Interviewer: You found out you have tendonitis. Probably wondering what treatments are available, what do you need to know about them and what to expect afterwards. We're going to talk about that next, on The Scope.
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Interviewer: Dr. David Petron is an orthopedic sports medicine specialist at Ï㽶ÊÓƵ of Utah Health Care and is also the chief medical officer for the Utah Jazz basketball team. So he knows what he's doing and today we're going to talk about tendonitis.
What Is Tendonitis?
Dr. Petron: Well first let me say what tendonitis is. There can be confusion about it. Tendon is muscle connected to bone. So at the end of the muscle, that's where the tendon is and then the tendon ultimately attaches to the bone. -Itis infers that it's an inflammation problem, when in fact most tendonitis is really what we call tendonosis because it ends up being a chronic problem. Usually in the first few weeks or maybe the first month we might call it tendonitis. After that it really is not an inflammatory problem, but it's more of a tissue break down problem and then we call it tendonosis.
Interviewer: And that's something that's not going to go away without some sort of intervention. Is that correct?
Dr. Petron: Frequently that's the case and generally the older the patient is, the longer it can take to go away. But even sometimes with prolonged rest, as soon as somebody goes back to doing their usual activity, the tendonosis problem comes back again.
Treatment Options for Tendonitis
Interviewer: So something's going to have to happen, what are the options? Typically are there a lot?
Dr. Petron: There a lot of options. The one thing that all these options have in common is they do something to disturb the tissue. So it gets in a chronic pattern where it won't heal itself and we need to do something to disturb that tendon to try to get the body to feel like it's an acute injury so that it can ultimately heal itself.
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Rest and ice
Early on the treatments are conservative, later on they can become more interventional. Some of the early treatments of course are just rest and ice, and relative rest. So say it's a swimming problem and a shoulder problem, you might be able to stay in aerobic shape by running or riding a bike, working on some shoulder exercises while you ease your way back into the pool. So that can be some of the most simple treatment, just relative rest and then gradual return to activity.
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Anti-inflammatories
Frequently people take anti-inflammatories and they're helpful for the pain, but they're not really helpful for healing. In fact there are some studies that show that they may actually slow down healing. Cortisone is something that people frequently may run into at their doctor's office. And I think that's okay when you're in the -itis phase, so the inflammatory phase. But later on we actually know that cortisone can slow down healing and cortisone in a tendon can actually weaken the tendon, so we've got to be careful about that.
Some of the more advanced treatments I'll just talk about briefly.
And then one other thing that we do is called extracorporeal shock wave therapy, which is kind of like a de-tuned lithotripsy. Same kind of technology used to break up a kidney stone. But you do that on the skin surface, again to disturb the tissue, break up the degenerative tissue along the tendon to get that to heal. So there are a few of the more advanced treatments that are being used now for tendons to heal.
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Focused aspiration of scar tissue (FAST)
There's something called FAST or focused aspiration of scar tissue. This is a newer treatment where you use a percutaneous needle that vibrates about 2000 times a second and then it has irrigation that goes in and fluid that sucks out the necrotic tissue. So it's a way of removing the scar tissue just kind of through a poke hole through the skin's surface.
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Platelet rich plasma (PRP)
Some of you may have heard of PRP or platelet rich plasma. That's where we draw your own blood off, spin it down, remove the platelets, which have some healing properties, and then re-inject that back into the tendon. Again to disturb the tissue and try to give it a jump start to ultimately heal itself. Even some use of stem cells now using in a similar way as PRP.
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Astym
Sometimes physical therapists will do something called Astym where they're using—I call it a butter knife—but it's basically some tools that they're rubbing, kind of like a deep tissue massage. Again to try to disturb that tendon to try to get it to turn over and heal itself.
- Extracorporeal shock wave therapy
Choosing a Treatment Option
Interviewer: My head's spinning. There's so many of them.
Dr. Petron: There's a lot out there, and like most things when there's a lot of different ways to approach it, not one way is perfect. So the physician needs to evaluate the patient and see what might be best for their situation.
Interviewer: Yeah that really sounds like you do need an expert. I mean you can do a little reading on the internet, but it sounds like an expert really needs to decide what is going to be best for your situation.
Dr. Petron: Right, in the early phases though relative rest and gradual return to activity in a lot of patients do well. But once you've had this for three months or six months or longer, probably ought to see a physician.
Interviewer: So getting in early is always the better option.
Dr. Petron: Right, if you start to feel some breakdown say in an Achilles tendon or a rotator cuff in your shoulder, stop. Because once you get into that tendonosis phase, it can be very difficult to get better.
How Long Until Treatments Work?
Interviewer: What are some common questions people have about these treatments?
Dr. Petron: One of the common things is when one of these treatments is done, is it going to instantly be better? And the answer to that is no. So some of that might be lowering the expectation. Because again, really the body still has to heal itself. So even with these treatments, it can usually be three months or so until they're healed.
Interviewer: So in three months, back to 100%? I mean is that fair?
Dr. Petron: Usually at least back to activity, their usual activity.
Interviewer: And then how do you prevent—
Dr. Petron: But there are some areas that really have a lousy blood supply, like the Achilles tendon. Once that's really inflamed, that can be even longer than that to return to play.
Preventing New Injuries After Treatment
Interviewer: So I get the treatment, I'm back to activity. How do I prevent this from now happening again and being a vicious circle?
Dr. Petron: Well the most important thing is start out slowly. All of these problems are not traumatic injuries, they're overuse injuries. So it's doing too much too quickly. So in general, the older the athlete, the slower you ought to ease into your particular sport.
Interviewer: And then eventually your body is going to be able to handle anything you throw at it?
Dr. Petron: The body adapts to the stresses put upon it. So just like a weight lifter gradually lifting more and more weight, muscles get bigger, tendons get stronger. That can happen to every part of your body. Bones get stronger, tendons get stronger, ligaments get stronger as you put stress on it. But the key is you need to do that in a controlled manner.
Interviewer: Let's wrap this up with the final thought. What do you think the big takeaway is?
Dr. Petron: Prevention is always key, so if you start to get feeling of tendon pain then back off on that activity. Relative rest, which means you can still stay active but don't overuse that tendon. If you do overuse it and you have the symptoms for say three months or longer, probably should seek the care of a physician.
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updated: February 12, 2019
originally published: April 8, 2015
