Tendonosis

[IbåNeZ]

Hey,

Right, best article i've found on tendonosis so far: **[can't post links yet - see below] - very informative, explains what it is, what the difference between tendonITIS and tendonOSIS is and also how to overcome it.

I have tendonosis in the knee (patellar) and the bicep which pretty much means it affects any excercise I do. So for the next few weeks/months I'll be following the workout detailed in the article above. I've chosen one excercise for each muscle group (as they're pretty long). Due to the rediculous amount of reps that need doing, squats, deads and pullups are all out of the question.

Chest - Bench
Shoulders - Military
Bi's - EZ bar curls
Tri's - Skulls
Back - Rows
Knee - Leg extentions

The workout goes like this (example for bench if you're used to doing 70kg):

Warmup : 30 x 10kg (slow)
1: 30 x 20kg (fast)
2: 60 x 20kg (fast)
3: 15 x 22kg (slow)
4: 10 x 28kg (slow)
5: 70 x 20kg (fast)
6: 100 x 20kg (fast)

I did that workout last night (chest and shoulders) and was all good except I could only make 40 x and 20 x on the last 2 sets.

This whole thing is counter-intuitive because you're training something that causes you pain. I'll be writing a log over the next few months to see how I get on with his but if anyone has tried this before or any similar treatments then any advice is welcome!

Cheers


**bodybuilding [dot] com / fun / drryan13 [dot] htm < If someone with more posts could post that for me, that would be great

[b34tBoX]

Well if you have tendinitis, you should be avoiding anything which brings pain because it'll just reset the injury every time you do it.
Here's where you don't push through the pain, otherwise you're forever be do it like this.

[IbåNeZ]

Hi!

tendonITIS and tendonOSIS

Unfortunately, they're two completely different conditions (see article)

Cheers!

[b34tBoX]

I'm aware, and that it is a form of Tendinitis.

Tendinosis, sometimes called chronic tendinitis, tendinosus, chronic tendinopathy or chronic tendon injury, is damage to a tendon at a cellular level (the suffix "osis" implies a pathology of chronic degeneration without inflammation).

Good luck with your injuries. I was predominantly suggesting that it would be best to rest rather than work through your injuries.

[IbåNeZ]

So you're saying that article is plain wrong?

[mc-]

here's the url
http://www.bodybuilding.com/fun/drryan13.htm

note that the refs from this artilce are from 2002 and before. much has moved on from this time. It's not clear that David Ryan would write the same article today.

Given that preface.

ok what i'd say and have said about this article before is that to say one has tendonitis or tendonosis is not particuarly useful in terms of rehab. THis distinction without a difference is largely why experts in the field have stopped pretty much using either term and now just say "tendonopathy" For instance, see

http://www.begin2dig.com/2010/04/ecc...-ideas-as.html

from 2008

Traditionally, pain in and around tendons associated with activity has been termed tendonitis. This terminology implies the pain associated with these conditions results from an inflammatory process. Not surprisingly, treatment modalities have mainly been aimed at controlling this inflammation. The mainstays of treatment have included rest, nonsteroidal antiinflammatory medications (NSAIDs), and periodic local corticosteroid injections.

There are two problems with this approach. First, several studies demonstrate little or no inflammation is actually present in tendons exposed to overuse [83, 96, 163]. Second, traditional treatment modalities aimed at modulating inflammation have had limited success in treating chronic, painful conditions arising from overuse of tendons. More recently, the term tendinopathy has been advocated to describe the variety of painful conditions that develop in and around tendons in response to overuse.

Indeed, as we see from the above, the idea that tendonitis is just inflammatory, rare, 14 days - is kinda dated.

So with none of the athletes dealing with joint stuff have i found these attempts at distinctions helpful for rehab.
I'd also suggest that the site of pain is not the source of pain: knowing that it's quite possible that someone will have inflammation for much longer than 14 days - but the effect of this might be that there's something buggered in one's forearm or foot, or there's a horrible memory chunked with this injury (pain has a large psycho-social component) that until that's addressed means that shoulder stays sore.

What is the main takeaway from the work is the note that folks stay on vitamin I (ibuprofen, other NSAIDS) too long, and that the best thing to do is to move the joint. What the specifications are for this movement - well - who knows?

For instance Ryan suggests

"Please note; that this part is likely to cause pain, but not more than 60% or a 6/10. "
I have a violent reaction to anyone saying move into pain - ever -

If you are moving into what your brain is reading as pain, (not discomfort) but pain, then that is a signal to STOP and CHANGE - to ignore that is not a good idea -- ever-- if your life is not in jeopardy or you are not deliberately testing your endurance thresholod. in this context of rehab, neither of those should apply. There is NO NEED from the research to move into pain to induce healing.

Ryan also suggests a bunch of stuff on speeds and times and what not. Again, i'm really suspect of prescriptions for rehab without being able

a) to test what we're doing
b) control speed

For instance, Ryan states
"Train at speeds to complete a movement at very high speeds for time intervals of 15, 30, 45, 60 seconds. " or "Reduce the speed and use more weight (1-10%) still maintaining a slower speed at first, and then progressing to a higher speed."

Well, why? and when?

When my colleagues and i work with athletes we agree that being able to move at speed is important - critical in fact - but that speeding up and conversley being able to SLOW down with control are both important.

In rehab howerver, we have found that focusing on movement quality first is more important than anything else.

SO our practice would concur with Ryan here "Determine the painful movements." is a good place to start:

by knowing where the pain is one knows what to avoid and the range of motion that needs to be improved.

Don't quite agree with this "Train the painful motion using lighter weights/slow movements at first, then progressing to faster and faster movements."

What does "train the painful motion mean?" -> in the quality movement space this would mean - looking at whole movements - so say the shoulder hurts when moving the arm in front of the body. Ok - when? how big is the movement - how small? We'd have an athlete do circles with as much control as possible in both directions - as close to the pain but not into the pain as possible.

We'd focus on movement quality before adding load. Why? Well, what happens to your movement quality when you go fast with a shoulder circle across your body - does the size change? does it stay as circular as it was or does it deform into an elipse?

SO once we have control of the movement, we'd move into some load - with a little jump stretch for instance. again moving towards the pain but not into the pain.

We have found that these signals from the joint area help strengthen the joint; by working with circles we also work on odd angle strength - remember injuries happen mainly at end range of motion or in deceleration. so by practicing our rehab positions for control through the ciricle we get many benefits.

Based on this rehab work that is very controlled and focused on quality and rehab, then we just test our regular movements - like the press or whatever it is we want to do as a whole complex movement - with whatever loads, speeds and ROM's can be handled.

**note - if rehab doesn't happen: it may be because just as the site of pain is not the source of pain, the muscle or tendon is not the issue - this may be a sign to consider as said visual, vestibular or proprioceptive issues. This is one space where a movement assessment is a good idea.
(http://www.begin2dig.com/2010/11/wha...for-petes.html)

You can probably guess that while Ryan specifies specific loads for rehabbing, we don't. Quality of the movement dictates what's done. Once standard speed is owned, we can work on super slow, accelerated and then sport speed as and when appropriate.

Ryan also says "Trial and error is the best way to determine which are best for your program."

Well, we'd say not trial and error but test and reassess. We'd also not use *just* the movement (like the painful part of the biceps curl as in Ryan's example) but would look at the range of motion in that joint - hence the circles - so in the curl example - we'd check shoulder circles and top and bottom elbow circles.

TAKE AWAY
- whether or not it's an osis or an itis is largely immaterial. if your arm is hanging off and you may need surgery is another issue, but there will be other markers to tell if life is that horrible.

- assess and develop quality of movement for the WHOLE joint range of motion as with circles

- develop control at one speed; then add load but maintain the movements; work the weak spots in that movement

- NEVER move into pain - make it smaller, lighter, slower to control the movement and maintain quality.

The goal of rehab is to heal the whole joint so that you can do your sport - but not *just* your sport. hence working the whole joint - and then build strength more as the rehab holds - with regular strength and conditioning.

hope that helps

[IbåNeZ]

Hey, thanks for taking the time to write that mc! very useful and definately what I needed

Cheers!

[Ace0123]

Great Job MC and very informative. I joined the bodybuilding.com forums because I have noticed there is not a lot of information about tendonosis and I wanted to share my injury, rehab etc...I am hoping for some feedback from others that may have had this and who are now healed or to provide some insight to others who may be experiencing what I am.

I was originally injured in October of 2011. I had a normal shoulder workout the day before with no pain. The next morning I woke up I was in some pain. I though it was a mild strain in my shoulder. I took a few days off and then worked out again. Pain was still there but only in benching (flat/incline), pull ups and military press. So I continued working out for 2 more weeks avoiding those exercises untill I realized I needed to see a doctor. I was having pain in my anterior deltoid and definitely some rotator cuff pain as well. I was originally diagnosed with deltoid tendonitis (which was the wrong diagnosis...i will get to that later).

I had an MRI and XRAY and it came back negative although i was told MRI even though it was closed was a poor image. Started physical therapy and did it for 2 full months with no good results. At same time I was on NSAID's for a month. Was told to work out by PT and do anything that didn't cause pain. I tried that and that was worst advice I could have gotten. Made my shoulder worse. And I didn't do any over the head exercises. During this time i also started accupuncture.

I switched doctors and went to a shoulder specialist at the Hospital For Special Surgery in late December. I was diagnosed with bicep tendonitis. Physical therapy still was not working well even with this new diagnosis. Doctor then sent me to a radiologist for an ultrasound guided cortisone injection in the bicep tendon. Wasn't painful but a few hours after injection the pain kicked in and I was in pain for about 3 days. After that the the original pain was still there although I must admit the rotator cuff pain went away. When the report from this procedure came back I was diagnosed with bicep tendonosis and also supraspinatus tendonosis and mild adjacent subdeltoid bursitis. 2 weeks later the shoulder specialist did another cortisone inject in my AC joint which he determined was very inflamed. He also put me on a 7 day powerful NSAID. AC joint got a little better and the bicep tendon still in pain. Did accupuncture for another 2 weeks with no great results. Also let me mention that the doctor I go to is a sports team shoulder doctor here in New York.

At this time I switched physical therapists which was over a week ago. A couple of the therapists seem to know more about tendonisis compared to the other PT. They understand the theory behind eccentric exercises to heal the tendon. Its been a full 3 months now with this injury. Dec 31st was last time I worked (again no over the head exercises) but I think i took a set back by listening to the original PT back then. I took a full 4 weeks off. No cardio, not even legs. Unfortunately gained weight. Was a little depressed and ate poorly. Returned to cardio about 9 days ago with doctors permission. Eating healthy and I lost a good 6 pounds. Have lost a ton of muscle but at this point I just want to get healthy. My doctor wants to avoid surgery on the bicep tendon because it is a major surgery and the rehab will be very long as well. Plus there is no guarantee that the surgery will even be successful.

I am not taking any more NSAID's because this will just make the tendon weaker. And definitely no more cortisone injections. We were hoping that the injury was still in its inflammation stage but apparently it is not and this seems like a degenerative tendon over time from overhead lifting and overtraining. And to this date the real pain seems to definitely be the long head biceps tendon.

The plan now is to hope i can rebuild this tendon through PT. Eccentric exercises definitely seem to hopeful in my recovery. In 2 weeks I am also seeing a pain management specialist in New York City. I want to discuss platelet rich plasma therapy (PRP) as I have researched that this could be very effective.

Anyone else with insight to bicep tendonosis would be appreciated.