Tendinitis is a condition where a tendon or the connective tissue that surrounds the tendon becomes inflamed.
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 ankle).1
What are the symptoms of tendinitis?
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.
Lifestyle changes that may be helpful for tendinitis
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
Nutritional supplements that may be helpful for tendinitis
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 tendinitis.
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 with tendinitis?
Refer to the individual supplement for information about any side effects or interactions.
Holistic approaches that may be helpful for tendinitis
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 elbow.28
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 and tenderness.
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 findings.