- Is it a tendonitis or tendon injury?
Tendonitis is a frequently used word. Too frequent if you ask the research. Recent research has shown that many tendinitis erased are not inflammation (tendinitis), but rather an overuse injury in the tendon (tendinosis) - yet it is the case that many of these diagnoses are incorrectly called tendonitis. Why is it important to distinguish between these two, you say? Yes, because the optimal treatment for the two is very different from each other. So proper classification is essential to be able to provide the best possible treatment and ensure optimal functional progress. In many cases, it can be the solution to avoid a long-term / chronic problem.
But, do I have tendonitis? Or?
Think of pain, a burning sensation in the area, decreased strength and mobility - all of which seem to be negatively affected by everyday activity. Must be symptoms of tendonitis, you say? Error. Several studies (Khan et al 2000 & 2002, Boyer et al 1999) have shown that these symptoms occur more often in tendinosis compared to tendinitis. A common diagnosis that is often mistakenly called tendinitis is tennis elbow / lateral epicondylite - it's a tendinosis condition. A systematic review study has shown that clinical signs of acute or chronic inflammation have never been found in surgical procedures in patients diagnosed with chronic tennis elbow / lateral epicondylitis (Boyer et al, 1999).
Another meta-analysis that looked at histological, immunohistochemical findings and microscope studies concluded that a tennis elbow / lateral epicondylitis is a tendinosis and not a tendinitis (Kraushaar et al., 1999). We recall that systematic review studies / meta-analyzes are the highest-ranking form of research study.
Here we will try and describe the difference between how a tendinitis and how a tendinosis occurs.
A tendonitis is a inflammation in the tendon itself and occurs due to microcracks that have occurred when the musculotendinous unit becomes acutely overloaded with a tensile force that is too strong or sudden. Yes, tendonitis is a diagnosis that can affect many, but research has shown that this diagnosis is severely overdiagnosed.
And tendinosis (tendon injury) is a degeneration of the tendon's collagen fibers in response to chronic overuse - in other words when the overuse continues even after the symptoms are there. This results in the tendon not being healed / restored, and over time we have an overload injury in the tendon - a tendinosis. It is best to take the symptoms seriously when they first occur. It is easier to prevent than to treat.
Most such ailments occur over time. Ask yourself: Did the damage happen suddenly or have you known it for a while?
Treatment of tendon problems: It is important to differentiate between tendinitis and tendinosis!
You have probably already begun to understand that tendonitis and tendinosis are treated in two different ways. In a tendinitis, the main purpose is to reduce the inflammation / inflammation - and as we know, there is no such inflammation in a tendinosis. This means that treatments that are effective against tendonitis are not necessarily effective against tendinosis. An example is Ibuprofen (Ibux). The latter will treat a tendinitis effectively, but will actually prevent the healing of a tendinosis (Tsai et al., 2004). This example could have long-lasting consequences if the person who actually had a tendinosis was recommended anti-inflammatory painkillers instead of getting proper treatment.
Cortisone injection, a mixture of the anesthetic Xylocaine and a corticosteroid, has shown in studies that it stops the natural collagen healing and is also an indirect cause of future tendon tears and tendon tears (Khan et al, 2000; & Boyer et al, 1999). In other words, one should really ask the question - will this be beneficial? - before giving such an injection. Cortisone can have a short-term good effect, but there is a risk of worsening the condition when you look at it in the long term. So why did I feel better immediately after the injection? Well, one of the answers lies in the content: Xylocain. An effective anesthetic that will make it feel like the local pain is releasing immediately, but keep in mind that it may be too good to be true - at least in the long run.
Coincidentally, there are some treatments that overlap when it comes to treating tendinitis and tendinosis. Deep-friction massage or instrument-assisted massage (eg Graston) is actually beneficial for both conditions, but in two different ways. In tendinitis, this form of treatment will reduce adhesions and generate functional scar tissue after inflammation subsides. In tendinous lesions, treatment will stimulate fibroblast activity and collagen production (Lowe, 2009).
-1- Treatment of tendinitis / tendonitis
healing time: Days up to six weeks. Depending on when the diagnosis is made and treatment begins.
purpose: Suppress the inflammation process.
Tiltak: Rest and anti-inflammatory drugs. Possible deep friction massage after the inflammation has subsided.
-2- Treatment of tendinosis / tendon injury
healing time: 6-10 weeks (if the condition is detected at an early stage). 3-6 months (if the condition has become chronic).
purpose: Stimulate healing and shorten healing time. Treatment can reduce tendon thickness after injury and optimize collagen production so that the tendon regains its normal strength.
Tiltak: Resting, ergonomic measures, support, stretching and conservative movement, frosting, eccentric exercise. muscle work / physical therapy, joint mobilization and nutrition (we go through these in more detail in the article).
First and foremost, let's consider this statement from a larger study: "Later spends over 100 days laying down new collagen" (Khan et al, 2000). This means that treating a tendon injury, especially one you have had for a long time, can take time, but seek treatment from a publicly authorized clinician (physiotherapist, chiropractor or manual therapist) and get started with the right measures today. Many of the measures you can do yourself, but in certain more serious cases it can be beneficial Shockwave Therapy, needle and physical therapy.
Treatment and proprietary measures against tendon injuries
- Rest: The patient is advised to listen for the body's pain signals. If your body asks you to stop doing something, then you do well to listen. If the activity you perform gives you pain, then this is the body's way of telling you that you are doing "a little too much, a little fast" and that it does not have time to recover sufficiently between sessions. Micro-breaks at work can be extremely useful, for repetitive work you should take a 1-minute break every 15 minutes and a 5-minute break every 30 minutes. Yes, the boss will probably not love it, but it's better than being sick.
- Take ergonomic measures: Small ergonomic investments can make a big difference. Eg. When working on the data, allow the wrist to rest in a neutral position. This results in significantly less strain on the wrist detectors.
- Use support in the area (if applicable): When you have an injury, make sure that the area is not subjected to similar tensile forces that were the actual cause of the problem. Naturally. This is done by using support in the area where the tendon injury is located or alternatively, it can be used with sports tape or kinesio tape.
- Stretch out and keep moving: Regularly light stretching and movement of the affected area will ensure that the area maintains a normal movement pattern and prevents shortening of related muscle. It can also increase blood circulation in the area, which assists the natural healing process.
- Use icing: Icing can be symptom-relieving, but make sure you don't use ice cream more than recommended and also make sure you have a thin kitchen towel or similar around the ice pack. Clinical recommendation is usually 15 minutes in the affected area, up to 3-4 times a day.
- Eccentric Exercise: Eccentric strength training (read more here and watch video) performed 1-2 times a day for 12 weeks has a clinically proven effect on tendinopathy. It has been seen that the effect is greatest if the movement is calm and controlled (Mafi et al, 2001).
- Get treatment now - don't wait: Get help from a clinician to "get over the problem" so that it is easier for you to perform your own measures. A clinician can assist with pressure wave treatment, needle treatment, physical work and the like to provide both functional improvement and symptom relief.
- Nutrition: Vitamin C, manganese and zinc are all essential for collagen production - in fact, vitamin C forms the derivative of what develops into collagen. Vitamin B6 and vitamin E have also been linked directly to tendon health. So making sure you have a good, varied diet is important. Maybe it will be necessary to take some supplements in the diet when the healing takes place? Feel free to consult a nutritionist or similar.
En tendonitis is not always a tendonitis - in fact, it is much more common that the injury is a tendinosis. We hope you have understood the importance of the correct diagnosis and what side effects it can have for the patient if the diagnosis decision is not made on the right basis.
Be critical, ask questions - be taken seriously.
Alexander… and the rest of the physical team at Vondt.net (Follow us on Facebook)
Click on the picture above to move on to the next article.
Also read: 6 Exercises against Carpal Tunnel Syndrome
Khan KM, Cook JL, Kannus P, et al. Time to abandon the “tendinitis” myth: Painful, overuse tendon conditions have a non-inflammatory pathology [editorial] BMJ. Published March 16, 2002.
Heber M. Tendinosis vs. Tendinitis. Elite Sports Therapy.
Khan KM, Cook JL, Taunton JE, Bonar F. Overuse tendinosis, not tendinitis part 1: a new paradigm for a difficult clinical problem.
Phys Sportsmed. 2000 May; 28 (5): 38-48.
Boyer MI, Hastings H. Lateral tennis elbow: "Is there any science out there?".
J Shoulder Elbow Surg. 1999 Sep-Oct; 8 (5): 481-91. (Systematic review study / meta-analysis)
Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies.
J Bone Joint Surg Am. 1999 Feb; 81 (2): 259-78. (Systematic review / meta-analysis)
Tsai WC, Tang FT, Hsu CC, Hsu YH, Pang JH, Shiue CC. Ibuprofen inhibition of tendon cell proliferation and upregulation of the cyclin kinase inhibitor p21CIP1.
J Orthop Res. 2004 May; 22 (3): 586-91.
Rattray F, Ludwig L. Clinical Massage Therapy: Understanding, Assessing and Treating Over 70 Conditions. Elora, Ontario: Talus Inc; 2001.
Lowe W. Orthopedic Massage Theory and Technique. Philadelphia, PA: Mosby Elsevier; 2009.
Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis.;Am J Sports Med. 1998 26(3): 360-366.
Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis; Knee Surgery Sports Traumatology Arthroscopy. 2001 9(1):42–7. doi: 10.1007/s001670000148.
What can I do even for muscle and joint pain?
1. General exercise, specific exercise, stretching and activity are recommended, but stay within the pain limit. Two walks a day of 20-40 minutes make good for the whole body and sore muscles.
2. Trigger point / massage balls we strongly recommend - they come in different sizes so you can hit well even on all parts of the body. There is no better self help than this! We recommend the following (click the image below) - which is a complete set of 5 trigger point / massage balls in different sizes:
3. Training: Specific training with training tricks of various opponents (such as this complete set of 6 knits of different resistance) can help you train strength and function. Knit training often involves more specific training, which in turn can lead to more effective injury prevention and pain reduction.
4. Pain Relief - Cooling: Biofreeze is a natural product that can relieve pain by cooling the area gently. Cooling is especially recommended when the pain is very severe. When they have calmed down then heat treatment is recommended - it is therefore advisable to have both cooling and heating available.
5. Pain Relief - Heating: Warming up tight muscles can increase blood circulation and reduce pain. We recommend the following reusable hot / cold gasket (click here to read more about it) - which can be used both for cooling (can be frozen) and for heating (can be heated in the microwave).
Recommended products for pain relief for muscle and joint pain
Biofreeze (Cold / cryotherapy)