Achilles, patellar (knee), plantar fascia, rotator cuff (shoulder), hip, elbow, wrist, ankle, neck, back

Tendonitis occurs when repetitive strain (typically in the form of micro-tearing of the tendon), overcomes the tendon’s ability to heal. These microtears can come from several sources including:

• Overuse: too much too soon (TMTS)

• One or many (with a new or incorrect technique) repetitions with the tennis racket, golf club, running, jumping, twisting, sprinting, climbing, swimming, cycling (enter sport or activity here)

• Inactivity (underuse) followed by excessive activity

• Wrongly sized equipment (grip, shoes, etc.)

• Compensations from tightness, weakness or old injuries (adhesions/scar tissue) elsewhere in the body (often the joint about or below).

Chronic Tendonitis

These ‘overuse’ micro-tears first result in inflammation/tendonitis. However, more chronic tendinosis can occur were irregular patterns of collagen form that are structurally weaker and inadequate to support the muscle or bone/joint. These adhesions and restrictions are the body’s attempt to stabilize the area and prevent further injury but are NOT elastic and can create a chronic and progressive version of tendinosis call Tendinosis or Tendinopathy.  This happens when the non-elastic fibrotic thickening (adhesion deposition) leads to bigger partial-thickness or full-thickness tears.
These progressive stages of tendonitis where the inflammation and chronicity has triggered small amounts of scar tissue.  This scar tissue serves to ‘patch-up’ the tendon in the short-term. However, the body/tendons leaves the scar tissue there and can lead to chronicity and an increase in severity in the long term regardless of how much time is taken to ‘rest’ or away from the sport.

Calcific Tendinosis

Some of these tears can even create holes (bigger tears) that get filled with calcium. This is called Calcific Tendinosis. I often used Shockwave Therapy to treat calcification of the rotator cuff (shoulder) tendons.

POSTURE and other implications

Overuse or prolonged static postures (computer, phone etc.) initially trigger mild or unnoticed inflammation followed by fibrotic thickening. Thickened tendon can also rub over underlying bone (ex. IT Band over lateral femoral condyle or tennis elbow tendons over radial head bone underneath) causing further aggravation/insult leading to less blood flow (blocked by scar tissue), then a viscous cycle ensues. You may notice some people (usually older) that have postures that look ‘hardened’ based on this process.

Treatment: tendonitis, (calcific) tendinosis, tendinopathy

• Full range of motion exercise and mobility
• Soft tissue treatment (if specific and deep enough such as Active Release, Graston Instruments, Shockwave etc.)
• I usually start with Class 3 B or 4 laser (depending on depth of injury) if the injury is acute.
• I also use Active Release Techniques, Graston Instruments and/or Shockwave to help break up scar tissue and help to remodel the tendons.
• Chiropractic adjustments (at your discretion and with your consent)
• This is followed by exercises to rebuild and made the elbow more tolerant of future activity, whether it be tennis, golf, computer use or anything else that overuse (or underuses) the elbow.

Often, 3-6 treatment are required for full resolution or significant healing.