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.

New Treatment Guidelines Stress Non-Drug Interventions for Back Pain

Back pain is one of the most common health complaints across the globe, and the No. 1 cause of job disability. It's also one of the most common reasons triggering opioid dependence, the side effects of which can be lethal.

In 2013 alone 16,000 Americans died from overdosing on prescription painkillers. If you have back pain and suffer depression or anxiety you're at particularly high risk for opioid abuse and addiction.

Mechanical low-back pain (LBP), is the second most common symptom-related reason for doctor's visits. LBP is typically preceded by some form of injury or strain, such as lifting, twisting while holding something heavy, a car collision or a fall.  

Prolonged sitting is also on this list, which may explain why simply standing up more is part of the solution in many cases. Some of the things that can help low back pain are controlling inflammation, restoring range of motion, improving muscle strength and endurance, coordination training and cardiovascular reconditioning and an exercise program.

Activity Is the First Line of Treatment

Research shows us emphasis is on functional movement and exercise. This holds true for most forms of back pain, not just LBP. This makes sense since your body needs regular activity to remain pain-free. When you sit for long periods of time, you typically end up shortening your iliacus, psoas and quadratus lumborum muscles that connect from your lumbar region to the top of your femur and pelvis. When these muscles are shortened it can cause severe pain upon standing, as they will effectively pull your lower back forward. When there's insufficient movement in your hip- and thoracic spine, you also end up with excessive movement in your lower back.

Most people tend to "baby" the pain and avoid moving about as much as possible, but in most cases, this is actually contraindicated.

Lesley Colvin, a pain medicine specialist in Edinburgh, says the best evidence is for exercise. 'If I had back pain, I'd do exercise that strengthens the core and stretching.' Just when you least feel like it, and it hurts the most, is when experts say you have to get moving. 'Avoid bed rest'."

Exercise is also the most effective way to prevent back pain in the first place, or a relapse, according to a recent scientific review of 21 studies. 

Among people who had a history of back pain, those who exercised had a 25% to 40%  lower risk of having another episode within a year than those who did no exercise. Medical doctors are increasingly starting to prescribe activity in combination with a wait-and-watch approach for back pain patients.

On February 14/17, the American College of Physicians issued updated treatment guidelines for acute, subacute and chronic low back pain, now sidestepping medication as a first-line treatment and recommending non-drug therapies instead. This is a significant change, and one that could potentially save thousands of lives by avoiding opioid addiction.

The new guidelines include three primary recommendations, all of which focus on alternative treatments and physical activity, leaving painkillers as a very last resort. Even in the rare case when an opioid is given, it should only be prescribed in the lowest dose and for the shortest duration possible.

Steroid injections and acetaminophen are also discouraged, as studies suggest neither is helpful or beneficial. Acetaminophen does not lower inflammation, and a review of the research shows steroids are on par with placebo when it comes to treating back pain in the long term.

1. “Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select non-pharmacologic treatment with superficial heat … massage, acupuncture, or spinal manipulation … If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants.

2. For patients with chronic low back pain, clinicians and patients should initially select non-pharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, or spinal manipulation.

3. In patients with chronic low back pain who have had an inadequate response to non-pharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy.

Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients.”

Scans and Surgery Are Useless for Most Cases of Back Pain

According to the American College of Physicians, scans like MRIs are also to be avoided, as they're "worse than useless" for diagnosing back pain. Exceptions include cases of known trauma to the spine and where there are warning signs of underlying disease causing the pain (such as cancer). Contrary to popular belief, disc degeneration does not cause back pain, so getting a scan and receiving a structural diagnosis of a bulging disc for example, is not going to be very helpful, at least not in terms of dictating a course of treatment for your pain. In many cases, such a diagnosis may simply lead to unnecessary surgery, which in many cases sends patients in a downward spiral of increasing pain and reduced mobility. According to the medical literature, spinal fusions for back pain have a success rate of about 20 to 25 percent. For 75 to 80 percent of these patients, the surgery simply results in lifelong pain and suffering.

Live Life and Avoid Medicalizing Your Pain 

Dr. James Weinstein, a back pain specialist stated "What we need to do is to stop medicalizing symptoms. Pills are not going to make people better … why not just go back to your normal activities? I know your back hurts, but go run, be active, instead of taking a pill."

While this may sound harsh to some of you, it's actually really good advice. As noted by Dr. Steven Atlas, an associate professor at Harvard Medical School who wrote an accompanying editorial about the guidelines, "We are moving away from simple fixes like a pill to a more complex view that involves a lot of lifestyle changes," and that is certainly a much-needed turnaround.

Non-Exercise Activity May Be Part of Long-Term Solution for Back Pain

Keep in mind that part of "staying active" includes avoiding sitting as much as possible. Avoid the hazards of sitting and began standing more. Be aware that your pain may worsen initially, but will improve with time. If you have a desk job, consider investing in a stand-up desk.

Non-Drug Solutions for Pain Relief

It's extremely important to be fully aware of the addictive potential of opioid drugs, and to seriously weigh your need for them. There are many other ways to address pain.  Clearly, there are times when pain is so severe that a narcotic pain reliever may be warranted. But even in those instances, the options that follow may allow you to at least reduce the amount you take, or the frequency at which you need to take them. 

If you need a pain reliever, consider an over-the-counter (OTC) option. Research shows prescription-strength naproxen (sold OTC in lower dosages as Aleve) provides the same pain relief as more dangerous narcotic painkillers.

Many studies have confirmed that chiropractic management is much safer and less expensive than allopathic medical treatments, especially when used for pain such as low back pain.

Chiropractic and naturopathic physicians are reliable, as they have received extensive training in the management of musculoskeletal disorders during their course of graduate healthcare training. We have comprehensive training in musculoskeletal management.

Medical doctors are often slow to change from pharmaceutical treatments.

As Chiropractors, this research backs up what we have been saying for over 100 years. Get the spine that is in abnormal position moving again with Chiropractic adjustments. Then stretch and exercise to strengthen the spine and its supporting structures. M.D.’s and researchers are finally coming around to what has been a Chiropractic tenant since its inception. So if you have back pain, do what the research says, get adjusted and avoid drugs.

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

CranioSacral Therapy

              CranioSacral Therapy

Now that a new school year has started and we are getting back into a regular schedule we need to start thinking about how we can help our children do their best this school year.

CranioSacral Therapy, like most other formal and complementary treatments is never successful in 100% of cases. However, the following gives some idea of the degree of success in certain situations:


· Dr. John Upledger's research has found that 50 – 60% of hyperactive child problems originate in the CranioSacral system and can be treated successfully with CST.

· Learning disabilities and dyslexia – again 50-60% of problems can be effectively treated with CST if the problem is caused by a malfunction of the CranioSacral system.

· Autism. Three years of intensive research with autistic children in the late 1970’s revealed significant reduction in self-destructive behaviour and improvement in displays of affection and social interaction. These improvements, however, usually deteriorated in 3-6 months after the CranioSacral Therapy treatment discontinued.

Jeannette Raskin C.S.T is at Family First Chiropractic on Wed and Sat. To book an appointment with  her call us at 403-347-3261. www.family1stchiro.ca 142 Erickson Dr Red Deer