the exam table of Gary Chimes, M.D.,
Ph.D., a specialist in musculoskeletal
injuries at the UPMC Rehabilitation
Institute in Pittsburgh. I explain
how tendinitis has so inflamed my
elbow that home remedies no longer
work. Perhaps he could give me a
prescription NSAID (nonsteroidal
anti-inflammatory drug ) more potent
than the over-the-counter versions?
“Of course, you’re the doctor,” I say.
“If you think I need cortisone shots or
surgery, just say so.”
Chimes smiles good-naturedly, no
stranger to know-it-alls whose or-
thopedic knowledge is based on TV
commercials for analgesics. Before I
can babble further, he explains that
inflammation is indeed the signature
sign of tendinitis. But whether my
elbow will show signs of it is doubtful.
To find out for sure, he turns on an
ultrasound device. “Besides provid-
ing three times the detail of an MRI,”
Chimes explains, “this technology
lets us see areas of new blood vessel
growth and circulation—a good proxy
for inflammation.”
Chimes holds the ultrasound wand
against the inside of my wrist. With
each heartbeat, small red flowers
bloom on the monitor. “This is what
blood flow looks like,” he says. Next,
he moves the wand to my elbow. No
flowers blossom here. “If your elbow
were really inflamed,” he points out,
“we would see much more blood flow
in the affected area.”
“So, if not tendinitis,” I stammer,
“what exactly do I have?”
“The term we’re using for prob-
lems like this is tendinosis,” Chimes
explains. “And don’t feel bad for not
knowing the distinction—a lot of gen-
eral practitioners don’t know either.”
basic ways: sudden trauma or long-
term overuse. Although the former,
like a wipeout on the ski slopes, makes
for great war stories, it is the slow,
steady accumulation of wear and tear
over many years that causes most
tendon pain in active older adults.
DO-IT-YOURSELF PHYSICAL THERAPY
Many patients—I was one of them—consider physical therapy penance we
must perform until the doctor relents and brings in “real” medicine, namely drugs
or surgery. But physical therapy is real medicine. Here are just two of the many
exercises my therapist taught me. Now that both my
shoulder and elbow tendons feel good again,
I continue performing these exercises daily to
keep the problems from coming back.
ROTATOR AND SCAPULAR SQUEEZES (SHOULDER)
Hold a stretch cord with both hands, a foot apart, keep-
ing your upper arms against your sides and your forearms
extended at right angles straight ahead. With your
elbows fixed by your side, slowly extend your hands out-
ward, hold several seconds, then return to the starting
position. Concentrate on squeezing your shoulder blades
together during the exercise. Do 15 reps daily, gradually
working up to 30. How this helps For each muscle that
moves us one way, an opposite muscle moves us the other.
Repetitive exercises like swimming can lead to imbalances by strengthening one
muscle more than the other. Stretch-cord “squeezes” help restore balance by working
the external shoulder rotators and scapula stabilizers—
key muscle groups that help stabilize the shoulder.
ILLUS TRATIONS BY PAUL HOPPE
AS YOU MAY RECALL from high
school biology, tendons are tough,
inelastic bands that connect muscles
to bones. They can be damaged in two
WRIST CURLS (ELBO W) Holding a 2- to 3-pound dumb-
bell or large can of soup, curl your wrist up and down. Go
slowly, particularly while lowering—the “eccentric con-
traction” phase of the curl. This lengthens and strength-
ens the muscle. Repeat 30 times with your palm up. Rest
a minute, then repeat 30 times with your palm down.
How this helps Eccentric contractions prompt tendon-producing cells called teno-
cytes to deposit healthy replacement tendon fibers at the injured site. —J. T.
