5 Steps To Fix Tendinitis

Tendinitis may be common, but the solution to finding relief for some reason is NEVER easy!  Fortunately, fixing it can be as easy as a 5 step process!

STEP ONE:  GET THE PROPER DIAGNOSIS

Tendinitis is one of the most overdiagnosed conditions in the body!  It is also one of the most mistreated.  What research has shown over the last few decades is that tendinitis is not the tendinitis that we know.  Tendinitis is most often a DEGENERATIVE condition and rarely an INFLAMMATORY one.

This is a game changer when it comes to treatment.  The classic treatment of tendinitis with rest, ice, compression, elevation, or R.I.C.E, as the common acronym refers, could actually make you worse!  Tendinosis, a degenerative condition, is more prevalent between the 2 diagnosis’ yet less diagnosed, and treatment of the condition requires almost the exact opposite of “R.I.C.E.”  Its treatment is also a 4 step process, but doesn’t come with the fancy acronym.

It is absolutely vital that you get the correct diagnosis for the correct treatment!

For more information between the differences between tendinitis and tendinosis watch this highly informative video here.

Since we already discussed the classic treatment for tendinitis, we will finish the final four steps for fixing tendinosis, the more prevalent yet less treated condition.
STEP TWO:  REDUCE YOUR LOAD

Tendinosis, as mentioned, is degenerative.  This means the tendon is actually breaking down from overuse.  In order for proper recovery to happen a general guideline is to reduce your load by a minimum of 50%.  Each case is unique, though, so it’s important to discuss your load and current activity with your provider.

STEP THREE:  MANUAL THERAPY

As tendon breaks down, weakened, dysfunctional tendon is the result.  Adhesion is the most common, most misdiagnosed and mistreated condition in the body.  When present it also speeds of the rate of degeneration in the body by placing increased stress on muscles, ligaments, nerves, and joints.  The bad tissue has to be removed for complete resolution.  Specifically applied manual therapy is the best treatment option to break down adhesion and the degenerated tendon.

Below is a short video over adhesion.

STEP FOUR: ECCENTRIC EXERCISE

Eccentric exercise is a very specific exercise used to load a tendon.  This helps to regrow stronger, healthier tendon!  Each eccentric exercise is different for each body part.

It is important to note that this type of exercise should only be instated AFTER manual therapy has been effective at breaking down a majority of bad tissue, and it has been determined you are ready for more load to be placed on the injured area.

STEP FIVE:  BRACING

Really, this is a step that can be implemented at any time.  Sometimes bracing should be used at the onset of care.  Other times bracing is used after treatment is going slower than thought.  Depending on the amount of degeneration, tendinosis is a condition that can take more than a few weeks to cure.  Bracing helps to offer support through treatment to aid in recovery and further reduce the load being placed on the injured area.  Usually, you can get away with using a fairly inexpensive brace from a local sporting goods or department store.

Tendinitis is a real pain – often misdiagnosed and mistreated.  If you, or someone you know has been struggling to find relief from tendinitis, you may have been misdiagnosed. You should seek a second opinion.  You deserve better answers and solutions to your problem!


We do hope that you have found this post helpful!  If you or someone you know is struggling with pain and have been diagnosed with tendinitis, we encourage you to share this article with them or get a second opinion.  If you live in the Cedar Rapids/Iowa City area, we would be happy to help! 

At Thrive Spine and Sport, we specialize in the diagnosis and treatment of adhesion and overuse conditions like tendinitis and tendinosis.  Currently, we are the only full body certified Integrative Diagnosis providers in the State of Iowa.  Integrative Diagnosis is the most advanced diagnosis and treatment system for musculoskeletal pain.  To fast track your recovery, call 319-423-0925 or fill out an appointment request here.

Thanks for reading!

Before You Get A Cortisone Shot: What You Should Know

Cortisone.  We have all heard the name.  Some of you probably know someone who has been treated with it – It may have been you.  But what is cortisone and what does it actually do?  Could cortisone actually make things worse? Let’s dive in and find out.

The emergence of cortisone started in the late 1940’s and it was immediately heralded as the safest and most reliable means to treat pain and inflammation.  Cortisone shots very quickly became the standard for overuse injuries, like “Tennis Elbow,” Achilles “Tendonitis,” “Bicep Tendonitis” and “Plantar Fasciitis.” Cortisone remains the standard today.

Cortisone, closely related to cortisol and also produced naturally in the body by the adrenal glands in response to stress, acts to suppress the immune system resulting in reduction of inflammation, pain, and swelling at the site of injury.  Cortisone is primarily used in the short term and typical results provide several weeks to months of relief.  Sounds good, right?

Not so fast.  A recently published review examined the results of several randomized trials, involving thousands of participants with overuse injuries.  These studies did find that, in the short term, cortisone did work to relieve pain better when compared to doing nothing (no shock there) or physical therapy. But what the review also states is that when the same participants were reexamined 6 and 12 months later, not only did they have a LOWER rate of recovery than the other test group, they also had a significantly HIGHER chance of RELAPSE!

So why is this? Cortisone shots are used for the treatment of INFLAMMATION!  Overuse injuries do not involve INFLAMMATION!  More research is now showing overuse injuries (“Tennis Elbow,” “Golfer’s Elbow,” “Achilles Tendonitis,” “Plantar Fasciitis,” etc.) to be DEGENERATIVE!  That means that the tendons of the involved structures actually begin to fray with overuse.

But why does cortisone work in the short term then?  Cortisone has an undeniable effect on the nervous system.  Cortisone increases the body’s pain threshold, increasing it in the short term.  This is why you no longer have pain and can return to regular activity.  But this is also why the pain returns after the cortisone wears off! Pain is a protective mechanism of the body.  Pain is the body’s way of telling you to stop doing what you are doing.  When pain is overridden, the degeneration of the overuse injuries continues to occur leaving you worse off than when you started.

So what should you do?  With any degenerative injuries, the tendons and other soft tissues must be restored.  The best way to do this is by getting a proper diagnosis!  Far too often these injuries are misdiagnosed.

Once a proper diagnosis has been established, you can begin the right treatment for your problem.  Most often this treatment includes, manual therapy and at-home exercises.  Bracing and load management are possible options for those responding to care slower than usual. Cortisone injections should be the LAST place to start with treatment!

At Thrive Spine and Sport, we pick up where others have failed.  If you have been debating on whether or not to get a cortisone injection, and you live in the Cedar Rapids or surrounding areas, I invite you to fill out the appointment request on this page or call our office today at 319-423-0925 and get to the bottom of your pain!  If you have any questions, please feel free to reach out to Dr. Cody Scharf at dr.cody@thrivespineandsport.com.

 

Thanks for reading!

5 Must Have Movements For Pain Free Running!

Let’s face the facts.  Runners are one of the most injured group of athletes.  Some studies suggest, as much as 70% of runners this year will suffer an injury that will either limit the runner’s   mileage,or stop them from running completely! The complications of running arise primarily from overuse.

Now I don’t want to paint a picture that running is bad for you, because it isn’t!  There are tremendous health benefits to running.  The problem is that most runners like to push their limits – often coming very close – several times a week.  This is where injuries start.

Runner’s knee, IT band syndrome, plantar fasciitis, Achilles tendinitis, sound familiar?  These are all examples of overuse injuries.  These don’t develop after one run but after miles and miles of pounding the pavement.  Generally, the problem isn’t that we run too much, so much as these, are often the result of biomechanical imbalances and deficits which lead to added stress on muscles, joints, and other tissues.

None of us want to stop running or have pain.  Wouldn’t it be nice to know what is causing our current pain and problems?  Or better yet, wouldn’t be nice to know if we were at risk for a specific injury? Fortunately we do have these things!  Below are 5 at-home assessments that can test and assess for some of the most common running injuries!

Ankle Dorsiflexion

Ankle dorsiflexion may be the most important assessment for a runner.  The feet and ankles are our foundation!  Plantar fasciitis, Achilles tendinitis, shin splints, and eventually stress fractures can all be caused by limited dorsiflexion.

To test this start by standing arm’s length away from a wall.  Place one foot close to the wall with the big toe touching the wall.  Place a ruler along the lateral foot.  While keeping the heel on the ground, bring the knee to the wall.  Continue to slide the foot back and bring the knee to wall until you can no longer get the knee to touch the wall without the heel coming off the floor.  Normal range is 5-6” and anything short of this makes you more likely for any running injury!

Clean Ankle Dorsiflexion
Clean Ankle Dorsiflexion

Knee Flexion

Reduced knee flexion directly leads to one of the most frequent injuries for runners – Runners knee.

To try this assessment, stand upright. Grab and pull an ankle until the heel comes into contact with the glute on the same side as the ankle.  Anything short of pulling the ankle to the glute is placing you at higher risk for Runners knee.

Positive Knee Flexion (Heel Short of Glutes)

Hip Flexion

While the hips are not given the label of the most commonly injured sites for a runner, a lack of hip flexion can lead to bursitis, IT band syndrome, muscle/labrum tears, and other problems downstream of the hips.

To test hip flexion, start by lying flat on the floor with the legs straight in front of you.  Try to bring the knee to the chest while keeping the opposing leg flat.  The front of the thigh should be flat against the chest.  Test the other side the same way.  Any pinching in through the front of hip, in the groin, or lateral hip is also a positive test and putting you at risk for injury.

Hip Flexion Test
Hip Flexion Test

Hip Extension

Hip Extension is another assessment that has a direct role in stride length.  Limited hip extension shortens the stride.  When putting in the final kick to finish our race, we can’t be held back!  By altering our stride, hip extension can cause any issue in the low back, hips, or knees directly.

To test this assessment is a little trickier and may require a partner. Start by getting into a lunge position.  Lean as far forward as you can on the hip while staying upright. There should be no forward lean!  Place a ruler under your back leg – this is the side we are assessing.   Then find your ASIS – it is the bony part in the front of your hip.  Place a level or a plumb line directly against the ASIS, directly over the ruler.  Where the plumb line or level hits the ruler is your measurement.  Note symptoms as well. Test both sides. Normal range of motion is 11-13” for most people although it can get much more.  Pain with this movement, inability to stay upright, or any measurement short of 11” is a positive test.

Hip Extension (Measure from under the back leg)

Toe Touch

The toe touch is an “all-inclusive” assessment.  The toe touch is one of the most basic, functional movements anyone who is an active runner should have.  Inability to touch the toes, shows reduced mobility in the low back and hips putting you at more risk of any injury, including low back pain.

Hopefully, you found all these assessments to be in normal range, but I’m guessing a few of you out there found some tests that were a little short or painful.

So why don’t you have the mobility?  The two most common reasons these movements are restricted are due to adhesion and joint shape issues.

Adhesion is a buildup of scar tissue through overuse in the soft tissue like muscles, ligaments, or around nerves. This is the most common dysfunction in the human body, but also the most commonly misdiagnosed condition.  The good news is that it can be easily fixed by a professional trained to diagnose and treat it! When present adhesion restricts range of motion, decreases strength, and causes pain.

Joint shape issues are either genetic or degenerative.  This is not nearly as common as adhesion is, and degenerative joints are often the result of years of bad soft tissue, use, and abuse.

So what can you do?

If you find yourself falling short in some of these assessments but were pain free, start a routine of some stretching and mobility. Stretch and foam roll the restricted areas daily to try to get within normal range.

If you currently find yourself in pain, or any of the assessments painful, it’s too late! You need to seek out a healthcare professional to get examined.  Find one that is trained to break up adhesion and properly evaluate these movements.  If you chose to continue to run with these restricted movements and pain, it is not a matter of if, but when, more significant injury will happen!

If you live in the Cedar Rapids/Iowa City area and struggling with any of these tests, call our office today at 319-423-0925!  At Thrive Spine and Sport we specialize in the diagnosis and treatment of overuse injuries caused by adhesion.

Pain and injuries are a part of running, just like any other sport, but that shouldn’t be the reason they stop you!

 

Thanks for reading!