How long will tendinitis keep me out for?

"To begin with, the medical profession no longer talks of tendonitis," Alexandre Batz adds when I ask him to shed some light on this condition. "Not the best start," I thought to myself. He explains: "We prefer to use the term 'tendinopathy' to talk about a tendon disorder. Tendonitis refers to an inflammation of the tendon, whereas, in general, this is not (or not solely) the case." Ah, much clearer now!

Unlike a muscle lesion, which generally occurs after a localised injury, tendinopathy often develops through repeated movements.

This is why athletes are not the only people to suffer from tendinopathy - quite the reverse!  "It is much more common to treat tendinopathy of the shoulder linked to the work activities of a maintenance officer, for example, than a tennis player!" But then, does that mean that some professions are more at risk of tendonitis than others? Well, yes! By way of example, the physio mentions: "Hairdressers! With the repeated movement of blow-drying, shoulder pain is a common occurrence".

More generally, of the patients suffering from this type of condition, known as hypersollicitation, there are also many people working, just like me, in front of a computer and they also often suffer from a sore thumb. This type of tendonitis even has a name: De Quervain's tenosynovitis (which should not be confused with carpal tunnel syndrome, which is the result of pressure on the nerves, whereas tendonitis is the result of irritation caused by overuse).

But don't imagine that sportsmen and women athletes (especially top-level athletes) are spared, since tendonitis can also be caused by practising sport.

As mentioned above, it is the inflammation that really differentiates the two. Tendonitis refers to inflammation of the tendon caused by repetitive movements and effort which, over time, becomes impossible to bear. Tendinopathy, on the other hand, is caused by more long term and severe deterioration of the tendon, which can occur if tendonitis becomes chronic. It can also occur after improper or excessive use of the tendon over time. Whatever the case, both are characterised by the repetition of movement.

So, after several weeks with a sore wrist, everything seems to be on the mend. But, suddenly, the acute pain returns. And yet, you don't remember taking out an annual subscription to tendonitis!

From a medial perspective, a condition becomes chronic when it lasts for longer than three months. In other words, tendonitis is known as chronic when several similar episodes appear in a short period of time.

As always, we recommend first seeing your GP. He or she will then conduct a diagnosis, and may prescribe medicines, time off work, imaging and, lastly, physiotherapy sessions. The physio will then confirm the diagnosis during your first session (the review) by analysing your symptoms and pain and taking note of everything you say.

Alexandre explains that this is a key aspect, "because, in some cases, pain can hide the real origin of another problem. For example, tennis elbow can be perceived as tendinopathy, when it actually comes from the neck".

To ensure optimal recovery, it is crucial to look after your physical condition and your lifestyle. For example, alcohol inflames the tendons. You are thus more likely to develop a tendinopathy if you drink alcohol regularly, when you are not sufficiently hydrated or if your sleep is poor quality.

When it comes to rehabilitation, sessions of physio are developed around 'unnatural' movements: eccentric contraction exercises, based on muscle extension or elongation. The muscle will therefore strengthen little by little and effectively.

Rest and time will do the rest, until you are completely healed!

"For a long time, it was thought that you needed to rest your tendon. In fact, all that does is to ensure the pain comes back as soon as you resume any physical activities," explains Alexandre. As always with physio, it's all a question of dose! We don't recommend either total rest or too much sport. As an initial treatment, we work on not triggering the pain again during exercises, as described above. The aim is to get the tendon moving again, but gradually.

Obviously, cold (ice) is a powerful analgesic, but also limits the healing of the tendon. Since pain from inflammation often occurs at night, apply a little ice for the first few days, just before going to bed, may be a good initial solution (ice is definitely preferable to taking anti-inflammatories!).

Cryotherapy, or cold treatment, can also be beneficial. However, it is time that lets the fibres grow back and soothes the pain: so, be patient!

In the past, patients were offered surgery (known as carding, consisting in removing tendon adhesions). Today, the use of surgery is rare and it is more common to prescribe cortisone injections. These do ease pain but fail to provide a long-term resolution to the problem.

While the healing time can vary, we are generally talking weeks. I am sure you are wondering why it takes so long. Alexandre tells me that the fibres of the damaged tendon never heal, but those new fibres will grow. Unfortunately, these healthy fibres are immature and therefore fragile. It is gradual stimulation that enables these fibres to get stronger.

The most common areas for tendonitis are the shoulder, knee, ankle or Achilles tendon. But whatever the affected area, building up your strength will help you stand up to everyday strain. Since the body can adapt, strength training is extremely helpful to balance out repeated gestures.

During the first few days, you are unlikely to want to do any sport. The symptoms and acute pain are often prevalent and rest is recommended. Following the advice of your physio, you can gradually resume physical activity, especially by working other muscles and avoiding the painful area.

Did you know that tendinopathy is the most common occupational disease in France? A table (table no.102 of the General Regime) lists the various occupational pathologies. The possibility of continuing to practise your activity depends on the intensity of the tendinopathy and how long it has around. "Patients sometimes wait two years before seeing a doctor"! , Alexandre reveals. If the pain is really incapacitating, your GP will provide you with an initial medical certificate to sign you off work, before prescribing supplementary checks and physiotherapy sessions.

If, in your professional activities, you are part of the office team, you should know that you can buy are ergonomic mouse to improve your comfort and avoiding overly intense contraction of the brachial nerve. Adapting your workstation is another solution: comfort equipment helps prevent tendinopathy, but it is above all strength training, for arduous jobs, which can combat the stress associated with repetitive movements. 

Runners, for example, should look at posture and see if they can adapt their running style. 

As for someone suffering from tendonitis of the shoulder, paying attention to any stiffness in the elbow and which can exacerbate the stress in your shoulder can make it necessary to correct your posture.