Treatment for Tendinitis/ Tendinosis

Last blog we discussed the differences between tendinitis and tendinosis, now we will discuss treatments. By the time you feel pain from tendinosis, your injury has been gradually building for many weeks or months. Remember that tendons heal slowly, due to limited blood supply. You will probably need to wait several months before a reasonable amount of repair has occurred, so have patience with this slow healing process. While both conditions are classically treated with conservative measures, the difference in care is absolutely critical to resolution of the problem. Conservative management stems around rest and anti-inflammatory medication for tendinitis, while conservative management of tendinosis aims to restore tendon regrowth and strength through manual therapy and eccentric exercise.

You'll need to avoid activities that cause pain, which can be a problem when some of those activities involve your work. Keep doing the normal daily activities that don't cause you pain. Treatment for tendinitis can be simply RICE (rest, ice, compression, elevation) to reduce inflammation and allow healing.

Braces are often used for the wrist, elbow, knee, and ankle. Some people find that braces can add stability and support during activity. Braces should not be worn all the time because you can lose strength and flexibility, but they can be helpful if worn part-time. This can be done for work or at night with wrist braces for carpal tunnel symptoms.

Stretching and strengthening with emphasis on eccentric exercise is especially helpful for tendinosis. Muscle is forced to lengthen while it contracts because it is being used as a brake or to absorb energy while doing "negative work." On the other hand, concentric exercise is when a muscle shortens as it contracts because it is acting as an engine doing "positive work." 

Correcting ergonomic problems can be very helpful in healing workplace tendinosis. Some foods and supplements, such as ginger and turmeric, can help reduce inflammation. 

 Your best bet is to maintain a healthy weight and eat a plant-based diet with plenty of antioxidant-rich whole fruits, vegetables, nuts, legumes, and grains, while eating minimal amounts of trans-fats, saturated fats, and simple carbohydrates.

Traditional treatments involve use of anti-inflammatories, corticosteroid injections, and/or pain medication for the treatment of tendonitis. It has been proven that these can actually further the degeneration of tendons and increase the risk of recurrence of the condition as well as increase the risk of tendon rupture. That being said, corticosteroid injections and anti-inflammatory medications have been shown to be effective in short term pain reduction for tendinitis.

Soft tissue mobilization can speed healing, restore proper collagen synthesis, strength and function. Chiropractic helps by aligning joints properly around the problem area which puts less stress on tendons. You then can break down the adhesions / restrictions and allows the tendons to heal properly. After an injury the body makes scar tissue to heal the area quickly but this must be broken down to allow proper healing of the tendon. If this is not done, tendons can weaken and rupture. I utilize soft tissue techniques such as Graston and ART and ultrasound therapy. These help breakdown adhesions/ scar tissue and stimulates collagen synthesis to heal tendinosis. If you or a loved one is having these problems call to book an appointment to get on the road to recovery. 

Dr. Stephen Kelly practices at Family First Chiropractic, 142 Erickson Drive, Red Deer, Alberta. 403-347-3261. www.family1stchiro.ca.

The World Of Tendons

A tendon is a cord or band of dense, tough, inelastic, white, fibrous tissue, serving to connect a muscle with a bone. Think Achilles tendon, which attaches your calf muscle to the heel. Damage or injury to tendons is quite common. There is two different issues-tendinitis and tendinosis. One you’ve probably heard of before. The other, probably not. While they both sound the same, in reality they are worlds apart.

Tendinitis is, by definition, inflammation of a tendon.  Tendinosis on the other hand is defined as chronic tendinitis without inflammation and implies chronic tendon degeneration at the cellular level. Basically, one is short-term with inflammation, the other long-term, without inflammation, though both are caused typically by overuse. Repetitive strain injury (RSI) goes by a lot of names – it can also be called tenosynovitis or chronic tendinopathy by doctors. Don’t let their fancy jargon scare you! It’s kind of simple – tendinitis happens when you repeat a motion frequently on tight tissues and when the rate of damage exceeds your body’s natural rate of repair. 

NORMAL TENDON Uniform, Organized, & Parallel            

 

 

FRAYED TENDON (TENDINOSIS) Unorganized, Tangled, & Random

 

      

                         

Tendinitis, the most popular diagnosis of the two, usually presents with swelling and tenderness at the sight of pain, often accompanied by stiffness, and less often by weakness. Tendinosis presents most often with stiffness, tenderness to the touch, and weakness–almost identical to tendinitis. Recovery of tendinitis lasts anywhere from days to six weeks, a relatively “quick fix.” Tendinosis recovery can last a few short weeks to a couple months or more depending on the level of degeneration. If left untreated, tendinosis often leads to “tear” injuries

Tendinitis and tendinosis, both, occur most often in the Achilles tendon (ankle), patellar tendon (knee), proximal hamstring (high hamstring), common extensor tendon (elbow), and the supraspinatus tendon (shoulder). With both of these problems being so relatively close, while treatment is vastly different, proper diagnosis is vital to the recovery process! So which one do you have? Let’s go to the research.

While tendinitis is the wildly over-popular diagnosis among general practitioners, it may not be the case. Most research coming out on this topic is now showing that at a cellular level, once believed tendinitis actually is, in fact, tendinosis.

According to Almekinders and Temple, “Most currently practicing general practitioners were taught, and many still believe, that patients who present with overuse tendinitis have a largely inflammatory condition and will benefit from anti-inflammatory medication. Unfortunately this dogma is deeply entrenched. 10 of 11 readily available sports medicine texts specifically recommend non-steroidal anti-inflammatory drugs despite the lack of clinical evidence.”

In light of this, chances are that if you have been diagnosed with tendinitis the diagnosis was incorrect. Furthermore, traditional, conservative treatment, of such, with the use of anti-inflammatories, corticosteroid injections, and/or pain medication may have left you worse off long term even though pain may have dissipated short term. This is because these drugs inhibit collagen repair and are designed to eliminate inflammation, not regrow tendon. As mentioned above, treatment of tendinosis should be aimed at restoring tendon function and strength. Drugs will not help solve the problem! With all this said, while we cannot assume a tendinitis diagnosis was incorrect, lingering, worsening, or reoccurrence of pain would suggest that it may in fact be tendinosis. It is recommended that treatment plans geared toward tendinitis, in these cases, be re-evaluated.

Tendinitis is one of the most commonly diagnosed injuries and all too many struggle to find relief. With the proper diagnosis and treatment plan, it doesn’t have to be that way!

The next blog will discuss treatments for tendinitis/tendinosis. Stay tuned!

Dr. Stephen Kelly practices at Family First Chiropractic, 142 Erickson Drive, Red Deer, Alberta. 403-347-3261.www.family1stchiro.ca.