What is tendinitis?

Tendonitis is inflammation or irritation of a tendon, recent research has suggested that a more appropriate term for tendonitis is tendinopathy. The condition causes pain and tenderness most commonly close to its attachment to the bone. While tendonitis can occur in any tendon, it's most common around the shoulders, elbows, wrists and heels.


Which tendons in the body tend to develop tendinitis?

  • Tennis elbow – extensor tendon of the forearm and wrist extensor muscles
  • Golfer's elbow – flexor tendon of the forearm and wrist flexor muscles
  • Rotator cuff tendonitis – tendons of the three shoulder external rotators muscles
  • Achilles tendonitis – tendons of the two calf muscles that plantar flex the ankle
  • Patellar tendonitis – tendons of the four quadriceps muscles that extend the knee

What are the common causes of tendinitis?

There are several factors that can predispose patients to developing this condition. These need to be assessed and corrected with direction from a physiotherapist and massage therapist. Some of these factors include:  
  • Joint stiffness including the ankle for Achilles tendonitis, elbow for tennis elbow, shoulder and neck for rotator cuff, and the hip and knee for patellar tendonitis
  • Muscle tightness including calf muscles for Achilles, forearm extensors for tennis elbow, forearm flexors for golfers elbow, and quadriceps for patellar tendonitis
  • Excessive training including unhealthy combination of volume, intensity, sets, reps, and the use of stressors such as hills, resistance etc. There are many decisions to be made when progressing your strength and fitness. Commonly, fitness enthusiasts simply add class after class without looking at these parameters and without managing the repetitive loads.
  • Poor biomechanics and technique.
  • Poor foot posture such as a pronation pattern where foot pronates, the leg internally rotates, kneed adduct and hips flex during testing postures or a supination pattern which favors different mechanics and cause different overuse injuries.
  • Inappropriate equipment footwear, racket, computer set up, golf club etc
  • Inadequate warm up including  the lack of proper prehab exercises, cardiovascular warm up, nervous system warm up, and a sport or activity specific warm up. Each of these are essential to get your body prepared prior to activity.
  • Muscle weakness including a base strength  which is what we refer to as general strength as well as specific strength which is activity specific strength.
  • Poor proprioception or core stability  will forces your muscles arms and legs to work harder and this imbalances may lead to overuse and tendonitis.

What is the prognosis of tendinitis?

The goals of any tendinitis treatment are to relieve your pain and reduce inflammation. Often, taking care of tendinitis on your own — including rest, ice and under the care of your doctor, over-the-counter pain relievers — may be all the treatment that you need. If your pain persists longer than a week with these strategies you should book an appointment with your physiotherapist for assessment and treatment    

What can physiotherapy and massage do for tendinitis?

Most patients with this condition heal well with appropriate physiotherapy. This, however, can be a lengthy process and may take up to 6 months in those who have had their condition for a long period of time. Early physiotherapy treatment is vital to hasten recovery in all patients with this condition. Many cases of tendonitis present with muscle tightness and this is found in both those who have lived an active lifestyle and by who have lived sedentarily lives. With the exception of rotator cuff tendonitis, most tendonitis will get worse with repetitive strengthening exercises and improve with soft tissue techniques such as active release, massage therapy, specific deep tissue techniques, myofascal techniques and heat.  Repetitive contractions and strengthening may irritate some tendonitis and require close supervision and progression of load and repetition.  Rotator cuff tendonitis on the other had requires a well thought out and progressive external rotation strengthening program with the shoulder positioned under 90 degrees flexion abduction.   A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose most tendinitis. Occasionally, further investigations such as an Ultrasound, X-ray or MRI scan may be required to assist with diagnosis and assess the severity of the condition.   Most people develop tendinitis because their jobs or hobbies involve repetitive motions, which put stress on the tendons needed to perform the tasks. Physiotherapists understand human movement, biomechanics and the medial sciences. Our physiotherapists are trained in kinesiology, the sport sciences. Using proper technique is especially important when performing repetitive sports movements or job-related activities and we can evaluate your movement patterns.   Occasionally, and if tendinitis is severe and leads to the rupture of a tendon, you may need surgical repair. But most cases of tendinitis can be successfully treated with rest, physiotherapy, massage therapy, and medications to reduce pain.


Physiotherapy and massage treatment may comprise of:

  • massage
  • Low Lntensity Laser Therapy is also very important to heal the damaged tissues
  • devices including crutches, braces, heel lifts, and night splints to rest the affected tissues
  • stretches – although stretching is not effective on it own
  • joint mobilization
  • ice or heat treatment
  • exercises to improve strength, flexibility, core stability and balance
  • education advice so we can be strategic and design a personal improvement plan
  • anti-inflammatory advice
  • activity modification advice
  • hydrotherapy
  • biomechanical correction including teach proper functional movement skills
  • footwear, training surface, and equipment advice
  • a gradual return to activity program
  • shockwave therapy

How can exercise and physical development help after tendinitis?

The Kinetic Chain

Our body functions best and with minimal stress when it is in optimal alignment and posture. Proper structural correction is achieved with proper footwear and support. Proper functional mechanics requires skill development and neuromuscular training and is the science of motor learning. The kinetic chain is a integrated functional unit of systems that work interdependently to allow structural and functional efficiency. It is made of the soft tissue system (muscle, ligament, tendon, and fascia), the Neural system ( peripheral nervous system of nerves and the central nervous system or brain), and the Articular system (joints). If any of these systems do not work efficiently, compensations and adaptations may occur in the other systems. A dysfunction in the kinetic chain leads to decreased performance and predictable patterns of injury.  Imbalances may result from postural stress, a pattern of overload, repetitive movement, a lack of core stability, and a lack of neuromuscular efficiency. All functional movement patterns involve deceleration, stabilization and acceleration, which occur at every joint in the kinetic chain and in all planes of motion at varying speeds.   Optimum posture and alignment provides optimal structural and functional efficiency to the kinetic chain. If one component is out of alignment, it creates predictable patterns of tissue overload and dysfunction, leads to decreased neuromuscular control and initiates the cumulative injury cycle. Muscle imbalance leads to abnormal neuromuscular control leads to overloaded tissue and tissue fatigue which leads to inflammation and eventually leads to tissue trauma or injury. The most common patterns of compensation are the Pronation Pattern of the lower body and the Forward Head Pattern of the upper body and these two patterns are the focus of our screen examination and our subsequent corrective preventative exercise plan. Identification of biomechanical imbalances in a way that is specifically related to the multi planner movements and that involves acceleration, deceleration, stabilization and occurs at multiple speeds in those specific body positions and posture activities of daily living.  Assessment of the muscular system (functional anatomy) the articular system (functional biomechanics) and the neural system (motor behavior) becomes important in the prevention and treatment of overuse injuries and repetitive strains. In order to live a healthy and active lifestyle, one has to train their body the way it moves during daily functional movements.


Exercise and Physical Development

The final step is to establish a personal improvement health plan to continue to develop physically throughout your life. This is especially necessary after injury or an accident when you have become deconditioned. All of our staff have a combination of health sciences and sports sciences training, having dual training in both kinesiology and physiotherapy and allowing us to provide a biomechanical focus. Once you have recovered from your painful arthritis, our therapists will perform a functional movement screen and analysis to identify individual muscle imbalances that are unique to your inherited structure, to your movement patterns, and to your goals and interests in living a healthy physical life. We develop a individualized program that focus on:  
  • Your specific imbalances and movement patterns at work, home, and those evident during the activities that you participate in.
  • You structural and genetic posture and alignment characterizes and how they affect your interests to do activity etc.
  • We look at the ergonomics specific to your workplace and home

How can low intensity laser therapy help tendinitis?

Low Intensity Laser Therapy (LILT) is the use of monochromatic light. Meditech Bioflex has been producing this technology for 20 years and has an extensive in house clinical lab.   The light source is placed in contact with the skin allowing the photon energy to penetrate tissue, where it interacts with various intracellular biomolecules resulting in the restoration of normal cell morphology and function. This process also enhances the body's natural healing propensities.   Low Intensity Laser Therapy does not heat or cut tissue. Unlike many pharmacological treatments that mask pain or only address the symptoms of the disease, Laser Therapy treats the underlying condition or pathology to promote healing. The technology utilizes superluminous laser diodes to irradiate diseased or traumatized tissue with photons. These particles of energy are selectively absorbed by the cell membrane and intracellular molecules, resulting in the initiation of a cascade of complex physiological reactions, leading to the restoration of normal cell structure and function.   The process is curative and therefore results in the elimination of symptoms including pain. In addition, it enhances the body’s immune system response and facilitates natural healing. The therapy is completely safe and has no adverse side effects. The technology is highly effective in the treatment of musculoskeletal conditions, arthritis, sports injuries, wound healing and a wide range of dermatological conditions. Whiplash injury typically involves injury to muscles, ligaments, and joints and typically involve several levels and a more wide spread area of injury due to the force full nature of the injury. Muscles of the neck, although short, cross over several joints and so the discomfort is generally more global initially. Laser therapy directed by multiple diodes are able to reach these tissues.    

Physiological effects of Low Intensity Laser Therapy

With LILT there is an increased production and release of:  
  • Endorphins which - natural analgesics
  • Cortisol – a precursor of cortisone
  • Growth hormone – instrumental in tissue repair
  • ATP – improves and regulates cellular metabolism
  • An increase in protein synthesis – collagen, DNA, fibroblasts
  • A facilitated venous and lymphatic flow
  • Increased angiogenesis – the elevation of oxygen saturation
  • Enhanced immune response
  These responses are some of the many processes that accelerate cellular regeneration (cartilage, epithelium) and restore normal cell morphology and function. Treatments are typically 25 minutes to over 1 hour depending on the condition and area being treated   The most popular technical / clinical information requested is available on the Meditech website under Laser Reports. You may visit the Meditech website research section directly for detailed abstracts, case profiles and articles on a variety of topics relating to the use of low intensity laser therapy in the treatment of various medical conditions.  

What life style and self-care measures can you do for yourself to relieve tendinitis?

To treat tendinitis at home, Rest, Ice, Massage, and sometimes Heat. This treatment can help speed your recovery and help prevent further problems.  
  • Rest. Avoid activities that increase the pain or swelling. Don't try to work or play through the pain. Rest is essential to tissue healing. But it doesn't mean complete bed rest. You can do other activities and exercises that do not stress the injured tendon. Ask your physiotherapist which activity is best. Although rest is a key part of treating tendinitis, prolonged inactivity can cause stiffness in your joints. After a few days of completely resting the injured area, gently move it through its full range of motion to maintain joint flexibility.
  • Ice. To decrease pain, muscle spasm and swelling, apply ice to the injured area for up to 15-20 minutes, several times a day. Ice packs, ice massage or slush baths with ice and water all can help. For an ice massage, freeze a plastic foam cup full of water so that you can hold the cup while applying the ice directly to the skin.
  • Heat. For more chronic tendon conditions, and if the goal is to release tight soft tissue, heat can be helpful in increasing blood flow to the muscle and tendon. This includes deep heat, moist head, and hydrotherapy
  • Over the counter Meds. Ask your doctor about medications. You can also try over-the-counter medications, such as aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others), in an attempt to reduce the discomfort associated with tendinitis.
  • Physiotherapy and Massage Therapy. Book an appointment with your physiotherapist and massage therapist for an assessment and treatment. Soft tissue techniques that release the tension in the muscles and or release the myofascial tensions placed on the extensor tendon will not only rehabilitate the injury but also prevent further injury and reoccurrence.
  There are many decisions to be made when it comes to the care of and prevention of all types of overuse injuries including some tendonitis. An experienced practitioner, a well executed assessment process, and a well thought out personal improvement plan can help.



To reduce your chance of developing tendinitis, follow these suggestions:
  • Develop Strength and fitness. Often those who develop tendonitis have are not prepared physically to perform either the volume or intensity of the activity which they participate in. If your goal is to be active, talk to your physiotherapist to help you develop the components of fitness that are most important to the activities that you do.
  • Prepare your muscles to play. Strengthening muscles used in your activity or sport can help them better withstand stress and load.
  • Recover from activity and get ready for the next. Ask your therapist about the strategies that are best for you to recover from your specific activity. Heat, ice, massage, baths, stretching and include.
  • Warm up first. Before you exercise, take time to increase your core temperature and break a sweat and then stretch in order to maximize the range of motion of your joints. This can help to minimize repetitive microtrauma on tight tissues. Remember, regular massage by your physiotherapist and or your massage therapist helps too. 
  • Use proper workplace ergonomics. If possible, get an ergonomic assessment of your work space and adjust your chair, keyboard and desktop as recommended for your height, arm length and usual tasks. This will help protect all your joints and tendons from excessive stress.
  • Mix it up. If one exercise or activity causes you a particular, persistent pain, try something else. Cross-training can help you mix up an impact-loading exercise, such as running, with lower impact exercise, such as biking or swimming.
  • Improve your technique. If your technique in an activity or exercise is flawed, you could be setting yourself up for problems with your tendons. Consider taking lessons or getting professional instructions when starting a new sport or using exercise equipment.
  • Ease up. Know your body. If you are not fit to perform the activity ease up, avoid activities that place excessive stress on your tendons, especially for prolonged periods. If you notice pain during a particular exercise, stop and rest. If you are unable to progress and develop your sport, seek help from a physiotherapist who understands how to develop athletes.

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