Injure – Rest – Train – Injure – Rest – Train

* Throughout this article the reference to forearm tendonitis is meant to refer to both medial epicondylitis (golfer’s elbow) and lateral epicondylitis (tennis elbow).

Familiar with this process?

This is often what we hear from individuals complaining of forearm or achilles pain attributed to tendonitis. They will participate in a Crossfit class, go for a run, or some other activity and it causes pain (usually at significant levels). They decided to rest a few days or weeks to let it heal, then they try again – pain again. This process gets repeated many times over in most clients before they come into us for tendonitis issues.

Why does this happen?

And why is it so different from a hamstring strain or sore back that usually bothers someone and is healed with rest.

The answer – tendonitis is different from almost any other type of injury. This means you must take a different approach to treating it.

The most important difference between tendon injuries and other injuries is that tendons lack a blood supply, or at best, have a limited blood supply. Without a blood supply the ability of tendons to heal is limited because our blood is what brings nutrients into a structure and takes waste out (“groceries in, garbage out”). This is how most of our musculoskeletal system is. Our muscles have a constant supply of nutrients that allow our muscles to repair and heal when damaged. Without this, the healing process has to rely on something different.

Tendons heal based on the stress applied to them. The process looks like this:

  1. Muscle contraction pulls on the tendon
  2. The tendon undergoes a certain amount of stress
  3. This stress triggers a reaction which results in collagen degradation then synthesis (collagen is what a tendon is made of)
  4. Collagen synthesis creates a stronger, more resilient tendon capable of withstanding greater amounts of stress

When we exercise this process repeats over and over until our tendon heals. Striking a balance of stress allows tissue healing without excess strain creating tissue destruction.

How do we know how much stress to apply?

For this, we combine current evidence, as well as anecdotal treatment of these injuries. The first point to note is that stressing a tendon in the midst of the tendonitis process WILL be uncomfortable. Research indicates you should not only expect this discomfort, but that it is required to create a proper stimulus for remodeling. It is suggested that the discomfort is somewhere in the 3-5 (out of a 10 point scale) range. This can vary by the source, but I usually suggest enough discomfort to be well aware the tendon is being challenged, but not enough to alter function. This applies to both the time you are stressing the tendon, as well as approximately 24 hours after it. If you can’t hold your coffee cup because of forearm pain the next day, you likely did too much!

In addition to these guidelines about pain there are many other factors in the treatment of tendonitis. You want to make sure you are setting up the affected area for success. That would mean good strength and mobility of the shoulder when treating forearm tendonitis, and good strength and mobility of the hip and ankle when treating achilles tendonitis. There are also several modalities that are often used successfully when treating tendonitis – dry needling, massage, blood flow restriction (BFR) training, and more!

By following the above guidelines, combined with an individualized treatment approach, Mobility Fit has a great track record of success when treating tendonitis of all kinds!