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-   -   Tendon Injury Nuthouse (http://tt.tennis-warehouse.com/showthread.php?t=442912)

Chas Tennis 10-13-2012 05:45 PM

Tendon Injury Nuthouse
 
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 -
Quote:

Originally Posted by andreh (Post 7774751)
http://bjsm.bmj.com/content/early/20...12-091957.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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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...........?

janm 10-14-2012 12:35 PM

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...

LeeD 10-14-2012 12:39 PM

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?

janm 10-14-2012 01:33 PM

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.

LeeD 10-14-2012 01:39 PM

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.

Chas Tennis 10-14-2012 01:45 PM

Quote:

Originally Posted by janm (Post 6955318)
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...

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

LeeD 10-14-2012 01:48 PM

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.

janm 10-14-2012 02:15 PM

Quote:

Originally Posted by LeeD (Post 6955448)
I think he needs to make some sort of decision by himself, for himself.

Not sure what you mean here?

janm 10-14-2012 02:22 PM

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

LeeD 10-14-2012 02:22 PM

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.

janm 10-14-2012 03:19 PM

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.

LeeD 10-14-2012 03:22 PM

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

Chas Tennis 10-15-2012 01:06 AM

Direct link to the paper.
 
Direct link to the 1 page article

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122566/

charliefedererer 10-15-2012 05:57 AM

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.




Chas Tennis 10-15-2012 08:31 AM

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.

Chas Tennis 10-15-2012 08:45 AM

Quote:

Originally Posted by charliefedererer (Post 6956506)
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 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."

janm 10-15-2012 10:07 AM

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

thanks

r2473 10-15-2012 10:34 AM

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.

Pacific lefty 10-26-2012 11:31 AM

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.

Chas Tennis 10-26-2012 12:04 PM

Pacific Lefty, That's great news, finally!


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