Treatment involves decreasing the demands on the injured tendon, and using modalities (such as heat, ice, ultrasound and electrical stimulation), medication, and adjustment to correct any misalignments. Improper technique, or problems such as poor flexibility or poor strength in the surrounding muscles or joints may help cause tendonitis. These must be corrected to allow the tendonitis to improve.

Decreasing the demands on the tendons involves rest-staying off bulls for a period of time, or taping or bracing. Taping or bracing helps either by limiting how much a tendon is stretched, or by redistributing the forces to other areas of the involved muscle, or to other muscle groups.

Modalities are very important in helping the tendon heal. Ice is very important! If ice is used immediately and often for the first 72 hours after an injury occurs it limits the amount of irritation and swelling that is caused by trauma and by chemicals released by the injured tissue, which cause inflammation. Inflammation causes pain so decreasing inflammation helps to lessen pain. Even after the initial 3 days, using ice on the injured tendon after riding is very important for the same reason. Allowing more inflammation to occur causes further injury. Ice should be left on for no more than 10-15 minutes at a time, but can be re-applied as often as needed.

Heat in the form of hot packs and heat rubs such as “Icy Hot”, increase the circulation to an injured area, and speed the healing process. Ultrasound is a deep heat, in the form of very high frequency sound waves that can be used to treat tendonitis. Sometimes it is used to drive medication such as a steroid through the skin and into the injured tendon.

Electrical stimulation is another modality that helps to speed the healing process. Cells in the body, including muscle and tendon cells, have a small positive or negative charge. Injury (tendonitis) can change the normal charge. Electrical stimulation helps return these charges to normal faster.

Pills called “non-steroidal anti-inflammatory drugs: (NSAID’s) such as Advil, Motrin, Allieve, or aspirin help to chemically decrease the amount of inflammation and relieve pain. It is important to always take the medicine with food, as they can injure the stomach lining.

There are many muscle groups besides the main ones involved in riding a bull, and strengthening these muscles, and using the best technique possible is very important to prevent excess forces on one muscle group and tendon. This helps in preventing tendonitis from occurring, or allows it to heal faster if you already have it. Having a chiropractor or an osteopathic physician to correct any misalignments helps to allow normal, correct use of the body and prevents overuse of one area.

If none of the treatments already mentioned has worked, steroid-type medications can sometimes be injected around (not into) the inflamed tendon. These are different steroids than the ones used by bodybuilders, and usually don’t affect the rest of the body. There are significant risks involved with injecting a tendon, and the injected tendon has to be completely rested for up to a week afterward. The risks include infection, further weakening or even rupture of the tendons, temporary increase in pain that may last several days, or the steroid being injected into the wrong place.

If a tendon is overused too much, it can actually rupture, or tear completely in two, and require repair through surgery- which means a lot of time off bulls, and a lot of hard work in rehab. So, take good care of your muscles and tendons (stretch and warm up well before riding), treat aggressively if you start to get tendonitis, and seek all the help and advise you need from your Extreme Sports Medicine team!