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Tendinitis, Paratendinitis and Tendinosis - Achilles Tendonitis


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


Tendinitis is a catch term for inflammation of the tendon itself, and can often co-exist with paratendinitis (shin splints).


The cause of tendinitis usually results from microscopic tears within the tendon and triggering an inflammatory response within the tendon. Common areas susceptible to tendonitis 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 tendinitis are tenderness, crepitus and local swelling.


Tendinitis 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.

Pain Study


Excerpts from Pain Study being prepared for publication by a large Western University

METHODOLOGY
A group of 32 injury victims were selected from two locations. One a pain clinic where the injuries ranged from sports trauma to falls, and two "old injuries acting up." The other location was an athletic training center at a large Western University during basketball, volleyball, and track seasons. The injuries involved were strains, sprains, and trauma from falls, etc. There were no broken bones or deep cuts.
The subjects were randomly assigned to two groups, red or blue. All subjects were required to sign a consent form in order to join the study, however, neither the subject nor the trainer/nurse/physician knew whether red or blue was experimental or control. Each subject was asked—and agreed—not to ingest any type of analgesic or other pain medication nor obtain any other methods of treatment for their injury while participating in this study.
Results - the perceived levels of pain were calculated by subtracting the perceived level at each reporting time from the original perception:
· Thirty minutes - all control group subjects felt worse or no change. 31% of the treatment groups felt somewhat better. Significance of .024.

· Two hours - control group subjects continued to feel worse or the same. 56% of treatment group felt significant improvement. Significance is .003.

· 24 hours - 25% of control had some improvement. 63% of treatment group had significant improvement.

· Three days - 30% of control group had slight improvement. 88% of treatment group had moderate to great improvement.

· Seven days - 33% of control group subjects had again slight improvement. 91% of treatment group subjects had great to total improvement. Significance is .004.

[IMAGE]

Goode WrapsOrder On-line or use 800 mumber.

What are Goode Wraps, anyway?
They are elasticized cloth bands or sports wraps. Each of these is impregnated with a unique blend of natural rare earth semiconductors that increase circulation to reduce pain or prevent swelling. Goode Wraps are available for the foot, ankle, knee, elbows, and wrist. In fact, the semiconductors can be added to almost any cloth like material.

[IMAGE]
Dr. Rudy J. Horwitz, Director Pennsylvania Psychological Services.
"By nature, I’m a skeptic. When my brother-in-law suggested I try an elastic band for my carpal tunnel problems, I quietly laughed. After explaining to me that the band was impregnated with semiconductors, I laughed some more. In fact, I continued laughing while wearing a band immediately after a particularly painful episode of my condition. However, my laughter stopped when I realized something--the band, in fact, did work! Unfortunately, the "band" was given to me after I went through several months of conventional treatment for my condition. This included the use of a fitted removable cast in addition to two to three hour-long hand therapy sessions over a period of six weeks. I am curious as to whether or not the use of the "band" would have shortened the treatment time."

[IMAGE]

Gilbert Spector, MD, Hogil Pharmaceutical Corporation.
"My wife reluctantly agreed to wear a patch over a hot spot in her lower back area. Twenty four hours later she was experiencing reduced levels of pain in her entire back. Forty eight hours and the relief continues! She gave her physical therapist a patch for his neck pain."


Time to Abandon the "Tendinitis" Myth
By K M Khan, assistant professor.Department of Family Practice, University of British Columbia, Vancouver, Canada V6T 1Z3

Tendinitis 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 tendinitis 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 tendinitis 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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