Layman's tendonopothy and inflammation article

A little wordy for me, but still lays down a good, easy to read synopsis of where we are at with Tendonitis -Tendonopathy

Of great interest to me is the Three Stage idea in treatment which seems to be taking hold.

Unfortunately the author offers little in terms of specifics of treatment, but does help in giving a basis of how to view this all to common injury.

Part 1 -

http://saveyourself.ca/blog/0379.php

Part 2 -

http://saveyourself.ca/blog/0380.php

Yeah, he's all over the place. It's hard to imagine reading a book by him

Or listening to one.

Believe he is describing "tendonosis". It can come about from cycles of tendon injuries

without proper healing. That last I heard it had immune system involvement as well,

even though not mostly of an inflammatory nature.

A biopsy might be needed to really confirm the diagnosis.

The treatment isn't radically different from tendonitis though so I doubt it matters.

If the achillies, rest, stretching/massaging the calf/foot muscles, ice/heat, graston ...

this worked for me in any event.

Yeah, he's all over the place. It's hard to imagine reading a book by him

Or listening to one.

Believe he is describing "tendonosis". It can come about from cycles of tendon injuries

without proper healing. That last I heard it had immune system involvement as well,

even though not mostly of an inflammatory nature.

A biopsy might be needed to really confirm the diagnosis.

The treatment isn't radically different from tendonitis though so I doubt it matters.

If the achillies, rest, stretching/massaging the calf/foot muscles, ice/heat, graston ...

this worked for me in any event.

Treatment is quite a bit different than tendonitis, because tendonitis clears up in a few weeks. If it takes longer, you are dealing with some level of degeneration. MRI can also be used to diagnose.

There are a lot of different protocols, but to my mind it is silly to only follow one. At first, slow concentrics + slow eccentrics are going to yield the best results because a degenerated tendon often isn't elastic enough to handle ballistic movements. Once you reach 70-80% of pre-injury strength (maybe as early as 50% if you are careful) you will want to slowly start building up ballistic curls with just your arm and no weight. You would pretty much never want to do this with more than 10-15 lbs, and go up in weight slowly because forces are multiplied by many times with this sort of thing. You extend the arm fairly quickly and then immediately do the biceps curl, it's like a plyometric. Stretch reflex is being used. This starts re-conditioning the tendon for elastic action, which is part of what they are made for.

It is also smart to do gentle graston-type work 2-3x per week for 1-2 minutes total per session on the injured area, along with cross friction massage for 1-2 minutes on the off days between graston-type treatments. This part of the rehab process helps A) recondition the nervous system, B) helps release mast cells which initiate the localized inflammatory processes that CAUSE HEALING, and in theory also recondition the fascia to be more flexible. This also helps cause new collagen fibers to be laid down parallel to the tendon, which is what you want. It is important to stretch gently after these graston and cross-friction sessions for at least 60s and preferably 3-5 minutes so that the initial proteins are laid down as straight as possible. Remember, healing starts immediately. There is no delay. The stretch should be held for the entire period of time, and it is important to not feel pain at all, on any level. Some tension, yes, but zero pain.

have not yet read the article. Just giving some practical information about progressive and concurrent treatment options.

Heat lamps can help accelerate the healing processes, as can any other form of heat as long as it is gentle and tissue temperature is not allowed to exceed 100 degrees or so.

Treatment is quite a bit different than tendonitis, because tendonitis clears up in a few weeks. If it takes longer, you are dealing with some level of degeneration. MRI can also be used to diagnose.

There are a lot of different protocols, but to my mind it is silly to only follow one. At first, slow concentrics + slow eccentrics are going to yield the best results because a degenerated tendon often isn't elastic enough to handle ballistic movements. Once you reach 70-80% of pre-injury strength (maybe as early as 50% if you are careful) you will want to slowly start building up ballistic curls with just your arm and no weight. You would pretty much never want to do this with more than 10-15 lbs, and go up in weight slowly because forces are multiplied by many times with this sort of thing. You extend the arm fairly quickly and then immediately do the biceps curl, it's like a plyometric. Stretch reflex is being used. This starts re-conditioning the tendon for elastic action, which is part of what they are made for.

It is also smart to do gentle graston-type work 2-3x per week for 1-2 minutes total per session on the injured area, along with cross friction massage for 1-2 minutes on the off days between graston-type treatments. This part of the rehab process helps A) recondition the nervous system, B) helps release mast cells which initiate the localized inflammatory processes that CAUSE HEALING, and in theory also recondition the fascia to be more flexible. This also helps cause new collagen fibers to be laid down parallel to the tendon, which is what you want. It is important to stretch gently after these graston and cross-friction sessions for at least 60s and preferably 3-5 minutes so that the initial proteins are laid down as straight as possible. Remember, healing starts immediately. There is no delay. The stretch should be held for the entire period of time, and it is important to not feel pain at all, on any level. Some tension, yes, but zero pain.

have not yet read the article. Just giving some practical information about progressive and concurrent treatment options.

Heat lamps can help accelerate the healing processes, as can any other form of heat as long as it is gentle and tissue temperature is not allowed to exceed 100 degrees or so.

Yes, I meant to mention it's a chronic condition. However, the distinction is easily blurred, especially if you're dealing

with a recurring case of tendonitis. Even tendonosis can have its good and bad days.

You laid down an excellent summary.

Still, I'm not seeing that the treatments are radically different, though one takes longer to resolve.

I have had both, and used strengthening exercises in both as well.

Do you see the physical treatments as being massively different?

You are on top of these things, although theory and practice are two different things.

The main impression I got from the article was the pointlessness of using AA drugs in this situation.

Future: There is pretty much no such thing as recurring tendonitis, especially when you are talking about something popping up a) once a month or something or b) every time you reach a certain strength level (approximately). Both of those are markers of degenerative changes.

However, I do believe that the body does occasionally try to re-start the inflammatory process in an attempt to heal itself. You're right though, if there's one thing to take away from that article it is this: You should never, ever, ever take anti-inflammatory drugs. Tendon inflammation is good, it means your body is trying to heal. Your job is to listen, take time off, and build strength back up slowly after the pain is gone.

The major difference between treatments is that the above paragraph is literally all you have to do for true tendonitis. The following is what you will have to do for tendonosis. It is much more complicated, simply because you have to manually start the processes that once were automatic. These can also be used to accelerate tendonitis recovery but that is optional: With moderate to severe cases of degeneration they are really not optional.

DIsclaimer: I am now hungry and unable to be quite as coherent as I would like. My time is up for today. I can fill in blanks tomorrow or something.

I am not yet a licensed physician, that is some years away, so what I am about to write is for informational purposes only and represents my personal opinions and experience as well as my current understanding of the science behind this area. Do not take what I am about to suggest as medical advice, it is not. Unfortunately there are virtually no clinicians of any specialty that integrate treatment the way I am about to suggest. I intend to be one of the first. It will probably not be possible all the time, because it will TAKE a bit more time than what insurance currently wants to pay for. Ah well, that's life. I will be working on ways to get the most out of all this in the least amount of time. Anyways... to my post:

I have to disagree with a lot of what he is saying. There is very, very good evidence that corticosteroids are almost never an acceptable treatment, and that the only time they should EVER be considered for use is with a severe acute injury that is not repetitive. They DO CAUSE direct degeneration of the connective tissues (tendons, cartilage, etc) and that is a fact. I don't say that often, but that is a FACT. Do not get cortisone shots, but if for some ridiculous reason you do, you MUST take it really easy for at least 6-8 weeks (take intensity down by at least 30-40% and keep it there) and then get yourself on a progressive, slow rehab program. You need to fix the damage that drug did or you are probably going to have a rupture. I've seen this a lot, most recently with my older brother. In my opinion his doctor should be sued for malpractice. Gave him 2 cortisone shots in like 6 months, and no warnings about taking it easy. Pisses me off.

The biochemistry thing is somewhat true, but we know so much more about the functioning of the immune system and chronic injury and why modalities like ART, graston, cross friction massage, etc can be of great use. It should also be common sense as to what needs to be done where, at least for people with a good base in functional anatomy. Deep tissues don't respond well to Graston because you can't reach them with the tools. You just end up wrecking the superficial muscles in the process... I know several people who were injured by thigh Graston work, and after trying it on myself I didn't like how it felt at all. I think that it may have some usefulness but primarily as a gentle treatment meant to prime the tissue for the real treatment in the thigh (which should really be ART-style or SMR)

Best areas for Graston are extremities, excluding the thigh, the entire back and shoulders, neck (especially the posterior 1/3) and bony prominences. You have to be careful with the bones, but that is an important area to not ignore. There are always connective tissues there that need to be addressed. Quads and hams seem to respond better to ART. Patellar tendon in particular responds well to cross friction, but everything responds well to that. Cross friction works well on a lot of places. ART works many places as well, and is a good compliment to Graston or perhaps visa versa.

You never treat an area for more than 2 minutes per session, with 2-3 sessions per week depending on how intense the sessions are. Exception is cross-friction, which can be used 2-3 times per day. This is because it is possible to be much more gentle on the tissues with cross friction while still stimulating the healing processes.

Gentle heat accelerates the healing process, as does proper nutrition. Do NOT take antioxidant supplements, they will prevent your body from destroying the messed up cells, and if you can't get rid of the trash you can't replace it with new parts. Make sense? Good. No? Anti-oxidants prevent oxidation. Lysosomes oxidize (digest) damaged cells, that's how we get rid of the trash. Then our macrophages and phagocytes and other immune cells take the trash away. Then we put fresh new cells in their places. Anti-oxidant supplements interfere with this process. Don't get in your own way. Just eat your veggies.

Underneath all of this, you MUST concurrently correct dysfunctional posture and movement before returning to strength training or all of the above is a wasted effort.

THAT is what we know so far.

Excellent points.

In my youth I received two cortisone injections for osgood schlatters. Even if it didn't weaken my tendons it was painful, and there is no evidence that the prognosis with shots is better than symptomatic treatment, i.e. doing nothing! And shots in the "bone" hurt like hell! In any event, that leg's achillies had the tendonosis so it may have been related.

You earned your salt. Enjoy your meal.

Edit: A practitioner will have to see a history of multiple tendonitis reoccurance (if you don't want to call it that,

never resolved then) before giving a diagnosis of tendonosis. So failure to resolve leads to tendonosis conclusion.

If it's a regular thing, more than once or twice a year perhaps, then consider it might not be tendonitis. Perhaps

that diagnostic approach change in time, and with earlier access to MRI, but that has been my experience.

Actually if you want to get real technical about it, there is no such thing as tendon-ITIS because the tendon has no inflammatory cells in it. It's actually called a tendonopathy...Also, it's quite a common misconception that the tendon itself is damaged...The sheath of fascia that covers the tendon (i've forgotten the name) is usually the culprit that is presenting the symptoms of a tendonopathy.

There is a post somewhere on here that Josh posted on the ideal process and rehab necessary to efficiently treat a tendonopathy.

Infact, if Josh could post the link to it...that would be very helpful!

cheers all