An activity that is very repetitive or experiences high forces can lead to tendonitis, and in chronic cases, tendonosis.  Excessive or prolonged strain in a tendon or muscle causes micro-tearing in the tissue that leads to scar formation and pain. Over time, the tissue quality is poor and resists basic treatment protocols such as RICE (rest,ice, compression and elevation). The scar tissue that has formed from the chronic micro-tearing  is painful and unhealthy due to it having poor flexibility, poor capillary blood supply, and decreased tensile strength.

In climbers, extreme loads can be placed on the muscles and tendons in the forearm and elbow, leading to elbow tendonitis. Elbow tendonitis is also common in golfers, musicians, and tennis players. Achilles tendonitis and plantar fasciitis are common in runners and hikers. Patellar tendonitis and IT band syndrome are seen commonly in bicyclists, just to name a few examples.

Chronic tendonosis needs active management to ensure proper healing. Rest itself will rarely work, as the tendon is weak and will experience further micro-tearing  when you return to sport. I have found that Instrument Assisted Soft-Tissue Mobilization (IASTM) with the proper tool and technique is essential to treating chronic tendonitis. In addition, decreasing the load on the tendon through trigger point release, Dry needling, and active stretching are integral to the healing process. Proper loading of the tissue with functional strengthening and sport specific activity is also extremely important as it is a key component needed to help return the tendon to its proper strength.  Eventually the tendon will be able to handle the loads you wish to place on it with the sports you love.

Key Principles:

1. Remodel the scar tissue into a healthier alignment of collagen fibers with the use of scar remodeling (IASTM) tools
2. Treat trigger points in the muscles in order to decrease the load on the healing tendon
3. Work the tendon and muscle complex with eccentric muscle contractions, and use stretching to achieve a proper length-tension relationship
4. Progressively and carefully load the remodeled scar tissue  with sport-specific activities to improve tensile strength of the collagen fibers