Rigorous physical training can lead to chronic injuries which can affect performance or curtail training altogether. One chronic injury that can be particularly frustrating and debilitating is tendinitis. While tendinitis can be caused by a direct impact injury, more commonly it is the result of chronic misuse or overuse of the muscles around a joint. Most people who suffer from tendinitis cannot recall a specific injury, and there is usually no obvious acute stage accompanied by visible swelling or bruising.
Tendons are the thick fibrous ends of the muscles, which attach muscles to bones. Misuse and/or trauma create small micro-tears at these attachments. These small traumas can cause the tendon to swell. The swelling in turn causes the tendon to rub against the tendon sheath or against adjacent structures creating irritation. Irritation creates further swelling, more rubbing and more irritation. While rest will relieve the pain, returning to training before the injured area is fully healed can easily stress the damaged tissue, perpetuating the cycle of pain, irritation and even inflammation.
Tendinitis occurs frequently in the: shoulder and elbow - the classic “tennis elbow” or “golfer’s elbow” - however tendinitis can also occur in the tendons around the hip and knee or Achilles tendon. Repetitive tasks such as working at a computer and working with power tools, as well as exercises such as forced stretching, or weight training, may also contribute to the development of tendinitis.
There is no need for tendinitis to become a chronic, debilitating injury. Chinese medicine offers effective prevention, treatment and rehabilitation from tendon injuries through correct application of massage in conjunction with herbal liniments, the use of medicinal plasters (Gao), and exercise.
1. Massage & Liniments
Gentle massage of the injured area with Dragon's Blood Tendon Lotion (Xue Jie Shu Jin Lu) is the key to breaking the cycle of pain and re-injury that characterizes tendinitis. Place a small amount of the liniment on the painful area and work it gently into the tissue by making small circles with the pad your thumb or a finger for several minutes. Pressure should be even and slow penetrating only to the depth of the tendon, not down to the bone. Tendon Lotion contains herbs that kill pain, heal damaged tissue and draw circulation to the injured area. This treatment can prevent a “tweaked “ tendon from developing into a chronic injury if performed immediately after class or training.
Tiger's U-I Oil (Hu Biao Ru Yi You) can also be useful for tendon injuries, particularly if used immediately before activities which may cause the tendinitis to flare up.
2. Gao – Medicinal Oinments and Plasters
Gao come in two forms, pre-made ointments that are packed on the local area like a pultice and left overnight or stick on plasters in which herbs have been impregnated into the adhesive. Both types of Gao are useful for both acute tendon injuries and chronic tendonitis. When the tendon first begins to ache, applying the Herbal Ice (San Huang San Gao) or the Wu Yang Pain Relieving Plaster can relieve inflammation, disperse the stagnant Qi and blood that causes the pain and improve local circulation. Use these instead of icing the local area. If the injury is older and more chronic, a warming plaster, like the 701 Dieda Zhengtong Yaogao Medicated Plaster or a poultice of Bone-Sinew Gao (Gu Ji Wai Shang Xiao Tong Gao) may be effective.
3. Internal Herbal Formulas
An internal herbal formula like Bonesetter’s Special Pill (Zheng Gu Zi Jin Dan) can be useful with chronic injuries like tendinitis, when deficiency (of Qi and blood) is part of the picture. In cases of chronic tendinitis, there is also the potential for penetration of wind, damp and cold due to the impairment of the Wei Qi and the relative deficiency of normal Qi (Zheng Qi) in the local area. This formula moves stasis and kills pain but it also focuses on nourishing blood and aiding the spleen in moving This helps prevent the penetration of wind and dampness and allows the Zheng Qi to flourish.
Correcting the misuse of the joint and surrounding soft tissue is both the key to preventing tendinitis and to rehabilitation. Incorrect technique, unnecessary tension and the inability to engage and relax muscles at the proper time is often the cause of tendon injuries. This is very common in sports like tennis or golf, where incorrect form can cause the tendons in the elbow to overwork in the wrong way leading to chronic tendon pain.
Another common training error is to practice in such a way that muscles are used repetitively in isolation, rather than connecting them in groups to the core muscles in the center of the body. This can overstress one tendon setting it up for injury. This is why many martial arts exercises focus on the development of “tendon strength” (fascial strength and integrity), and whole body power, as opposed to isolating individual muscles, or performing exercises which focus on increasing the size and strength of the belly of the muscle. Qi Gong exercises are particularly useful for rehabilitating injured tendons and developing tendon strength, because they train the fascia and move Qi (and therefore blood and fluids) through the injured area, while developing the whole length of the muscle evenly.
Ice and Tendinitis
Although it is very common to ice tendon injuries, most current sports and physical therapy research has indicated that ice does nothing to heal the injury, and icing the area may in fact interfere with proliferation of the fibroblasts that create new, healthy tissue. Often tendinitis is not accompanied by heat, and redness, or even swelling, so it does not meet the medical definition of inflammation. In Chinese medicine, “tendinitis” is often considered to be related to lack of circulation in the locally tissues, a problem that increased, rather than decreased, by the use of ice.
By: Tom Bisio