Tendinitis Takes Rafael Nadal Out of Olympics

Rafael Nadal, the Olympic Gold Medal tennis singles winner in Beijing, will not defending his title. Nadal has been forced to withdraw from the Spanish Olympic Tennis Team because of tendinitis in his right knee.

Currently ranked number 3 in the world, Nadal  has won eleven Grand Slam singles titles, including an all-time record seven French Open titles, and had been ranked number 1 from June 7, 2010 to  July 3, 2011.

In 2009, Nadal was sidelined for much of the year with bilateral knee tendinitis. However he came back strong in 2010, winning three out of four Grand Slam titles.

However, this year his knees have once again become a problem. It is said that he injured his right knee in January during the Australian Open. He still managed to make it to the finals, but was beaten by Novak Djokovic in five sets. The match was the longest ever match for a Grand Slam title, lasting 5 hours and 53 minutes.

Last month at Wimbledon, Nadal was upset by 100th ranked Lukas Rosol. He had to withdraw from a charity exhibition scheduled against Djokovic a week later to “rest his knee.” He still hoped he could rehab his knee sufficient to participate in the London Olympics.

But it is not to be. Today, Rafael Nadal withdrew from the Spanish Tennis Team. It told reporters that this is “one of the saddest days of my career as one of my biggest ambitions, that of being Spain’s flag-bearer in the opening ceremony of the Games in London, cannot be.”

I do not find myself in a condition to compete. I have to think about my companions. I can’t be selfish, and I have to think of what’s best for Spanish sport, especially tennis and Spanish players, and give fellow sportsmen with better preparation the chance to compete.

What Is Tendinitis?

Tendinitis is a common condition that involve inflammation of the soft tissue around muscles and bones, most often in the shoulder, elbow, wrist, hip, knee, or ankle. A tendon is a flexible band of fibrous tissue that connects muscles to bones. Tendons transmit the pull of the muscle to the bone to cause movement. They are found throughout the body, including the hands, wrists, elbows, shoulders, hips, knees, ankles, and feet. Tendons can be small, like those found in the hand, or large, like the Achilles tendon in the heel. Tendinitis is an inflammation of a tendon.

What Causes Tendinitis?

Tendinitis is most often the result of a repetitive injury in the affected area. These conditions occur more often with age. Tendons become less flexible with age, and therefore, more prone to injury. People such as carpenters, gardeners, musicians, and athletes who perform activities that require repetitive motions or place stress on joints are at higher risk for tendinitis .

Tendinitis causes pain and tenderness just outside a joint. Some common names for tendinitis identify with the sport or movement that typically increases risk for tendon inflammation. They include tennis elbow, golfer’s elbow, pitcher’s shoulder, swimmer’s shoulder, and jumper’s knee.  These conditions can also occur with any activity that involves repetitive wrist turning or hand gripping, such as tool use, hand shaking, or twisting movements.

How is Tendinitis treated?

Treatment focuses on healing the injured tendon. The first step in treating this condition is to reduce pain and inflammation with rest, compression, elevation, and anti-inflammatory medicines such as aspirin, naproxen (Naprosyn1, Aleve), or ibuprofen (Advil, Motrin, or Nuprin).

Ice may also be used in acute injuries, but most cases of tendinitis are considered chronic, and ice is not helpful. When ice is needed, an ice pack can be applied to the affected area for 15-20 minutes every 4-6 hours for 3-5 days. Longer use of ice and a stretching program may be recommended by a health care provider.

Activity involving the affected joint is also restricted to encourage healing and prevent further injury. In some cases a physician may recommend a support strap (called an infrapatellar strap or a Chopat strap), a knee brace, or custom orthotics to provide some pain relief, limiting the pull of the tendon on the bone.

The doctor or therapist may use ultrasound (gentle sound-wave vibrations) to warm deep tissues and improve blood flow. Iontophoresis may also be used. This involves using an electrical current to push a corticosteroid medication through the skin directly over the inflamed tendon.

Gentle stretching and strengthening exercises are added gradually. Massage of the soft tissue may be helpful. These may be preceded or followed by use of an ice pack. The type of exercises recommended may vary depending on the location of the affected tendon.

If there is no improvement, the doctor may inject a corticosteroid medicine into the area surrounding the inflamed  tendon. While corticosteroid injections are a common treatment, they must be used with caution because they may lead to weakening or rupture of the tendon (especially weight-bearing tendons such as the Achilles [ankle], posterior tibial [arch of the foot], and patellar [knee] tendons).

If there is still no improvement after 6-12 months, the doctor may perform either arthroscopic or open surgery to repair damage and relieve pressure on the tendons.

Can Tendinitis Be Prevented?

To help prevent inflammation or reduce the severity of its recurrence:

  • Warm up or stretch before physical activity.
  • Strengthen muscles around the joint.
  • Take breaks from repetitive tasks often.
  • Cushion the affected joint. Use foam for kneeling or elbow pads. Increase the gripping surface of tools with gloves or padding. Apply grip tape or an oversized grip to golf clubs.
  • Use two hands to hold heavy tools; use a two-handed backhand in tennis.
  • Don’t sit still for long periods.
  • Practice good posture and position the body properly when going about daily activities.
  • Begin new activities or exercise regimens slowly. Gradually increase physical demands following several well-tolerated exercise sessions.
  • If a history of tendonitis is present, consider seeking guidance from your doctor or therapist before engaging in new exercises and activities.

(Source: NIAMS)

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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