Every baseball player experiences arm pain from time to time, it’s the nature of the Beast.
However, many times we aren’t sure of the nature of the pain.
This article by Dr. Josh Renkens will help answer and guide you through a common diagnosis, tendoinitis.
By nature of what I do and the techniques I most often use, I see overuse / repetitive strain injuries on a daily basis in our facility.
You know when you feel that nagging, on-again-off-again pain, only now it is irritating you more and more frequently? Yes, that’s the type of injury I am talking about.
Maybe you have been told you have tendonitis. You have most likely been told to ice it, stretch it (of course everybody is told to do that), or perhaps take some medication. Watch this video and learn more.
Despite trying all of these, the tendonitis seems to be getting worse. But why?
For starters, there is a good chance it is not tendonitis, but rather it is tendonosis. I repeat – tendonOSIS! It is not the inflammation that is responsible for the pain, but rather it is the tendon and contractile elements of it along with the associated muscles and fascia.
This is the deal:
- Tendons connect muscles to bone (the fascia is involved too).
- They help produce joint movement by transmitting muscular force.
- Tendonitis is a condition whereby a tendon becomes injured, inflamed, and painful.
The takeaway message here is inflammation must be present and is THE limiting factor when it is simply tendonitis.
When initial injury occurs, our remarkable body sends various types of cells to the area to destroy the injured tissue and begin the healing cascade. Rest, ice, compression, and elevation are supposed to combat inflammation.
Problem IS, inflammation is rarely present in cases of ongoing, chronic tendon pain.
What has been discovered is that instead of inflammation, the tendon is degenerated; it is swollen, gray (instead of white) and soft (instead of possessing tensile strength). Repeated or sustained muscular contraction causes a decrease in blood flow to the working muscles and tendon. An accumulation of waste products ensues which in turn attract cell types that produce fibrotic adhesions.
This positive feedback loop (more contraction –> more waste –> more adhesions) quickly becomes problematic as it increases stress on the tendon.
The adhesions prevent normal glide and stretching and prohibit normal muscle contraction.
This, of course, causes:
- Decreased range of motion
- Decreased strength
- And usually in that order.
This, then, requires neighboring muscles (synergists) to become overworked. You can guess what happens next. This puts other muscles in a compromising position and role and they soon become overloaded and begin to breakdown themselves.
The cycle continues until the body can no longer compensate. Now the system has broken down and chronic pain sets in.
Remember this: If it gets better with 3 to 5 days or rest and does not return, it probably was a simple case of tendonitis. If it does not go away or returns once you resume activity, it is most likely tendonosis and requires more attention.
So what do you do?
The first step is to breakdown the fibrotic adhesions. There are many ways to do this, and like most things, some ways are much better than others. The best in the game use a combination of ART (Active Release Technique), Fascial Manipulation, and instrument-assisted soft tissue techniques. These methods can efficiently breakdown the adhesions.
Other modalities (laser, taping, stim) can then be used to stimulate cellular healing activity. Once normal glide, range of motion, and length/tension relationships of agonists and antagonists has been restored, properly chosen strengthening exercises should be used to restore and enhance full function.
Have you ever dealt with arm pain and told it was tendonitis? How long did it last and did it go away?