Introduction
The tendons are some of the body’s weakest links. While muscle and bone heal well after injury, the fibrous tissue that connects muscle to bone has a relatively poor blood supply, so it recovers only slowly.
Inflammation in the tendon or its sheath is called tendonitis. Symptoms include tenderness, redness, swelling, and pain on exertion, and they 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’ tendonitis), forearm, and thumb.
Overuse of a tendon (repetitive strain injury) is the most common cause of tendonitis. This form of 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 on its own. Nonsteroidal anti-inflammatory drugs (such as 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 at best. The role of physical therapy in recovery from tendonitis also has not been well evaluated from a scientific perspective. A technique called extracorporeal shockwave therapy does not appear to work.
Principal Proposed Natural Treatments
Although the evidence remains incomplete and somewhat inconsistent, acupuncture treatment has shown considerable promise for the treatment of 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 given 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. Good 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.
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.
Bibliography
Bisset, L., et al. “A Systematic Review and Meta-analysis of Clinical Trials on Physical Interventions for Lateral Epicondylalgia.” British Journal of Sports Medicine 39 (2005): 411-422.
Ceecherelli, F., et al. “Comparison Between Superficial and Deep Acupuncture in the Treatment of the Shoulder’s Myofascial Pain.” Acupuncture and Electro-therapeutics Research 26 (2001): 229-238.
Fink, M., et al. “Acupuncture in Chronic Epicondylitis.” Rheumatology 41 (2002): 205-209.
Nourbakhsh, M. R., and F. J. Fearon. “The Effect of Oscillating-Energy Manual Therapy on Lateral Epicondylitis.” Journal of Hand Therapy 21 (2008): 4-14.
Oken, O., et al. “The Short-Term Efficacy of Laser, Brace, and Ultrasound Treatment in Lateral Epicondylitis.” Journal of Hand Therapy 21 (2008): 63-68.
Trinh, K. V., et al. “Acupuncture for the Alleviation of Lateral Epicondyle Pain.” Rheumatology 43 (2004): 1085-1090.
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