Natural treatments for tendonitis
Tendonitis refers to the inflammation of tendons, which are the fibrous tissues connecting muscles to bones. Common symptoms include tenderness, swelling, and pain, often resulting from overuse or acute injury. Natural treatments for tendonitis are gaining interest as alternatives or complements to conventional therapies. Prominent among these is acupuncture, which has shown promise in alleviating pain and improving function, particularly for conditions like tennis elbow and shoulder tendonitis. Other natural remedies include various supplements such as glucosamine, chondroitin, and white willow, although their effectiveness lacks robust scientific backing. Physical therapy, involving methods like massage and specific exercises, is also frequently recommended to support recovery. Techniques like the RICE protocol (Rest, Ice, Compression, Elevation) and kinesiology taping are non-invasive approaches practiced by individuals to manage symptoms. Emerging treatments such as extracorporeal shockwave therapy and turmeric (curcumin) are being explored for their potential benefits in promoting healing and reducing inflammation.
Natural treatments for tendonitis
DEFINITION: Treatment of tendon inflammation.
PRINCIPAL PROPOSED NATURAL TREATMENT: Acupuncture
OTHER PROPOSED NATURAL TREATMENTS: Arnica, Boswellia, bromelain, chondroitin, citrus bioflavonoids, creatine, devil’s claw, glucosamine, horse chestnut, manganese, massage, oligomeric proanthocyanidin complexes, osteopathic manipulation, oxerutins, prolotherapy, proteolytic enzymes, vitamin C, white willow
Introduction
Tendons are structures in the body that connect muscles to bone. Tendons can be compared to ropes in that they are both strong and flexible. Despite these attributes, tendons are some of the body’s weakest links. While muscle and bone heal well after injury, the fibrous tissue connecting muscle to bone recovers slowly. This is because tendons have a relatively poor blood supply.
Inflammation in the tendon or its sheath is called tendonitis. Symptoms include tenderness, redness, swelling, and pain on exertion. These conditions may last for months or years. Tendonitis occurs most commonly in the elbow (lateral or medial epicondylitis, also known as tennis elbow and golfer’s elbow), knee (peripatellar tendonitis), hip (iliotibial band tendonitis), shoulder (rotator cuff tendonitis), lower calf (Achilles tendinitis), forearm, and thumb.
Overusing a tendon (repetitive strain injury) is the most common cause of tendonitis. This injury frequently occurs in computer keyboard users, people who perform manual labor, and athletes (such as tennis players and golfers). Acute injury to a tendon, such as an excessive stretch, can also cause tendonitis.
Conventional treatment consists primarily of avoiding the movement that caused the injury and allowing the body to heal independently. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may help reduce pain but have not been shown to speed recovery. Steroid injection into the affected tendon is thought to help in certain cases, but the scientific basis for this commonly used method remains weak.
Principal Proposed Natural Treatments
Physical therapy is often recommended for individuals with tendonitis. Physical therapy methods vary greatly and may include massage, exercise, stretching, and education. In a 2023 review of 110 studies concerning various types of resistance training exercises that may improve tendonitis, eccentric exercise, concentric exercise, isometric exercise, excentric with concentric exercise, and isokinetic programs were most commonly used. The study found that each area of the body responds differently to exercise-focused treatments, and each type of injury requires individual consideration. Overall, it is important to rest the injured tendon while balancing the incorporation of safe training methods to regain strength and heal the impacted area.
Often part of physical therapy treatment plans, the RICE protocol, short for Rest, Ice, Compression, and Elevation, is a non-invasive and medicine-free method to relieve pain and swelling from soft-tissue injuries like tendonitis. The tendon needs rest for the first forty-eight hours after symptoms begin, and during this time, ice can be applied for alternating periods of twenty minutes. To reduce swelling, wrapping the area to reduce mobility and provide some support may be helpful, and keeping the injured area above the heart also helps. Additionally, kinesiology tape (KT tape) may be used in some cases to support the tendon from the skin’s surface instead of a brace. This tape allows a larger range of motion than a brace, which may promote healing.
Although the evidence remains incomplete and somewhat inconsistent, acupuncture treatment has shown considerable promise for treating tendonitis. Most studies have evaluated the effect of acupuncture on tennis elbow (lateral epicondylitis). For example, a placebo-controlled, single-blind trial of forty-five people with tennis elbow compared the effectiveness of real and sham acupuncture twice weekly for ten weeks. The results showed significant improvement in pain intensity and ability to use the elbow among those who received real acupuncture. Positive results were also seen in a placebo-controlled study of forty-eight people with tennis elbow.
Another study compared superficial insertion of acupuncture needles (sham treatment insertion) with normal deep insertion in eighty-two people with tennis elbow. The results showed greater improvement among the participants treated with deep acupuncture in the short term. However, the difference was only temporary; by the three-month follow-up, both groups had pain to the same extent.
Benefits have also been seen in studies of people with tendonitis in the shoulder. A trial of fifty-two people with rotator cuff (shoulder) tendonitis found acupuncture more effective than sham acupuncture. Another study compared superficial to deep-insertion acupuncture in forty-four participants with shoulder pain and also found relative benefits. In this trial, the results of deep acupuncture endured for a minimum of three months.
Laser acupuncture is a widely used substitute for needle acupuncture, but it may not be effective. A double-blind study of forty-nine people with tennis elbow failed to find ten treatments with laser acupuncture more effective than the same number of treatments using fake laser acupuncture. Another study of fifty-eight persons with the same condition found laser acupuncture to be no more effective than ultrasound treatments or wearing a brace.
Laser acupuncture is a widely used substitute for needle acupuncture, but it may not be effective. A double-blind study of forty-nine people with tennis elbow failed to find ten treatments with laser acupuncture more effective than the same number of treatments using fake laser acupuncture. Another study of fifty-eight persons with the same condition found laser acupuncture to be no more effective than ultrasound treatments or wearing a brace.
A technique called extracorporeal shockwave therapy (ESWT) was first popularized in the 1990s, but it began gaining renewed popularity in the first decades of the twenty-first century as a regenerative medicine to help heal soft tissue injuries like tendonitis. It is purported to relieve pain and inflammation by breaking up calcium deposits, promoting cell growth, and helping the body form collagen. Longitudinal studies are lacking to support its use for this purpose, but some evidence is promising.
Other Proposed Natural Treatments
A form of massage called deep transverse friction massage has shown some promise for tendonitis, but the research record is too weak to draw conclusions. Similarly, oscillating-energy manual therapy, an osteopathic technique based on the principle of craniosacral therapy, may be beneficial for tennis elbow (tennis elbow or lateral epicondylitis), but more research is required to be sure.
The supplements glucosamine and chondroitin are widely used for the treatment of osteoarthritis. Evidence suggests that they may work by enhancing the production of substances that keep cartilage healthy and flexible. On this basis, they have also been recommended for treating or preventing tendonitis. However, there is no direct evidence that they work.
The herb white willow contains a substance called salicin, which is quite similar to aspirin. It seems likely that appropriate doses of the herb might offer some symptomatic relief for tendonitis.
Other natural treatments sometimes recommended for tendonitis but which lack scientific substantiation for that purpose include prolotherapy and the following herbs and supplements: Arnica, Boswellia, bromelain, citrus bioflavonoids, creatine, devil’s claw, horse chestnut, manganese, oligomeric proanthocyanidin complexes, oxerutins, proteolytic enzymes, and vitamin C.
A natural substance that became a subject of scientific study in the 2020s was curcumin. This chemical is contained in the turmeric plant, closely related to ginger. Turmeric is thought to contain natural anti-inflammatory and antioxidant properties, which may assist in treating afflictions such as tendonitis. A 2022 study in the medical journal Nutrients suggested that turmeric properties may go further in preserving tendons and regenerating them after injury. However, most research concerning turmeric's positive impact on healing soft tissue has been performed on animals.
Bibliography
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