Tendonitis: How Ice Will Make It Worse



This week’s topic…. Tendonitis.

I’ve had a few cases of tendonitis at my Physical therapy clinic in Glendale, Arizona this past month and they’ve got three things in common…

There’s a weakness in the muscle or one of the surrounding muscles, lots of muscle tension, and a history of repetitive movement under load.

All of these affect each other and one will cause the other to get worse. A weak muscle puts a lot of pressure on the surrounding muscles. This then causes tension to increase in these muscles. As a result, other muscles have to work harder and this overuse causes tension.

So What is Tendonitis?

It might sound very complex but it’s pretty simple…. watch this video explanation for more clarity.

Tendons attach all the muscles in our body to our bones and without them, muscles could not do their job. Tendonitis is an overuse injury, making it chronic in nature. Often times my clients say they feel it building up slowly over time.

The pain that’s felt is because the tendon becomes irritated and inflamed. This irritation becomes worse and eventually, it hurts every time that muscle and tendon are in use.

If you are suffering from a condition called tennis elbow with pain over the outside of the elbow when you move your wrist or grip anything watch this video for more explanation.

So Why Does This Happen?

This happens as a result of a biomechanical imbalance causing the muscles to do too much or do a different job than what it was designed for. This imbalance can also cause the tendons to do work in a different path, causing irritation or inflammation.

When there is localized irritation over a tendon the muscle becomes stronger than the tendon itself. This puts the tendon under a lot of pressure, as it cannot support the action that the muscle is performing.

I’ve seen this with one of my patients who came to us after having surgery. He told me at first, his Achilles tendon pain started as an ache and he tried to push through it until sadly it became so damaged that the tendon snapped away from the bone when he stepped down from his truck.  He said he thought someone had hit him in the leg with a bat!

Tennis elbow isn’t just for tennis players? Click here to read this blog.

How Do You Treat Tendonitis?

Tendons work under the concentric (shortening phase) and eccentric (lengthening phase) contractions of the muscle and are put under more load during the eccentric phase.  The eccentric phase is targeted with repeated movements under load like a backhand in tennis, running or jumping, or with follow-through in the throwing motion. Taking time out of certain activities like golf, pickleball or tennis will help the tendon calm down.

This creates space for cross-training and resistance training to help keep the activity load-balanced over multiple muscle groups.

Tendonitis is a warm injury so icing while resting is essential. This allows the tendon to cool and reduces the pain you’re feeling.

Physical therapy can also help to remove any swelling in the tendon and release the tension in the surrounding muscles, with plenty of hands-on treatment including an instrument or tool-assisted soft tissue mobilization (also known as “scraping”), joint mobilization, cupping, or trigger point dry needling.

This allows the muscles and tendons to go back into the position that they were designed to be in. Stretching can also be a vital part of recovery by relieving the pressure on the tendon.

Strengthening the surrounding muscles and the tendon itself then becomes necessary.  Watch this video for some example exercises to treat tendonitis of the elbow or lateral epicondylitis.

For example, the bicep bends the elbow; so to strengthen the tendon you must resist lengthening of the elbow.  For more examples of this exercise see our video here

This ‘training’ can last up to 4 weeks. But don’t worry, this means that the pain has less chance of coming back.


What’s The Worst Thing You Can Do For Tendonitis?

…. And I’ve seen it countless times, it to just rest and ice, then go back to the original activity. Do not do this. It will only end up making things worse in the long run.

Strengthening the tendon is vital!  See this video for some simple exercises to help.

I hope this has helped.  If you or someone you know thinks that they may have tendonitis give us a call.

Nick Hunter, PT, DPT

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