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What is tendinitis? How Do We Fix It?

Dec 30, 2021
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What is tendinitis? How Do We Fix It? 


  •  What is a tendon? 
    •  A Tendon is the dense connective tissue that attaches a muscle to a bone.  If you have ever cooked chicken tenderloins.  It is that annoying white piece that you have to cut off each piece.  


  •  Qualities of a Tendon. 
    •  Dense connective tissue that is designed to transmit force and energy through the body. 


    •  Stiffer Tendons. 
      •  Transmit more force quickly / power. 
      •  Running, jumping, throwing, etc. 
      •  Tend to be shorter
      •  Potentially increase risk of muscle strains. 


    •  Less Stiff Tendon
      •  Lengthen easier, more pliable, but transmit less force
      •  Think Yoga
      •  Potentially less risk of muscle strain but also less capable of generating power. 


  •  Why do we get Tendon Pain?
    •  Microtrauma. 
      •  Prolonged damage to a tendon caused by some form of stress leads to inflammation. 
      •  Normal recovery the body repairs the damage cells and everything gets built back stronger. 
      •  If because of repeated stress that your body can’t repair you may get increased inflammation that makes the area more sensitive. 
    •  Nerve Sensitization 
      •  With prolonged inflammation you may notice an irritability of the nerve, the skin may be more sensitive and you may be more reactive to normal types of pressure or stimulus. 


    •  Tendinitis. 
      •  Inflammation of the tendon that causes an increase in pain during palpation or use of the tendon. 
    •  Tendinosis. 
      •  A degeneration of the collagen may occur over time if the tendon repair process and inflammation is left unchecked. For more detailed information on the topic click here:


  •  How do we fix it: 
    •  Tissue Density Problems. 
      •  If you tend to be a stiff / powerful person
        •  Add in long slow holds like isometic exercises. 
        •  See this example for a Push-Up isomtric exercise.
        •  Deciding how much and how often to load is the challenge. 
          •  Need Enough stress to stimulate a change. 
          •  Not so much that you can’t repair the change. 
      •  If you tend to be a hypermobile person: 
        •  Add in weightlifting and even progressing to plyometric type exercises that will promote tendon stiffness. 
        •  Again the challenge is to load appropriately. 
        •  See this example of a jump landing. 
    •  Nerve Sensitization. 
      •  In this scenario we need to determine why the nerve is mad at you. There are 4 options. 
        •  1. Local irritation of the tissue 
        •  2. Irritation of the nerve somewhere along its path. 
        •  3. An imbalance of the autonomic nervous system.
          •  Fight / Flight (sympathetic) vs. Rest /Digest (Parasympathetic. 
        •  4. Chronic pain leading to changes in the way your brain actually process the information from the nerves. 
        •  ***It is beyond the scope of this paper to discuss how we sort which of these things is the primary culprit. We just want you to know they exist!
    •  Tendinosis
      •  We need to rebuild the collagen or connective tissue that makes up the tendon itself. 
      •  Couple of ways we can do this. 
        •  Local Dry Needling into the tendon. 
          •  Triggers fibroblasts that cause regrowth. 
        •  Progressive exercise loading.  
          •  Similar to above on tendon length. Typically With Progressive Isometric and eccentric exercises. 
        •  Blood Flow Restriction Training. 
          •  BFR stimulates fibroblasts and a host of other repair molecules similar to high intensity exercise without the risks. 
        •  Nutrition. 
          •  You Must have the building blocks for collagen growth. We recommend two things. 
          •  30 min pre-workout consume
            •  Bone collagen needs to be present to rebuild the connective tissue. 
              •  Our favorite is Great Lakes Bone Collagen. 
              •  Amazon affiliate link (we appreciate the support)= 
            •  Vitamin C. Is a precursor to the cell pathways to rebuild connective tissue. 
            •  In depth information at the following link 


Written by Dr. Nicholas Sanders PT, DPT, CSCS, CIDN.  Dr. Sanders is the founder and owner of PHYT For Function where we provide a convenient and simple solution for people to continue to do the activities they love without muscle, joint, or nerve pain.  He is a national instructor for Integrative Dry Needling and Co-Creator of a Neuro-Inflammatory Manual Therapy course. 

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