Anterior Shoulder Pain Part 3: Tendinitis

Why does the shoulder take so long to heal? How come tendinitis never seems to go away? Even as physical therapist, I believe I can increase the rate of healing pretty quickly. However, after experiencing tendinitis for myself, I now see some things just take time.  I never knew how much time it takes for tendons to heal.  I would like to review the healing response of a tendon once it is injured.

As I woke up, at the start of my tendinitis, my arm was much more sore than with a usual workout. It was then I realized that my shoulder had worked past fatigue and had created an inflammatory process. The first initial stage of healing for a tendon is the inflammation stage.   This is routine for any kind of injury and inflammation usually last 3-7 days. Throughout the entire week, most positions of moving my shoulder felt painful and sore.  Not much to do but rest in this phase. For more background on hurting your shoulder see Part 1 here. Anterior Shoulder pain??

pectoral strain

My shoulder continued to be sore over the next 4-6 weeks. I tried everything from dry needling, cupping, Graston, self-massage, and stretching to alleviate the pain more quickly. Some of it helped, but the pain continued to be there no matter what I did.  Working out was doable but created soreness the next day.  Probably causing the tendon become more inflamed.  Being a physical therapist, I felt like I could work out without causing further injury or setbacks, so I continued to take it easy.  Although it was sore, I knew I was not causing any more damage.  However, some exercises I could not do like dips, rowing, and pull ups.  These exercises really did make my shoulder feel as though it was taking steps back in regards to healing. This stage of healing (4-6 weeks) is called repair. In this stage inflammation subsides and tenocystes and fibroblasts take over the role of formulating new collagen where the slight tearing occurred. This stage last for 2 months and a process of synthesizing and reabsorbing collagen along the areas of injury occurs.  The injured area is beginning to repair itself. This is where I believe a noticeable improvement in pain and soreness is seen and where I believe physical therapy can do the most good. This remodeling is occurring along normal use and so challenging the tendon may help. Remodeling a tendon can be a good thing over the course of time. Soft tissue work and strengthening of the tendon during this stage needs to be done in a safe manner but might allow the tendon to recover faster and stronger.

8_phases-plain-large

Remolding is the next phase and continues for months.  This remolding even once finished, does not make the original tendon as strong.  So lets turn to the biggest factor we can change. This is factor is prevention and like with most injuries we need to figure out how it got injured in the first place. This is where as a physical therapist, I hear from all sorts of clients every excuse in the world. If you have pain you didn’t do it right, that’s a fact!  I hear things like my form is good, the trainer is good and want hurt them, well they never had issues before, or my doctor said it was just arthritis and age. Pain is the bodies way of saying you did something wrong and I’m not doing this anymore until you fix it.  Pain is alerting you to move differently or it will continue to cause more pain until you listen. Don’t ignore it, fix it. This is where physical therapy can continue to help with identify poor movement, weakness, limited mobility, and poor form.

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