This month, I want to touch on the topic of "tendonitis". Tendonitis is very common in all athletes, and is found amongst nordic skiers as well. Tendonitis is the inflammation of tendons around different joints. Depending on the activity you partake in, tendonitis flares up in specific areas. Some common places are the shoulder, knee, elbow, wrist, and ankle (specifically, the achilles). The inflammation and pain from tendonitis are a result of either overuse or overloading (too much weight or pressure on the tendon). This is why it is found most commonly in athletes. We tend to use the same motions over and over in practice or training, and certain sports require doing that motion under stress of weight or against the pull of gravity.
Some common forms of tendonitis found in nordic skiers are knee and elbow. The knee is common because we run a lot for training and that puts stress on the joint and in some people this flares up and turns into tendonitis. I have also seen cases of patellar tendonitis (the knee cap) due to rollerskiing. Rollerskiing is done almost daily 7 months out of the year. The skis are heavy and sometimes track differently depending on how worn the wheels are. This can cause tendonitis because the knee is forced to perform a motion that places it repeatedly in a funky direction, like out to the right or left, thus putting extra stress on the knee and knee cap.
Elbow tendonitis can also develop as a result of frequent rollerskiing. In a previous post, I described how I have developed tendonitis in my elbows and listed a few stretches that can help the pain. This type of tendonitis comes from repeated poling motion while hitting the cement or pavement with force for long periods of time. This is overuse and overloading on the tendons in the elbows, and in result causes inflammation and pain. The stretches I listed in the older blog helped, but here are some other ways to treat tendonitis that Therapeutic Associates suggests:1. Ice! When you notice pain around certain joints and tendons, make sure to apply ice for at least 15 minutes after the activity that causes the pain. Being religious about icing is very important because it will immediately help the swelling go down.
2. Take ibuprofen or other anti-inflammatory over-the-counter drugs to combat the swelling.
3. Rest the area. Take a break from the activity that is causing the pain. The sooner you can do this after the onset of pain, the faster you can heal the area. How developed the tendonitis is will determine how long you need to take a break from the activity. In some cases you may have to take up to a month away from the activity, and in others a week will suffice.
4. Stretching in the early stages will help restore the tendons flexibility and lengthen them, releasing any knots. Check out my older blog about pain in the elbows due to excessive rollerskiing for some pictures of stretches for the elbows. But, be careful with stretching if your tendonitis is more advanced. Stretching as the tendonitis is in a more advanced stage will only traumatize the weak tissue and the symptoms might actually get worse. Be sure to check with your PT about what they think is best to do.
5. After light stretching, it is important to work with your physical therapist on eccentric exercises. These are decelerating movements where the muscle is lengthening and working at the same time. For example, with elbow tendonitis, you could do bicep curls but lower the curl slowly with light weight. Also, try triceps extensions with slow extension and release. For lower extremities (knee or ankle), try single-leg dead lift slowly lowering down to lengthen the hamstring. Do 3 x 15 reps of these exercises depending on where you are experiencing pain, and always with light weight! These eccentric exercises are the best way to strengthen chronic tendopathy.
6. Along with stretching and eccentrics, the PT's at Therapeutic Associates also may perform ASTYM on the affected area. This process is also described in a previous blog below and targets areas of built- up stress and tight tendons/tissues.
7. Use supportive braces or compression sleeves when doing the activity to provide extra support and keep some of the pressure off of the affected area.
Go out, have fun, and GET MOVING!!
