When Linda Tepper developed intense pain in her left arm from her elbow to her wrist, her doctor thought it might be a pinched nerve. He suggested a diagnostic dye-injection procedure, but she was wary. “It cost hundreds of dollars, and the dye would have been injected into my neck,” says Tepper, a 55-year-old secretary at the State University of New York at Purchase, “so I said no.” Instead, she was sent home with prescriptions for a muscle relaxant and the nonsteroidal anti-inflammatory drug (NSAID) Celebrex.
But the drugs didn’t help. Two months later, still in pain, Tepper visited an acupuncturist, who diagnosed tendinitis of the elbow. After two 45-minute sessions of needle therapy, the pain disappeared and hasn’t returned.
Tepper, who rarely picks up a tennis racket—and never plays golf—doesn’t appear to be a typical candidate for tendinitis, which involves inflammation of the ropelike tissues that attach muscle to bone. But she spent 14 years as a student hauling around heavy books, which can make a person just as vulnerable to the condition as jocks on the tennis court or running path. Any repetitive activity, including word processing, manual labor, playing an instrument, even needlework or video games, can cause a tendon’s tough, glistening-white fibers to become inflamed. The result is that the area gets flooded with dead cells, inflammatory chemicals, and free radicals that cause pain, tenderness, and swelling.
Persistent tendinitis can progress into something more serious called tendinosis, in which the tendon’s collagen actually begins to break down. In fact, some doctors believe that many diagnoses of tendinitis are actually tendinosis—and it’s important to get it right, since treatment may vary slightly, and tendinosis takes much longer to heal. If your symptoms persist longer than about six weeks, see a sports physician or a physiatrist; these practitioners are generally more familiar with tendinosis and can help you diagnose your condition correctly.
Using an NSAID, as Tepper did, is the standard treatment for tendinitis, along with the tried-and-true remedy known as RICE (rest, ice, compression, elevation). But NSAIDs are hard on the stomach and, over time, can lead to ulcers and kidney problems. Some people benefit from a cortisone injection directly into the tendon, but that can only be given sporadically, as cortisone weakens tendons. And surgery, a last-resort treatment, brings mixed results and has obvious disadvantages.
Fortunately, nature’s medicine chest is stocked with safe, effective treatments that can soothe a tender tendon and help it heal. The key is to attack the problem as soon as it arises by backing off from the repetitive motions that caused it and easing the resulting inflammation. That way it’s less likely to progress to chronic pain or disability.
The truth is that natural NSAIDs are not quite as strong as synthetic ones, so if you’re really in pain at the beginning of a bout, OTC drugs might be your best bet. But you can try the natural versions, which won’t upset your stomach, and for pain that lasts more than about a week, it’s definitely advisable to switch to the natural types.
Choose from the list below, and don’t feel compelled to stick to just one: Chris Spooner, a naturopath at the Environmental Medicine Center of Excellence at the Southwest College of Naturopathic Medicine in Tempe, Arizona, says he loads up on “three or four at once.”
Wobenzym. This product, which contains various plant and animal enzymes, has been available in Germany for many years and is commonly recommended by physicians there, says Spooner. Take six tablets three to four times a day on an empty stomach.
Zyflamend is a blend of herbs, including holy basil, ginger, and turmeric, that have anti-inflammatory properties. Take one twice a day at mealtime with a full glass of water.
Bromelain. In Germany, Commission E, a government-appointed group that evaluates plant-based medicines, has approved the use of this enzyme to reduce post-surgery swelling, but Spooner says it works for tendinitis, too. For acute tendinitis (i.e., soon after the injury has occurred), take 250 to 750 milligrams every two hours. If the pain lasts more than a few weeks, switch to three times a day and take the pills on an empty stomach.
Fish oil. This supplement is rich in anti-inflammatory omega-3 fatty acids. Take 500 to 1,000 mg three times a day. Note: Omega-3 fatty acids thin the blood, so check with your doctor first if you regularly use a blood-thinning drug such as aspirin or warfarin.
Curcumin. A component of the deep-yellow Indian spice turmeric, this potent antioxidant helps reduce inflammation and increase circulation. Look for products standardized for 95 percent curcumin. Take up to 2,000 mg a day (if you develop digestive problems, cut back on the dosage, 400 mg at a time). After a few weeks, cut back to 400 mg three times a day. Note: Don’t take curcumin if you’re pregnant, since it may stimulate uterine contractions.
Pack on a Poultice
It’s made for horses, but Chinese Herbal Poultice (made by Equine Science), filled with natural anti-inflammatory substances, also soothes tendinitis in people, Spooner says. “It contains myrrh and camphor, which help move cellular waste out of the inflamed area and move oxygen and other nutrients in.” Follow the package instructions for how to use. Note: You can find this product on amazon.com.
Rub on Relief
Used for decades worldwide, the homeopathic ointment Traumeel contains arnica, witch hazel, and other herbs that ease inflammation. Smear the ointment liberally over the painful area, cover with plastic wrap, and leave on overnight, says Spooner. Note: Some people with persistent tendinitis get injections of Traumeel directly into the painful area. Consult a naturopathic doctor to find out if the injectable form is right for you.
Heat Things Up a Bit
For tendinitis that persists longer than 48 hours, ice alone can actually interfere with the healing process because it constricts blood vessels, inhibiting blood flow to the area. The best strategy is to alternate between hot and cold.
Apply a hot compress to the affected area or immerse it in very hot water for three to four minutes. Then apply ice or immerse in ice water for one to two minutes. Switch between heat and cold several times, always ending with cold. Note: Never use analgesic creams or rubs with heat. The combination could burn your skin.
Promote Collagen Repair
When tendinitis progresses into tendinosis, you need something that specifically aids in collagen repair, says Rick Marinelli, director of the Natural Medicine Clinic in Portland, Oregon. In fact, tendinosis is not considered an inflammatory condition, though natural anti-inflammatories may still help (synthetic ones have a slightly different mechanism of action, though, and may actually cause more harm).
As for repairing collagen, “vitamin C, manganese, copper, and zinc are all important,” says Marinelli, “so eat your fruit, veggies, and lean protein.” In addition, choose one or two supplements from the following list.
Proanthocyanidins. This class of plant chemicals promotes an enzyme needed to make collagen (proline hydroxylase). The most common sources are grape seed and white pine, which come in supplement form. Take 100 to 400 mg of each or both, in divided doses, twice a day.
Glucosamine sulfate. No studies confirm its effectiveness for tendinosis, but Spooner believes this popular arthritis remedy can help. “Glucosamine is a building block of collagen, and as such supports its production,” he says. Take 500 mg three times a day. Be patient; glucosamine can take at least six weeks to work.
Vitamin C. This super-antioxidant is vital for collagen formation. Take 2,000 to 3,000 mg a day. (If you develop digestive problems, reduce the dosage, 500 mg at a time, until symptoms stop.) Spooner recommends C with added bioflavonoids.
Stretch and Strengthen
You don’t want to engage in the same activity that caused your condition, but you don’t want to be sedentary, either, since exercise increases the flow of blood and nutrients to the affected area. Choose something that doesn’t stress the affected limb. “For example, if you have Achilles tendinitis, try nonimpact activities like swimming instead of jogging,” says Spooner. Gentle stretching is important, too. Stretch the affected area backwards, forwards, and from side to side a couple of times a day for 5 to 10 minutes. Note: If any of these exercises are painful, stop right away—and do them even more gently the next time you give them a try.
Consider a Good Needling
Like Tepper, countless Americans have turned to acupuncture to ease their tendinitis. It’s thought that the hair-thin needles increase circulation to the area, relax muscles and nerves, and stimulate repair of damaged tissue. Pain relief often occurs within one to three sessions, but it can take up to 12 for the benefits to kick in. Note: To find an acupuncturist in your area, go to acufinder.com.
Try the Real Sting
Laugh (or wince) if you want, but the medicinal use of bee stings, called apitherapy, can help ease tendinitis pain and inflammation, says Theodore Cherbuliez, a physician and former president of the American Apitherapy Society in Scarsdale, New York. Honeybee venom contains powerful anti-inflammatories; one compound, mellitin, is 100 times more potent than some synthetic versions. Another, hyaluronidase, loosens the “glue” that connects cells, allowing nutrients in and waste out.
Here’s how it works: The apitherapist first cools the skin to make it less sensitive, then places a honeybee directly on the painful area and allows it to sting. Acute tendinitis may take two or three stings per session for two to five sessions. (Note to squeamish types: You can also opt for injectable venom.) To find a qualified apitherapist in your area, contact the American Apitherapy Society at apitherapy.org. (Before you can get access to the list, you have to join the society for a $45 fee.) Note: Before you try apitherapy, get tested for an allergy to bee venom, even if you’ve been stung in the past without harm.
In this procedure, called iontophoresis, a weak electrical charge delivers steroids through the skin, straight into the affected area, via a reaction involving ions (particles with a positive or negative charge).
Here’s how it works: The physical therapist (or physician) places one electrode containing the medication on the affected area, and a second electrode at least 4 to 6 inches away. Then, he or she connects the clips from the dose controller to the electrodes. The electrodes and the drug both hold the same charge, and like charges repel each other. So when the current is on, the drug is pushed away from the electrodes, forcing it through the skin.
Your pain should decrease within hours of getting the treatment, and the relief should last for up to two days; it can take from one to six weeks of treatment for the relief to remain permanent, says Lisa J. Allen, a physical therapist in Chantilly, Virginia.
To find a practitioner, call a vendor of the iontophoresis units and ask for a referral to an MD or a physical therapist in your area who has bought one. Two to try: IOMED (800.621.3347) and Empi (800.328.2536). Note: If the treatment goes well, you might consider continuing it at home. “There are new electrodes that use microcircuitry, so all you need are prescriptions for the iontophoresis patches and the steroid,” says Allen. (Your doctor can write them.) Cost: $12 per patch, sold in boxes of six to 12.
Shock It to Me
Nothing’s tamed your tendinitis? Before scheduling surgery, try something called extracorporeal shock wave therapy (ESWT). In this noninvasive outpatient procedure, a practitioner zaps the painful area with either high- or low-energy sound waves. The pressure of the waves stimulates the healing process, possibly by increasing blood flow to the area. The device used for ESWT is similar to the one used in the treatment of kidney stones.
The therapy is FDA-approved for plantar fasciitis (inflammation of the tissue on the bottom of the foot) and elbow tendinitis. However, some doctors use it on other spots as well. One treatment may be enough to help, but you may need up to three. Side effects include pain during and immediately after treatment and swelling and bruising of the skin. Note: Be prepared to pay out of pocket: ESWT can cost from $1,500 to $4,500 and isn’t always covered by insurance.