Spring is finally here! That means more and more older runners and athletes are flocking to my office complaining of a multitude of aches and pains. 'Tis the season to overtrain and suffer from the dreaded tendonitis. What is this mysterious 'itis? Why does it effect aging athlete's more than the younger ones? Why does one person have multiple bouts of recurrent tendonitis all over their body and another does not? These are all great questions!
Let's start with the basics. A tendon connects your muscles to the bones. It is a flexible but really tough band of fibrous tissue. A muscle contracts to move one of your joints and transmits a force on the tendon to cause the movement. Tendons, when functioning normally, glide very smoothly when the muscle contracts. When they are irritated, they cause pain and even creaking when they glide. This is tendonitis, or in easier terms, inflammation of the tendon.
Tendonitis can occur in any tendon, but in your foot and ankle the most common tendons effected are the ones that stabilize you foot when you run, jump and play with the other kids. These are the Achilles tendon, the posterior tibial tendon, the anterior tibial tendon and the peroneal tendons. Less likely to be irritated are the multitude of smaller flexor and extensor tendons in your feet.
Tendonitis is more common in your aging athletes between 40 and 60 years old. This is because the aging process causes our tendons to become less elastic and therefore less forgiving. A stress that would've been easily absorbed in our 20-year-old tendons causes tendonitis and even rupture in our 40+-year-old tendons.
Tendonitis is usually due to repetitive stress with an underlying biomechanical abnormality or anatomical deviation. This is why it is important to treat the tendonitis and the underlying cause before return to sport. If not, recurrence rates are high!
What does tendonitis feel like? Pain and swelling in the tendons usually first thing in the morning or at the beginning of an activity. The pain and stiffness often "warms up" in the early stages, but can become constant if you ignore the early symptoms. Sharp stabbing pains can occur but these are usually a sign that your tendon is so stressed it may actually tear!
How is it diagnosed? Usually your doctor will perform a physical exam and then rule out a bone problem or fracture with an x-ray. Sometimes an MRI is needed to rule out a small or partial tendon tear.
Treatment for tendonitis begins with relative rest. Take the stress off the inflamed tendon by doing alternative exercise like cycling or swimming. Sometimes complete rest is needed. Ice, anti-inflammatory medicines, bracing, physical therapy and even a cortisone injection may be needed. Functional foot orthotics are often quite helpful in chronic tendonitis because they stabilize the abnormal movements and help treat the underlying biomechanics of your feet.
Remember that after having a bout of tendonitis, slowly return to activity and try to avoid the overuse that caused the tendonitis in the first place! Too much, too soon, too fast syndrome is often the culprit in tendonitis!