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Shin Splints, Achilles Tendonitis, Paratendinitis and Tendinosis

Of all the overuse problems associated with physical activity, tendonitis is among the most common. In the past, all conditions have been termed tendonitis and treated accordingly. There now are several different pathological entities. These are: tendonitis, paratendinitis, tendinosis, partial and complete rupture.

Tendonitis is a catch term for inflammation of the tendon itself, and can often co-exist with paratendinitis.

The cause of tendonitis usually results from microscopic tears within the tendon and triggering an inflammatory response within the tendon. Common areas susceptible to tendinitis are; achilles, patella, adductor longus, supraspinatus, biceps, tibialis posterior and flexor hallucis longus tendons.

The first signs of tendonitis are usually noticed following exercise and especially first thing in the morning. During the warm-up phase of exercise the pain frequently disappears and only returns after the cool down period. Consequently, the sportsperson can train through the pain in the early stages and therefore interfering with the healing process.

The main characteristics of tendonitis are tenderness, crepitus and local swelling.

Tendonitis responds well to a combination of; ice, rest, frictions, massage and strengthening once the tendon becomes less painful. When strengthening, eccentric exercises have been very successful in helping preventing recurrence.

Paratendinitis

Paratendinitis describes inflammation of the outer layer of the tendon and usually occurs when the tendon rubs over a prominence. It is also seen in association with tendinosis and partial tears.

Paratendinitis can also be called tenosynovities or tenovaginitis.

[IMAGE]

Time to Abandon the "Tendonitis" Myth

By K M Khan, assistant professor.Department of Family Practice, University of British Columbia, Vancouver, Canada V6T 1Z3

Tendonitis such as that of the Achilles, lateral elbow, and rotator cuff tendons is a common presentation to family practitioners and various medical specialists.

Most currently practicing general practitioners were taught, and many still believe, that patients who present with overuse tendonitis have a largely inflammatory condition and will benefit from anti-inflammatory medication.
Unfortunately this dogma is deeply entrenched.

Ten of 11 readily available sports medicine texts specifically recommend non-steroidal anti-inflammatory drugs for treating painful conditions like Achilles and patellar tendonitis despite the lack of a biological rationale or clinical evidence for this approach.

Instead of adhering to the myths above, physicians should acknowledge that painful overuse tendon conditions have a non-inflammatory cause.

A critical review of the role of various anti-inflammatory medications in soft tissue conditions found limited evidence of short term pain relief and no evidence of their effectiveness in providing even medium term clinical resolution of clearly diagnosed tendon disorders.

Laboratory studies have not shown a therapeutic role for these medications. Steroid injections provide mixed results in relieving the pain of tendon problems.
If general practitioners, orthopedic surgeons, and other members of the healthcare professions treating tendon disorders made a quantum shift from previous flawed teaching about overuse tendonitis and adopted these data there would be immediate ramifications.

Some pockets of the sports medicine, orthopedics, and rheumatology specialties have adopted this paradigm, 2-4 10 but it must no longer remain within that cabal. It is time for medical educators to accept the irrefutable evidence that the term tendonitis must be abandoned to highlight a new perspective on tendon disorders.

Adopting the tendinopathy paradigm is essential if general practitioners are to practice evidence based medicine.

British Medical Journal March 16, 2002; 324: 626-627

Goode Wraps Relieve Pain, Swelling and Stiffness by Relaxing Muscles

Philosophy and Application

DR. MERCOLA'S COMMENT:
Using anti-inflammatory medication for these tendon problems is a prescription for disaster as they clearly do not treat the underlying cause and have the potential to cause significant complications.

Put simply, the philosophy is that the body is a self regulating bioenergetic and biomechanical phenomena which will continue to regulate itself for as long as it has the reserve energy necessary to sustain life, by the ongoing process of biological adaptation.

Bowen realized that the body would regulate itself and return to balance if the appropriate neurological and neuromuscular context was created so that it could. There was never the question of if it could, this was implicit -- the fact that the person had life was evidence enough that it could!

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