Tendonitis

Many of you have heard the word, but what is it really and how does it ruin so many weekends and workouts for people. So the name itself is inflammation of the tendon from a failed healing response. OK what’s a tendon. If you remember from grammar school it is the area that attaches the muscle to the bone. So common places for this are basically any part of your body that moves.

I volunteer at a runner’s clinic after the Boston Marathon where we see people a day or two after their race.  I kept track of my day of seeing patients and their diagnoses. At the end of the day, I saw a patient with a tendonitis in every major tendon in the lower extremity-gluteus, quads, hamstrings, iliotibial band, peroneal, anterior tibial, posterior tibial, and of course the Achilles. So what does that tell us about tendonitis. It can strike any body part at any time, and there is a high chance of getting it,  if you run 26 miles. Here’s the other demographic. The people we see are usually not the elite or professional runners. They are the people that decided to run and have fit it into their schedules of life and kids and work.  So training plays a huge role in tendonitis. Is it too much training or too little?

From what I have seen tendonitis starts as a result of something different in life. New exercise, new weight, new distance, higher intensity, faster speed, change in course, change in repetitions. For the CrossFit world, you can see where things can go wrong fast. Take say Angie. 100 Pullups, 100 Pushups, 100 Situps, 100 Squats. Great workout, not for everyone. Tempting to jump in and have at it like anything in Crossfit…BUT…beware.  My gym Crossfit New England does a good job at scaling recommendations for people as should other gyms. Here’s why

The tendon has to accommodate to stress. If the tendon is overstressed it will develop small microtears in its substance or collagen fibers. When enough of these microtears occur, inflammation kicks in. The body actually sends the same cells it uses to kill infections at your tendon (monocytes and macrophages) and they try to repair and remodel the tendon. These cells release substances that are noxious and painful, causing swelling and tenderness.  Then the body sends the scar formers (fibroblasts) to try to strengthen the weakened area and decrease the inflammatory phase.You can see tendonitis on the left and normal tendon on the right.  So what does this mean for you.

Say you have a biceps tendonitis or Achilles tendonitis. Bottom line when it comes to working out and avoiding injuries comes down to what  I call it the rule of threes.. You should not have pain 1)while you are working out, 2) right after the workout, or 3) the next day. Call it what you will also…tightness, achiness, soreness, tweaked, spent. There is a difference between muscle fatigue and tendon pain that I hope everyone does not have a chance to feel, but when you get the latter you will know it.

11 Comments

  1. Hi Sean,

    For the last few weeks, I have been experiencing pain when my left knee cap is on the ground (i.e. stretches, lunges, etc.). It appears as though there is some swelling below the knee cap in the tendon or ligament. I’m not sure if it’s tendonitis or something else. I don’t want to make it worse, and would like it to heal. Any thoughts on what it might be and how much I should back off wodding? Thx!

    • Hi Brad, The most common things in this area are patellar tendonitis and patellofemoral syndrome. Look in 321gomd under knee and patellofemoral pain and there is an article on it. With either condition you don’t want to push through pain and if it is not better then get it checked out.

  2. Recently got tendonitis in patellar region of right knee. Prescription was for no squats or lunges or similar. I forgot to ask if cycling on my stationary trainer was okay during recovery/healing period. Also, does it help to ice/compress after?

    Thanks,
    Sean

    • During recovery phase follow the same rules no pain during, right after or the next day. If you can follow these simple rules you should be fine. Keep resistance on low setting, and listen for any pain, stay below pain threshold. Ice is fine for afterwards if it is sore, don’t have to use ice.

  3. This describes my elbow pain exactly. I’ve gone to a chiropractor to do some stim and massaging, but it hasn’t helped much. Religious icing does help it recover after pull-up workouts (when it seems to flair up the most). I live out of state but work in Boston a few days a week, should I call the office to see if my insurance is accepted?

  4. Prolo/PRP and look into dry needling. You need to rekindle some inflammation and let you body try to get it rite this time.

  5. A good alternative to any kind of Cortisone shot would be Prolotherapy. Look it up. I had severe shoulder pain from missing a Muscle Up. We to specialist and got this taken care of no surgery, no rehab. Only had to scale weights. Just some info for the board.

  6. my tendonitits is Golfers Elbow….. I have done everything from ice- rest-(hard at times) an tot he extreme, cortizone shot. The shots have NOT been much?, 3 in like 5 years, which the last one was about a month ago an is the only one I have felt pain continually after. I am so frustrated with this since, if I’m on here, I do CF. My profession is a hairstylist which i realize hampers the rest time, since there isnt one. I’ve also been riding/training horses my whole life as well. Any words of wisdom I haven’t heard yet???
    thanks!!!

    • The one thing apart from PT that you have not tried is PRP (platelet rich plasma) injections. There is some recent data suggesting that it does better than cortisone with tennis elbow (lateral epicondylitis) and patellar tendonitis. Happy to talk to you more about it in the office if you want.

    • I believe if it truly is torn then it will hurt sahewmot to swing but when you swing as you know you are using your shoulders, back and especially your hips. When I tore a ligament in my elbow I was wondering the same thing you are and to be honest it didnt hurt all that bad when i swung. It only hurt when I was playing catch with teammates and what not. I would say to take it a little easy if you are beginning to practice up for the upcoming ball season. Last thing you want is a year ending injury.

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About Me

Dr. Sean Rockett is an Orthopedic Surgeon specializing in Sports Medicine. His group is Orthopedics New England with offices in Dedham, Natick and Newton, Massachusetts. Dr. Rockett is a CrossFit Level 1 Trainer and has been a CrossFitter at CrossFit New England since 2007. Dr. Rockett is on the Medical Team for the CrossFit Games and the Northeast Regionals.

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