I received a letter from a good friend and mentor of mine last week and I thought it might be helpful to pass on the latest information regarding treatment of tendonitis.
I will summarize the best I can.
A lot of people are suffering with tendonitis and like so much else out there, the proper treatment is necessary to find relief.
I repeatedly write and talk about how important it is to keep searching for solutions.
I understand it gets frustrating if this has been a long-standing problem for you, but somewhere out there, someone new will hear what you say a bit differently and find the solution you have been searching for, in some cases for years.
First things first: what is a tendon?
A tendon is a structure that attaches a muscle to the bone. It gains its primary strength from collagen fibers that run through it.
Collagen is like the little strings that run through packing tape.
This provides a tensile strength allowing us to move our bones and joints when the muscles contract.
Tendons are the junction between muscle and bone.
A tendon injury is often diagnosed as a tendonitis. Tendonitis implies that there is an inflammation, using Latin word roots, it translates literally as “an inflammation of the tendon.” Inflammatory responses are often the result of an acute injury or a repetitive stress injury.
Once an inflammatory response occurs, it must run its course.
The most common approach to an injury of the tendon is to make the inflammation go away.
A typical tendonitis will resolve in two to four weeks if it is an acute onset, and if it is a longer-standing tendonitis, it should be better in four to six weeks.
The vast majority of cases of “true" tendonitis resolve in a 6-week time frame.
The common tendonitis treatment is anti-inflammatory medications, rest and ice.
Typically, people who have had long-term problems and who have tried treating it with either injections or oral medications, will not respond very well and will become frustrated.
The latest research has helped me to realize that the majority of patients who come in with “tendonitis” may actually have a tendonosis, which is a degenerative condition of the tendon.
Tendonosis is characterized by degeneration of the collagen fibers in the tendon, tendon weakness, abnormal growth of unhealthy blood vessels through the tendon and most importantly no inflammatory cells.
It is not an inflammatory condition.
This means that anti-inflammatory drugs will not be effective.
Basically, the strong fibers of collagen, which are typically lined up in a nice orderly fashion, become a tangled mess of strings with little pockets of “jelly” and small weak blood vessels.
I can describe this as being like a big bowl of spaghetti that you accidentally left out on the countertop over night.
When you wake up the next morning and look in the bowl, the spaghetti is a big twisted, rigid mess.
The treatment of tendonosis is very different from treating tendonitis. This may explain to some why they are struggling to find relief from an inflammation: it isn’t inflamed.
There are some important distinctions to make that will help you determine if the pain is coming from an inflammatory response or not.
First and foremost is how recent the injury is.
If the injury happened recently, within the last four weeks, then it likely is inflamed.
If the injury was months or years ago, it is likely not going to respond to typical treatments.
This, by the way, is one explanation of why people with sciatica, which is often the result of an inflamed nerve root, are not getting better with anti-inflammatory treatments. If the condition is chronic — older than three months old — it is likely the result of changes to the tissue instead of inflammation.
For the treatment of tendonosis, my rule of “going to the pain, not through the pain” is especially important.
If you try to push through the pain, you will be left with more pain and more problems.
The key is to learn the proper exercises to rebuild the tendon and regain the strength of the tissue.
Unfortunately, it is too much to write the specific exercises needed to recover from a tendonosis, but there are definite solutions, even if it has been a problem for years.
The down side to treating a tendonosis properly is that it takes at least eight weeks to have a physiologic change.
Some people may even take eight to nine months to recover fully.
The good news is that the vast majority of people can and will respond to proper treatment.
As a general rule, if you have been treated for several months or years, it is likely you are not getting to the sources and if you are interested in resolving the condition fully, you need guidance to get from point A to point B.
There are also a few things that we do at the Wellness Center that can help the healing process, but keep in mind the process takes a long time — up to nine months if you have a long-standing problem to begin with.
My main point is similar to most of my main points- there is hope.
Even if you have a chronic condition and you have “tried everything” to resolve it, it may be that you just need to try someone or something else.
I have been treating chronic conditions for years and more and more research is coming out supporting the approach I was taught.
It is not always easy to identify the exact problem you are facing, which is why it is so important to continue looking for answers.
Thanks for reading my columns! I look forward to seeing you at the Wellness Center. If there are specific questions or topics that you would like Matthew to write about please call 332-4336 or e-mail me at firstname.lastname@example.org.
Matthew Goodemote, a Gloversville native, owns Community Physical Therapy & Wellness. His Health & Wellness column will answer your questions and discuss topics that are relevant to your everyday way of life. If you would like to ask a question, e-mail Matthew at email@example.com.