Originally published in the British Horn Society Magazine July 2023.
Tendonitis is a common condition that affects millions of people worldwide. It occurs when the tendons, the thick cords that connect muscles to bones, become damaged, inflamed or irritated. Tendonitis can cause pain, discomfort, and limited mobility, which can significantly impact a person's daily activities including playing the horn.
What is a tendon?
Tendons are thick bands of fibrous connective tissue that attach a muscle to bone across a joint. When the muscle contracts the tendon shortens and the joint bends. When the muscle and tendon relax, the joint straightens. Think of your elbow. When your elbow bends it’s because your bicep muscle contracts, which pulls on the tendon and brings your hand closer to your shoulder. When the bicep muscle relaxes, the tendon also relaxes and your arm will straighten.
How do we get tendonitis?
There are many reasons why a tendon may become inflamed or irritated. Sometimes it can be activity related or due to an underlying health condition.
1. Overuse or repetitive strain injuries. If we repeatedly load a muscle or tendon then it doesn’t have time to go through its natural repair process. This can cause micro trauma within the tissues. If those tissues are still over used then inflammation will occur. I have seen quite a few horn players come through my clinic with shoulder pain caused by inflammation to the tendons around the shoulder. Holding the horn for long periods without a break especially when standing to play can place quite a lot of strain through the left arm and shoulder.
2. Poor technique or form. Incorrect posture or technique during physical activity can put extra pressure on tendons which could lead to injury, irritation and inflammation.
3. Previous injury. In connection with point 2, if there has been a previous injury or if there is an underlying issue with a joint then we try to compensate for this by using the body in a different way. For example, if a horn player has had a shoulder issue in the past that hasn’t quite resolved this could place extra load on their elbow or wrist. Over time, a secondary issue of tendonitis in the elbow could occur, not necessarily because there is a problem with the elbow but because there is a problem with the shoulder that has impacted on the elbow.
4. Lack of warm-up. Warm up exercises prepare the muscles and tendon for the activities ahead. Lack of this increases the possibility of tendon injury. For example, going for a long run without first preparing the muscles and tendons could lead to muscle or tendon strain - or worse, a tear.
5. Age. Sadly, age does play a part. As we get older our muscles and tendons lose some density making them more fragile and prone to injury. In addition to this our recovery time is slower with age which can mean that problems last a little longer than they would with someone much younger.
6. Medical conditions. There are a few conditions that affect connective tissues such as rheumatoid arthritis, diabetes or lupus.
What does it feel like?
When a tendon becomes inflamed pain is usually the first symptom. This can range from a mild niggle to more disabling pain. Heat and redness over the affected are common and in more severe cases a lump or nodule is noticeable.
You may notice that certain movements are painful and ease with rest. It is also common to have pain on movement after resting, such as first thing in the morning or if you’ve been sitting/stationary for a while and get up to walk around. This is because inflammation builds up the less active we are. Once we are up and moving, our immune system and lymphatic system kick in to help drain the inflammation. However there is a fine line between moving about to ease pain and over doing things which aggravates pain.
What is the treatment?
Clinically we grade tendon injuries on a scale of 1-3. 1 is a mild injury with a small amount of inflammation. Grade 2 is moderate and grade 3 is more severe.
Generally, a grade 1 tendon injury should self-resolve with some conservative home treatment such as rest, avoiding aggravating activities, the use of a cold pack or shop bought anti-inflammatory medication (ibuprofen). Some gentle rehabilitation exercises will help mobilise and strengthen the area concerned but advice should be sought for this.
Grade 2 injuries will respond to the above self-care but may need some clinical advice to get to the root of the underlying problem and help the tissues repair quicker and in the correct way. Targeted rehabilitation exercises may be prescribed and some hands on treatment from an Osteopath will help.
Grade 3/Severe pain and disability should be thoroughly checked out by an Osteopath, Physiotherapist or GP. Imaging is sometimes required to rule out a tear to the tendon. Such tears may need a surgical repair if it is a complete rupture. Severe pain will require prescribed medication and sometimes pain relief and anti-inflammatory medication can be administered straight into the tendon via an injection.
However, most tendon injuries tend to fall into grade 1 or 2.
The bottom line is, if you think you have a tendonitis then do get it checked out. In the short term rest it, take steps to reduce inflammation (speak to a pharmacist about using anti-inflammatory gels or pills) or use an ice pack.
I hope this post is helpful. As always, feel free to contact me for further information.