Tendinopathy, also known as tendinitis, is often accompanied by tenderness and pain at the site of attachment between bone and muscle. In this article, we discuss how tendonitis, or tendinitis, develops and what enzymes can help reduce pain and inflammation.
What is tendinitis?
- Symptoms of tendinitis: Tendinitis is characterized by tenderness and pain at the site of attachment between bone and muscle. The painful tendon symptoms can occur as a result of a tendon tear, reduction in the quality of collagen fibers (tendinosis), or inflammation of the tendon.
- Causes of tendinitis: Tendinitis can result from overuse of the tendons and joints due to sports, repetitive movements, prolonged exposure to colds, advanced age, and conditions such as diabetes and rheumatoid arthritis.
| Proinflammatory cytokines: | Tendon cells that are cyclically stressed exhibit a higher concentration of pro-inflammatory cytokines such as interleukin 1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF), which have a key role in the development of tendinitis. |
| Increased production of COX-2, phospholipase A2 and stress-activated protein kinase: | Increased production of COX-2, phospholipase A2, and stress-activated protein kinase also occurs, contributing to increased inflammatory responses. |
| Proinflammatory mediators such as prostaglandin 2 (PGE2) and thromboxanes: | Pro-inflammatory mediators such as prostaglandin 2 (PGE2) and thromboxanes can be up to 50% elevated in people with chronic tendon strain. |
How do pain and inflammation develop in tendinitis?
- Pro-inflammatory cytokines: Tendon cells that are cyclically stressed exhibit a higher concentration of pro-inflammatory cytokines such as interleukin 1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF), which have a key role in the development of tendinitis.
- Increased production of COX-2, phospholipase A2, and stress-activated protein kinase: Increased production of COX-2, phospholipase A2, and stress-activated protein kinase also occurs, contributing to increased inflammatory responses.
- Pro-inflammatory mediators such as prostaglandin 2 (PGE2) and thromboxanes: Pro-inflammatory mediators such as prostaglandin 2 (PGE2) and thromboxanes can be up to 50% elevated in people with chronic tendon overload.
Explain me like I’m 5:
If your tendons have a lot of stress, there may be substances in your body that cause inflammation, these are called pro-inflammatory cytokines. Enzymes in your body make these substances.
This happens, for example, in tendinitis, a painful tendon condition. Other substances can also create inflammation, such as COX-2, phospholipase A2, and stress-activated protein kinase. This can also lead to inflammation in tendinitis.
Prostaglandin 2 (PGE2) and thromboxanes are also substances that can cause inflammation. In people with chronic tendon strain, these substances are often elevated, which can cause a lot of pain and inflammation.
Treatment of tendinitis
| Effects | Effects |
|---|---|
| Glucocorticoids and classic analgesics | Glucocorticoids and classic analgesics (NSAIDs) are often used for tendinitis because they can reduce both pain and tendon thickness. |
| Rest and exercise therapy | It is important to give the tendon adequate rest and do specific exercise therapy under the guidance of a physiotherapist/physiotherapist to recover from tendinitis. |
| Enzymes as an alternative treatment | Small studies show that enzymes may be an effective treatment in reducing pain and inflammation in tendinitis. |
- Glucocorticoids and classic painkillers: Glucocorticoids are the most frequently used in tendinitis alongside classic painkillers (NSAIDs) because they are able to greatly reduce both pain and tendon thickness.
- Rest and exercise therapy: In addition, it is important to rest the tendon in question sufficiently and have it supported by a physiotherapist/physiotherapist with specific exercise therapy.
- Enzymes as an alternative treatment: There are several small-scale studies showing that enzymes can also be effective in reducing pain and inflammation.
| Effective ingredient | Effect |
|---|---|
| Bromelain | Has anti-inflammatory effects and may help reduce swelling and pain. |
| Trypsin | Has proteolytic activity, which means that it can help break down proteins and thus contribute to the repair of damaged tendon tissues. |
| Rutin | Has antioxidant activity and may help protect cells from free radical damage. |
| Boswellia serrata | Has anti-inflammatory effects and may help reduce swelling and pain. |
| Curcuma longa | Has anti-inflammatory effects and may help reduce swelling and pain. |
| Nutritional therapy | Can help strengthen collagen fibers, preventing the development of inflammation and degradation of tendons. |
Enzymes in tendinitis
- Prospective randomized clinical trial with multi-enzyme complex: For example, the medical journal Arthritis & Rheumatology published a prospective randomized clinical trial in 2009. In it, Canadian postal workers with shoulder tendinitis were given six tablets of a multi-enzyme complex daily for eight weeks; 90 mg bromelain, 48 mg trypsin, and 100 mg rutin. According to the pain index SPADI (Shoulder pain and Disability Index), pain decreased no less than 54.5%, compared to 18% in the control group who received only physical exercise.
- Phytotherapeutic combination of Boswellia serrata and Curcuma longa: Similar tendon pain reduction with the phytotherapeutic combination of Boswellia serrata and Curcuma longa was published in March 2021. This was a Walloon open-label post-observational study led by Professor Yves Henrotin. In it, Belgian patients with tendinopathy were administered two tablets containing the two phyto-extracts twice daily for one month. Regardless of the cause, localization and duration of the tendon complaints, the pain score decreased by fifty percent.
- Nutritional therapy to strengthen collagen fibers: It is important to use nutritional therapy both preventively and post-curative to strengthen collagen fibers and thus prevent degradation and inflammation of tendons.
Conclusion
- Enzymes as a complementary approach to tendinitis: Enzymes can be an effective and natural complement to the treatment of tendinitis, in addition to classic analgesics and rest.
- Importance of nutritional therapy: In addition, it is important to pay attention to proper nutritional therapy to strengthen collagen fibers to prevent tendonitis.
Source reference
- U. Fredberg, K. Stengaard-Pedersen. Chronic tendinopathy tissue pathology, pain mechanisms, and etiology with a special focus on inflammation. Scand J Med Sci Sports 2008: 18: 3-15.
- Orest Szczurvedo et al. Oral enzyme combination versus diclofenac in the treatment of osteoarthritis of the knee – a double-blind prospective randomized study. Clin Rheumatol 2004;23(5):410-5.
- Orest Szczurko et al. Curcuminoids and Boswellia serrata extracts combination decreases tendinopathy symptoms: findings from an open-label post-observational study. December 2020. Current Medical Research and Opinion 37(1):1-1.
- Gregory Shaw et al. Vitamin C-enriched gelatin supplementation before intermittent activity augments collagen synthesis. Am J Clin Nutr 2017;105:136-43.
- Luke Curtis. Nutritional research may be useful in treating tendon injuries. Nutrition Volume 32, Issue 6, June 2016, Pages 6
