The best description of the problem was stated by Leadbetter (site below), …”treatment of persistent signs of inflammation by repeated efforts to turn off the body’s alarm is not a substitute for finding the cause of the fire.” For most people I recommend not taking NSAIDs and that if your pain has not resolved in 8 days, schedule an appointment for treatment.

Most often the cause of pain is fascial or muscular tightness and adhesion (small amounts of scar tissue) that have accumulated over a long time which decreases blood flow in the affected tissue. There are many treatments that are effective but nothing I’ve seen works as quickly as Active Release Technique, trigger point therapy, and chiropractic manipulation. This combination of treatments quickly and effectively addresses the cause of pain, often instantly and permanently fixing the problem. Most “tendinitis” is actually a degenerative “tendinosis” with argues against the use of anti-inflammatories. More at tendinitis vs. tendinosis.

NSAIDs are often used for pain relief but it does nothing to actually heal the injured tissue. Healing happens by restoring normal function through rehabilitation and hands-on therapies like active release technique, chiropractic adjustments, trigger point massage, exercises, stretching, and self treatment.

Be careful because NSAIDs are contraindicated with any renal or liver disease. Also, gastrointestinal bleeding is an important problem considering that about 2500 rheumatoid arthritis patients die each year due to NSAID use.

It has been shown that corticosteroid injection is NOT effective in – acute trauma, injection into the tendon, immediately before competition, and in joint instability or malalignment. Leadbetter suggests a 6-week preinjection trial of rest, adjusted exercise level and intensity, and conditioning. After injection, Leadbetter suggests 2-6 weeks of rest (protected activity).

Injection into tendons should ALWAYS be avoided. This causes an inhibition of the formation of connective tissue during healing resulting in weakening of the tissue and greatly increasing the likelihood of future tearing or rupture. If you choose injection, injections should be in the tendon sheath surrounding the tendon.

See my previous post Natural Pain Relief for natural alternatives to NSAIDS.

Leadbetter WB. anti-inflammatory therapy in sports injury:the role of nonsteroidal drugs and corticosteroid injection. Clin Sports Med. 14;1995:353-410.

Berger RG. Nonsteroidal anti-inflammatory drugs: making the right choices. J Am Acad Orthop Surg. 1994;2:255-260.

Tendinitis is an outdated term used to describe a recent injury to a tendon that results in inflammation (swelling) surrounding a tendon. Research has shown that commonly, there are no inflammatory cells found in painful tendons. The term tendinosis or more generally tendinopathy can often be used instead.

Tendinosis is the term used for a chronic long term injury to tendons. Chronic tendon problems are degenerative in nature which means the tendons contain increased blood supply, abnormal structure, and fat deposits but NO INFLAMMATORY CELLS.

A better term to use is tendinopathy. This is a general all inclusive word that is less descriptive but identifies the problem as the tendon versus any other structure.

So why is any of this important?

If most tendon problems are chronic and degenerative with little to no inflammation, then why are we often using non-steroidal anti-inflammatory drugs (NSAIDs) to treat them? The pain relieving effects of these drugs are obvious but the anti-inflammatory effect (occurs after 4-5 days of high dosage) doesn’t actually treat the problem. The actual problem is a weakened tendon from frequent mild strain where the tendon doesn’t have the time or nutrition to heal itself. The final strain the patient complains about was just an accident waiting to happen. Therefore treatment should be aimed at creating new collagen at the injury site. The most non-invasive methods to stimulating collagen growth is through nutrition, eccentric exercise, and deep massage techniques.

Deep massage techniques such as deep friction massage, instrument assisted soft tissue mobilization, and Active Release Technique all have the ability to initiate new collagen formation. Quality nutrition and a focused exercise program will further support the creation of additional collagen to rebuild the damaged tissue. This approach helps in most cases so a surgical consultation is rarely needed.

I’d love to help you feel better.