“A painful condition, there are things you can do to stop it from affecting your quality of life”, writes Aznim Ruhana Md Yusup
IN our bid to be in good physical shape, we are, at time, guilty of doing too much, too soon. So instead of becoming fitter and healthier, we end up being impaired by pain and injury.
This happens when we overestimate what our body can do. Age may be a number in our mind, but the physical wear and tear as you get older is too real to ignore. That pain in your shoulder or knee is also too real to ignore.
What could be happening here is tendinitis, which is the inflammation of the tendon. A tendon is a tissue that connects muscle to bone, helping to move the bones and joints when the muscles contract.
“But the tendon is what we call a watershed area, the blood supply there is not very good. If you do strenuous activity, what might happen is that your tendons go through overuse, which causes the inflammation.”
“It is something that happens to young people too,” Dr Tai continues. “But younger people can recover faster. At 40 or 50, the blood supply gets worse so you don’t always recover.”
Tendinitis can occur in any tendons in the body but most often in the elbow, wrist, shoulder, knee and ankle. It’s generally referred to by the body part involved or the activity that caused it. So, for example, if you play basketball a lot, you might have patellar tendinitis or jumper’s knee.
Daily repetitive actions like using a computer mouse, or in Dr Tai’s case, holding a scalpel to operate on patients, can also lead to tendon overuse. Acute injury that damages the tendon is another cause of tendinitis.
LOOK TO R.I.C.E
When people have tendinitis, they usually complain about pain. “So if I have patellar tendinitis, every time I play basketball, my knees hurt. But when I walk, it is not that bad. This is because the stress you put on the knee when you walk is different. When you’re jumping and when you land, it puts more stress on the tendon.”
Dr Tai explains that the pain comes in stages, so it might be mild at first. It might not even be immediate, with the physical hurt only occurring the next day. But the tendinitis becomes more serious when it starts to hurt as you’re doing the activity. And it’s at its worst when it hurts even when you’re not doing anything at all.
For some people, tendinitis can appear as swelling. According to Dr Tai, this is typical of the four signs of inflammation; Pain, swelling, redness and heat, although in this case, redness and heat are not as common.
Treating tendinitis boils down to R.I.C.E. “R stands for rest. If you play badminton and you get tendinitis in your shoulder, then you should stop playing for a while. If you have a wrist tendinitis, wear a wrist brace or splint to hold it in its place. So you rest and protect the area and don’t do anything to aggravate the injury.”
The I stands for ice. This is because inflammation generates heat, so you need ice to cool it down and reduce further damage.
C is for compression, because of the swelling. And E is elevation, as you might need to elevate the affected area so that there would be less swelling.
Dr Tai has added P to the list, which stands for painkillers. “And it’s a group of painkillers known as anti-inflammatory tablets. They don’t directly reduce the pain but they are anti-inflammatory. If you reduce the inflammation, you reduce the pain.”
“Another thing that I ask the patient to do is physiotherapy. There are different modalities that can help you reduce the pain and the swelling.”
If that doesn’t work then Dr Tai would consider a steroid injection to the area. It’s effective but there is fine line that doctors need to tread between reducing the inflammation and possibly causing harm to the patient.
“If you use steroid injections too many times, it can cause ruptures of the tendon. Steroid can potentially weaken the tendon, the bone and the muscle. In rare occasions, the bone can become dead as a result of repetitive steroid injection.”
While older folk are more likely to suffer from tendinitis, there is no link between males or females being more prone to the condition. “Anatomically, there’s no real advantage or disadvantage whether you are male or female. Female patients that I see tend to get tendinitis on the wrist because of housework.”
“If men get tendinitis on the wrist, they’re usually gardeners. There are certain types of activities that women do more than men that cause tendinitis, and vice versa. So it’s related to the activities that they do, rather than gender.”
Dr Tai’s advice is to rest and look after yourself the moment you spot the early signs of tendinitis. And if you play sports regularly, you should warm up before starting your session. “Regular exercise will help get your muscles and tendon in the right shape so you won’t get this problem later on. But don’t over-exert yourself.”
“If you’re over 40 or 50, don’t start doing marathons if you haven’t been doing it earlier. At 25, you can play 10 games of badminton. But at this age, it will hurt you.”