Tendon attention - holding it all together
Without your tendons, you'd literally fall apart. They're the tough, non-stretchy bands of tissue that connect your muscles to the bones they're attached to. Some of them in particular can be prone to wear and tear. But there is relief at hand, including some exciting new medical developments.
An inflammatory issue
'-Itis' is the medical word for inflammation (think tonsillitis or appendicitis). Tendonitis is inflammation of a tendon, while tenosynovitis is inflammation of the sheath that surrounds the tendon. One or both of these conditions is responsible for tennis elbow, repetitive strain injury, heel and ankle pain and some kinds of shoulder pain.
What causes it?
Tendonitis and tenosynovitis are usually caused by overuse or injury - sometimes repeated minor injuries. You're more likely to get these conditions if you're middle-aged, and especially if you:
- Do a lot of sport (golf, tennis etc)
- Do repeated movements with the same part of your body a lot (eg, writing, painting, using a computer mouse).
Your Achilles tendon (named after the Greek hero's weak spot) attaches your calf muscles to your heel. Some sportsmen snap the tendon while exercising, but pain, stiffness, weakness and inflammation are also common.
Tennis and golfer's elbow
This is inflammation of the outer and inner attachments of your arm muscles at your elbow - so called because tennis serves and golf swings overuse the tendons. However, in my practice lots of people who haven't touched a club or racket in years come in with it - many other repetitive injuries can cause the same symptoms.
Repetitive strain injury
This is thought to be more related to inflammation of the tendon sheath surrounding some of the smaller muscles, especially of the hands and wrists. These days, too much time at the computer is a common culprit.
The plantar fascia is the tough connective tissue that runs forward along your sole from the bottom of your heel. It isn't a tendon, but it's also vulnerable to inflammation and causes similar pain.
Shoulder pain and stiffness
The shoulder is a very complicated joint, with lots of bits to go wrong! Certain kinds of shoulder problem are caused by inflammation of the various tendons around the shoulder.
What's the treatment?
Most of these conditions are treated in a similar way, at least in the short term:
- Rest. This helps the condition settle, and if your wrist is affected you may be given a splint to help keep it still
- Ice packs - frozen peas wrapped in a towel applied for 10 minutes two to three times a day (it really is that simple!) can reduce inflammation. Don't forget that you should never apply ice directly on to your skin
- Painkillers like anti-inflammatory tablets, paracetamol or codeine in various combinations can reduce pain and inflammation. You may need to be careful with anti-inflammatories if you have indigestion or kidney problems
- Physiotherapy. Options available include gentle manipulation, exercises and ultrasound treatment
- Specially designed insoles called 'orthotics' may be fitted for you if your feet or Achilles tendon are affected
- Steroid injection may help if there is a particularly tender spot, especially in plantar fasciitis or tennis/golfer's elbow.
Extracorporeal shockwave therapy - tomorrow's world or today's treatment?
Shockwave therapy - in which pulses of high-energy sound waves are passed through your skin to the tendon, had been used for years to treat kidney stones. It's not widely available on the NHS, but the National Institute for Health and Care Excellence (NICE) has looked at studies using it to treat tendon problems and confirmed that on the whole it's a relatively safe procedure.
It has recommended that as long as the specialist has discussed all the pros and cons fully, it may be worth considering in certain cases of plantar fasciitis, tennis elbow, Achilles tendinitis and a few kinds of shoulder pain. The shockwaves can be painful, and you may need a local anaesthetic, but it's certainly less painful than surgery, which is the last resort treatment until now.
Clinical trials are still going on because more evidence is needed about how well it works. For now, more and more sports clubs are using it for high-level sportsmen. For the future? Watch this space!
With thanks to 'My Weekly' magazine where this article was originally published.