Tendon Injury Nuthouse

Discussion in 'Health & Fitness' started by Chas Tennis, Oct 13, 2012.

  1. Chas Tennis

    Chas Tennis Hall of Fame

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    Direct link-to 2002 paper
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122566/

    UPDATE 9/23/2013 - This 2012 paper found by andreh discusses the issue and says that tendinitis and tendinosis should be viewed a little differently -
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    There was a 2002 British article discussing the nature of tendon injuries such as Achilles 'Tendinitis', Tennis Elbow, Golfer's Elbow, etc. , the accuracy of information about these injuries, treatment effectiveness, tendinitis vs tendinosis, etc.

    This article discusses the short paper-

    http://www.bmj.com/content/324/7338/626?tab=responses

    The link to the 2002 paper itself is on the top of the article.

    http://www.bmj.com/content/324/7338/626 - but you must be subscribed to view it.

    To view the article the British Medical Journal offers a free 1 month subscription. See link on the page.

    I signed up and got the article. Is this how things are, mostly...........?
     
    Last edited: Sep 23, 2013
    #1
  2. janm

    janm Rookie

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    I''ve become interested in tendons since I suffered an injury of my rotator cuff. As mine was a acute type injury I cannot answer your question re my treatment plan.

    I'm more curious in the role of NSAIDS or ICE for treatment of tendons. Wether that be tendonitis, strain/tear...

    I don't really understand why its necessary to reduce swelling after injury?

    Is it to help with pain? to further this keep the joint mobile otherwise one may keep the area protected and stiff.

    To prevent impingement of certain tendons?

    Some other function...?

    I've read somewhere NSAIDS my help with collagen allignment and keep the healed area from thickening too much. Don't know if this is good or bad. For tendons what can get impinged i'd imagine its good but what about others that don't suffer this problem. Wouldn't a thicker area where an injury has occured before be good.

    So far i've read so much contradictory stuff i'm unclear on the above.

    Sorry if i have gone off topic a bit...
     
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  3. LeeD

    LeeD Bionic Poster

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    I always thought ice to decrease swelling was to allow more good blood to enter the injured area, so recovery time can be faster. If you leave clotted blood around too long, no new goodies come into the injured area, how can it heal?
     
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  4. janm

    janm Rookie

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    The blood that leaks into surrounding tissue increases the bodys reponse by actiing as an irritant.

    Not sure about vasoconstriction following application of ice will increase blood flow or mop up clotted blood quicker. It will stop blood leakage to surrounding tissue to an extent through damaged capillaries I think.
     
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  5. LeeD

    LeeD Bionic Poster

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    Either way, it's now believed that after a catastrophic injury, and after it stablilizes, some amount of increased heartbeat and exercise does promote quicker healing and recovery.
    My first broken leg, in the mid '60's, it was still a belief by some members of the medical society to just rest to recuperate, with no excercise or movement of the parts surrounding the actual injury.
     
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  6. Chas Tennis

    Chas Tennis Hall of Fame

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    I believe the report very briefly mentions some of those topics. What did you think?
     
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  7. LeeD

    LeeD Bionic Poster

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    I think he needs to make some sort of decision by himself, for himself, and spend less time reading about studies conducted by people who never had an injury or ever will because they stay safe and locked up 24/7.
     
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  8. janm

    janm Rookie

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    Not sure what you mean here?
     
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  9. janm

    janm Rookie

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    Chas I will get to the article soon, just don't had that much time to go though it yet
     
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  10. LeeD

    LeeD Bionic Poster

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    Posts 1 and 2.
    You can read till the sky turns green.
    You can cite every report ever made on the subject.
    Still, you gotta make your own decision based on your experience, for you yourself.
    What you decide might not be applicable for another guy, just for yourself. That don't mean you should withhold it, just that the other guy doesn't need to heed it.
     
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  11. janm

    janm Rookie

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    Just read its pretty short.

    I guess its pretty much to the mark. I'm still not sure of the extent of my injury but its pretty clear the doctor gave me NSAIDs because I was complaining about pain and not because of any specific treatment plan.

    Having read an article before showing how british GPs treat tendon complaints its pretty standard here.

    rest for a few weeks -> NSAIDs -> phsio
    surgery if its serious

    I guess this article is saying avoid SAIDs, rest then phsio without pain upto collagen turnover naturally is the best bet for recovery for small injuries.

    I've read somewhere turnover can be as long as 300-500 days.
     
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  12. LeeD

    LeeD Bionic Poster

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    you need only to have suffered such injuries to know recovery can take much longer than any doctor's guess..
     
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  13. Chas Tennis

    Chas Tennis Hall of Fame

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  14. charliefedererer

    charliefedererer Legend

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    No one knows exactly what is going on at the tendon level in any one patient suffering from tendonitis/tendonosis.

    There just is not a good test that will tell us how much inflammation really is present.




    The bottom line is that it takes a long, long time for tendon to heal.

    It has a lousy blood supply, and has to support very high forces.



    Most people are familiar with the way a skin injury heals so very quickly in a couple of weeks.

    They can't wrap their heads around the concept that different tissues heal at different rates.

    Skin is growing at a very rapid rate and has a great blood supply. The pulling force on skin at any one point is quite small.

    Tendon isn't growing at all under normal conditions, and has a lousy blood supply. The force of muscle pulling on tendon is great.



    People think 2 weeks is a long time - long enough to injured tendon to heal.

    They are wrong.



    [​IMG]
     
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  15. Chas Tennis

    Chas Tennis Hall of Fame

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    Paper - Tendinosis

    A 2009 paper with more discussion, along the same lines.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445129/

    There is also some information on the amount of elongation in % necessary to stretch, injury and cause failure of tendon tissue.

    I believe that the 2002 paper is reasonable and honest.
     
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  16. Chas Tennis

    Chas Tennis Hall of Fame

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    The level of knowledge is not that great yet but the 2002 Kahn report says:

    "Animal studies show that within two to three weeks of tendon insult tendinosis is present and inflammatory cells are absent."
     
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  17. janm

    janm Rookie

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    charliefedererer that table is it for tendonosis, tendon tear or full tendon tear and subsequent recovery?

    thanks
     
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  18. r2473

    r2473 Legend

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    I fully tore my distal bicep tendon. At 17 weeks, I'm very close to 100% I think.

    I had golf elbow (from weight lifting) a few years ago. As I recall it took about 3 months to fully recover from that. It has not returned.
     
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  19. Pacific lefty

    Pacific lefty Rookie

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    I think that sometimes, in my experience anyway, NSAIDS mask the pain and you can be tempted to think the injury is not as serious as it is, and therefore play through it. I would be very wary about using them too much.

    Six months on now, from the SAD surgery and I played three sets with my mixed partner, took one set off of him, and happily enough felt no pain whatsoever afterwards.
     
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  20. Chas Tennis

    Chas Tennis Hall of Fame

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    Pacific Lefty, That's great news, finally!
     
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  21. arche3

    arche3 Banned

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    I had severe tennis elbow from too much tennis, poly strings, and my wife making me help her garden one summer. It look me over a year time recover.
     
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  22. Chas Tennis

    Chas Tennis Hall of Fame

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    Detailed Technical Paper on Tendon Healing & Remodeling

    Biology of Tendon Injury: Healing, Modeling and Remodeling (2006)
    P. Sharma1 and N. Maffulli2

    http://www.ismni.org/jmni/pdf/24/14MAFFULLI.pdf

    This paper is very technical but also has some interesting discussions often related to Achilles tendon injuries.

    [You can search for terms in a .pdf document by right clicking and selecting "Find". Is that an Adobe software feature? ]
     
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  23. Chas Tennis

    Chas Tennis Hall of Fame

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    Current Concepts in Examination and Treatment of Elbow Tendon Injury, Todd Ellenbecke

    Current Concepts in Examination and Treatment of Elbow Tendon Injury, 2012, Todd Ellenbecker, R. Nirschl, and Per Renstrom
    Update 2/25/2014 - available free
    http://www.thera-bandacademy.com/el...13-sportshealth-elbow__635071763835825895.pdf


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    Abstract
    http://sph.sagepub.com/content/early/2012/10/29/1941738112464761.abstract

    Not free
    http://sph.sagepub.com/content/early/2012/10/29/1941738112464761.full
     
    Last edited: Feb 25, 2014
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  24. Chas Tennis

    Chas Tennis Hall of Fame

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    Last edited: Nov 6, 2014
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