Epicondylitis, Tendinitis, Teno-Synovitis, Plantar-Fascitis….. We’ve all felt it at some point. That nagging burning tweak in your connective tissue that just won’t go away. Nothing went “pop,” you didn’t fall wrong, it just hurts, and you can’t figure out why. Fundamentally these conditions are all one of inflammation, and “inflammation” is the literal meaning of the “itis” suffix. Once you’ve developed the “itis” it is vital that you get on top of your recovery fast. If it lasts beyond 4-6 weeks, it will become an “osis.”
The good news is that inflammation is relatively easy to control, the bad news is that inflammation causes abnormal re-structuring of the tendon mass if it persists for too long. That’s the “osis,” it’s an ‘abnormal or diseased condition or state’, In this case, it’s one of the tendons, hence the term “Tendinosis” that some of you may have heard during your recovery and research. The “osis” is still treatable, but it takes longer to fix due to the need for rehabilitative exercises.
Disclaimer: I am not a doctor, I’ve just seen and helped a few folks recover from injuries. If you see a way to improve this article, please contact me and I’ll happily update with new information. The primary purpose of this article is to have a quick summary of this subject to deliver for folks who want more information. I’ve been answering the same question for a number of people and this article should save me a lot of time and enable a faster response for those who have an injury!
I mean, it should be obvious that I’m not a doctor… at the end of this article I suggest using a horse product to increase blood flow to your tendons. If that doesn’t discredit my information in your eyes, keep on reading!
A note on Tendinitis
What to call it depends on where you feel the pain. There are two places you can feel it, and each has three names which all identify the same condition:
- Inside Elbow Pain: Golfer’s Elbow, Medial Tendinitis, Medial Epicondylitis
- Outside Elbow Pain: Tennis Elbow, Lateral Tendinitis, Lateral Epicondylitis
Medial refers to a position near the body’s centerline. Lateral refers to a position far away. Your elbow has two attachment points called Epicondyles for the muscles of your wrist and fingers. If you have an “itis” affecting the tendon mass in these areas, the strictest definition is Epicondylitis: an inflammation of the epicondyle. Medial and Lateral just states which side it’s on. To keep things simple, I’ll call it inner or outer elbow pain to simplify when directing you to particular exercises or treatments.
How to contract the “itis:”
If you don’t know how you got into this pickle, it will be devilishly hard to figure out how to get out of it and stay healthy.
The itis is caused by a sudden increase or change in your activity level. Here are a few examples:
- Suddenly increasing the length of your hikes far beyond the norm can lead to Plantar Fascitis
- Getting too Gung-Ho over Campus Boarding can lead to Medial Tendinitis
- Suddenly developing a fascination for crimping can lead to Lateral Epicondylitis
- Hiking in new, more rugged/rocky terrain with flimsy footwear can lead to Plantar Fascitis
- Projecting a fun boulder with a gnarsty open-handed crux and trying it too many times a day can lead to Teno-Synovitis (aka “Trigger Finger”)
- A spur of the moment windsurfing trip on vacation can lead to Medial Epicondylitis
- Taking on a massive landscaping project involving shears and loads of small hand movements lead one friend of mine to develop both Medial and Lateral Epicondylitis. The case was so extreme that the inflammation impinged her Ulnar Nerve and caused swelling of the hands and a loss of mobility in her fingers. My friend couldn’t fully close her hand! After about two weeks of following my rehab suggestions, she regained full use of her hands. Since she caught it fast after only two weeks, she was able to fully recover after two weeks of treatment without quitting her landscaping job.
The key is to look back and figure out what changed in your life. If it’s elbow pain, look for anything where you used your hand, particularly if there was flexing or twisting at the wrist. If the pain is elsewhere, look for the motion that would cause stress in that area.
Now that you know what you did, it’s time to begin the healing.
- Cease or reduce the offending motion
- Stop the inflammation
- Stretch to limit the re-structuring of your tendons
- Exercise to rehabilitate your tendons
- Encourage blood flow to the affected area
1: Stop making it angry!
Whatever motion got you in this predicament, it’s time to stop. Or at least significantly reduce the offending behavior. The first rule of self-rehabilitation is “No Pain MUCH Gain!” Tendons and connective tissue are notoriously slow to heal, so moving the joint keeps blood flowing to the area and promotes healing. How much, and how intense? As much volume and as intensity as you can without causing pain or soreness.
2: Stop the inflammation
Now that you’ve finished making it angry, we aren’t generating any new stimulus for inflammation, but we still have to bring down the existing inflammation, and there are a few ways to do that without resorting to NSAIDs and pharmaceuticals.
- Fish Oil: Studies have shown that doses of Fish Oil from 2-4,000mg can be helpful as an anti-inflammatory. Look for a Fish Oil that’s high in DHA and EPA (as those are the two most beneficial components) which is also low in contaminants. Labdoor.com is a 3rd party tester of supplements, and they have some great recommendations for what to use! If you want to walk into a store and grab one off the shelf, Vitamin Shoppe has the best-rated product of anything I’ve found in-stock at a local store. Read more about Fish Oil here
- Turmeric and Black Pepper: In studies, curcumin (a naturally occurring component of Tumeric) has been shown as such a strong anti-inflammatory that it rivals pharmaceuticals. Black pepper contains piperine, which increases its absorption by 2,000%
- Tart Cherry Juice: This has been used by marathon runners since the 1940’s to combat Delayed Onset Muscle Soreness (DOMS) after intense training sessions, and it’s just as effective today. It tends to be a bit expensive to drink the juice itself, but it’s quite easy to get the extract in any supplement store
- Acai Green Tea: Acai berries have the same cytokines as Tart Cherries, and work as an excellent anti-inflammatory. The largest benefit of the Acai Tea from the Republic of Tea is that it runs significantly cheaper than Tart Cherry Extract. I order it in loose-leaf by the pound and drink it every day because it’s delicious and I’m an unrepentant hot-tea addict!
3: Stretch it out
Part of the worry is that long-term inflammation can lead to restructuring of the tendon mass. Stretching the affected tissue can help to slow or stop this process giving you more time to recover, and shortening the recovery process.
- Stretch for inside elbow pain (Medial Epicondylitis)
- Stretch for Outside Elbow Pain (Lateral Epicondylitis)
4: Rehab the tendons
The next step is to use eccentric motions to rehabilitate the tendons as these have been shown most effective in studies for rehabilitation of connective tissues. Eccentric motions are those where the muscle is working through its extension. Think about controlling a dumbell with your bicep, and you resist the weight as it lowers then have help lifting the weight back up. That’s what we’re talking about. All of the work should be done as the muscle extends and it is un-weighted for the contraction.
- Eccentric Wrist Flexor exercise (For Inside Elbow Pain)
- Eccentric Pronator Teres Exercise (For Inside Elbow Pain)
- Eccentric Wrist Extensor Exercise (For Outside Elbow Pain)
5: Keep it flowing
Exercise, but carefully! We want to increase blood flow to the affected area, without making it angry! Remember, No pain, best gains. Cardio gets your blood moving, as can light exercise of the problematic tissue.
In extreme cases, it could be useful to use a liniment or topical rub to help with the healing. Icy Hot works fairly well, but many horse-liniments use the same active ingredient (Menthol), but at a higher concentration. Chapman’s Horse liniment has a whole page on their website to stating that their product is safe for human use, I’ll let you decide if this course is acceptable or not. I do know from experience that Absorbine Horse liniment has been immensely helpful to a few folks whom I’ve seen self-treat their tendinitis issues. But for goodness sake, read the ingredients label and do your research. Steer well clear of anything that has DMSO in it.