Tendonitis is a term that you may have heard before, and is a fairly common injury. A tendon is the connection between the muscle and the bone, and tendonitis is inflammation or irritation of a tendon. This injury is typically caused by overuse or repetitive action. While it can occur in any tendon in the body, it occurs in some areas more often than others, giving the injuries to those areas their own names. Golfer’s elbows, tennis elbow, swimmer’s shoulder, jumper’s knee, etc. all fall into the tendonitis category. Left unaddressed tendonitis can progress into tendonosis. Tendinosis is a chronic condition that leads to degeneration of the inflamed tendon. Tendinosis is more severe than tendonitis and more difficult to treat.
The goal is to avoid either of these conditions from occurring in the first place, but if you do end up experiencing tendonitis here are some things to think about. Tendonitis is inflammation of a tendon. Inflammation is commonly defined as a reddened, hot, swollen, and often painful or stiff area of the body. This is true as a description of what inflammation looks like, BUT also remember that inflammation is a bodily process controlled by your immune system. The body is trying to repair or heal itself. Keep this in mind while recovering for several reasons. One, you want to eliminate what is triggering the inflammation if possible. In a repetitive motion or overuse injuries this can be addressed by assessing movement patterns and posture. Second, you don’t want to stifle the inflammation process itself, this is how the body heals.
Once the tendonitis occurs, it's time to start focusing on healing. Kelly Starrett said in a training I attended “There are no fast healers. You either heal at the rate of a human being… or slower.” It’s something I think about for myself and treating patients. There are alot of great tools and treatment modalities in the work, but nothing is going to bypass the body's healing process. However we can optimize it! Let’s talk about some ways to do that.
As I mentioned, inflammation is a necessary part of the healing process that should not be blocked, but it should also not be left unmanaged. When an injury happens in the body, white blood cells are sent to the area as part of the healing process. Fluid from the blood cells leaks into the area which causes the signs of inflammation (redness, swelling, pain). We can manage this by encouraging circulation to the area. Increased circulation can help flush the area and decongest the tissue. This can be done with manual techniques, such as massage, acupuncture or electro-acupuncture, as well as movement. If the area is painful to touch, body work on an area above the injury could also be beneficial in improving blood flow to the injury. For example, massage or electrostimulation to the thigh could be beneficial in treating achilles tendonitis. Will acupuncture “fix” tendonitis? No, it will not magically repair the tendon, but it can help optimize your recovery by helping your body do its job more efficiently.
Now let’s talk about self-care. Yes, going to a professionally trained healthcare provider is very important for assessment and treatment, BUT the treatment should not stop there. Realistically, how often are you going to be in that treatment room? Once, maybe twice a week for an hour. What about all those other hours during the days and weeks you are recovering? Don’t put your healing on hold and only optimize your healing for the time you are in the office. There are plenty of things you can do at home or work throughout the day to keep that road to recovery from growing longer. (This is a very basic and abbreviated list)
On a final note, you may have noticed I didn’t mention icing the injury. This wasn’t a mistake. Ice is something I rarely if ever recommend for an injury. If you are interested in learning why, check out this article here.
The American College of Sports Medicine defines Delayed Onset Muscle Soreness, or DOMS, as pain that develops 12-24 hours after exercise with the greatest pain between 24-72 hours after exercise. If you have spent anytime in the gym you have likely experienced this at some point in your life. DOMS can occur when the body is adapting when you are new to exercise or raising the intensity of a workout. Along with high intensity workouts, eccentric exercise has been linked to higher instances of DOMS. Eccentric exercise is when the muscle is tense during lengthening. i.e running down hill puts tension on the quads as they are lengthening and absorbing the impact from the ground. It’s important to note that DOMS occur AFTER the workout. If you are having pain during a workout. If you are having pain during a workout, that is something that should be investigated further to prevent injury. Delayed onset muscle soreness is exactly that…..soreness, but it isn't only that. It can present as tenderness to touch, stiffness and slight swelling. This part of muscle repair. When you are strength training/exercise you are causing tears and breaking down the muscle, as the body repairs the muscle it grows bigger/stronger. Because DOMS is the result of muscle repair, many people have a “no pain, no gain” mentality and believe that soreness after a workout is the sign of a good workout. I don’t subscribe to this line of thinking. It is possible to build muscle with a moderate intensity workout. Unless you are brand new to exercise (and sometimes even if you are brand new) DOMS in my opinion can be a sign the intensity was a little too much.
Here are some methods I use to prevent DOMS from occuring in the first place:
I'm always available for questions.
Thanks for reading!
Whether you have personally used one or not, you have probably seen a foam roller at some point in your life. They are in most gyms and common in rehab facilities, but a question I often get is, do they even work? The short answer is yes, but not in the way most people think.
Foam rollers, or the dozens of other tools used for mobility work, are often explained as literally rolling out muscle “knots” or “adhesions”, inferring that we are in some way physically ironing out or flattening our muscles with these tools. This isn’t really the case. Foam rollers can release muscle tension and increase mobility, but it’s a neurological response that gets us the results. Foam rollers and all of those other tools help us communicate with our bodies and send signals to our brain, which causes a physiological response in the body that will release an area of tension. It’s important that we check in with our bodies regularly, and a foam roller is a great way to do that. I personally keep mine in the living room and use it daily, even if it's only for 5-10 minutes.
Now, let’s talk about some guidelines. First, we want to stay off of any bony areas. You want to be in the meaty areas of the muscles. I.e, stay away from elbows, knees, rolling directly on the spine, etc.
Next, more isn’t always better. Remember we are not trying to physically crush those “knots” in our muscles, that’s a misconception that has led to using more force than our bodies can handle. We only need to use enough pressure to elicit a response from our nervous system. This means we should be able to breathe throughout the practice. If you find yourself holding your breath and bearing down, you are using too much pressure. You want to get close to that line, but not cross it.
The goal should be to improve to the point that this process is not painful. Tissue should not be painful with moderate compression. If you work consistently over time, you should be able to achieve this.
Finally, I want to emphasize that using a foam roller is not the be all and end all of self care for muscular health. Does foam rolling work? Yes. Can it help increase mobility and range of motion? Yes. Does it help decrease pain caused by muscular tension? Yes. Should it be the only self care practice used for improving or maintaining mobility, muscular tension and body health? Absolutely not.
Foam rolling has its place in the selfcare world. It is a great introduction to self care because it can be done in small doses, give you great results, gives your body feedback, and help you build consistency, but it should be paired with other modalities. Active stretching and strength training should be incorporated to help reinforce the progress made with your foam roller. Once we gain that range of motion and mobility, we have to use it or lose it.
Thanks for reading! If you have any questions, please don’t hesitate to reach out.