Tendonosis: An evidence-informed look at how massage therapy can help resolve this painful condition
Tendonosis is a common and painful condition where the attachment site of a muscle to a bone (the tendon) gets damaged. Previously, these types of injuries were referred to as "over-use" injuries, but that term is no longer believed to be correct. We now know that tendonosis is due to overloading of a tendon.The injury is not caused because a person is using their tendon too much, the injury is caused because they are using their tendon in a manner that it is not designed for or ready for.
Let's look at walking for an example. Many people can walk for an hour with little to no discomfort. During this walk, the muscles of the legs are supporting 100% of the person’s body weight with every step that is taken. Now if we compare that to trying to hold a "wall sit" position or a half squat position, most people will fatigue and have to stop within minutes. A wall sit, or half squat, use the same legs muscles, still only support 100% of the body weight, but they are so much harder to maintain over time. This is primarily due to physics (the angles of the hips and knees), the fact that the muscles are forced to be constantly engaged and holding instead of contracting and relaxing, and that we simply don't do wall sits very often compared to walking. The contrast between walking and holding a squat highlights how it is not always a "weak muscle", or an "over-used" muscle that causes a tendon injury, but rather, a muscle that is used in a way that it is not prepared for or designed for, and is ultimately overloaded.
Walking vs. a wall sit: many people can walk for hours with little to no discomfort. A wall sit engages the same muscles and supports the same amount of a person's weight as walking, yet most people fatigue and have to stop within minutes.
Common places for tendonosis to occur are the elbow (tennis elbow or golfer's elbow), the shoulder (rotator cuff tendons), and the ankle (Achilles tendon). Massage therapy can be an effective strategy when dealing with these painful and common conditions.
When a tendon becomes injured, our nervous system and our immune system will respond together to protect the area from further damage and begin to heal the damaged tissue. During the early stages of this response, our nervous system triggers a generalized guarding of the area. Muscles around the injury site will tense up, sometimes even cramp. Muscle guarding can be significantly painful, sometimes more so than the actual injury. This guarding response, although purposeful, is often exaggerated. A massage therapist is able to use manual therapies to decrease the nervous system firing and allow for this muscle guarding to decrease. This is why it can be beneficial to massage an entire limb, not just the painful site, when dealing with a tendon injury. Studies have shown people can experience a significant decrease in pain and an increase in range of motion after a massage therapy treatment when dealing with muscle and tendon injuries. (1)
Occasionally, chronic, or long lasting tendon injuries fail to heal properly. Months can go by, and they don't seem to get any better. When healing does not happen within the expected time frame, the nervous system can stop signaling the body to heal and the injury may linger. In this case, a massage therapist can use a variety of techniques to help stimulate and re-start the normal healing process. These are often a combination of cross-fiber friction techniques, joint mobilizations, and other manual therapy interventions. Studies have shown these combinations of techniques to be beneficial at improving pain, grip strength and functionality at 6-12 weeks and continue 6 months after treatment (2).
As great as massage therapy can be for pain and initial improvement for tendonosis, the lasting solution is generally strengthening the tendon/muscle and addressing the movement pattern and joint position that overloaded it in the first place (3).
For complex cases where tendonosis is a result of multiple joint issues, or complex injuries, and it is not responding to manual therapy treatments, we are fortunate to have a team of physiotherapists who are extensively trained to evaluate and treat complex movement disorders including tendinopathies. Sometimes an athlete needs to be able to hold the squat position for a long period of time, or an electrician may need to use a screw driver 1000 times per day. Sometimes there just isn't a "stop using it so much" solution, or a "try using your other hand" solution. A physiotherapist can create a customized active rehabilitation plan or a return to work / sport progression plan to ensure the muscles, tendons and joint are prepared and adequately strengthened to be able to perform whatever task is required.
Do you think you may be experiencing a tendon injury? Reach out and our team of professionals will help you get back to what you love and need to do, without pain.
1.Bervoets, D. C., Luijsterburg, P. A., Alessie, J. J., Buijs, M. J., & Verhagen, A. P. (2015). Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review. Journal of physiotherapy, 61(3), 106-116.
2. Yi R, Bratchenko WW, Tan V. Deep Friction Massage Versus Steroid Injection in the Treatment of Lateral Epicondylitis. HAND. 2018;13(1):56-59. doi:10.1177/1558944717692088
3. Irby, A., Gutierrez, J., Chamberlin, C., Thomas, S. J., & Rosen, A. B. (2020). Clinical management of tendinopathy: a systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments. Scandinavian journal of medicine & science in sports, 30(10), 1810-1826.
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