chronic tendonitis not healing

Discussion in 'Health & Fitness' started by boosted180, Mar 8, 2014.

  1. boosted180

    boosted180 New User

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    I hurt my shoulder 2 years ago playing tennis. I was diagnosed with tendonitis/ impingement syndrome, and told to stay off of it for about 4 weeks, do physical therapy and should be fine. It was a very mild injury according to the orthopedic specialist.

    About 1 1/2 years ago, a similar thing happened with my ankle after a very minor sprain. Same kind of diagnosis and treatment - stay off of it 4 weeks, do PT and I should be fine.

    It's now been 2 years and my shoulder and ankle still get inflamed, tender, sore with even the smallest amount of activity, never mind playing tennis. Even doing physical therapy would irritate it a day or two later. While I'm doing it, it's fine, but 1-2 days later, it would get inflamed and stay sore/ tender for 3 days to a week. Even taking long walks hurts my ankle. Then I found out about Egoscue and it sounded great and felt great to do it. But same result - while I did it, it was fine, but a day or two afterwards, the area of the body that I was working on (ankle or shoulder) would get really ****ed off and stay ****ed for a few days to a week.

    What is wrong with my body??

    I don't know what to do anymore. I cant play tennis, cant work out, cant walk, cant ride my new bike, cant even do physical therapy/ Egoscue to fix my problem.

    I googled "chronic tendonitis not healing" and came across something called "precision muscle balancing technology" and their description sounds exactly like what I have. Has anyone heard or tried it? Or have any idea of what my problem is? I've seen so many doctors/ physical therapists/ acupuncturist/ did PRP and still don't have an answer to why my body wont heal!
     
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  2. boramiNYC

    boramiNYC Hall of Fame

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    My guess is it's due to how you use your arm and shoulder. There's this thing called scapulohumeral rhythm and it's very common it is off and causes chronic shoulder problems. You have to learn to recoordinate the scapula and arm movements in everything you do.

    Ankle can be off as well very easily.
     
    Last edited: Mar 9, 2014
    #2
  3. ollinger

    ollinger Legend

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    You're lucky if an inflammatory condition resolves in 4 weeks; many take 6 months or more. You're not staying off it long enough. Aside from that you may just be genetically unfortunate, or perhaps eat a diet that promotes inflammation; start downing that turmeric!
     
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  4. boosted180

    boosted180 New User

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    What do I need to do to "learn to re-coordinate" the shoulder and ankle?

    It sounds a lot like what I'm doing with Egoscue. Their approach is that most pain is caused by misalignment and doing the simple exercises/ stretches will help regain posture/ alignment. And I feel like it really did that for me. The take photos weekly and I definitely am much more straight posturally now than when I started.

    But the frustrating thing is that lately, after I do the excercises, I get tendonitis a few days afterwards. So I cant even do them anymore, or at least have to be extra careful and do them much less than normally.

    Anyway, what do you suggest for "re-coordinating" the shoulder and ankle?
     
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  5. boramiNYC

    boramiNYC Hall of Fame

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    I have read a few books by Mr. Egoscue and generally in agreement with many of the his principles but I'm afraid in some cases no 'simple' exercise solves the problem like in your case. Again I'd guess some of the coordination problems you have are so deeply rooted even many simple exercises cannot be performed precisely, which is important.

    For example, when you raise the straight arm to the side up to about 30 deg the scapula should remain in place but sometimes the scapula cannot be held still due to corrupt coordination or scapulohumeral rhythm. In such a case you have to learn how to lift the arm up to 30 deg while holding the scapula firmly in place. But it's not so simple because you've been using a certain pattern for very long time and you're wired to move the scapula while you lift the arm even a little bit.

    To change this many steps are involved. Most important being the movement pattern change in your mind and nerves, remove soft tissue restrictions of range of motion for even some uncommon joints, muscles reconditioning (strength, flexibility, balance around joints), restoration of postural deficiencies in more foundational anatomical structures (for shoulder, thoracic and cervical spine curves and ribcage posture) and will power to recognize the bad pattern in all your activities and adjust them.

    And this is one of the simplest cases of corrupt shoulder coordination. So as you see it can be a very intense process and not one professional usually cannot resolve all these issues let alone understand all of them.

    In my experience not heavily involving your own mind in these kind of rehabilitation is half hearted at best since your mind will revert right back to the habitual usage.

    So I recommend some mind-body control methods along with physical rehabilitation.

    There are a few ways to achieve improvement in mind body control. Yoga and Tai Chi are pretty well known but for more direct focus on mind and body control look into methods like Alexander technique or Feldenkrais method. Dr Sarno's work touches on the same topic in a little different angle.

    Hope I have given you some food for thought.
     
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  6. spun_out

    spun_out Rookie

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    I sound like a broken record in this forum, but have you tried rolling your shoulder and calves or get ART? The treatment may bruise you but shouldn't cause inflammation.
     
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  7. boramiNYC

    boramiNYC Hall of Fame

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    ^^^
    These are some good options for soft tissue work along with myofscial release. For someone whose problem is mainly due to soft tissue issues these work like magic.
     
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  8. Torres

    Torres Banned

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    When you say the 'ankle', exactly which part do you mean? And how would you describe the pain? And what movement or motion results in the pain?
     
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  9. NickC

    NickC Professional

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    Look up anti-inflamatory foods too. Eat lots of those. There are a few chemicals in foods we eat on a daily basis that don't help with your tendinitis, so stop eating those.
     
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  10. boosted180

    boosted180 New User

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    Can you give me more info on this? Or a link or resource where I can learn more?
     
    #10
  11. boosted180

    boosted180 New User

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    The weird thing is that when I "sprained" it, it wasn't even the normal way you think of spraining your ankle (inversion or eversion sprain where you roll over it). I was just going one way and my opponent hit the ball behind me and I had to stop suddenly and go the other way. I felt a really high intensity, sharp pain on the lateral side of the ankle, pretty deep. Then over the past year or so, the location of the pain seems to be moving around. Sometimes I feel it on the medial side, sometimes lateral, sometimes dorsal. It sounds almost like it's not "real" and I'm making it up!

    Even the slightest amount of activity aggravates it. If I don't do any activity at all including Egoscue or PT, then it would feel so normal, that I'd get all happy and go out there and do something and then again, the pain comes.

    Similar situation with the shoulder. Sometimes the pain feels like it's at the end of the deltoid muscle, sometimes deeper like one of the rotator cuff muscles/ tendons, sometimes the joint space itself hurts and it makes grinding noises.

    Since the location of the pain does not remain the same, I know it's not an old "injury" not healing (like a torn or partially torn or damaged ligament or tendon or muscle). It's been such a long time!!

    It definitely has something to do with coordination of the muscles in my shoulder and ankle areas. Originally it was an injury, but in an effort to not aggravate it, I guess my body developed a weird kind of compensating mechanism and now my muscle coordination/ memory is all screwed up and when I move, it's not "normal' movement and that's what's causing the pain, inflammation, tenderness??
     
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  12. boosted180

    boosted180 New User

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    I've been doing Yoga for a very long time and it feels WONDERFUL! But it doesn't seem to help with my specific shoulder/ ankle problems right now.

    I'll look into the Alexander and Feldenkrais method. Thanks!
     
    #12
  13. RogueFLIP

    RogueFLIP Professional

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    Boosted,

    Your story is one I hear all the time in the John Barnes Myofascial Release clinic I work in.

    I think I mentioned this to you in another thread you made???

    If so, I won't repeat myself.

    If not, I'll try to answer any general questions you have.

    Good luck.
     
    #13
  14. boosted180

    boosted180 New User

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    It must have been someone else. I haven't done another thread about this. I wrote one about doing PRP, but not about my injuries not healing.

    So what suggestions or comments do you have?

    This is one of the most frustrating things I've ever been through. I'd really appreciate anything that can possibly be a solution for my problem. Thanks.

    PRT, by the way, did nothing for me. In fact, I feel like it may have worsen things for my ankle. The pain from PRP was much more than what I experienced originally with spraining my ankle. I literally could not walk for about a week after the PRP injection. I know it is effective for some people, but for me, I really regret doing it. It may have thrown my muscle balance out of whack even more, and definitely exacerbated the tendonitis.
     
    Last edited: Mar 17, 2014
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  15. spun_out

    spun_out Rookie

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    Searching for trigger point massage calf or shoulder on youtube should get you started. For the calf, don't forget to roll the sides in addition to the soleus and the gastroc. And you don't even need a ball for the calves. You can just use the other knee, edge of a table or couch, etc. The shoulder is best with a ball (I use a baseball and a golf ball).
     
    #15
  16. RogueFLIP

    RogueFLIP Professional

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    First off, understand that I'm just basing things off your posts. I haven't seen you, examined/palpated you.

    Second, I'm not claiming to have answers to your situation, or that anything I suggest is going to "cure" you.

    I just want to try to make you more aware of potentially what might be happening in your body.

    Here's an article from Runner's World that explains the concept of fascia. Easier to read than me type :)

    http://www.runnersworld.com/injury-treatment/understanding-your-fascia?page=single

    Thing is, there's many different types of myofascial release therapists, and they're not all the same.

    Obviously I'm biased towards John Barnes' method (that's why I linked a neutral website).

    Some of the proposed treatments in the article are a little oversimplified but still.....
     
    #16
  17. Chas Tennis

    Chas Tennis Hall of Fame

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    Thread 'Tendon Injury Nuthouse'
    http://tt.tennis-warehouse.com/showthread.php?t=442912&highlight=tendon+injury+nuthouse

    See especially the very first article from 2002.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122566/

    Detailed paper on tendinosis
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445129/

    It sounds as if you have tendinosis, defectively healed tendon. You should discuss with a well qualified Dr.

    4 weeks is not enough time to heal a tendon tear. Research this subject yourself starting with the CharlieFedererer tables that give healing times.
    http://tt.tennis-warehouse.com/showpost.php?p=6956506&postcount=14

    Do a timeline for each of your injuries especially

    1) how long did you continue to stress it with tennis or other activity after the first acute injury (maybe it came on gradually?)
    2) how long did you allow it to heal without stressing it?
     
    Last edited: Mar 18, 2014
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  18. boosted180

    boosted180 New User

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    Thanks for the input, guys. As far as timeline:

    2 years ago, I hurt the shoulder serving. I took about a week off and played again. It was not terrible, but definitely something wasn't right. So it continued like this for about a month and half. At that point, it hurted so badly that I thought if I don't stop, I'm really gonna damage something. So I stopped for 3 months. It felt much better but when I started playing again, it hurted - not horribly, but something just "wasn't right". So it was just off and on like that for another 3 months when I saw the orthopedic specialist (specializing in shoulder sports injuries). After doing an x-ray and physical exam, he said whatever happened 8 months ago mostly has healed but take another month off and then start physical therapy and I should be fine. I did as he said and PT felt really good, and I was playing again without pain. I was so happy!

    And then at some point it started hurting again and even PT hurted. And it's been like that since then.

    As for ankle, I sprained it about a year ago. Continued to play off and on for about 3 months. Then I thought, I better stop to let it heal completely, so I took 2 months off. It felt better and started playing again and it was good for awhile. And then 5 months ago, I sprained it again and took a month off, but it wasn't feeling any better. I played twice after that and then haven't touched the racket since then (around beginning of December). After I stopped playing I got PRP (platelet rich plasma injections), which in retrospect was a horrible thing for my ankle. It hurted way more than the initial sprain and I think it screwed up my ankle even more.

    The frustration is that rest doesn't seem to fix it. PT doesn't seem to fix it. I also tried acupuncture, massage, PRP, Egoscue and nothing seems to make it better. Egoscue was probably the best out of everything and overall I feel better, definitely have better posture, but there's something just not right in the shoulder.

    The ankle now feeling much better and no pain as long as I'm super careful not to push it. So I think I'm making progress there, but the shoulder is behaving really strangely. My trapezius and levator scapulae feel always super tight (maybe compensating for rotator cuff muscles or deltoid?). Not sure...

    For both shoulder and ankle, activity seems to feel ok while I'm doing them, but in a day or two they get really sore and tender and inflamed. And stay that way for a few days to a week. The shoulder especially feels very weak and susceptible. Ankle's not so bad anymore.
     
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  19. Chas Tennis

    Chas Tennis Hall of Fame

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    I have no medical training.

    Shoulder injuries are often difficult to diagnose. They usually involve soft tissue injuries and MRIs are often used for diagnosis. For a labrum tear, and maybe other injuries, a special MRI with dye is used.

    http://tt.tennis-warehouse.com/showthread.php?t=475366

    You original shoulder diagnosis was with an X-ray and physical exam? Was there a clear diagnosis?

    Have you studied the Ellenbecker video on the shoulder, impingement and the shoulder-arm orientation during serving to minimize the risk of impingement?
     
    Last edited: Apr 3, 2014
    #19
  20. tennisenthusiast

    tennisenthusiast Hall of Fame

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    I am throwing out another thing to test. Did you check your Vitamin D levels? Sometimes if there is D deficiency, muscles will not heal properly and ache all the time. No harm is getting that tested. It can be part of your routine physical test at the doctors.
     
    #20
  21. LeeD

    LeeD Bionic Poster

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    I'm bummed you feel so pained.
    I've had bouts of not being able to lift my arm enough to shave or brush my teeth, rotator cuffs not kosher.
    I haven't been able to run for 7 years now, my left ankle swelling and painful from both impact and load.
    But I play tennis 3 days a week, windsurf close to 5 days a week, still ride my road and mountain bikes, and just try to enjoy the fact I am still alive, still have most of my functions (except good judgement), and still able to collect my monthly social security checks.
    I have a bud who had polio as a kid, got up into USTA B level, or 4.5, with one leg a good 4" shorter than the other. And, he's 5'5" tall.
    I have a bud who's enjoying solid 3.5 level tennis with BOTH hips replaced, at 70 years of age, still smiling and getting better at tennis.
     
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  22. Arthuro

    Arthuro Semi-Pro

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    You need a PRP shot and prolotherapy. You need to find someone that does this under ultrasound. DO NOT GO TO DOCTORS THAT DO THIS BLIND, without ultrasound guidance. This should heal your condition in about 2-3 months.
     
    #22
  23. boosted180

    boosted180 New User

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    I think I've mentioned this somewhere already, but PRP turned out to be the worst thing I did for my ankle. I know it's helped a lot of people so I don't know if it's the doctor or it just wasn't right for my situation, but I regret doing it. The pain was way worse than the original sprain and I felt like it crippled me for a week - literally couldn't walk. And afterwards it took about a month for me to even get back to where I was before PRP.

    BTW, he didn't use ultrasound. I asked him before hand and he said, "for your situation, it's pretty straight forward. I don't need to use the ultrasound." In retrospect, I didn't like the way he did things at all. He wasn't even really interested in figuring out what was wrong with my ankle. All he wanted to do from the first moment he saw me was to sell PRP.
     
    Last edited: Apr 3, 2014
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  24. boosted180

    boosted180 New User

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    Yes, I've seen the video, but at this point it doesn't matter b/c I have not (can not) play. On some days it hurts even to brush my teeth. Something is really not right.

    But on the positive side of things, my ankle seems to be improving noticeably. Now I can do some light PT type exercises and Egoscue without pain or inflamation afterwards. I've taken long walks also without issues and finally able to ride my bike without ankle pain. (But the shoulder hurts and tightens up pretty badly after my ride).

    On someone's advice on this forum (cant remember who), I saw someone for an Alexander Technique lesson. I was quite surprised by how good it felt! It's definitely different than anything else I've done. I don't want to get excited too soon b/c I've been disappointed too many times in the past. But I'm looking forward to my next appointment and to seeing what it's all about. So far it sounds very good though.

    As far as MRI, that's been on my mind since I first hurt my ankle and shoulder, but they required a doctor's order, which required me to see him first, then get the MRI, then come back to see him again to talk about the MRI. So inefficient and costly! I don't have insurance currently but should have it soon and will do all that then. First visit with the orthopedic specialist is $275, MRI is about $550, then follow-up visit another $175. For a cash patient, it's almost $1000 even before I get a diagnosis!

    We'll see how things go...
     
    #24
  25. Lefty5

    Lefty5 Hall of Fame

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    You have to reduce the inflammation if its ongoing. You can do this a couple ways.
    1. Look into Curcumin supplements and double the recommended dosage
    2. Stop eating inflammatory foods (i.e. Wheat, Bread, Yeast, Flour) also known as Gluten Free. Try it for a month and it seriously could solve everything for you.
    3. Don't give up strengthening exercises. Critical.

    Good luck
     
    #25

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