Get In Swing Without Tendon Pain

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Get In Swing Without Tendon Pain

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Spring's here. It's time to restring your tennis racquet or dust off

the old golf clubs, but that tendon pain in your elbow, shoulder or

ankle may force you to keep the clubs in the bag or the racquet in

its case.

For some people, resting the affected tendon may be all they need to

ease the pain, but others with chronic pain struggle to find relief.

The good news is physicians now have a large array of techniques

from new approaches to physical therapy and rehabilitation to new,

less-invasive treatments that stimulate your body to heal the

problematic tendon that can help you keep swinging your racquet or

clubs without pain.

" We're altering the landscape in dealing with a lot of these tendon

issues, " said Dimeff, M.D., medical director of Cleveland

Clinic Sports Health. " These are still difficult problems to deal

with, but the options are so much better now than they were 10 years

ago. "

What's causing the pain?

Most people attribute tendon pain to tendinitis (inflammation of a

tendon), but more often the pain results from tendinosis, a

breakdown of connective tissue resulting in a series of tiny tears

in and around the tendon. Experts refer to the two conditions

collectively as " tendinopathies, " which occur most commonly in the

elbow (tennis elbow or golfer's elbow), the ankle (Achilles tendon),

in the shoulder (rotator cuff) and the knee.

While tennis, golf and other activities that involve repetitive use

and overuse of a tendon are the usual culprits, other daily

activities also can trigger pain. Generally, tendinopathies occur in

middle and older age, from your 30s to your 70s.

First treatment approaches

If your tendon pain lasts more than a few weeks, see a doctor to

rule out another, potentially more serious cause of the pain, such

as a stress fracture. If your pain is sports-related, the doctor may

have you check the size and weight of your racquet, golf clubs or

other equipment and work with a pro on the mechanics of your swing.

The initial treatment for a tendinopathy usually entails warming up

the muscle/tendon before exercise, resting it, applying ice and

wrapping it shortly afterward, and taking pain relievers. You also

may do gentle stretching exercises to prevent stiffness.

Dr. Dimeff also recommends physical therapy and rehabilitation to

stretch and strengthen tendons and muscles. The therapy includes

eccentric (pronounced " ee-sentric " ) exercises that elongate the

muscle and tendon while strengthening them. The exercises require

the guidance of a physical therapist.

On the treatment vanguard

Researchers have learned that with cortisone injections often

prescribed for tendinopathies, the tissue damage caused by the

injection may be more therapeutic than the cortisone itself. The

trauma to the tendon tissue prompts the body to deliver blood and

nutrients to the site as part of its healing response.

This idea of creating a healing trauma is behind newer treatments

such as noninvasive shockwave therapy and autologous blood

injections. In shockwave therapy, the doctor uses high-energy

ultrasound waves to hammer problem areas and stimulate healing. The

treatment, although somewhat painful and therefore not for everyone,

is relatively safe, carries few adverse effects and can be effective

for many tendinopathies.

Newer to the treatment armamentarium are autologous blood

injections, in which the doctor injects your own platelet-rich blood

into the region of the injured tendon to deliver nutrients that help

heal it. A study in the November 2006 issue of the British Journal

of Sports Medicine found that the blood injections relieved pain in

patients with medial epicondylitis ( " golfer's elbow " ). Side effects

include soreness and a minimal risk of infection.

Another newer tendinopathy treatment option under study is the

topical nitroglycerin patch. Normally indicated to treat chest pain

(angina), the patch is not widely used off-label to treat

tendinopathies, but Dr. Dimeff has found it effective in his

patients. Nitroglycerin dilates blood vessels and increases blood

flow to the tendons. It also increases levels of nitric oxide, which

may stimulate healing.

Dr. Dimeff typically prescribes the patch for three months. The

patch is easy to use, is relatively inexpensive and carries few side

effects (headache and dizziness are the most common). However,

nitroglycerin can lower blood pressure, and patients on blood-

pressure medications should talk to their physician or cardiologist

before using it.

While these newer therapies offer promise in treating

tendinopathies, they can require several weeks of treatment, and

they don't eliminate the need for physical therapy and

rehabilitation, Dr. Dimeff said.

" The important thing is to stick with the program and don't jump

from doctor to doctor. Go to somebody who's listening to you and

willing to try some of these other new things, " he said. " And, I

can't emphasize enough the importance of the rehab exercises. With

all of these newer treatments, you still have to be doing the rehab

exercises. "

What You Can Do

- Use moist heat to warm up your problem tendon before exercising.

Afterward, apply ice and wrap the tendon with a compression strap or

sleeve.

- Use simple analgesics such as ibuprofen, naproxen or acetaminophen

before activity and as needed.

- If your tendon pain is sports-related, make sure your tennis

racquet, golf clubs or other equipment is sized correctly for you,

and have a pro analyze your swing to make sure it's not causing your

pain.

- Talk to your doctor about physical therapy, and work with your

physical therapist to learn eccentric exercises that elongate and

strengthen muscles and tendons.

- Ask your physician if newer tendinopathy treatments such as

shockwave therapy, autologous blood injections or nitroglycerin

patches are right for you.