Also indexed as: Tendonitis
Tendinitis tenderness can slow you down and cramp your lifestyle.
What can you do to calm the inflammation and ease the pain? According to research or other
evidence, the following self-care steps may be helpful:
- Uncover the cause
- Work with a knowledgeable health professional to find out what is
causing your tendinitis and apply effective treatments
- Discover proteolytic enzymes
- Take several tablets of bromelain or similar enzymes every day to
reduce the severity of symptoms and speed healing
- Get to know DMSO
- Under the guidance of a qualified healthcare professional, apply
this topical anti-inflammatory agent (10% dimethyl sulfoxide gel) twice a day to reduce pain
- Make an appointment with an acupuncturist
- See a qualified practitioner for a series of treatments that may
reduce pain and increase function
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full tendinitis article for more
in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and
lifestyle changes that may be helpful.
Tendinitis is a condition where a tendon or the connective tissue that surrounds the tendon
This is often due to overuse (e.g., repetitive work activities), acute injury, or excessive
exercise. People who are at higher risk of developing tendinitis include athletes, manual
laborers, and computer keyboard users. Occasionally, tendinitis may be due to diseases that
affect the whole body, such as rheumatoid
arthritis or gout.
The most common sites of tendinitis are the shoulder, elbow, forearm, thumb, hip, hamstring
muscles (in the back of the upper leg), and Achilles tendon (behind the
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What are the symptoms?
People with tendinitis may have symptoms, which appear after injury or overuse, including
swelling, redness, tenderness, and sharp pain in the affected area, which is worsened with
movement or pressure.
Over-the-counter pain medications, such as
aspirin (Genuine Bayer®, Ecotrin®, Bufferin®), acetaminophen (Tylenol®), naproxen (Aleve®),
and ibuprofen (Motrin IB®, Advil®),
are routinely recommended to relieve minor pain and reduce inflammation. Topical methyl
salicylate (Icy Hot®, Bengay®), trolamine salicylate (Aspercreme®), and
combination counterirritant products (Maximum Strength Flexall 454®) may be beneficial to
Prescription strength nonsteroidal
anti-inflammatory drugs (NSAIDs), such as
celecoxib (Celebrex®), ibuprofen (Motrin®), naproxen (Anaprox®, Naprosyn®), meloxicam (Mobic®), and indomethacin (Indocin®), may be necessary to
treat inflammation and pain. Acetaminophen combined with codeine (Tylenol® with Codeine) or hydrocodone (Vicodin®, Lortab®, Norco®)
may be used to treat moderate pain.
Treatment may include local injections of
steroids such as dexamethasone (Decadron-LA®), methylprednisolone
(Depo-Medrol®), and hydrocortisone (Solu-Cortef®), or anesthetics such as lidocaine
(Xylocaine®), as well as immobilization and controlled physical therapy.
Lifestyle changes that may be helpful
Many people suffer from tendinitis as a result of their work environment. Studies have
shown that tendinitis of the wrist, hands, and fingers are often caused by repetitive work and
physical stress.2 3 4 Physical changes to the work
environment, such as setting up the work station so that the body is in a balanced, untwisted
position, minimizing the need to use excessive force, avoiding overuse of any one joint,
changing positions frequently, and allowing for rest periods, have all been shown to diminish
symptoms of lower arm tendinitis.5 One study of computer workers with arm and wrist
tendinitis found that using an ergonomic keyboard versus a standard keyboard reduced the
severity of pain and improved hand function after six months of use.6
Vitamins that may be helpful
DMSO, or dimethyl sulfoxide, has a long
history as a topical anti-inflammatory agent. One double-blind trial used a 10% DMSO gel
topically on patients with tendinitis of the elbow and shoulder and found that it
significantly reduced pain and inflammation in each joint.7 Other
preliminary8 9 and double-blind10 11 trials found
DMSO to be effective in treating tendinitis, but one double-blind trial found no difference
between the effects of a 70% DMSO solution and a 5% DMSO placebo solution.12
Certain precautions must be taken when applying DMSO, and it should only be used under the
guidance of a qualified healthcare professional.
Alternative healthcare practitioners frequently recommend proteolytic enzymes for various minor injuries.
Research demonstrates that these enzymes are well absorbed when taken by mouth,13
14 and preliminary15 16 17 18 and
double-blind19 20 21 22 trials have shown their
effectiveness for reducing pain and swelling associated with various injuries and for speeding
up the healing process. Unfortunately, many of these studies did not specifically identify the
patients’ injury, so it is unclear whether the positive results included improvements in
Bromelain, a proteolytic enzyme, is an
anti-inflammatory agent and for this reason is helpful in healing minor injuries, particularly
sprains and strains, muscle injuries, and the
pain, swelling, and tenderness that accompany
sports injuries.23 24 25
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Holistic approaches that may be helpful
Acupuncture may be helpful for treating
tendinitis. A controlled trial compared acupuncture to sham (fake) acupuncture in people with
shoulder tendinitis and found that acupuncture treatment produced significantly higher scores
on a combined measurement of pain, ability to perform daily activities, ability to move
shoulder without pain, and strength.26 This study also reported that the beneficial
effects of acupuncture continued for at least three months following treatment. Another
controlled study found traditional “deep” acupuncture more effective than
superficial acupuncture for tennis elbow immediately after a series of ten treatments, but at
3 to 12 months’ follow up, both treatment groups had improved similarly.27 A
third controlled study found no benefit from ten treatments of laser acupuncture for tennis
Certain treatments used by physicians and other healthcare practitioners have been shown to
be effective for tendinitis. In a controlled trial, patients with tendinitis of the shoulder
received 24 treatments over six weeks of either ultrasound or a sham treatment.29
Ultrasound resulted in considerable improvement in pain level and overall quality of life, but
many of the patients had their original symptoms return after nine months. The use of
ultrasound for tennis elbow has not been validated, according to a systematic review of
controlled studies.30 One controlled trial compared the effects of ultrasound alone
to ultrasound plus a topical steroid medication (a process known as phonophoresis, where
ultrasound is used to drive a substance into the skin).31 Both of these treatments
were given three times per week for three weeks and both produced similar reductions in pain
Preliminary studies have suggested that daily use of TENS (transcutaneous electrical nerve
stimulation) for one to two weeks reduces or eliminates pain in patients with
tendinitis.32 33 Controlled studies are needed to confirm these
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