TENDINITIS

Tendons are the tough, white, cords that connect muscles to bones, and are the least elastic of the Elastic, Collagen-Based Connective Tissues.  Are tendon problems common?  Governmental stats reveal that overuse injuries of muscle tendons are a leading reason people visit the doctor.  And although your doctor will almost certainly refer to your problems as “tendinitis”, in almost 100% of the cases, it is actually an incorrect and outdated term.

Over the past three decades, dozens of medical studies have conclusively shown that the major cause of “tendinitis” is not INFLAMMATION (aka “itis“), but something called “osis” (a derangement or degeneration of).  The truth is, even though doctors (self included) still use the term “tendinitis” with their patients because it is what they have heard their whole life, their AMA-mandated Diagnosis Codes almost always indicate that the problem is Tendinosis (HERE).

Is this differentiation between “tendinits” and “tendinosis” really that important, or am I simply splitting hairs and making a big deal out of nothing?  Instead of answering that question myself, I will let one of the world’s preeminent orthopedic surgeons and tendon researchers (Dr. GA Murrell) answer it for me, as quoted from the December 2002 issue of the British Journal of Sports Medicine

“Tendinosis, sometimes called tendinitis, or tendinopathy, is damage to a tendon at a cellular level (the suffix “osis” implies a pathology of chronic degeneration without inflammation). It is thought to be caused by micro-tears in the connective tissue in and around the tendon, leading to an increased number of tendon repair cells. This may lead to reduced tensile strength, thus increasing the chance of repetitive injury or even tendon rupture. Tendinosis is often misdiagnosed as tendinitis due to the limited understanding of tendinopathies by the medical community.”

Why doesn’t the medical community grasp this information and abandon their insistance on treating Tendinopathies with THE BIG FIVE (followed by surgery when those don’t work)?   We’ll get there in a moment, but for now, the real question we need to be asking is how this issue affects you, the Chronic Pain sufferer? 

It means that if you are dealing with a chronic tendinopathy, you are probably being treated using a model that is at least 25-30 years behind the times as far as the medical research is concerned!  Think not?  Read what Dr. Warren Hammer, board certified Chiropractic Orthopedist (in practice since the late 1950’s), had to say about the subject in a 1992 column from Dynamic Chiropractic:

The American Academy of Orthopedic Surgeons has provided a new classification of tendon injuries….  In the microtraumatic tendon injury the main histologic features represent a degenerative tendinopathy thought to be due to an hypoxic [diminished oxygen] degenerative process. The similarity to the histology [study of the cells] of an acute wound repair with inflammatory cell infiltration as in macrotrauma seems to be absent.  A new classification of tendon injury called “tendinosis” is now accepted.

“Tendinosis” is a term referring to tendinous degeneration due to atrophy (aging, microtrauma, vascular compromise). Histologically there is a non-inflammatory tendinous degeneration due to atrophy (aging, microtrauma, vascular compromise), as well as a non-inflammatory intratendinous collagen degeneration with fiber disorientation, hypocelluarity, scattered vascular ingrowth, and occasional local necrosis or calcification.

If your doctor is still treating you for Tendinitis and not Tendinosis, they are caught in a time warp. Plainly stated, Tendinosis is not an inflammatory condition (itis)!  It is a degenerative condition (osis)!  Not only is there debate over whether or not tendinitis actually exists, clicking on the previous link will show you that the drugs you are being prescribed are actually creating more degeneration — way more degeneration. 

What do I suggest?  TISSUE REMODELING of course!  The fantastic thing is that you will know quickly (one or two treatments) whether this approach is going to work for you.  The doubly cool thing about this method is that it’s NOT CRITICAL that we differentiate TENDINOSIS from FASCIAL ADHESIONS when treating as they are dealt with in like manner (links have numerous microscopic pictures).

IMPORTANT:  Please note that some muscles only cross one joint.  However, many muscles cross two joints.   muscles that act on more than one joint have a greater propensity for problems.  It also means that one muscle has the potential to give you problems (including tendinosis) at two different joints. 

• ROTATOR CUFF TENDINOSIS:  The Rotator Cuff is made up of four muscles that surround the shoulder.
  

• SUPRASPINATUS TENDINOSIS:  The Supraspinatus Tendon is not only the most commonly injured of the Rotator Cuff Muscles, it is the most common to find tendinopathy in as well.
  

• TRICEP TENDINOSIS: Tricep Tendinosis is rare.  About the only people I ever find it in is carpenters (hammering) and weightlifters.  However, here is the webpage.

• BICEPS TENDINOSIS: Because both heads of the bicep muscle have attachment points in the front of the shoulder, Biceps Tendinosis is frequently mistaken for Bursitis or a Rotator Cuff problem.
  

• LATERAL EPICONDYLITIS (Tennis Elbow): Although I have never seen anyone who got this problem playing tennis (hey, I live in the Ozarks), it is nonetheless extremely common.

• MEDIAL EPICONDYLITIS (Golfer’s Elbow): Not quite as common as Tennis Elbow above.

• WRIST / FOREARM FLEXOR TENDINOSIS: This is tendinopathy on the palm side of the forearm and wrist.

• WRIST / FOREARM EXTENSOR TENDINOSIS: This is tendinopathy on the backhand side of the forearm and wrist.

• THUMB TENDINOSIS: This extremely common problem can be debilitating.  You will frequently hear it referred to as DeQuervain’s Syndrome (in 15 years, I have never seen a case of DQS we could not solve).

• GROIN (Hip Adductor) TENDINOSIS: I have included Tendinosis of the Groin under “Hip Flexor Tendinosis” below.

• HIP FLEXOR TENDINOSIS: Hip Flexor Tendinosis will manifest in the upper front thigh or groin area.

• PIRIFORMIS TENDINOSIS: This problem is related to Piriformis Syndrome, and causes pain in the butt (sometimes with sciatica as well).

• SPINAL TENDINOSIS: Although most people never think of it, the potential for developing Spinal Tendinosis is greater than you ever imagined possible.
  

• KNEE TENDINOSIS: Often referred to as “Patellar Tracking Syndrome,” this condition is arguably the single most common reason that people visit a Sports Physician.

• QUADRICEPS / PATELLAR TENDINOSIS: A form of Knee Tendinosis

• HAMSTRING TENDINOSIS: Hamstring Tendinosis can cause knee, hip, and buttock problems.

• ACHILLES TENDINOSIS: Achilles Tendinosis is found in the large tendon in the very back of the lower leg / ankle.
  

• ANKLE TENDINOSIS: This common Tendinosis can typically be dealt with by following a few simple procedures.

• TIBIALIS ANTERIOR TENDINOSIS: This is related to the category above, and is typically found in the front of the ankle.

• POSTERIOR TIBIAL TENDINOSIS: This is related to the category above, and is typically found near the bony knob on the inside of the ankle.

• APONEUROSIS / APONEUROTICA TENDINOSIS: Although you have probably never heard the word before, “Aponeurosis” are flattened out tendons.  They are almost always referred to as fascia, but technically this is incorrect.

This list is in no way considered “comprehensive”.  It is simply a list the most common areas that I treat.  The truth is that Tendinopathies can be found virtually anywhere that there is a tendon —- including the spine.  For VIDEO TESTIMONIALS, click the link.

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