in the first place. Eccentric training may be effective for preventing tendonitis as well as for treatment. But, it’s also important to avoid repetitive activities that place force on a tendon. Runners are susceptible to Achilles tendonitis because they do the same movements over and over. Cross-training can help since you’re doing a variety of exercises rather than the same repetitive movements. Always wear supportive shoes that fit properly when doing any kind of exercise, especially running. If you experience discomfort, don’t exercise through it. Stop and evaluate. Make sure your training is balanced too. When you train one muscle, work the opposing one too for balance.
Hopefully, you’ll never get tendonitis or tendonosis! If you do, you now know why it takes so long to heal.
References:
MedLinePlus.gov. “Tendon vs. ligament”
Arthritis Res. 2002; 4(4): 252–260.
Rheumatology, Volume 47, Issue 10, 1 October 2008, Pages 1444–144.
Clin Orthop Relat Res. 2008 Jul; 466(7): 1539–1554.
Int J Ther Massage Bodywork. 2012; 5(1): 14–17.
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