Tendinosis – a chronic degeneration of the tendon caused by repeated microtears. This is not an inflammatory condition,and may not respond well to an anti-inflammatory protocol ( ITP).
Tendinosis is a degeneration of the tendon’s collagen in response to chronic overuse; when overuse is continued without giving the tendon time to heal and rest, such as with repetitive strain injury, tendinosis results. Even tiny movements, such as clicking a mouse, can cause tendinosis, when done repeatedly.
Swelling in a region of micro damage or partial tear may be detected visually or by touch. Increased water content and disorganized collagen matrix in tendon lesions may be detected byultrasonography or magnetic resonance imaging.
Symptoms can vary from an ache or pain and stiffness to the local area of the tendon, or a burning that surrounds the whole joint around the inflamed tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day as swelling impinges on the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain, which may contribute to the symptoms.
Tendons are very slow to heal if injured. Partial tears heal by the rapid production of disorganized type-III collagen, which is weaker than normal tendon. Recurrence of injury in the damaged region of tendon is common.
Physical therapy, rest, and gradual return to the activity in which tendinosis was experienced is a common therapy. There is evidence to suggest that tendinosis is not an inflammatory disorder; anti-inflammatory drugs are not an effective treatment,and inflammation is not the cause of this type of tendon dysfunction.There is a variety of treatment options, but more research is necessary to determine their effectiveness. Initial recovery is usually within 2 to 3 months, and full recovery usually within 3 to 6 months. About 80% of patients will fully recover within 12 months. If the conservative therapy doesn’t work, then surgery can be an option. This surgery consists of the excision of abnormal tissue. Time required to recover from surgery is about 4 to 6 months.
Treatment and self-care recommendations for tendinosis include:
- rest ( With repetitive work tasks, the patient is recommended to take a break for one minute every 15 minutes and a five-minute break every 20–30 minutes.This reduction isn’t much considering its role in preventing long-term pain and disability. Some people will need to rest even more than this at the start of treatment. The patient should be advised to stay aware of their body as it heals. If the activity they are engaging in is causing pain, then they are probably doing too much.)
- adjust ergonomics and biomechanics( example: a person that types a lot on the computer should find a neutral position for their wrists to rest while typing)
- use appropriate support ( bracing,taping)
- strech and keep moving though conservatively ( Lightly stretching and moving the affected area through its natural range of motion while minimizing pain will prevent shortening of the related muscles (preserving active range of motion and flexibility). It can also increase circulation, thereby assisting the healing process. Stretching can also elongate the muscle-tendon unit, reducing the tension placed on the tendon during activity, thereby reducing the chemical changes that cause degeneration)
- apply ice ( Ice causes vasoconstriction and is thought to address the abnormal neovascularization of the tendon tissue. Clinical experience indicates that icing is helpful for tendinopathies even though the reason why it works is not yet fully understood. Use ice for 15–20 minutes several times a day (allowing for at least 45 minutes in between icing session), and after engaging in activities that utilize the tendon)
- eccentric strenghtening ( An eccentric strengthening regimen done 1–2 times daily for 12 weeks has been clinically proven to be a very successful treatment for tendinosis, especially when the exercises are performed slowly. Eccentric strengthening is “lengthening a muscle while it is loaded and contracting. For example, lengthening one’s bicep while holding a dumb-bell in one’s hand would stimulate eccentric contraction. Eccentric strengthening might also help to reduce ground substance and tendon volume (swelling/thickening). It can be helpful to consult with a physical therapist to maximize the benefit of strengthening exercises and to minimize the possibility of re-injury.)
- masssage ( Massage stimulates circulation and cell activity, especially when done at the appropriate depth. Deep-friction massage applied to the tendon serves to stimulate fibroblast activity and generate new collagen.)
- nutrition ( Vitamin C, manganese, and zinc are all important for the synthesis of collagen production.Vitamin B6 and Vitamin E have also been linked to tendon health. Patients might benefit from talking with their primary health care provider or a nutrition specialist to be sure their intake of these nutrients is sufficient )
While the cellular damage is unlikely to be reversed completely, these treatments and self-care recommendations can increase the strength of the tendon by stopping the cycle of injury, introducing healthy collagen into the area, addressing unhealthy vascular changes, and decreasing the over-abundance of ground substance. Proper treatment of tendinosis should eliminate or significantly decrease pain, increase range of motion, increase strength, and return the patient to pain-free, normal daily activities.
Tendinosis causes tissue changes that make the tendon more prone to injury, so it is important that the patient continue to take care of the compromised tendon once the initial phase of treatment is complete. Ongoing massage, stretching, strength training, and warming up before starting work or exercise can help to prevent re-injury and keep the tissue as healthy as possible.