Tendonitis can happen anywhere in the body. However, the most common areas for tendonitis are called your body’s watershed zones. The term ‘watershed area’ refers to regions of the body that receive dual blood supply from the most distal branches of two large arteries. Because of that, these tendon zones are where blood supply is weakest, thus increasing the chance for injury.
Luckily, there are quite a few ways to treat this condition, but beware, the most common one is also the worst one.
Did you know that to reduce the inflammation many docs give steroid shots which may actually weaken tendons? There are fortunately other, more wholesome, methods and you can get a good overview of these methods further below.
Wrist tendonitis, also called tenosynovitis, is a common condition characterized by irritation and inflammation of the tendons around the wrist joint. Many tendons surround the wrist joint. Wrist tendonitis usually affect one of the tendons, but it may also involve two or more. Often wrist tendonitis occurs at points where the tendons cross each other or pass over a bony prominence.
The wrist tendons slide through smooth sheaths as they pass by the wrist joint. These tendon sheaths, called the tenosynovium, allow the tendons to glide smoothly in a low-friction manner.
When wrist tendonitis becomes a problem, the tendon sheath or tenosynovium, becomes thickened and constricts the gliding motion of the tendons. The inflammation also makes movements of the tendon painful and difficult.
Tendinitis is the inflammation of the tendon and results from micro-tears that happen when the tendon and surrounding muscles are acutely overloaded with a force that is too heavy and/or too sudden.
Signs and Symptoms of Tendinitis
Tendinitis produces the following signs and symptoms near a joint:
Tendons are usually surrounded by a sheath of tissue similar to the lining of the joints (synovium). They are subject to the wear and tear of aging, direct injury and inflammatory diseases. The most common cause of tendinitis is injury or overuse during work or play. The pain is usually the result of a small tear in or inflammation of the tendon that links your muscles to your bone. Tendinitis can also be associated with inflammatory diseases that occur throughout your body, such as rheumatoid arthritis.
Because tendonitis is most caused by repetitive stress—commonly from a sports injury or work stress—rest is very important. However, after a few days of rest it is important to introduce mobility again. The following 8 treatment options have proven successful:
Acupuncture is aimed at increasing the blood supply and blood circulation to the affected tendon, which in turn encourage the release of endorphins and serotonin (the body’s natural pain relievers). Oftentimes this can be adequate relief from pain with no need for prescription painkillers.
These causes can lead to what’s called “local Qi and blood congestion in the channels” according to traditional Chinese medicine or TCM. TCM includes the use of acupuncture and Chinese herbs. Acupuncture needles are inserted at or very near to the source of the pain. This addresses the local symptoms by improving the circulation of Qi and blood in the affected area. (Qi is called ‘Prana’ in yogic terminology)
Chinese herbs can reduce the inflammation in soft tissues and strengthen the tendons. In TCM, one of the functions of the liver is to control and moisten the tendons and ligaments. Therefore, healthy liver function is expressed in ease of movement. Acupuncture and herbs for tendonitis usually involve treating the liver also.
Both acupuncture and Chinese herbs are extremely effective in treating tendinitis. Acupuncture, in particular, is the treatment of choice, giving excellent results in both acute and chronic cases. Acute cases can often be resolved in a few treatments.
As is often the case with many conditions, the two most important areas in life to attend to in order to prevent it are exercise and diet. Regular acupuncture “tune-ups” can also aid in preventing the development of tendonitis in the first place, as well as preventing a recurrence of tendonitis once it has been relieved.
2. Physical Therapy
Physical therapy can help increase the range-of-motion, and reduce pain and inflammation affecting the tendon. Closely monitored physical therapy exercises can also strengthen the attaching muscle to provide better protection against greater tendon damage. Once the pain and inflammation associated with tendonitis have subsided, strengthening exercises can help patients prevent future injury and suffering. Patients also learn how to exercise safely and efficiently.
Electrotherapy is a long-used and highly effective treatment when it comes to reducing inflammation and swelling, decreasing pain, promoting tissue repair, and increasing blood circulation, and eventually, range-of-motion in the joint.
Interferential therapy (IFT) uses low frequency electrical stimulation of the nerves to create a physiological reaction. Low frequency electro treatments are commonly associated with pain but IFT aims to avoid the unpleasant side effects and the pain. The electric frequency is rhythmically increased and decreased in amplitude and reacts with the muscles and tissues to produce increased mobility and pain relief. It is most effective when used in conjunction with ultrasound, and is used to relieve aches, pains and joint stiffness, to reduce swelling, increase blood flow and speed up recovery time.
Other forms of electrotherapy include pulsed shortwave therapy and laser therapy. Pulsed shortwave therapy is a non-thermal method of healing (meaning it does not produce an increased temperature unlike other treatments). Laser therapy can be used to repair damaged tissues and can be very accurate, but it is also a very intense (meaning not too pleasant) form of treatment.
Ultrasound technology is often utilized by physical therapists in order to increase joint circulation. The ultrasound machine sends sound waves and produce heat towards the affected joint to reduce pain, loosen tight muscles, and speed healing.
Ultrasound is a form of mechanical or sound energy, but at very high frequencies beyond humans’ hearing capabilities. The ultrasound wave is applied to the injured part of the body, which absorbs the sound energy thereby relieving pain, lessening stiffness in the joints and increasing blood flow. It is suggested that ultrasound can increase the rate of healing and improve the quality of the repair. It is most successful on more absorbent tissues. It is popular because of its relative safety.
5. Ice and Heat
Alternating ice packs and heat packs to an injured joint will lesson inflammation (with ice) and increase circulation and loosen tightness (with heat). Ice causes vasoconstriction (constriction of the blood vessels) and is thought to address the abnormal neovascularization of the tendon tissue (abnormal or excessive formation of blood vessels in the tendon tissue). Use ice for 15–20 minutes several times a day (allowing for at least 45 minutes in between icing session), and after engaging in activities that utilize the tendon.
Cryotherapy (or freezing damaged tissue using nitrogen or carbon dioxide) is a method used to eliminate injured tissue from the actual joint and surrounding the tendon in order to reduce pain and restore full range of motion.
Cryotherapy is a relatively new form of treatment in which the body is briefly exposed to very cold temperatures in order to promote healing and other therapeutic results. Cryotherapy has been shown to decrease inflammation of the body’s tissues, muscles and joints. It can also help improve the body’s circulation and healing, and also slow down cellular metabolism and reproduction. Cryotherapy can help to reduce pain and muscle spasms in the body as well as reduce the swelling of injuries.
Cryotherapy has also been shown to promote faster healing in joint, muscle and tendon injuries. Cryotherapy works by lowering the skin temperature of the body very rapidly and for a short period of time — usually for just a couple of minutes, and no more than 4 minutes. This is accomplished by spraying the body with a fine mist of safe, non-toxic nitrogen. (Nitrogen actually makes up 80% of our natural atmosphere.) The recipient steps into a cryotherapeutic chamber about the size of a spray-tan booth and receives the treatment while standing up.
This dramatic but brief reduction in the body’s temperature causes the release of a sudden burst of adrenaline, giving an immediate boost to the body’s immune system. This immune system improvement can last for days or even weeks after the treatment. There is also a shorter terms release of endorphins, the body’s natural painkiller. This changed physiology within the body can result in accelerated healing and promote increased well being in all of the body’s organs, cells and systems.
Massage stimulates circulation and cell activity, especially when done at the appropriate depth. Deep-friction massage applied for 10 min to the tendon serves to stimulate fibroblast activity and generate new collagen. It can also be effective to apply friction to the tendon in multiple short bursts of 20–30 seconds interspersed with other techniques; this strategy allows for mobilization of the tissue while minimizing discomfort for the patient. Myofascial techniques and trigger-point therapy can reduce fascial restrictions, scar tissue, and trigger points in the muscle connected to the tendon, relieving tension on the tendon. Myofascial techniques, lengthening deep-tissue techniques, stretching and active-release techniques can reset muscle memory to a more lengthened position, reducing the tension placed on the tendon during activity. A variety of massage techniques can decrease overactive pain messages from sympathetic nervous system firing, increase circulation, and improve overall tissue health
Yoga students with varying degrees of tendonitis in their shoulders, elbows or wrists find this condition quite painful, and it has the potential to really restrict what you can do with your arms/hands. But you can still do yoga with tendonitis, and it can, in fact, help to relieve the symptoms and prevent it from occurring.
Often, mild tendonitis will heal itself, but there are some simple yoga exercises you can do to encourage this process.
Essentially, relying too much on the joint, without making proper use of the muscles that surround that joint, puts pressure on the tendons, and can lead to tendonitis. In yoga, poses like Downward Facing Dog, Plank, Chaturanga (and any other poses where you’re holding your weight on your hands) can leave you at risk of tendonitis if you’re not conscious about using the muscles in your hands and arms to hold you up. Take a quick look at your hands next time you do Down Dog — if your fingers are lifting up off the floor, you’re probably not using your hands.
Simply pressing the whole hand into the floor and lightly gripping the mat with your fingers really helps to build up the strength of the muscles in the hands and arms, and that strength will protect take the pressure off your joints and tendons, thereby reducing the risk of developing problems like tendonitis.
The first and most important step is to stop whatever activity triggered the pain or swelling. If that’s a particular yoga pose, then stop doing it, at least for now. More generally, resting the area is also important. But total immobilisation can actually aggravate the problem, so carefully maintaining at least some normal movement in the area is vital.
Suffering from tendonitis in the shoulders, elbows or wrists does not necessarily mean you can’t practice yoga at all, but it does mean you need to be careful. You will probably find you need to be especially careful with weight-bearing poses. As a general rule, if it hurts, then discontinue that particular movement or position. Some discomfort is inevitable however and is part of the healing process.
Exercises to help relieve (and prevent) tendinitis
Again, with each of these exercises, it’s important to be patient with yourself, and stop if the exercises prove painful.
Stretch for tendonitis of the shoulders, elbows and wrists: Interlace your fingers and reach your palms away from you, out in front, lengthening out your arms. Moving slowly, begin to lift your hands up towards the ceiling. Keep your shoulders relaxed down, and your arms lengthening out. Go only as far as you can without pain, and make sure you can still breathe. Hold for a minute or so. Interlace your fingers the other way (with the opposite forefinger on top) and repeat.
Strengthening to relieve/prevent tendinitis of the shoulders, elbows and wrists: Stand about thirty centimetres from a wall and place the palms of your hands on the wall, shoulder-width apart. Spread your fingers. Relax your shoulders. Press your fingertips into the wall, as if you’re trying to get a grip on it. To go further, you might also begin to push into the wall with the palms of your hands, as if you’re trying to push the wall away from you. To go further still, you might also begin to bend your elbows, keeping them tucked in line with your shoulders, then straighten them again — essentially Plank and Chaturanga against the wall. This exercise is especially good if you find it difficult or painful to hold yourself in a regular Plank on your mat.
Use of Props
Foam wedges can help reduce the severe angle of extension of the wrist in poses such as Upward Facing Dog, Handstand and many of the arm balances. You can find them anywhere props are sold (and often in yoga studios).Many students report the disappearance of their pain with regular use of this prop.
There are also several variations of common poses that involve the wrists. For example, you can do Downward-Facing Dog with the forearms on the floor (often called Dolphin Pose). You can also try Ardha Adho Mukha Svanasana (Half Downward-Facing Dog or Right Angle Pose) at the wall, with the arms and torso parallel to the floor. This helps lessen the pressure of full body weight on the wrist joints. Upward facing dog done on fists instead of open palms eliminates the extension of the wrists, which can lead to wrist pain.
With some thoughtful investigation and exploration, you can not only continue your yoga practice but also promote healing.
Tendinitis in your wrists is a painful, irritating condition that’s usually caused by making the same repetitive movements over time, but rather than bench yourself entirely, try these modified yoga poses for wrist tendinitis. Continue following the course of care suggested by your doctor and even in the modified poses ease back if you experience any further pain.
The extension of your wrist, or the degree to which you can bend your hand back is going to be affected by tendinitis. Age and over or under use will cause a lack of ability to achieve the 90-degree angle which qualifies as the maximum extension of your wrist; but tendinitis reduces that capability even more. Use Prayer pose to speed your recovery from wrist tendinitis. Place your hands together in front of your heart. Keep the heels of your hands touching at all times and gently lower both hands towards your waist. Do this every day, holding the pose for 1 to 2 minutes with the aim of increasing the extension of your wrists.
If you suffer from wrist tendinitis, trying to achieve the full 90-degree hand extension would not be advisable. You can modify the pose in one of two ways. Instead of placing your wrists directly under your shoulders, move your hands forward of your shoulders and experiment with which angle can support your weight without causing pain. Alternatively you can curl your fingers under and support your weight on your knuckles.
Intense Side Pose Stretch
While excellent for stretching your back, hamstrings and hips, this side pose is a therapeutic way to gently stretch your wrists while they are healing. Spread your legs 3 feet apart. Turn your right foot out 90 degrees and your back foot in 45 degrees. Twist from your waist to the right and on an exhale slowly bend forward over your right leg. Ideally your upper torso should be lying atop the length of your right leg. Extend your arms back and lay your hands on the floor with your fingers pointing towards your left or back foot. If you find the stretch too intense for your wrists, flip your hands so that the tops lay flat on the floor instead. Take five breaths in this pose and then switch sides.
The Sphinx is considered a gentle stretch for your back and is often used as a warm-up to the more intense stretches like Upward Facing Dog and Cobra. Both Upward Dog and Cobra however rely heavily on your wrists to bear a significant amount of your weight. With the Sphinx you get the benefits of a back bend without putting pressure on your wrists. Lie on the floor on your belly with your arms stretched out in front of you. Contract your butt and hamstring muscles and extend your legs fully behind you with your toes laying flat on the floor. On an inhale raise your head, chest and shoulders off the floor and slide your arms back towards you until your elbows are stacked directly under your shoulders. Let your forearms, wrists and hands lay relaxed on the floor and spend up to 5 minutes in Sphinx pose breathing fully and evenly.
Braces and Splints
Protecting the affected tendon will also provide quite a bit of relief and give it time to heal. And a wrist splint or knee brace can provide protection when performing activities or sports that demand effort from the joints in the affected area.
Tendinitis causes tissue changes that make the tendon more prone to injury, so it is important that you continue to take care of the compromised tendon once the initial phase of treatment is complete. Ongoing massage, stretching, strength training, and warming up before starting work or exercise can help to prevent re-injury and keep the tissue as healthy as possible.
Remember, having an injury doesn’t mean that you should rest everything and neglect other training. If you have elbow tendonitis for example you can still do legs and core work as well as do other skill work and corrective exercizes to improve flexibility and mobility.
To Your Health!