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Because it's your free weekend, you're asked to accompany the boy scouts to Moab. You dust off an old hardbody bike, pump up the tires, then drive seven obnoxious 14-year-olds to Moab in your Suburban. After banging your antique bike down 14 miles of the Porcupine Rim trail trying to keep up with those hyperactive brats, you hurt everywhere. A few days later, most everything is feeling better. But your wrist still hurts, and it goes "scritch, scritch" when you move it.

Tendonitis is an inflammation of a tendon, usually caused by repetitive minor trauma -- in other words, you create a lot of tiny strains within the tendon, then your body attacks the injured area with inflammatory cells. Most commonly, the tendonitis will occur right where the tendon attaches to bone, or where it wraps around a bone or joint.

Wrist Tendonitis:
Most common is "De Quervain's tendonitis" of the thumb extensor tendon. It often follows biking on rough surfaces: gripping the handlebars tightly while multiple shocks slam your wrist. The tendonitis is on the forearm just upstream from the wrist. It begins on the thumb side of the radius and winds around to the top side. Often, there's a bulge of swelling over the tendon. If you press fingers gently over the swollen area and move the thumb up and down, you may feel a rubbing sensation.

Location of swelling in thumb extensor wrist tendonitis.

bf-wrst.jpg (10282 bytes)

Tennis Elbow (Lateral Epicondylitis):
At the bump on the outer side of your elbow, the muscles that raise your wrist and fingers attach. If there are multiple shocks to the tendons where they attach, tendonitis develops. Classically, this is the shock of backhanding the ball with a tennis raquet. But depending on your riding technique, you can also stress these tendons from shocks transmitted up from your handlebars. There will be pain on the outer side of the elbow when making a tight fist or raising the wrist up. It will be tender to touch slightly down from the tiny bony bump on the outer side of the elbow.

Pitcher's Elbow (Medial Epicondylitis):
The muscles that flex the fingers and bend the wrist downward attach at the small bump on the inner side of your elbow. While riding, the wrist is turned down and up, which stretches these muscles to their maximum length. When you make that jump or log-drop, the sudden yank on the tendon can cause minor injury. Add up enough of these shocks, and the tendon becomes inflamed. There's pain on the inner side of the elbow when pressing the hand against the face, or when straightening the elbow fully while the wrist is bent upward. It will be tender to touch slightly down from the tiny bony bump on the inner side of the elbow.

Ileotibial Band Tendonitis:
This is an inflammation of the tendon band that crosses the outer side of the knee. This problem is more common in runners who "pronate" at the foot, but can occur in bikers that ride hardtails over two many bumps. There's tenderness just up from the head of the fibula (the bone bump on the outer side of the knee, just around from the kneecap tendon. Pain occurs when the knee is fully straightened or fully bent.

Patellar Tendonitis:
This is an inflammation of the kneecap tendon. It's caused by injuring the patellar tendon, usually by jumping the bike. There will be tenderness and swelling directly over the patellar tendon, just down from your kneecap. This tendonitis needs to be treated carefully. If recurring minor injury and inflammation continue, the tendon may rupture.

Achilles Tendonitis:
This is inflammation of the achilles tendon, on the back of the ankle just above the heel. This tendonitis is usually due to bike jumping. The tendon is weakened by repeated sudden forced upward bending of the foot, such as occurs when the bike rotates upward suddenly riding through a short sharp dip. Call it "BMX heel." There will be tenderness over the achilles tendon, and pain when raising the heel off the ground while standing on the toes. This tendonitis needs to be treated carefully. If ongoing inflammation weakens the tendon, it can rupture.

See the doctor if:
    - tendon pain prevents routine use
    - a major tendon is involved (patellar, achilles)
    - there's significant swelling or discoloration
    - the problem is not improving with rest

Initial care:
When the tendon pain first begins, ice pack the area (just as you would an acute injury). This may prevent further swelling and inflammation. Repeat the ice for 30 minutes every two hours, for two days. If you tolerate these medicines, begin an anti-inflammatory medicine such as ibuprofen 600 mg four times a day. Rest the tendon. If minor motion causes pain, use: a splint for wrist tendonitis, a sling for elbow tendonitis, and crutches for knee or ankle tendonitis. Apply an elastic wrap ("ace" bandage) to compress the tendon.

Ongoing care:
After a few days' rest, begin stretching exercises. Put the joint above and the joint below the painful tendon through their full range of motion. It may help to warm-pack for 10-20 minutes before the stretches. Repeat four times a day. Return to your activities gradually. In particular, avoid the activity that started the tendonitis. It may take 3 to 4 weeks for tendonitis to resolve.

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