"Your medically-based source

       on magnetic field therapy"

HEALTH TOPICS Tendonitis

Common terms for tendon-related problems, based on the body part involved:

The spelling may be tendonitis or tendinitis. Specific terms used are: tibial tendonitis, over-pronation, epicondylitis, golfer’s elbow, tennis elbow, tibial dysfunction, patellar tendonitis, calcific tendonitis, wrist tendonitis, triceps tendonitis, biceps or bicipital tendonitis, posterior tibial tendonitis, Achilles tendonitis, quadriceps tendonitis, running overuse, impingement syndrome, adhesive capsulitis, frozen shoulder, DeQuervain’s tenosynovitis, heel spurs, plantar fasciitis, tendinosis, tendinopathy, iliotibial tract friction syndrome, hamstring syndrome and flexor carpi radialis tendonitis.

What is the cause?

Causes of tendonitis vary. The most common cause is increasing the duration or intensity of an activity or exercise program too quickly. Tendonitis in the knee, foot, and calf are common in athletes who participate frequently in sports that involve running and jumping. Tendonitis in the knees can also occur from biking. Swimming, swinging a golf club, or pitching a ball can cause tendonitis in the shoulder. Wearing worn-out shoes, poor conditioning, or training mistakes are other possible causes. Body structure problems like having bowlegs, one leg shorter than the other, or flat feet can also cause tendonitis. Tendonitis may also occur from repeated motion such as typing or using a hammer. Basically, any tendon in the body, stressed beyond its capacity, in the short or long term, can develop tendinitis.

During physical exercise, much stress and force are exerted on the tendon, increasing the risk of injury.

There are internal (intrinsic) or external (extrinsic) factors to getting these tendon/ligament/tissue problems.  The intrinsic mechanism starts within the tendon from tissue mechanical properties, direct tendon overload, intrinsic degeneration, or other insult. The extrinsic mechanism is associated with damage to the tendon through compression (impingemnt) against surrounding structures, especially common in the shoulder. Intrinsic conditions include trauma or reactive or degenerative changes starting in the substance of the tendon. The suspected causes of intrinsic degeneration are the blood supply, aging, and tensile overload. Lack of blood supply within the area of greatest impingement is a primary reason that tendinopathy starts. But, increased blood supply or flow or angiogenesis may be associated with symptomatic disease due to mechanical impingement.

Tension overload is another intrinsic injury mechanism that can result in damage to the tendon. In the bursa and joint portions of a tendon, the strain and stress is greater on the bursa side rather than the joint. Certain activities may make joints more subject to tears due to tendon overload because the joint side of the tendon may be closer to its failure strain.

Degenerative changes with calcification, fibrovascular proliferation, and microtears are seen in older but not in younger individuals. Age has also been shown to have a great influence on the mechanical properties of tendons. The healing potential of older people is decreased, including their tendons, and would therefore make older people more susceptible to overload injury. Younger tissues heal better and faster. Older age may simply make the tendons more susceptible to damage with compression or tension overload.

Tears may be partial-thickness, involving the bursa or joint, or full-thickness.  Tears most commonly occur in the region between the bony insertion of the tendon and the nearest muscle junction. The initial degeneration will alter the mechanical environment, and mechanical damage to the tendon due to extrinsic or intrinsic factors will increase, which will in turn alter the mechanical environment, increasing mechanical damage, and the cycle continues, initiating a tear. Bursal, joint and tendon tears are often found at the time of surgical repair and the causes for these tears are unknown.

Several subcategories have been identified: (1) hypoxic degeneration, (2) hyaline degeneration, (3) mucoid or myxoid degeneration, (4) fibrinoid degeneration, (5) lipoid degeneration, (6) calcification, and (7) fibrocartilaginous and bony metaplasia. A major issue is that tendinosis is not necessarily symptomatic. The role of physical activity on the presence of tendinosis is not clear, even though it appears that ultrasound changes are present in asymptomatic patellar tendons of a proportion of elite athletes, but rarely present in non-athletes. In the Achilles tendon, following a rupture, patients' asymptomatic opposite side tendons also have intratendinous alterations.

How can I prevent tendonitis?

·      When you exercise, wear equipment that is proper and right for the activity.

·      Gently stretch before and after exercising.

·      Use proper form and posture during your activities, whether they are sports or job-related. For instance, be sure your tennis stroke is correct and that your tennis racket has the proper grip size.

·      Warm up before exercising or doing other activities.

·      Ice any stiff or sore joints after exercise or work.

What are the symptoms?

Tendonitis can range from mild to severe. Symptoms may include: pain, tenderness, stiffness, heat or restriction of motion. The pain may only come on from use of the muscle with the tendon or when more severe may be constant, especially noticeable at night.

Tests for tendonitis

X-rays may be taken to examine the site for bony ab norma lities or evidence of arthritis. Some people have an unusual anatomy in which the bone around the tendon reduces the space between it and the tendon.

X-rays will indicate this, and will also reveal any bone spurs around the tendon. If the tendon area is noticeably swollen, your doctor may want to take fluid out of any related joint to test for infection.

A test called an arthogram may be used if your physician suspects a tear of a tendon around a joint. For this test, dye is injected into the shoulder joint before x-rays are taken. If dye leaks out of the place where it was injected into the joint, there is likely to be a tear at that location. An MRI scan can also show whether there has been a tear in the tendons. Sometimes ultrasound is used to examine the joint.

Another common test for impingement involves the injection of a small amount of local anesthetic (such as novocaine or lidocaine hydrochloride) into the space around the tendon. This test helps eliminate the possibility that the pain results from a problem in the spine. If pain subsides immediately after injection, tendonitis syndrome is likely to be the cause of discomfort.

How is tendonitis typically treated?

This condition requires multiple approaches to treatment, since it has multiple aspects. No one treatment approach will address the whole problem. Traditional research on the subject focuses just on the condition or pathology and is diagnosis based. My treatment approach is whole problem and whole person based and deals with the problem from multiple directions. How well treatment works will still depend on the mix of factors involved in any given individual. One time miracles happen but mostly it’s a long term process, especially to prevent future problems.

Often people try to endure their pain. They hope that it will simply go away. Unfortunately, more serious symptoms may begin if these early symptoms are ignored. The occasional pain will change to constant aching, pain, and stiffness before, during, and after exercise. The tendon will also become tender to touch.

If you are having pain, some conservative options include:

·      Temporarily stop the activity that is causing the problem.

·      Ice the area for 5 to 10 minutes with ice massage every 3 or 4 hours.

·      The best way to do this is to freeze water in a paper cup, peal part of the cup away, and rub the ice directly on the injured area.

·      You can continue activities that do not stress or cause pain to the injured area.

·      Make sure to stretch before doing any activities.

·      You may need to cross train or cross exercise - instead of doing only one sport, try swimming, rowing, jogging, or biking to prevent overuse.

·      Take pain medicines as needed.

·      See your provider if the problem does not clear up in a couple of weeks.

·      Irritated tendons can rupture if left untreated and continue to be stressed.

·      When this happens more serious treatment such as a wearing a cast or surgery is needed.

Improving sleep and reducing stress are key in reducing your pain. Good nutrition is foundational. Exercise often helps, unless it’s movement makes the problem worse.

Pain medicine is good and bad. It can certainly help to relieve pain. Short term courses – several days to several weeks may be necessary. Long term use of any pain medication carries risks, even Tylenol. These risks need to be understood. Besides causing heart, liver, stomach and bowel and kidney problems, when taken in high doses or long term, they can also often reduce the ability of the immune system to function. Almost always, pain medicines only treat the symptom. Clearly, potential problems caused by the treatment need to be weighed against problems caused by the original condition itself. It has been estimated that about 10,000 people die per year in the USA from complications from anti-inflammatory pain medications, such as ibuprofen. By far, most would not have died from their pain. It is easy to see that alternatives need to be available to treat chronic pain, other than pain pills.

Physical therapies are often necessary. Naturally, treating or removing the underlying cause is required but often not possible. Changing behavior may be all that is needed, whether it is a cause or a contributing factor. In younger people, tendonitis is due almost entirely to excessive tensile activity and repetition overuse. And, remember that lesions are present also often in the joints, ligaments or tendons that don’t hurt. In older people, the ligaments and tendons have been used for years, often just fairly routinely, and not under significant or excess tension. Sometimes injuries, known or unknown, may happened in younger years that now become evident with daily wear and tear. This means that changing activity patterns is necessary, as much as possible, to not reactivate or worsen the tendonitis.  

Because the symptoms of pain can wax and wane, treatment (as with that of other chronic conditions) is an ongoing process vs a single episode. Flare-ups often worsen with any underlying stress. Stress, even day-to-day hassles, can cause flare-ups. Treatment approaches need to be individualized as not all individuals show the same response to any given program.

Surgical intervention is only recommended when dysfunction is significant without improvement after 6 to 12 months of conservative treatment. This may include either arthroscopy and/or open surgery. Either form of surgery can repair some of the damage and relieve impingement pressure on the tendons and bursa. Surgery is not without its risks though.

If your doctor has prescribed a sling, you should remove it only at those times during the day when you perform home exercises advised by the physical therapist. Exercising the joint is critical to prevent a stiff or "frozen" joint. The use of ice, which decreases the size of blood vessels in the sore area, helps prevent inflammation.  Your physical therapist will work with you to develop strength in the muscles containing the tendons. Stabilizing and strengthening the muscles through the consistent practice of a series of exercises decreases the possibility of impingement or other related conditions returning. It may likely be several months before you achieve maximal results. Correcting impingement syndrome also means you are less likely to be subject to chronic bouts of impairment from related conditions such as bursitis, arthritis, or tendonitis.

Magnetic therapies alone can produce wonders in reducing swelling, pain, inflammation, stiffness and improving mobility and range of motion. Immediate use after significant muscle activity will dampen the inevitable oxidative stress and free radicals caused by irritation of the muscles. In fact use before expected activity will stimulate heat stress proteins, repair genes, tissue oxygenation and circulation and thus protect the muscles and tendons from damage during activity. Professional athletes use these treatments before and after activity to remain competitive longer and have less disability long term. Whole body treatments are especially useful, because often multiple tendons are involved in many sections of the body. More intense local at home therapy with simple magnetic systems that have whole body and local/regional applicators is now available.

Once tendinitis starts it will likely be a lifelong problem, to some degree. It may seem to disappear for periods of time but this only means it is only quieter symptom-wise. Regular use of magnetic therapies during both painful and pain-free periods, is very likely to reduce or prevent future flares and progression. In more severe cases, with appropriate use of magnetic fields, surgery may be also able to be avoided.

Magnetic fields have a reasonable chance of actually initiating tissue repair if they are used routinely, by stimulating the laying down of collagen. Because magnetic fields also relax muscles, muscles irritated by overuse will also quiet down compounding the benefit. The duration of any physical therapy may be lessened by daily home treatment with magnetic fields and icing may be unnecessary. However, avoidance of the offending exercise and muscle strengthening and range of motion exercises will often still need to be done.

The magnetic fields that have been seen to work on different aspects of the problem include static magnets, various frequency-intensity fields and high frequency fields. Since most tendon problems are superficially located in the body, even high frequency fields can help.

The basic actions of magnetic fields that can help pain:

·      reducing muscle tension

·      improving circulation

·      reducing nerve irritability

·      stimulating the immune system

·      improving cell function

·      helping the body to detoxify

·      improving the uptake of nutrients

·      decreasing inflammation

·      reducing pain

·      helping nerve function

·      helping liver function

·      balancing the acupuncture meridians

·      improving sleep

·      reducing stress

·      balancing the endocrine system

·      reducing trigger/tender point tenderness  

Other options for pain management

Other treatments can be tried: acupuncture, massage and cranial electrical stimulation using the Liss machine, relaxation response training, meditation and movement therapy, training in coping skills and/or chiropractic. TENS machines, lasers, infrared, moist heat, etc., can also be appropriate depending on the problem area.

All of these therapies can be used alongside magnetic fields to create even better pain control. Also, the magnetic therapies can be used in your home. You don’t have to make as many trips to a practitioner.

How to use PEMF devices for pain

Since the recommended devices can have complicated set-ups and treatment regimens and often do not come with explicit directions, consultation is the best way to get individually tailored protocols, specific to any given individual’s unique overall health issues or needs.  Otherwise, the manufacturer’s directions can be a starting place.

Always check for sensitivity when you start. If you think you may be sensitive, or know you are, start low and go slow in advancing the settings.

In addition:

q       Always treat your day’s water ration on the system with you in the morning – preferably in a glass container without a metal lid.

q       Take your morning supplements before you get on the system. There are no supplements I know of no supplements that have to be avoided with these treatments.

q       Have a drink of water – at least 10-16 ounces before you get on the system.

q       Have your breakfast first to stimulate digestion. 

q       Let your body tell you what it needs in terms of settings, length of treatments and/or placements of applicators.

q       It doesn’t matter when supplements are taken relative to magnetic field therapy. In the ideal circumstance they should be taken about half an hour to one hour before the magnetics treatment.

q       Key is daily use – twice a day if you can. In the morning to wake up the cells. In the evening to clean out the effects of the day’s stresses on the body. You can still use the system mid-day if needed for any other given problem/s. Health Maintenance settings may be combined at any given treatment session with treatment settings and pillow/pad placements as needed.

q       In the morning:

o         If sensitive, start at the lowest setting and gradually- typically every 3-4 days -  increase the settings until the strongest setting is reached.

o         If not sensitive, typically start the mid-range and increase the settings, by one or two every day until the strongest setting is reached.

o         Once the highest setting is reached is reached, you can stay at that level or whatever level seems to produce the best results from then on, unless you have a reaction or your intuition tells you another setting is preferred.  

q       In the evening:

o         Always use the lowest setting for at least 20 minutes just before bedtime. This is always the last setting to use for the day. It is the “finishing” treatment – the “finishing” touch.

o         You can combine any other settings in a separate treatment session if you want just before ending the day with the finishing treatment.

Reviews that can help

Stress review paper

Pain review paper

References

1. Andrew, C, Bassett, L, Jackson, SFA. critique of medical uses of weak pulsing electromagnetic fields. Interactions Between Electromagnetic Fields and Cells.  A. Chiabrera, C. Nicolini, H. P. Schwan, eds., London :  Plenum, p. 569-579 Proceedings of a NATO advanced research workshop, September 17-28, 1984 , Erice , Sicily , Italy ; NATO advanced science institutes series. Series A, Life sciences. v. 97, 1985.
2. Bassett, A. Therapeutic uses of electric and magnetic fields in orthopedics. Biological Effects of Electric and Magnetic Fields.  Volume II:  Beneficial and Harmful Effects.  D. O. Carpenter and S. Ayrapetyan, eds., San Diego :  Academic Press, p. 13-48, 1994.
3. Bassett , CAL. Beneficial effects of electromagnetic fields. J Cell Biochem 51(4):387-393, 1993.
4. Binder, A, Parr, G, Hazleman, B, Fitton-Jackson, S. Pulsed electromagnetic field therapy of persistent rotator cuff tendinitis.  A double-blind controlled assessment. Lancet (8379):695-698, 1984.
5. Biophysical estimation of the environmental importance of electromagnetic fields. Markov, MS. Rev Environ Health 10(2):75-83, 1994.
6. Chard, MD, Hazleman, BL. Pulsed electromagnetic field treatment of chronic lateral humeral epicondylitis. Clin Exp Rheumatol 6(3):330-332, 1988.
7. Cleary, SF. In vitro studies:  low frequency electromagnetic fields. Health Effects of Electric and Magnetic Fields on Workers, Proceedings of a Scientific Workshop, January 30-31, 1991 , Cincinnati , OH .  PJ,Bierbaum and JM, Peters, eds., DHHS (NIOSH) Publication No. 91-111, p. 17-43, 1991.
8. Detlavs, I, Klavinsh, I, Turauska, A. Application of magnetic fields with various parameters in clinical practice. Bioelectromagnetics Society, 17th Annual Meeting, 18-22 June, Boston, MA, Abstract No. 2-8, p. 13-14, 1995.
9. Devereaux , MD , Hazleman, BL, Thomas, PP. Chronic lateral humeral epicondylitis -- a double-blind controlled assessment of pulsed electromagnetic field therapy. Clin Exp Rheumatol 3(4):333-336, 1985.
10. Fitton-Jackson, S, Rest, JR, Hickman, J, Bord, S. Treatment of tendon injury in the horse by a pulsed magnetic field . Bioelectrical Repair and Growth Society (BRAGS), Seventh Annual Meeting 11-14 October 1987, Toronto, Ontario, Canada, p. 71, 1987.
11. Giacomi, R, De Biase, CF, Carfagni, A. The use of electromagnetic field in orthopaedic surgery: our experience. Second World Congress for Electricity and Magnetism in Biology and Medicine, 8-13 June, Bologna , Italy , Abstract No. N-12, p. 177, 1997.
12. Green, S, Buchbinder, R, Hetrick, S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev (2):CD004258, 2003.
13. Greene, J. Microwave diathermy: the invisible healer. FDA Consum 13(1):7-11, 1979.
14. Henninger, R. Treatment of superficial digital flexor tendinitis. Vet Clin North Am Equine Pract 10(2):409-424, 1994.
15. Jackson, SF, Hickman, J, Murray, C. Effects of pulsed magnetic fields on acute tendon injuries . Bioelectromagnetics Society, 7th Annual Meeting, 16-20 June, San Francisco , CA , C-5, 1985.
16. Jackson, SF. The effect of pulsed electromagnetic fields and dexamethasone on tendon cells in culture. Bioelectromagnetics Society, 8th Annual Meeting, 1-5 June 1986,  Madison, WI, p. 49, 1986.
17. Jasti, AC, Wetzel, BJ, Aviles, H, Vesper, DN, Nindl, G, Johnson, MT. Effect of a wound healing electromagnetic field on inflammatory cytokine gene expression in rats. Biomed Sci Instrum 37:209-214 ISA - The Instrumentation, Systems, and Automation Society, Volume 408, Technical Papers from the 38th Annual Rocky Mountain Bioengineering Symposium, Copper Mountain, CO, 19-23 April, 2001.
18. Johnson , MT , McCullough, J, Nindl, G, Chamberlain, JK. Autoradiographic evaluation of electromagnetic field effects on serotonin (5HT1a) receptors in rat brain. Biomed Sci Instrum 39:466-470, 2003.
19. Johnson, MT, Vanscoy-Cornett, A, Vesper, DN, Swez, JA, Chamberlain, JK, Seaward, MB, Nindl, G. Electromagnetic fields used clinically to improve bone healing also impact lymphocyte proliferation in vitro. Biomed Sci Instrum 37:215-220, 2001.
20. Johnson , MT , Williams, CD, Markov , MS , Nindl, G. Effects of therapeutic pulsed electromagnetic fields on physical healing parameters in a rat model of tendinitis. Bioelectromagnetics Society, 25th Annual Meeting, 22-27, Wailea, Maui, HI, Abstract No. 16-1, p. 153, 2003.
21. Kader , MA . Magnetotherapy in orthopedics. Bioelectromagnetics Society, 23rd Annual Meeting, 11-14 June, St. Paul , MN , Abstract No. P-73, p. 162, 2001.
22. Kraus, W. The treatment of pathological bone lesions with non-thermal, extremely low frequency electromagnetic fields. Bioelectrochem Bioenerg 27(3):321-339, 1992.
23. Lee, EWC, Maffulli, N, Li, CK, Chan, KM. Pulsed magnetic and electromagnetic fields in experimental achilles tendonitis in the rat: a prospective randomized study. Arch Phys Med Rehabil 78(4):399-404, 1997.
24. Liu, L-M, Cleary, SF, Graham, R, Diegelmann, R. ELF electric field effects on tendon fibroplasma in vitro. Bioelectromagnetics Society, 8th Annual Meeting, 1-5 June 1986, Madison, WI, p. 49, 1986.
25. Murray , JC, Lacy, M, Fitton Jackson, S. Effect of pulsed electromagnetic fields on degradative pathways in cultures of synovial fibroblasts. Bioelectrical Repair and Growth Society (BRAGS), Vol. V, 5th Annual Meeting, 13-16 October, Boston , MA , p. 36, 1985.
26. Nessler, JP, Mass, DP. Direct-current electrical stimulation of tendon healing in vitro. Clin Orthop (217):303-312, 1987.
27. Nindl, G, Williams, CD, Markov, MS, Johnson, MT. Effect of therapeutic low-frequency electromagnetic fields on proliferation of rat and human T-lymphocytes in vitro, in vivo and ex vivo, an IL-2 dependent process. Bioelectromagnetics Society, 25th Annual Meeting, 22-27, Wailea, Maui, HI, Abstract No. 14-4, p. 140, 2003.
28. Pilla, AA. Electromagnetic therapeutics: mechanisms and clinical applications .  Bioelectromagnetics Society, 21st Annual Meeting, 20-24 June, Long Beach, CA, Abstract No. 5-1, p. 30-31, 1999.
29. Pujol, J, Pascual-Leone, A, Dolz, C, Delgado, E, Dolz, JL, Aldoma, J. The effect of repetitive magnetic stimulation on localized musculoskeletal pain. Neuroreport 9(8):1745-1748, 1998.
30. Rouleau, P, Riviere, B, Gaudeau, C, Guery, JP. Preliminary study on use of GEM1 equilibrium in a physiotherapy department. European Bioelectromagnetics Association (EBEA), 1st Congress, 23-25 January, Brussels , Belgium , 1992.
31. Sandrey , MA , Vesper, DN, Johnson , MT , Nindl, G, Swez, JA, Chamberlain, J Balcavage, WX. Effect of short duration electromagnetic field exposures on rat mass. Bioelectromagnetics 23(1):2-6, 2002.
32. Vasko, KA, Lockhart, KA. The use of bioelectricity for the treatment of soft tissue injuries in equine sports medicine. Bioelectrical Repair and Growth Society (BRAGS), Vol. VI, 6th Annual Meeting, 19-22 October, Utrecht , The Netherlands , p. 71, 1986.
33. Wetzel, BJ, Nindl, G, Vesper, DN, Swez, JA, Sandrey , MA , Johnson, MT. Quantitative analysis of rat tendinitis healing: impact of a therapeutic pulsed electromagnetic field . Bioelectromagnetics Society, 24th Annual Meeting, 23-27 June, Quebec City, QC, Canada, Abstract No. 15-4, p. 104, 2002.
34. Zhalnenkov, NN. Portable medical devices permitted by the RF Ministry of Health for domestic use. Med Tekh (2):45-48, 1997.
35. Zharkov, PL, Slepushkina, TG, Iudin, BD. Tendinitis of the greater-trocanter-region and its treatment with decimeter-band-waves and sine-modulated-currents. Vopr Kurortol Fizioter Lech Fiz Kult (4):41-44, 1983

[ SEEING IS BELIEVING! ] [ MAGNETIC FIELD BASICS ] [ TREATMENT BASICS ] [ HEALTH TOPICS ] [ PRODUCTS & LITERATURE ] [ CONSULTATION ]

info@drpawluk.com
Copyright © 2005-2009 William Pawluk, M.D., M.Sc.