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Tendonosis/Tendonopathy

Tendonosis/Tendonopathy

Tendonosis or Tendonopathy is a new term used to describe painful conditions that occur at tendons in response to overuse. Recent published medical research suggests there IS NO inflammation present in these conditions!  So traditional treatments such as NSAID’s, ice, and cortisone injections are not the most effective treatment options.

SDRI has been researching Tendonosis/Tendonopathy for 20 years and have developed a comprehensive, effective and evidence based treatment protocol that is highly effective for common areas affected by tendonosis.

Do you want a Detailed and Comprehensive Review of Tendonosis?

Plantar Fasciosis – This results from repetitive bouts of plantar fasciitis where a runner takes NSAID’s and maybe even a cortisone injection while they continue to run and develop excessive scar tissue formation.  Eventually that scar tissue becomes fibrotic tissue, thickens, loses its normal mechanical properties and becomes more sensitive to pain.

Achilles Tendonosis – This condition is similar to plantar fasciosis and in fact is both mechanically and functionally related to the plantar fascia.  Achilles tendonosis develops in much the same manner  as plantar fasciosis and will eventually become so tight and painful that even walking is uncomfortable.

High Hamstring Tendonosis – This condition really creeps up on athletes.  It starts out with the athlete thinking they have “tight” hamstrings and they often take bad advice from friends, family, other athletes and even doctors.  Part of the issue is that we have 4 hamstring muscles so that when one of them is injured the other 3 can take up  the slack.  The athlete will deal with the discomfort that gradually progresses.  If they are really unlucky they end up in a physical therapy office that declares them to have “weak hamstrings” and actually have them perform exercises that worsen the condition!  An MRI is necessary to accurately diagnose High Hamstring Tendonosis versus a new high hamstring tear.  In my experience I have personally seen many runners that have chronic hamstring tendonosis accompanied by an acute, recent tear.

Patella Tendonosis – This condition starts out as “jumper’s knee” or patella tendonitis.  Due to eccentric loading on the patella tendon during running and jumping excessive scar tissue formation can develop and become extremely painful.  It is not uncommon for patients to tell me that their doctor did an x-ray and pronounced “nothing wrong”.  X-rays do not show tendons and are not the proper test for evaluating the patella tendon.  An MRI is necessary to accurately access and diagnose patella tendonosis.

Rotator Cuff Tendonosis – Due to repetitive wear and tear it is not uncommon for the Supraspinatus tendon to develop tendonosis especially in those that do repetitive overhead activities.  These patients are often diagnosed as having rotator cuff “strains” and injected with cortisone which can lead to further degeneration of the tendon.

How is Tendonosis Treated Effectively at SDRI?

  1. Remove the offending variables.  If this means that you have to stop running than…..you have to stop running for a period of time or the condition will continue to worsen.
  2. We recommend Platelet Rich Plasma Therapy injection (PRP) to restart the healing process and let your tendon begin to repair. PRP is known to initiate the inflammatory response and combined with proper rest and rehabilitation techniques result in proper healing.  PRP as and Effective Treatment for Proximal Hamstring Injuries Not all PRP doctors are equal and do nto have the same approach to performing the injection.  Our doctor uses small gauge needles to limit injury to the muscle, tendon or ligament by the needle itself as well as uses a specific concentration of platelets in the injection.
  3. We follow a science based approach to rehabilitation following the PRP injection and take advantage of the bodies normal physiological response to connective tissue healing.  It is absolutely incredible to me how many patients I have seen that already had PRP performed by an ignorant doctor who thought he/she was injecting magical unicorns and rainbows into the patient and told them it was OK to resume athletic activity days after the injection!  This flies in the face of conventional science and physiology.  The injection simply restarts stage one of healing the Inflammatory Stage which takes 7-10 days to get through.  This is followed by the Repair stage which can take up to 6 weeks and ultimately by the Remodeling Stage which can take 6 months to a year for complete resolution.

4.  After the initial inflammatory phase the repair phase begins.  At this time we begin strengthening the tissue in a synergistic effort to promote stronger connective tissue formation.  During this time the connective tissue is under repair and great effort must be taken to not over stress the tissue.  This phase will last up to 6 weeks.

5. During the last phase known as the remodeling phase the athlete is gradually returned to normal athletic activity in a progressive manner.  The type of connective tissue that was injured, cartilage, ligament, tendon or muscle that was injured will dictate how long this last phase takes to complete.