Rigorous physical training can lead to chronic injuries which can affect performance or curtail training altogether. One chronic injury that can be particularly frustrating and debilitating is tendonitis. While tendonitis can be caused by a direct impact injury, more commonly it is the result of chronic misuse or overuse of the muscles around a joint. Most people who suffer from tendonitis cannot recall a specific injury, and there is usually no obvious acute stage accompanied by visible swelling or bruising.
Tendons are the thick fibrous ends of the muscles, which attach muscles to bones. Misuse and/or trauma create small micro-tears at these attachments. These small traumas can cause the tendon to swell. The swelling in turn causes the tendon to rub against the tendon sheath or against adjacent structures creating irritation. Irritation creates further swelling, more rubbing and more irritation. While rest will relieve the pain, returning to training before the injured area is fully healed can easily stress the damaged tissue, perpetuating the cycle of pain, irritation and even inflammation.
Tendonitis occurs frequently in the: shoulder and elbow – the classic “tennis elbow” or “golfer’s elbow” – however tendonitis can also occur in the tendons around the hip and knee or Achilles tendon. Repetitive tasks, such as working at a computer and working with power tools, as well as exercises such as forced stretching, or weight training, may also contribute to the development of tendonitis.
There is no need for tendonitis to become a chronic, debilitating injury. Chinese medicine offers effective prevention, treatment and rehabilitation from tendon injuries through correct application of massage in conjunction with herbal liniments, the use of medicinal plasters (Gao), and exercise.
1. Massage & Liniments
A “tweaked “ tendon can be prevented from developing into a chronic injury by massaging it with Extra Strength Die Da Jiu immediately after class or training. If the injury is a bit more chronic, with tendon or ligament pain that is present during certain movements, gentle massage of the injured area with Dragon’s Blood Tendon Lotion (Xue Jie Shu Jin Lu) is the key to breaking the cycle of pain and re-injury that characterizes tendonitis. Place a small amount of the liniment on the painful area and work it gently into the tissue by making small circles with the pad your thumb or a finger for several minutes. Pressure should be even and slow penetrating only to the depth of the tendon, not down to the bone. Tendon Lotion contains herbs that kill pain, heal damaged tissue and draw circulation to the injured area.
Gao – Medicinal Oinments and Plasters
Gao come in two forms, pre-made ointments that are packed on the local area like a poultice and left overnight, or stick-on plasters in which herbs have been impregnated into the adhesive. Both types of Gao are useful for both acute tendon injuries and chronic tendonitis.
When the tendon first begins to ache, applying Herbal Ice (San Huang San Gao) or Wu Yang Pain Relieving Plaster can relieve inflammation, disperse the stagnant Qi and blood that causes the pain, and improve local circulation. Use these instead of icing the local area.
Correcting the misuse of the joint and surrounding soft tissue is both the key to preventing tendonitis and to rehabilitation. Incorrect technique, unnecessary tension and the inability to engage and relax muscles at the proper time is often the cause of tendon injuries. This is very common in sports like tennis or golf, where incorrect form can cause the tendons in the elbow to overwork in the wrong way, leading to chronic tendon pain.
Another common training error is to practice in such a way that muscles are used repetitively in isolation, rather than connecting them in groups to the core muscles in the center of the body. This can over-stress one tendon, setting it up for injury. This is why many martial arts exercises focus on the development of “tendon strength” (fascial strength and integrity), and whole body power, as opposed to isolating individual muscles, or performing exercises which focus on increasing the size and strength of the belly of the muscle. Qi Gong exercises are particularly useful for rehabilitating injured tendons and developing tendon strength, because they train the fascia and move Qi (and therefore blood and fluids) through the injured area, while developing the whole length of the muscle evenly.
Ice and Tendonitis
Although it is very common to ice tendon injuries, most current sports and physical therapy research has indicated that ice does nothing to heal the injury, and icing the area may in fact interfere with proliferation of the fibroblasts that create new, healthy tissue. Often tendonitis is not accompanied by heat, and redness, or even swelling, so it does not meet the medical definition of inflammation. In Chinese medicine, “tendonitis” is often considered to be related to lack of circulation in the locally tissues, a problem that is increased, rather than decreased, by the use of ice.