Sprains/Strains/Tendinitis

Strains

Strains are common injuries we sustain with daily activities, recreation, and competitive sports. But what is a strain?

A strain is the tearing of muscle fibers. Muscle fibers are the individual units that make up your muscles. You may suffer a strain when you call upon the muscle to perform strong or repeated contractions. To further confuse the layperson, strains are classified into grades I, II, and III. Another way to think of these grades is mild (grade I), moderate (grade II), severe (grade III).

• A grade I strain is a mild disruption of the muscle fibers. There may be mild swelling and tenderness, and stretching and using the injured muscle may be painful.
• A grade II muscle strain indicates moderate muscle fiber damage. The pain is moderate to severe; it definitely hurts to use and stretch the injured muscle, and ecchymosis may be present. Ecchymosis (commonly called bruising) indicates that there was internal damage to blood vessels that resulted in bleeding within and around the muscle. This bleeding is often visible under the skin as a purple, blue, red, yellow, and even green in color.
• A grade III strain is the most severe. It is the complete tearing of a muscle into two pieces or separating the muscle from its associated tendon. There is severe pain, complete loss of muscle strength, swelling is normally present with ecchymosis, and there may be a palpable "indentation" where the muscle is torn. Medical intervention is usually necessary. Typically, an orthopaedist (musculoskeletal specialist) will evaluate your condition and surgical repair may be necessary.

Strain Characteristics

• Muscle spasms
• Pain around the injured joint
• Edema (swelling)
• Limited flexibility and range of motion due to pain

Treatment for Sprains

Treatment for Strains is similar to that of sprains. Directly after a strain, control the swelling with RICE for 24 to 48 hours:

• Rest the injured joint/extremity and use a sling for an arm or shoulder injury or crutches for a leg or foot injury.
• Ice for 20 minutes every hour.
• Compress with an elastic Ace bandage or brace for an ankle or knee, a splint for an injured finger, or buddy-taping for an injured toe.
• Elevate above the heart, if possible.

An over-the-counter acetaminophen, such as Tylenol® or non-steroidal anti-inflammatory drug (NSAID), such as Advil® may help reduce swelling and pain/ pressure relief. After this home treatment, be sure to have the injury evaluated by your doctor to rule out a fracture or a severe strain.

Most mild strains heal within a few days to a week. Seeing a physical therapist can also help you regain your range of motion. Your physical therapist can also show you injury-prevention techniques to help prevent future strains.

If your symptoms don't improve within a couple of days, or you experience any of the following, see your doctor to have it immediately evaluated:

• An audible "popping" sound with the injury
• Pain and swelling that gets worse over time
• Fever or chills
• Difficulty standing or walking without pain
• Limited flexibility and range of movement around the injured joint
• Numbness or tingling
• Joint/extremity deformity or signs of instability

Moderate strains may require bracing for a period of time, followed by physical therapy to help regain normal function and range of motion. Severe strains may require surgery to repair the tear, followed by physical therapy to rehabilitate the injury.

Tendinitis

Tendonitis (also spelled "tendinitis") is inflammation of a tendon. Tendons are strong bands of tissue that connect muscles to bones. Tendonitis can occur within in any of the 600 muscle-tendon units in your body. But it commonly occurs in the rotator cuff (supraspinatus tendon) in the shoulder, wrist extensors (lateral epicondyle) and pronators (medial epicondyle) in the elbow, patellar and quadriceps tendons in the knee, and Achilles tendon in the heel.

Common tendonitis conditions include:

• Lateral Epicondylitis (Tennis Elbow)
• Medial Epicondylitis (Golfer's Elbow)
• Pitcher's Shoulder
• Swimmer's Shoulder
• Jumper's Knee
• Achilles Tendonitis

Most of the time, tendonitis is caused by aging or overuse and repetitive movement injuries in recreational sports, hobbies and work that cause stress on the tendons. Improper technique is largely responsible for most tendonitis cases.

Is Tendinopathy Another Term for Tendonitis?

No, tendonitis is inflammation of the tendon resulting from micro-tears that occur due to aging or overuse and repetitive movements. Tendinopathy is an umbrella term for the degeneration of the collagen protein that forms the tendon in response to chronic overuse. It is characterized by a combination of pain, swelling, and impaired performance. Tendinopathies in athletes typically occur in the Achilles and patellar tendons. In others, these injuries usually occur in the Achilles and lateral epicondyle (outer part of the elbow joint).

Tendonitis vs. Tendinosis

Tendonitis and tendinosis are two different conditions. Tendonitis is an acute condition characterized by a painful tendon with signs of inflammation within the tendon that can be seen under a microscope (histologic examination). Tendinosis is a chronic (persistent or recurring) condition caused by repetitive trauma or an injury that hasn't healed, characterized by localized swollen tendon nodes.

The good news is that tendonitis can be treated at home and with physical therapy. Surgery is rarely needed.

At-home Tendonitis Treatments

Things you can do at home for your tendonitis include:

• Rest the injured area and avoid activities that worsen the pain.
• Apply ice or cold packs for 10 to 15 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
• Take over-the-counter pain relievers such as acetaminophen or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, if needed. Be sure to follow the precautions for nonprescription medicine. Always take these medicines exactly as prescribed or according to the label.
• If one exercise or activity causes you a particular, persistent pain, try something else. This is called "cross-training". Mixing up an impact-loading exercise (e.g., running or high-impact aerobics) with low-impact exercises like riding a recumbent bike or swimming can help give your tendonitis a chance to heal and can help prevent future occurrences.

Physical Therapy for Tendonitis

Dry needling is one of several very effective treatments for tendonitis. We can help reduce the risk of injuring your tendons further by evaluating your movement patterns and teaching you the correct form and techniques so you can continue enjoying your recreational activities and proper workplace ergonomics so you can be more productive at work.

Contact us today for more information on how we can help relieve your tendonitis pain and prevent you from getting tendinosis or tendinopathy.