Tendinitis is an overuse injury that affects the tendons and causes them to swell. Tendons are the fibrous tissue that connects the muscles to the bones. If you have this type of condition there is pain when you have active resisted, stretching and active free movements. This type of condition usually happens in the longer tendons compared to the shorter tendons.
When treating this type of condition, you can be in a face up, face down or sidelying position for the treatment, though usually sidelying isn’t used very often unless there is a reason why you can’t be on your stomach or on your back. Also when you are sidelying it makes it more difficult to be able to work on both sides as at one point in the treatment you will be laying on top of the injured side.
The reason why the unaffected side is worked on, and usually first, is to be able to use the reflex arc affect. This is where the body lets the injured side to relax more effectively when the uninjured side is being relaxed, making the treatment less uncomfortable. Usually when the unaffected side is being worked on, the affected side has heat on it to help the muscles relax, again to make it easier and less uncomfortable for the patient during the treatment. Some muscles are covered in a tendon sheath, and the muscle will have to be in a stretched state to be able to bring the tendon out of the sheath, to be worked on.
A lot of times with tendinitis, though the tendon itself has become inflamed, part of the goal after a massage is to create some controlled swelling to the area. That is because the swelling that is around the tendon, tends to be stagnant, meaning that it doesn’t move and flush out debris or toxins like it should. When a therapist induces more swelling into the area, they are actually promoting new, healthy fluid into the tissues that are able to flush out the old stagnant swelling. The way that the therapist does this is through a technique called cross fiber frictions. This part of the treatment isn’t very long as it can be uncomfortable. With later sessions the duration of this technique increases.
Before the frictions are applied, to the affected side only, there is some trigger point and some deep tissue massage done on the muscle that has the affected tendon, as well as the surrounding muscles. This will help with balancing out the structures around the tendon, to aid in the body’s ability to flush out the area, as the other muscles could be trying to protect itself, causing them to push against the lymphatic system. Also when the muscles are balanced, and all starting to work together, this will decrease your chances of having the condition for that tendon, happen again. Lymphatic drainage will also be done at this point as well, to further help the lymphatic system.
Once the tissues are warmed up, and a lot of the tightness has been resolved, the oil that was used is either washed off or wiped off of the area where the tendon is. This is when the muscle is placed in the best position to be able to get to the tendon, which may mean that it has to be in a stretched position to be able to reach the tendon. Then the cross fiber frictions are applied. They are a sustained pressure against the tendon, and the therapist will move their thumb or finger back and forth across the tendon, without any gliding over the skin, as they are only moving over the tendon itself. At this point you will have to keep communicating with the therapist, as they will be pressing deep enough on the tendon that it will be uncomfortable. At this point they will have you using a pain scale of 1 to 10, one being no pain and a 10 being the worst pain ever. They don’t want to go past a level 7 on that scale, so if you feel like they are going past that number, tell them and they will lighten their pressure until it is less then 7. What these cross fiber frictions do is help with breaking up the adhesions covering the tendon, and forces the fibers to go in the proper direction.
After the cross fiber frictions have been completed, the therapist will do another round of lymphatic drainage on the area treated. Remember, the swelling that naturally happens from the cross fiber frictions, needs to stay under control, so you will also have to ice the area several times after the treatment. You do not want the swelling to become stagnant, as it will not help you heal.
Then the remaining time will be more of a relaxation massage to end your treatment.