Article about tendon healing

Discussion in 'Health & Fitness' started by andreh, Sep 23, 2013.

  1. andreh

    andreh Professional

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    http://bjsm.bmj.com/content/early/2013/03/08/bjsports-2012-091957.full

    Interesting article. If nothing else it summarizes all research on tendon disorders done to date. It revisits inflammation and seems to suggest that the tendinosis diagnosis has now gone too far, although it does not claim that the old tendinitis diagnosis was correct either. Good read.
     
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  2. RogueFLIP

    RogueFLIP Semi-Pro

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    Thanks for the link.

    To me, it's the same old same old.

    This study shows Treatment A works, this review of studies shows it doesn't.

    Steroids can be beneficial for short term, but damaging for the long term. But we're not sure exactly how they work.

    NSAIDS - some short term benefits. But not everyone benefits.

    I don't have answers, but trying to find a cookbook one size fits all recipe to treating ailments...well, I'm sure we'll be seeing more articles like this 5, 10 years from now.
     
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  3. andreh

    andreh Professional

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    ^^ Indeed, nothing new. Just a convienient summary, really.
     
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  4. boramiNYC

    boramiNYC Hall of Fame

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    still it's appalling how little modern medicine knows about physiology of soft tissues in general. not enough attention has been paid to it thus far. imo it's critical in movements and lots of chronic pains modern medicine has no clue.
     
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  5. andreh

    andreh Professional

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    Agreed. In soft tissue healing and chronic pain management medicine is lagging far behind other fields. It's not lethal so nobody puts any effort into it, but it can be severly debilitating to live with these conditions. You won't die, you will just wish you would when you have severe pain day in, day out.
     
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  6. RogueFLIP

    RogueFLIP Semi-Pro

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    Well, sounds like you guys are in around the same dock as me when it comes to role soft tissue plays in injury and such. Good to hear.

    Are you guys bodyworkers?
     
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  7. Chas Tennis

    Chas Tennis Hall of Fame

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    Thanks for posting the very interesting paper.

    I added it to the earlier papers on tendinitis and tendinosis that I've posted several times.

    This is not the most readable paper but it deals with the tendon-bone interface.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2100202/#!po=2.00000

    I guess that after many years of our lives our tendons and attachments each may have some percentage of tendinitis, tendinosis and also healthy tendon tissue. The tendinitis may be temporary, off and on. ?

    I don't have confidence in the treatments for tendinosis. I think it's best to decide beforehand what you are going to do when you get that next tendon injury. For me, I taking off and hoping to dodge the tendinosis bullet.
     
    Last edited: Sep 25, 2013
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  8. andreh

    andreh Professional

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    I found it interesting that there are only quality studies indicating eccentric exercise help for the "mid-portion" achillies tendon. No (quality) studies for other tendons, including the lateral elbow extensors.
     
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  9. Chas Tennis

    Chas Tennis Hall of Fame

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    NCBI - Free Full Paper References - Tennis Elbow

    Here's a list of free full reference papers on Tennis Elbow from the National Center for Biotechnology Information (NCBI)

    http://www.ncbi.nlm.nih.gov/pmc/?term=tennis+elbow

    Have a look at the short 1907 article "Tennis Elbow". Lawn tennis players and blacksmiths are at risk.....
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2356886/

    Search 'Tennis Elbow 1907' and find 3 other short articles.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2356860/?page=6
     
    Last edited: Sep 25, 2013
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  10. andreh

    andreh Professional

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  11. Chas Tennis

    Chas Tennis Hall of Fame

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    Very complicated connections of the tendon near the joint.

    This is very complicated and these papers are not an easy read. I don't know if these 2004 publications have changed the view of tendon injuries or have been updated by more recent research.

    If I understand correctly, these references describe the tendon 'insertion' site as a much more complicated "enthesis organ" possibly involving inter-connections between tendon(s), bone, ligament(s), and other nearby tissues. Maybe thinking of the tendon as 'focally' inserting on the bone is too over simplified when considering Golfer's Elbow, Tennis Elbow and Achilles injury, etc.

    http://onlinelibrary.wiley.com/doi/10.1002/art.20566/pdf

    www.ncbi.nlm.nih.gov/pmc/articles/PMC1755120/pdf/v063p01015.pdf

    Read more: http://asmiforum.proboards.com/thread/2013/golfers-elbow-tendons-attach#ixzz2fuvstq7X
     
    Last edited: Sep 25, 2013
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  12. andreh

    andreh Professional

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    This is turning into a great thread to collect articles on tendon issues. Good.
     
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  13. boramiNYC

    boramiNYC Hall of Fame

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    a trainer with science background. like to read on subjects like functional fitness, coordination, balance, anatomy, mind-body theories (alexander, feldenkrais, pilates, rolfing etc), posture, motor control, fascia studies, biomechanics, kinesiology, etc. soft tissue manipulation and osteopathy are very interesting stuff too but luckily i haven't needed them. have had lower back pain for years but pretty well under control and doesn't interfere with training and performance.

    was always curious. did your PT study help with your tennis?
     
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  14. Chas Tennis

    Chas Tennis Hall of Fame

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  15. rufus_smith

    rufus_smith Professional

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    After many years of studying tendinitis about the only thing I'm sure of is that, when given a true long rest from irritating activities, an injured tendon will heal itself after one-twelve months.
     
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  16. lcalamar

    lcalamar Rookie

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    Perhaps relevant or not (apologies if not)...

    I had been dealing with a lower back issue that kept me from playing tennis for several months. I was seeing a chiropractor as well as a medical Dr. - and a physical therapist.

    I didn't start to see help until I saw a massage therapist the specialized in soft tissue treatment. Microfascial therapy and overall tissue connectivity treatment.

    It is likely that the PT stretches and exercises - as well as rest - finally kicked in and provided some relief at the same time I began to see the massage therapist.

    I have come away with a feeling that beyond muscular and skeletal issues - we have this 3rd 'system' of connectivity tissue which is widely ignored or mis-understood.

    Curious of anyone else's thoughts on this...
     
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  17. ollinger

    ollinger Legend

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    yes....we are all connected
     
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  18. boramiNYC

    boramiNYC Hall of Fame

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    yes that has become my belief as well. commonly the soft tissue researchers mention that in the traditional dissection class medical doctors simply cut and peel away the soft tissues like fascia to reveal the muscles to study without realizing what those soft tissues do. and to a certain extent it reflects the attitude traditional medical community held almost forever. until now where many of them realize the view (skeletal, muscles, nerves) may not have been complete. good news is research on fascial system has become more active now. (check out http://www.fasciacongress.org/) but not enough yet imo. and i have a feeling many mainstream medical scientists still don't realize its importance and relegate it as some pseudoscience crap.

    but bodyworkers in many different traditions building knowledge on their empirical and anecdotal evidences have known better and I'm thankful for that. recently fascia system has been better systemized and mapped by a rolfing teacher and scholar, Tom Myers. Check out http://www.anatomytrains.com/ It even has quite a bit of similarities to the meridian lines from oriental medicine. Truly fascinating stuff if you are interested in this field. in movement science and studies, I think this is the cutting edge.
     
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  19. aussie

    aussie Professional

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    Interesting that there is now rethinking on this tennis elbow has no inflammation theory. I remember discussing my tennis elbow with a leading football club doctor here in Brisbane some months ago before I went down the PRP path (in another thread) and I mentioned that there would be no inflammation present in the tendon connection to the lateral condyle.

    He seemed quite bemused and asked why then on the ultrasound was there clear imaging of inflammation and why had a cortisone injection given me at least temporary pain relief if there was no inflammation? I had no real answer but to say that that is what current studies show.

    Seems that he may have been at last partially right and that anti-inflammatory treatment may well be of benefit in treating tennis elbow. And to think that I have spent the last 3 months trying to create inflammation to make it heal!

    100 plus years and we still don't know enough about this condition to develop a successful treatment.
     
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  20. Chas Tennis

    Chas Tennis Hall of Fame

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    It seems reasonable that most tendon injury cases involve:

    1) some tendinitis (recent or on going),
    2) tendinosis (more or less stable or increasing) and
    3) according to the 'enthesis' references above - at least my interpretation of them - there's a likelihood that adjacent tissue structures at the elbow might be involved to some degree.

    It still seems that - with the encouragement of TV commentators, 'he/she has a little tendinitis' - many people are completely in the dark when they first get an injury. They play on the injury for weeks or months to see how it will do and they miss the best opportunity for optimal healing. At least that is what I believe. Prevention of chronic tendinosis conditions - for those that don't already have considerable tendinosis - seems the most effective way to go. Prevention is the best option because understanding of tendinosis is still evolving and the treatments are not very effective or at least not widely acknowledged to be very effective.

    I believe that everybody should become aware of tendon injury issues and decide beforehand what they will do when they are hit with a tendon injury. If it comes on so gradually as to hardly be noticed, it is much more difficult to decide on. Probably a reasonable guideline should be agreed on by Drs and posted in tennis & golf clubhouses and the internet. Now, most of the information is cut & paste on the internet and not really backed up by very good research.
     
    Last edited: Sep 29, 2013
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  21. RogueFLIP

    RogueFLIP Semi-Pro

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    Glad to hear your back hasn't interfered with your hobbies.

    Off the top of my head, PT really only helped my tennis in regards to injury recovery times and such.

    I was already pretty analytical prior to becoming a PT, and PT school only amplified that, which has probably HINDERED my tennis improvement because I tend to overTHINK everything when I should be FEELING more.
     
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  22. RogueFLIP

    RogueFLIP Semi-Pro

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    After many years of TREATING tendinitis/osis about the only thing I'm sure of is that if you address the surrounding soft tissue components and possible postural misalignments, an injured tendon can heal itself faster.
     
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  23. RogueFLIP

    RogueFLIP Semi-Pro

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    Do you mean Myofascial Therapy?

    Goddamn right it's been ignored/misunderstood. This connective tissue or fascial system surrounds the body head to toe without interruption, and goes all the way down to the cellular level.

    Here's a neat article about fascia:

    http://www.runnersworld.com/injury-treatment/understanding-your-fascia?page=1
     
    #23
  24. RogueFLIP

    RogueFLIP Semi-Pro

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    It's kind of hard to appreciate the whole body because of this reductionist view. Those who have studied anatomy via slides, pictures and what you see in books can't really appreciate how everything is all connected. You don't get those red muscles and yellow nerves once you peel away the skin.

    I remember spending hours upon hours in cadavar lab dissecting and throwing away the tough fibrous connective tissue so I could get to the "important" stuff like the nerves, muscles, and organs. My PT training basically ignored the whole system.

    But really, a little common sense. Do you really this tissue, which surrounds every organ, muscle, nerve, bone doesn't have an impact? C'mon.
     
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