In this article I wrote about it being a tendinitis. If you want to read about it, click on the link. Based on this article, we have to ask ourselves: Is NSAID and rest the solution to your tendon pain?
It has been seen that it can have a certain effect on pain, as it affects the (possible) inflammatory processes described in the previous article. But there are still concerns in relation to the use of NSAIDs both in terms of systemic effects (stomach/intestine, asthma and heart) and the potential to affect tissue healing. If you look at BJSM’s latest update on the acronym POLICE / PRICE, it has been changed to PEACE and LOVE! Where A in peace is that you should avoid anti-inflammatory medicine as it can interfere with the healing of soft tissue as described above.
In my world, therefore, NSAID, like many other passive measures, is only a spice. The very essence is to make your tendon withstand load. NSAID or other passive measures cannot help you with that!
What about rest?
The language the tendon understands is stress. Without load, the tendon loses its properties. In other words, if you rest for too long, the tendon loses its tolerance to being active, going uphill, running, jumping, and so on.
In order for a tendon to maintain its function, function better, withstand load and become less painful, it must be loaded. The easiest and best way to do this is through heavy and quiet strength training.
Depending on which phase the tendon is in and how sensitive it is, you can load it to different degrees. Here, you can vary with special articulation, speed and weight. A calm pace of execution will put less stress on the tendon and the risk of it being irritated is small. If, for example, one is to be rehabilitated back into sports, on the other hand, the tendon must withstand both speed and compressive forces. This and sport-specific exercises must be added towards the end of the rehabilitation so that you are ready for sport again. In other words, it is important that you are rehabilitated back to what the requirements are for YOU!
So a good piece of advice is NOT peace and rest. Taking the load off the tendon entirely is NOT smart, but reducing the things that are provocative for a SHORT PERIOD makes sense. This is important to communicate as many people are given advice on anti-inflammatory medicine (such as IBUX, ibuprofen and Voltaren) and rest. And since it does not seem to be a tendonitis of great importance, the effect of these medicines is uncertain and seems to have a more short-term effect.
What about cortisone?
Cortisone has been shown to have a short-term effect (2), and an effect on frozen shoulder (3). So, for example, it can make sense if a frozen shoulder or phlegm causes severe night pain and severe loss of function. But injecting many injections is not lucky. Nor has it been shown to have a beneficial effect in the long term. Studies have shown that it has a direct harmful effect on the tendon (1, 4, 7). So one must consider short-term effects against long-term effects .
What about pressure wave?
Pressure wave for tendon pain in the lower part of the body, there is some evidence that can be useful. But the mechanisms are unclear and the tissue effects are unclear. It is possible that it can have an additional benefit in case of calcium in the tendon. The guidelines for the shoulder are that the lime should be larger than 5 mm. ESWT can be an addition to good follow-up of a tendinopathy with exercise, information and activity adaptation. (5, 6)
So the most important thing is that you achieve and have a great focus on making the tendon more functional. If you manage to do that, the pain picture will probably also change over time. Regardless of whether you improve tendinitis or the appearance of the tissue.
Is ibux and rest the solution to tendon pain?
I would argue that it is not, but it may be part of the solution. So the spice!
These passive measures are the spice of the treatment and do NOT always have to be a necessity. Doing targeted, structured rehabilitation with progression is the very key. If you add understanding and knowledge about tendons, pain and the person with tendonitis, you are a long way off. And in addition to having someone who provides security, gives tips and makes YOU responsible for doing the work, I can next promise you that you are close to the goal of getting better from your tendon pain!
That’s what TendonFix is all about!
Read more here about TendonFix being like a PIZZA!
I have an opinion about pain management, but some things are better left NSAID.
- Mobilization with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomized trial, Bisset et al 2006.
- PageMJ(2014) Manual therapy and exercise for adhesive capsulitis (frozen shoulder).Cochrane Database SystRev.
- Corticosteroid Injections for Adhesive Capsulitis: A Review, Xiao 2016.
- Orchard et al 2018. The Use of Ultrasound-Guided Injections for Tendinopathies
- Mani-Babu et al. 2015. The Effectiveness of Extracorporeal Shock Wave Therapy in Lower Limb Tendinopathy
- Korakakis et al. 2017. The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction
- Dean BJ et al 2014. The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon.