Physician/Exercise Physiologist

Tendons attach muscle to bone and are usually surrounded by a sheath that allows them to move easily. Tendinitis is inflammation of the tendon or sheath resulting from overuse by repetitive motion or trauma such as a fall. Symptoms include warmth, pain, swelling, and sometimes a crunching sensation.

Make sure you have tendinitis and not another condition such as arthritis by examining the condition’s history and trying to see what activities re-create symptoms; this also can help determine the exact anatomic location of the injury. An ultrasound or MRI tells you whether it’s tendinitis or tendinosis–collagen degeneration within the tendon.

Once diagnosed, modify daily activities. A massage therapist with tendinitis, for example, should start using more forearm strength to reduce stress on overused fingers. A general rule in dealing with tendinitis is to stop the offending activity, use ice, and try gentle stretching. Avoid pain relievers and anti-inflammatory medications such as ibuprofen, naproxen sodium (Aleve), and ketoprofen, which only mask symptoms and prolong recovery. However, taking supplements such as Pycnogenol and hyaluronic acid can be very effective. Plus, certain exercises also can strengthen tendons and make them resistant to wear. A physical therapist can develop a specific program for your condition.

Diet doesn’t play a major role in this condition, but consuming anti-inflammatory foods can be beneficial for chronic, long-term inflammation. The Mediterranean diet is low in red meat and fried foods, which promote inflammation in the body, and focuses on fruits, vegetables, olive oil and fish, which produce anti-inflammatory byproducts when metabolized.

–Jason Theodosakis, MD, clinical assistant associate professor University of Arizona College of Medicine, Tuscon, Arizona


Tearing tendinous tissue causes bleeding, which leads to inflammation in the body and the release of pain-inducing chemicals. With acute tendon injuries, such as a sprained ankle, I’ll concentrate on the symptoms directly resulting from the injury, which include the degree of swelling, stiffness, discoloration, and response to movement. Chronic tendinitis cases may require an evaluation of a person’s whole constitutional state on mental, emotional, and physical levels. In these instances, unresolved anxiety and stress, for example, can lead to tension in the body, causing strains that are difficult to heal.

Remedies include nutritional, herbal, topical, and natural anti-inflammatory agents as well as manipulative approaches. Hydrotherapy involves alternating between three minutes of applying a moist warm compress and one to two minutes of applying a moist cold compress, forming a sequence that causes tissue to expand and contract. The blood, inflammatory debris, and lymphatic congestion surrounding the torn tissue are drawn away from the area, ultimately increasing the speed and comfort of the healing process. I often recommend natural multi-ingredient agents including glucosamine, chrondroitin sulfate and MSM, which help the body rebuild tissues while increasing tensile strength and elasticity. Certain combinations of enzymes can decrease pain and inflammation while quelling oxidative stress on the tendon. Traumeel ointment is an anti-inflammatory homeopathic topical product that promotes tissue healing.

–Mitchell A. Fleisher, MD, Homeopathic Family Medicine & Nutritional Therapy, Nellysford, Virginia

Orthopedic Massage Therapist

Studies show that overuse disorders such as tendinitis are on the rise as occupations and physical activities that involve repetitive motions become more common. Orthopedic massage specifically targets such pain and injury in the body’s movement structures. With tendinitis, the goal of massage is to relieve tendon stress by reducing the tightness of muscles pulling on tendons while stimulating the tissue-healing process.

Tendinitis treatment often begins with muscle-relaxation techniques that reduce tightness and promote elasticity while avoiding excess pull on tendons. Deep longitudinal-stripping massage works directly on the tendon to encourage fibroblast proliferation (the growth of cells found in connective tissue) and proper healing. Deep-friction massage involves rubbing back and forth across the tendon while applying tissue-stimulating pressure and movement. Self-massage friction techniques are relatively easy to perform and generally can be done several times a day for several minutes to quicken the healing process. Consult a massage practitioner for specifics on where and how to apply pressure.

–Whitney Lowe LMT, Founder, Orthopedic Massage Education & Research Institute, Sisters, Pregon