Clients frequently come to me suffering from joint pains they believe are tendinitis or bursitis, and that they hope are not due to arthritis. With simple assessment techniques, I can evaluate which tissues are injured or causing pain and which treatment approaches can help.
Tendinitis and tendinosis are dysfunctions of tendons, which are the crucial structures in our bodies that connect our muscles to our bones. Tendons must be tough enough to withstand our strongest muscle contractions, and flexible enough to allow the myriad of movements we make every day. Tendons stay strong and elastic with good circulation, nutrition, hydration, exercise and rest.
A healthy tendon can tear in extreme situations when a sudden force overpowers it. Anyone can suffer trauma like this in the course of their daily life. In this case, the tear causes inflammation and pain, known as tendinitis, and scar tissue forms as the healing process continues.
In contrast, tendinosis is the result of a much more common scenario when repetitive strain and chronic overuse cause a breakdown within the integrity of the tendon on a molecular level. This derangement of the tendon tends to occur without inflammation (Lowe, 2006, p. 10 and Hendrickson, 2009, p.20), and thus without the healing process that inflammation brings. The science and art of orthopedic massage come together to initiate a renewed healing process in your body for both tendinitis and tendinosis.
An effective orthopedic massage will have five crucial elements in it:
1. Skilled orthopedic testing to identify and locate the injured or deranged tissue
2. Skilled Cyriax frictioning of the precise location revealed by the testing
3. Release of tension in adjacent muscles that have had to work harder to compensate for the injured tendon
4. Opening of constricted areas due to postural patterns that may be contributing to the strain at the injured site
5. Instructions for client self-care between sessions (including simple targeted stretches and rehabilitative exercises; good food, water, and rest; stress-reduction strategies)
The first goal of effective orthopedic massage is to accurately identify the compromised tissue using skilled orthopedic evaluation. If orthopedic tests reveal either tendinitis or tendinosis, my treatment will include Cyriax frictioning on the exact place discovered to be injured. This orthopedic massage technique stimulates a mild local inflammatory healing response, which will enable the scar tissue to remodel. Treatment is most effective when combined with targeted stretches (creating elasticity in the healing tissue) and rehabilitative exercises (creating strength in the healing tissues). A strong elastic scar or remodeled tendon will be much more functional, and much less likely to be re-injured.
Frictioning is performed for only a few minutes per massage session. The rest of the session relieves the tension caused by injury overcompensation, postural and other patterns that contribute to the problem.
The final key to optimal healing of tendinitis or tendinosis is the self-care the client offers themselves between massage sessions. Besides proper directed exercises for the specific site of injury, we must take care to eat, hydrate, and rest well. We also need to look at any areas of our life that are causing stress. All stress, whether physical, chemical, emotional, and mechanical, is perceived by our body’s chemistry similarly, raising the stress hormones. This, in turn, affects our immune system and our ability to heal. When dealing with tendinosis or tendinitis, your body is experiencing a stressor. You may be emotionally stressed from the pain. Orthopedic treatment of the injuries through therapeutic massage can reduce the stress of the injury site. The remaining time in an hour massage session, caring for areas of tension,will further reduce the stress felt in your body.
Lowe, Orthopedic Assessment in Massage Therapy, p. 10, 2006
Hendrickson, Massage and Manual Therapy for Orthopedic Conditions, p. 20, 2009