Tendonitis is when the tendon of a muscle is injured or damaged and becomes inflamed. Tendons have less vascularization (blood flow) than muscles and therefore take longer to heal once they have been injured or damaged. Tendons take much longer to adapt to increased levels of exercise or activity than muscles because of the difference in vascularization as well. This makes for a frustrating injury and it is the reason why a tendonitis injury can take so long to recover from.

The first thing to remember is that rest goes a long way with a tendonitis injury. Reducing stress to the injured tendon will allow your body to start mending the damaged tissue. The healing process can be helped along theoretically by promoting more blood flow to the tissue. Things that can promote blood flow are heat (wet or moist heat works best), massage, dry needling and other similar modalities used by physical therapists. But none of these promote blood flow nearly as well as actively using the injured tendon and the muscle it is connected to. But there is a fine line when it comes to using an injured tendon to promote healing or blood flow and using the injured tendon too much which can interrupt healing or even cause more damage.

The trick to treating tendonitis is to know where to draw the line between rest and activity. How do you know where to draw this line? Listen to your body. If a certain level of activity reduces pain and the tendonitis feels better after the activity then it is likely helping. If a certain level of activity seems to make it feel worse or it is not improving then you need to reduce the activity. One thing to keep in mind is that tendonitis will generally feel better during activity so make sure you also evaluate your response after the activity is finished. Keep tabs on how it feels later that day and the following morning. If it feels worse afterward then you have most likely crossed that fine line. Exercise or activity levels should be measured by three variables. The variables of activity or exercise levels are intensity, duration and frequency. Adjusting these variables can help you figure out where to draw that line when treating tendinitis. For example light easy exercise done for a short duration may seem to have a positive effect but that same level of activity done daily may irritate the tendonitis.

As a tendon heals from injury the pain will reduce as the inflammation reduces. But keep in mind that once the tendon has healed it has likely lost some strength and endurance and possibly some flexibility of the muscle that it attaches to. To prevent a re injury to the tendon it is important to remember that you need to slowly increase the three variables of exercise or activity. Remember that tendons have less vascularization than muscles so they need a little longer to adapt to increased levels of activity or exercise. Studies have shown that it can take between three to six weeks for a tendon to adapt to a new level of exercise so keep that in mind as you return to your previous level of activity or exercise.

Lastly, and this is the most important take away about treating tendonitis, is to remember that tendonitis is rarely the problem in and of itself. Tendonitis is a symptom of a problem. If you treat the symptom but do not fix the underlying problem that led to tendonitis then the tendonitis is likely to come back again and again. Tendonitis is classified as an overuse injury. This can simply mean that your tendon is not getting the rest and recovery it needs from activity or exercise. In this case the problem is the method of training. The variables of exercise need to be adjusted so that the tendon can make physiological adaptations necessary to tolerate the desired level of exercise. Too much intensity, too much duration, too much frequency or a combination of these can result in injury to a tendon. Overuse can also occur because of faulty mechanics. Faulty mechanics of how you move or how you perform an activity or exercise can increase the strain on a muscle and tendon because it is compensating for poor mechanics. In this case the faulty mechanics is the problem. If you fix the mechanics you will reduce the strain on the affected tendon which will allow you to resume the activity or exercise while at the same time reducing the stress to the tendon. If you do not fix the faulty mechanics then there is a significantly greater chance of reinjury to the tendon.