Is it Tendinitis, Tendinosis, or Tendinopathy? More Importantly, Can Massage Therapy Help Me?

Is it Tendinitis, Tendinosis, or Tendinopathy? More Importantly, Can Massage Therapy Help Me?

Can massage help with tendonitis?

Short answer: A) It depends on your symptoms and B) YES is perfect for soft tissue injury!

Whether you have been diagnosed with any of the aforementioned Tendin-itis-osis-opathy conditions, a skilled massage therapist can be an integral part of your recovery plan to speed up healing time, decrease your time off, to get you back in action in this game of life.

First, let’s get a thumbnail sketch of what exactly all these structures and terms are so that we might better understand what is happening on the inside at the site of injury, and how to best approach our treatment options.
Tendon: A tough fibrous connective tissue that connects muscle to bone. They are among the strongest soft tissues in the human body. The main purpose of a tendon is to transfer the force of a muscle contraction to the bone for movement. The tendons you see on the backside of your hand connect to muscles in your forearm, allowing you to move your fingers.
Tendinitis: Inflammation of the tendon results from micro-tears that happen when the musculotendinous unit (where the tendon and muscle come together) is acutely overloaded with a tensile force that is too heavy and/or too sudden. Tendinitis is still a very common diagnosis, though research increasingly documents that what is thought to be tendinitis is usually tendinosis. [1]
Tendinosis: A degeneration of the tendon’s collagen in response to chronic overuse; when overuse is continued without giving the tendon time to heal and rest, such as with repetitive strain injury, tendinosis results. Even tiny movements, such as clicking a mouse, can cause tendinosis, when done repeatedly. [1]
Tendinopathy: A general term for tendon damage involving overuse, microtears, and collagen degeneration, manifested by inflammation, pain, and weakness. [2]

Most tendon injuries occur near a joint, hence the very descriptive names you may be familiar with: tennis elbow, golfer’s elbow, pitcher’s shoulder, swimmer’s shoulder, or jumper’s knee.

Now that we’ve got a clearer understanding of the players in your situation, let’s look at what happened to get you here.

What causes tendon injury?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse and aging. Anyone can have a tendon injury. But people who make the same motions over and over at their jobs, sports, or daily activities are more likely to damage a tendon. [3] This chronic overuse weakens the tendon over time leading to injury. Without proper treatment, the condition will persist and possibly lead to a rupture, at which point surgery is usually required. Although a tendon injury may appear to happen suddenly, the tendon has most likely already weakened over time.

What are the symptoms of a tendon injury?

Pain, stiffness, decreased range of motion, weakness in affected area, possible redness and heat in cases with inflammation. Remember that since tendon injuries usually occur near a joint, the pain may feel like it is radiating around and/or out of the affected joint.

Is There Anything I Can Do At Home To Help?

Rest, but don’t stop: Most likely, by the time you’ve gotten to the point of injury and/or pain, the tendon has been weakening in the background for some time. Tendons take longer to heal than other soft tissues, like muscle, so resting the affected area (wrist, knee, shoulder, etc) is key. However, rest doesn’t necessarily mean hanging out the “Do Not Use” sign. Sometimes wearing a recommended brace or splint, or not using the injured body part can lead to atrophy and stiffness. This is less than desirable. We want to keep things moving and flexible, while avoiding activities that overload the area causing pain. (With your doctor’s approval, of course.) If you need to continue working, consider adjusting the way you do things (voice to text instead of typing) to avoid interrupting the healing process.

Ice is nice: Get friendly with the anti-inflammatory chilly goodness of an ice pack. Great to use after some activity, or anytime during the day when you have 20 minutes to cool off. For those tricky, boney, curved, non-flat areas of the body, consider a gel-pack which maintains its flexibility when cold. Some of them are even designed to be used warm as well. A worthwhile investment!

The best defense is a good offense: Under the advice of your doctor, adding in gentle strength training exercises is a great way to build muscle in the weakened area. In addition this will help to bring the opposing muscle groups back into balance, thus reducing the risk of future injury recurrence. Many times, this is where some visits to a physical therapist will come into play in your recovery. They will be able to asses your progress and recommend safe exercises for you to perform both for short term recovery, and to continue for long term wellness and performance.

How Can Massage Therapy Help Me?

Although massage therapy has a multitude of benefits for everyone’s health & wellness, there are specific massage techniques that are uniquely qualified to help with tendinopathy. Please be aware that the following techniques are contraindicated during the acute phase of injury, primarily the first 24 to 48 hours, or if the area is swollen or enflamed.

Deep Transverse Friction (DTF) or Cross Fiber Friction (XFF) massage, developed by John Cyriax, will greatly benefit your recovery. Unlike traditional swedish massage which is more superficial in nature and uses strokes that run in parallel with muscle fibers, XFF is a more focused approach. Your therapist will work on the affected tendon with deeper pressure in order to pin the tendon to the underlying structure. Then, using small movements, will work perpendicular (or transverse) to the tendon fibers in a back and forth manner.

XFF massage has shown to be beneficial in recovery of tendinitis or tendinosis, deep-friction treatments are beneficial for both conditions, but for very different reasons. In the case of tendinitis, deep friction serves to reduce adhesions and create functional scar tissue once inflammation has subsided. In the case of tendinosis, deep-friction treatments serve to stimulate fibroblast activity and collagen production [4]. This should provide you some piece of mind in that whether you are dealing with Itis or Otis, massage therapy and XFF is going to give you massive benefit.

Closing Thought: Emotions

As you can see, tendon injuries are not to be shrugged off, but rather something that will require your time and attention in order to heal properly. If not taken care of appropriately, you may possibly wind up with a chronic condition. That doesn’t sound like much fun. Take the advice of someone who’s been in your shoes: You might have to slow down for a short while. Most likely, a healthy “No” is going to be needed to keep you from getting back to normal too quickly. This can be tough not only in the workplace, but also at home. I didn’t cover it in this article, but there certainly is an emotional component to any kind of injury. We are hurt, vulnerable, out of our flow, needing the help of others (to varying degrees depending on our injury). Many times there are financial or social/community impacts- our world can get rocked real quick! This is a lot to handle when we aren’t prepared. Luckily, your doctor, chiropractor or massage therapist can suggest resources in dealing with these issues: Counselors, support groups, maybe even a therapist that specializes in energetic/emotional work. Don’t be afraid to ask for guidance, especially if these are unchartered waters for you. Lean on those who have been where you are, and those that have the expertise to help you short cut some of the pitfalls on the path as you successfully navigate your way to optimal healing.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/
[2] http://medical-dictionary.thefreedictionary.com/tendinopathy
[3] http://www.webmd.com/first-aid/tc/tendon-injury-tendinopathy-topic-overview#1
[4] Lowe W. Orthopedic Massage Theory and Technique. Philadelphia, PA: Mosby Elsevier; 2009

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