Sunday, July 6, 2008

Heal Thyself—Spotlight on Tendinitis (page 1 of 4)

By Julia Van Tine

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.

Ease Inflammation
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.

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