Tuesday, May 12, 2009

TendonOSIS vs TendonITIS

TendonOSIS vs TendonITIS. What is the difference and does it matter?

Here it the crash course for you.

TendonITIS is normally from inflammation (itis)

TendonOSIS is normally from messed up connective tissue.

Most things are actually tendonOSIS (even though most docs call everything tendonITIS).

Once your overall movement quality improves, pain will normally dramatically reduce. I remember Dr. Cobb stating, "It movement can get you into pain, movement should be able to get you out of pain." I've found the Z Health exercises to be very effective here. For this line of thinking, it really doesn't matter much.

In general, tendonOSIS gets better (less pain) as you train in that session. TendonITIS normally gets worse.

If you are looking for a different approach, tendonOSIS responds better to longer eccentric contractions, but make sure there is no startle (flinching, fascial contortions, altered breathing and not painful). Try 10 reps or so of 5 sec eccentrics and work up to 2-3 sets and can be done as often as needed (sometimes daily). If someone is working with me, I will also evaluate their movement (normally via gait) to make sure their movement is not getting worse.

Most should see some change in 1-2 weeks and completely gone in about 3 weeks (but results will vary of course).

If it is tendonITIS I would try higher amounts of fish oil (EPA/DHA combined of about 2-4 grams per day), more fruits and veggies and if you want to get fancy tumeric and/or bromelain along with a good multi vitamin/mineral.

If pain still persists and appears to still be refractory to all of the above and you have not seen the sun in months, I would try some Vit D. Ideally you would talk to your doc about getting a blood test for Vit D and go from there. In many states, you can have your blood levels of Vit D testing on its own. ZRT labs will test for Vit D. Check out the SHR show below for more info.

Super Human Radio Show - # 258 - Responsible Vitamin D Supplementation

Hope this is helpful!
Rock on
Mike T Nelson

Edit--thanks to Kevin for sending me the following abstract

Clin Orthop Relat Res. 2006 Feb;443:320-32.

Biomechanical basis for tendinopathy.
Wang JH, Iosifidis MI, Fu FH.

MechanoBiology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. wanghc@pitt.edu

Tendinopathy affects millions of people in athletic and occupational settings and is a nemesis for patients and physicians. Mechanical loading is a major causative factor for tendinopathy; however, the exact mechanical loading conditions (magnitude, frequency, duration, loading history, or some combinations) that cause tendinopathy are poorly defined. Exercise animal model studies indicate that repetitive mechanical loading induces inflammatory and degenerative changes in tendons, but the cellular and molecular mechanisms responsible for such changes are not known. Injection animal model studies show that collagenase and inflammatory agents (inflammatory cytokines and prostaglandin E1 and E2) may be involved in tendon inflammation and degeneration; however, whether these molecules are involved in the development of tendinopathy because of mechanical loading remains to be verified. Finally, despite improved treatment modalities, the clinical outcome of treatment of tendinopathy is unpredictable, as it is not clear whether a specific modality treats the symptoms or the causes.

Research is required to better understand the mechanisms of tendinopathy at the tissue, cellular, and molecular levels and to develop new scientifically based modalities to treat tendinopathy more effectively.