Tendinitis? What is that?
"We received a question about tendonitis and if we treat them, so we thought a topic focusing in how we treat this disease would be great for our future patients."
Tendinitis/tendonitis or tendinopathy is characterized by inflammation or disease suffered by the tendon, which is a fibrous structure that joins muscle to bone.
The main symptoms that we find in tendinitis are: pain, swelling, difficulty in performing movements and decreased muscle strength. Tendonitis can affect any tendon in the body, but is most common in the shoulder, wrist, elbow, hand, hip, knee, and ankle joints.
Inflammation can arise because of:
• Repetitive movements;
• Natural aging, as the tendon loses elasticity with age;
• Lack of muscle stretching;
• Excessive or inappropriately performed sports activities;
• Autoimmune diseases.
But despite all the cons, the good news is that tendinitis is treatable. One of them is through physical therapy. It is an important ally to treat pain, swelling and inflammation caused by the disease.
Physical Therapy sessions can be performed using various techniques, including ultrasound, laser, exercises and manual therapy. But, regardless of the method, with physiotherapy the benefits are attested, because it:
• Helps to stretch and strengthen the muscle, reducing the overload on the tendon;
• Restores the natural ability of these structures;
• Reduces stress on joints;
• Prevents the appearance of new lesions.
A very common example of tendinitis is on the shoulder!
What is shoulder tendinitis?
Shoulder tendinitis arises when a tendon in the shoulder becomes inflamed, with shoulder pain being one of the main symptoms. This shoulder pain or painful shoulder condition typically worsens at night.
Supraspinatus tendinitis is one of its most frequent causes, but any other tendon that forms the rotator cuff can be affected by this condition of inflammation in the shoulder. The rotator cuff is a set of muscles and tendons that surround the shoulder joint. Its function is to centralize the humeral head in front of the scapula and allow shoulder mobilization.
Tendinitis affects both the left and right shoulder, and bilateral tendinitis is relatively common.
When shoulder tendinopathy becomes chronic, structural alterations of the tendon occur, with the disorganization of its fibers evident on imaging exams, which is why it is called tendinosis of the cuff.
Signs and symptoms of shoulder tendinitis
The main symptom of shoulder tendinitis is pain. This is usually located on the anterolateral aspect of the joint, occurs either with exertion or at rest, worsening during the night and often preventing the patient from resting.
In addition to the discomfort caused by pain, functional impotence can occur with difficulty in performing the normal range of motion and decreased muscle strength of the affected limb.
Some of the causes of shoulder tendinitis
The causes of shoulder tendinitis are varied, but they are often associated with work, or the excessive effort that this sometimes entails, as well as the overload caused by the practice of certain sports such as: weight training, gym (in particular crossfit), swimming, tennis , handball and volleyball. These are the so-called “overhead” sports that cause multiple small traumas, extreme muscle tension and enormous ranges of motion, with stretching of the surrounding structures of the shoulder.
Simple tiredness or fatigue can be accompanied by muscle pain in the shoulder, due to acidosis caused by the accumulation of lactic acid in the tissues. This type of shoulder pain usually resolves naturally with simple rest and ice, without the need for any specific therapeutic intervention.
Calcifying tendinitis of the shoulder or calcifying tendinitis of the rotator cuff is a form of tendinopathy in the shoulder that occurs due to calcium phosphate deposition, usually of unknown etiology. It may be silent in the initial, formative phase, often being a mere imaging finding, but in the resorptive phase, shoulder calcification can cause inflammation of the surrounding tissues and become extremely painful. Outbreak evolution is the rule and can take years to resolve. Its treatment involves non-invasive methods, such as physical therapy with shock waves, NSAIDs or corticosteroids, or possibly by arthroscopy removal.
What does Physical Therapy for tendonitis consist of?
Physiotherapy in shoulder tendinitis uses several therapeutic methods and techniques that aim to:
promote better tendon recovery;
avoid retractions of the joint capsule;
balance the muscles involved in shoulder mobilization;
correct incorrect shoulder movements;
resume/increase patient functionality.
How to establish the physical therapy program?
The physiotherapy program for shoulder tendinitis is always individualized, that is, it is established by the specialist in Physical and Rehabilitation Medicine (Physical Therapist) according to the symptoms and the patient's condition, not only at the shoulder level, but also level of other joints and even possible pathologies (diseases) of the patient. Age is also an important factor to consider.
The treatment in this inflammatory shoulder pathology will depend on the patient's complaints, especially the pain intensity, and also on the objectification or not of joint mobility and/or muscle strength deficits in the clinical examination. In some cases, inflammation is associated with the existence of tendon calcifications, which must also be taken into account when deciding on the most appropriate treatment.
Physical therapy sessions must be daily and the duration of treatment (number of sessions) is always dependent on the evolution of each case, but is often prolonged.
Physical Therapy modalities and techniques
In the treatment of shoulder tendinitis, cold physical agents (usually in the form of ice),
ultrasounds and electrical currents with an anti-inflammatory objective are widely used.
Extracorporeal shock waves are a therapeutic method in increasing use, especially in the case of calcific tendinitis of the shoulder.
Massage is a widely used technique, in its various aspects, depending on the clinical condition.
Aiming above all to reduce pain, certain postures and techniques of traction and dislocation of the shoulder joint are used. .
In order to reduce the tendon overload at the shoulder joint, the physiotherapeutic treatment should include a series of mobilization and muscle strengthening techniques that aim to restore the harmony of the shoulder movements, especially if the clinical examination found mobility and/or mobility deficits in muscle strength.
It is essential to counteract the anomalous elevation of the humeral head in the various arm movements, to work on the re-centering of the humeral head on the scapula, including exercises (always suitable for each case) that globally reinforce the centering and depressing muscles of the humeral head (muscles of the rotator cuff and latissimus dorsi and pectoralis major muscles).
It is also essential to counteract the deviation of the shoulder blade to the side, especially in raising the arm, also with muscle strengthening exercises (specific for each frame) that globally promote the stabilization of the shoulder blade (anterior serratus muscles, trapezius and rhomboids) .
Muscle strengthening must be carried out with different methods and using different types of exercises, also trying to achieve a balance between the agonist / antagonist muscles of the shoulder, namely at the level of the internal / external rotators (the latter are often deficient in relation to the first). Regarding the deltoid muscle, there must be some care in strengthening it, especially in its intermediate portion, as it promotes the elevation of the humeral head.
Joint capsule stretches are a frequently used technique, especially for the posterior portion of the capsule.
Proprioceptive training is a work in which exercises are used with a progressive increase in its difficulty and instability, so that the shoulder joint exercises its action in an adequate and automatic way, namely at the muscular and postural level.
The shoulder rehabilitation program can be carried out in the form of Hydrotherapy or, ideally, be complemented with this type of treatment.