Steve Low, local health and fitness guru, has written an informational article, "On Tendonitis." This is unfortunately a fairly common and very frustrating injury in the Parkour community.

"Tendonitis, in general, is an overuse injury. This is generallyseen from doing too much that your body cannot handle. Since ourmuscles have better blood supply than our tendons and bones, they oftenare able to adapt to the stressors of exercise placed on them faster.This leaves bones and tendons vulnerable to overuse since they cannotheal as fast. If excessive stress is placed on them, they start tobreak down and become painful." 

I. Introduction

First off, I am not a doctor or a physical therapist.Any "advice" you take from this post herein is at your own risk.Remember, this is the Internet, so always check your facts if you'redoubtful of their veracity.

Secondly, having browsed many injuryforums throughout the past couple of years + working part time in a PTclinic + seeing different things from docs has given me someperspective on how some injuries develop. Thus, this is probably goingto be the first a couple different posts on various topics. Again, takeany "advice" at your own risk.

There's one thing we need to goover first. The overuse injury "tendonitis" is actually not aninflammation injury. It's often confused with tendonosis which is thecorrect diagnosis. Real tendonitis (inflammation of the actual tendon)is quite rare. However, I am still writing "tendonitis" because that isthe common form and what it is still addressed as in the healthcarefield. But it's good to know in any case.

You can find more details about this (as well as many more details about etiology and physiology) here.

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II. How tendonitis develops


Forall intents and purposes this is going to be brief and simple (as Iknow some of you like my explanations better than dense material). Themore in depth coverage is provided by the link in the above section.

Tendonitis,in general, is an overuse injury. This is generally seen from doing toomuch that your body cannot handle. Since our muscles have better bloodsupply than our tendons and bones, they often are able to adapt to thestressors of exercise placed on them faster. This leaves bones andtendons vulnerable to overuse since they cannot heal as fast. Ifexcessive stress is placed on them, they start to break down and becomepainful.

Common places where tendonitis is easily developed arewith excessive pulling exercises at the medial epicondyle (inner elbow-- aka tennis elbow). Similarly, with golfer's elbow at the lateralepicondyle. Patellar and achilles tendonitis with overuse in running,plyometrics, or weightlifting, triceps tendon soreness with excessivepressing, hamstring tendonitis down at their insertion on the tibia,and a couple other places.

Often if you have sore joints ortendons are starting to become sore, this is when you should know thatyou should back off from exercise. This is often a sign of excessivevolume. Continuing to train through this may often lead to moredetrimental overuse, and if continued beyond that chronic overuse whichis very difficult to get rid of. This will also hinder your trainingsignificantly, so it is not advisable ever to push through any type of pain.

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III. Corrective measures


Iam going to be writing these in order of importance on what you shouldbe doing. Thus, I am going to be integrating some explanations into theadvice on what to do. If anything in unclear, please comment and I willprobably update and clarify that for you.


1a. Stay away from painful exercises.Period. It hurts, don't do them. Should be obvious but people don'tlisten. Pain = your body telling you that something is wrong. Listen toyour body.

1b. Rest.Especially if it's mild overuse. 1-2 weeks of total rest should clearup tendonitis totally. If it does, work your way back into exerciseslow as it's very easy to aggravate again.

If it's chronic then pure rest may not help.If it does not clear up after 2 weeks of total rest then you probablyhave a chronic condition. This is to be treated different than justmild tendonitis with prehabilitation exercise.

2a. Self massage.Cross friction and myofascial release the whole area inbetween bothjoints that surround it (shoulder to wrist for medial epicondylitis;ankle-hip for something knee; etc.). ART, graston technique, etc. mayalso help. As much as possible... at least 30 mins a day if not more.Also, tennis ball/golf ball areas & foam roll may help.

Thepurpose behind massage is to promote blood flow to the area for healingas all tissue needs nutrients and waste products carried to and fromthe area. Also, massage helps improve tissue quality through helping torelease and reorganization depending on how bad it is damaged/tangledup.

2b. Ice after any use & when sore.10-15 mins per sessions 2-5 times a day (or every hour on the hour).Direct ice massage on the skin tends to work the best, but be carefulof giving yourself frostbite. Like massage, icing helps limit some painand too much inflammation especially immediately after exercise orprehabilitation work + promotes good blood flow to the area afterwardsas the body tries to warm up the area.

3a. Light stretching that is not painful for agonists + strengthen antagonists.So stretch forearm flexors, strengthen forearm extensors *until* painsubsides for medial epicondylitis (opposite for lateral epicondylitis).

Reason behind this is to help correct muscle imbalances, andtightness/shorteness of agonist muscles which may contribute tosystemic overuse. Both of these tend to put more stress on the jointsand supporting structures such as the tendons and ligaments, soloosening and correcting the imbalance should help get the tissue tofunction properly.

3b. Light eccentric exercisestend to help especially if the muscle(s) aggravated cannot smoothly doit. This is important with chronic overuse from 1a as pure rest may nothelp anymore. Eccentric exercises that are anymore than slightlypainful (preferably not painful) will probably be detrimental.

Eccentricexercises are important because they help induce small amounts ofmicrotearing which is part of the inflammatory process to promotehealing. Too much is obviously detrimental which is why you want tohave no pain or just slight amounts of pain. If you can only use 1 lbsor other microloading features without significant pain then so be it.

Afterit starts improving significantly you can add in concentric work but becareful not to overdo it as again an injury is very easy toreaggravate. For something like mediali epicondylitis you shouldstrengthen everything in the forearm... for example, rice bucketexercises.

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4. Other methods

Mostof these modalities below have been proven ineffective in peer reviewedstudies, but some help depending on the person. If you have exhaustedthe options above (as well as done physical therapy) then it may be agood idea to try some of the below in conjunction with the above #1-3if you want to avoid surgery. They may work for you even if they don'twork in controlled studies.

Joint/tendon/cartilage healthsupplements: glucosamine & chondroin sulfate, MSM, shark, etc.Might be a good idea to start eating the cartilage and tendons off yourmeat too.

Other modalities: Platelet rich plasma, prolotherapy,ultrasound, electric stimulation, autologous blood injection, dryneedling.

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5. NSAIDs/pain relievers/cortisone injections will only help with the pain and not with healing. If your pain is this bad it may be a good idea to see a professional anyway.

Systemic anti-inflammatories such as fish oil are goodto be taken anyway for overall health (and do not factor into thisconsideration). Systemic inflammation can hinder recovery because ofpoor blood flow to the tissue leading to poor tissue quality and slowhealing. Thus, it is important to overall limit inflammation fromdietary sources (too many carbohydrates), as well as take healthsystemic anti-inflammatories like omega-3s from fish oil.

Thereason I advised against the above NSAIDs like ibuprofen othermedicinal anti-inflammatories because once the healing process startsfor the tendon with above modalities, there needs to be someinflammation to promote tissue quality improvement. Bombing yourselfwith too many may hinder this process as well as other gains associatedwith muscle growth/repair from workouts. You can read more about this on Kelly Starrett's blog.

Systemicanti-inflammaries tend to be not strong enough to interfere with normalhealth especially from natural sources like fish oil.

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6. Planning prehabilitation sessions

Exercises, massage then ice. Or you can do massage, exercises, ice. Doesn't really matter.

You can do massage at any point during the day so if you get in 2-3 sessions or more that's great. Same with the ice.

Integrationwith regular workouts is the same. Do your workouts, then prehab work.If the workouts require use of the injured limb (it had better be lightwork if any at all) then make sure the tissue is sufficiently warmed upbefore doing anything.

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