Information on tendonitis that won't go away

[Suezee]

I have no tenderness anywhere on the outer portion of my forearm or thumb and no numbness either. The more I've been reading, the more I think it's the biceps tendon but I don't have too much pain in rotating my hand from thumb up to thumb to the side (palm up). I mean I have a little pain when I do that but more when I rotate it the other way...

When your palm is up, can you straighten your elbow ALL the way straight?

[BBLou]

Absolutely. No problem.

[Ekie]

Saw the doc today, got a case of bicep tendonitis. Got a script for meloxicam and prednisone. Looking into what to do now.

Edited to add:

Further study leads me to believe that I am dealing with tendonosis not tendonitis which are treated differently.

[BrotherWolf]

Saw the doc today, got a case of bicep tendonitis. Got a script for meloxicam and prednisone. Looking into what to do now.

The doctor didn't tell you what to do ?? time to get a new doc ...

[Ekie]

The doctor didn't tell you what to do ?? time to get a new doc ...

Yeah, he told me to take the steroid and such, but I ain't doing that. And yes, time to find a new doc.

[BrotherWolf]

Yeah, he told me to take the steroid and such, but I ain't doing that. And yes, time to find a new doc.

Yeah that's the standard generic response... stop arm training for a few weeks , take some NSAID
Tendinitis respond well to heat, rest, elevation and stretching and as I am finding out
a nitric oxide supplement or L-Arginine(precursor of NO) helps quite a lot, being a vasodilator helps blood to get into the damaged tissue and heal it .

It made a huge difference to my tennis/golfers elbow I was already taking L-Arginine but at lower dosage, after reading more about Arginine and nitric oxide I decided to up the dosage and take superpump 250 , pain is now gone during the day and night I only feel it on my warmup sets

[StressMonkey]

I'm just getting over something with my right forearm. If I twisted my arm a certain way I felt pain. The worst was a curling position (elbows bent, arms in front, palms facing up). It's weird because it started when I got back from Thanksgiving break, over which I wasn't doing any lifting.

[Ekie]

Yeah that's the standard generic response... stop arm training for a few weeks , take some NSAID
Tendinitis respond well to heat, rest, elevation and stretching and as I am finding out
a nitric oxide supplement or L-Arginine(precursor of NO) helps quite a lot, being a vasodilator helps blood to get into the damaged tissue and heal it .

It made a huge difference to my tennis/golfers elbow I was already taking L-Arginine but at lower dosage, after reading more about Arginine and nitric oxide I decided to up the dosage and take superpump 250 , pain is now gone during the day and night I only feel it on my warmup sets

Am studying up and running into the supplements you mention. Got a three day weekend coming up so should have a plan to implement next week.

[BrotherWolf]

Am studying up and running into the supplements you mention. Got a three day weekend coming up so should have a plan to implement next week.

It might help .....

[apmark]

I just wanted to clarify a point about tendonosis and tendonitis and treatment with one of the various forms of IASTM (Instrument Assisted Soft Tissue Mobilization). Most, if not all forms of IASTM are off shoots from one of Dave Graston's research and development. He created the first instruments and did the research on rat tendons. His current technique is called SASTM (Sound assisted soft tissue mobilization). When I trained with him recently, he said that the goal is to find the "Osis" (Tendonosis) and make it an "Itis" . By doing this, localized inflamation is created and the cellular activity brought into the area by the inflamation can reabsorb the tendonosis and return the tissue to functional tissue. One important point is that the area must be stretched and exercised while the remodeling of the tissue is occuring. He even insisits that all his clients do aerobic exercise(treadmill) even if they are coming for treatment of elbow or wrist conditions.

[Suezee]

Saw the doc today, got a case of bicep tendonitis. Got a script for meloxicam and prednisone. Looking into what to do now.

Edited to add:

Further study leads me to believe that I am dealing with tendonosis not tendonitis which are treated differently.

YIKES! Taking Prednisone for symptoms that you can work through...that's like shooting a quail with a sawed-off shotgun! Tendinosus vs. -itis is most likely in the 35 -55 age range. You ask most people in the medical profession about tendinosus, and they nod their heads and know that's the current research-based thinking, but then they still insist in treating these problems as an inflammatory situation, advising rest and meds. Ugh! It drives me crazy.

You want to see some pictures of what this stuff looks like? Go to googlescholar.com. In the search box type these names: Kraushaar and Nirschl. About the 3rd or 4th one listed will be "Current Concepts Review: Tendinosis of the Elbow...." There are some great photos of what healthy tendons look like, as compared to those with tendinosus. There's another well-known study by Kannus, who biopsied the tissue of over 800 people who had spontaneous ruptures of their Achilles tendons. NONE of these people had any inflammation going on in these tendons, and none of these people had any pain in the Achilles prior to the rupture. That means that this degenerative process was going on for some time, then the tendon just "blew". It also explains why you can get pain in a tendon following a typical work-out, without any changes.

Alot of advances in sports medicine have come about because people like all of you refuse to be told to shut down your activity. Science is finally showing that complete rest is not alway the best path to recovery and that you were right all along.

[Ekie]

YIKES! Taking Prednisone for symptoms that you can work through...that's like shooting a quail with a sawed-off shotgun! Tendinosus vs. -itis is most likely in the 35 -55 age range. You ask most people in the medical profession about tendinosus, and they nod their heads and know that's the current research-based thinking, but then they still insist in treating these problems as an inflammatory situation, advising rest and meds. Ugh! It drives me crazy.

Like BrotherWolf pointed out, this is a typical medical response, however the Prednisone is a bit over the top. Same doc prescribed me Prednisone for a rash too this past summer. The symptoms of the rash were not near as bad as the side effects of Prednisone, so declined to take it then too.

You want to see some pictures of what this stuff looks like? Go to googlescholar.com. In the search box type these names: Kraushaar and Nirschl. About the 3rd or 4th one listed will be "Current Concepts Review: Tendinosis of the Elbow...." There are some great photos of what healthy tendons look like, as compared to those with tendinosus. There's another well-known study by Kannus, who biopsied the tissue of over 800 people who had spontaneous ruptures of their Achilles tendons. NONE of these people had any inflammation going on in these tendons, and none of these people had any pain in the Achilles prior to the rupture. That means that this degenerative process was going on for some time, then the tendon just "blew". It also explains why you can get pain in a tendon following a typical work-out, without any changes.

Thanks for the resource, was not aware of that search engine. Saved that study and read it, kind of a dry read. The did mention eccentric exercises for therapy, and I started that yesterday. Eccentric exercises involving the bicep are quite easy to do.

Alot of advances in sports medicine have come about because people like all of you refuse to be told to shut down your activity. Science is finally showing that complete rest is not alway the best path to recovery and that you were right all along.

If you rest a tendon it will atrophy and thus become weaker, so kinda obvious that this is not the long term answer.

There are several treatments being performed and researched that use the preceding facts as their base. One of these techniques is performed by certified physical therapist and is called ASTYM. Practitiioners use special instruments to identify and treat the dysfunctional tissue described above. ASTYM stimulates the body's healing response, which results in resorption/remodeling of scar tissue, and regeneration of degenerative tendons. This is not some wacky treatment, but a technique that was developed and researched by physicians and physical therapists. They have published research on rat tendons that show what they claim actually occurs. They also have documented 90% success rates for tendon problems throughout the whole body.

Checked out the website, no mention of the bicep tendons. There is a clinic about 15 minutes from work.

[Suezee]

Checked out the website, no mention of the bicep tendons. There is a clinic about 15 minutes from work.[/QUOTE]


I pulled the outcome studies and they "lump" sprain/strain of the forearm into 1 category. Number of cases studied: 90-with a 93.3% success rate. The other is biceps problems at the shoulder, which involved the long head biceps tendon. Trickier to treat, with a success rate of 82.9%. Nothing documented for mid-belly problems, like yours. (I mean your "biceps" belly...don't even ask me about my "belly" problems...)

In my practice,weight lifters do great with ASTYM, and they can continue lifting during the process. They just have to decrease their resistance as their symptoms allow. I had one guy with a mid-biceps injury that was over 3 years old. He was primarily a surfer and lifted to train for that sport. In 3 weeks, he was lifting 20 lb. preacher curls. Lifting without restrictions, however, took him about 3 more months after I was done with the treatment. In my practice, I have found with the more elite/extreme athletes, like long distance runners and body builders, that they can return to modified lifting relatively soon, but the body needs some time tolerate the super high level training.

Congrats on reading that Nirschl article...I needed toothpicks to keep my eyes open!

[Ekie]

The other is biceps problems at the shoulder, which involved the long head biceps tendon. Trickier to treat, with a success rate of 82.9%. Nothing documented for mid-belly problems, like yours

I was not clear enough, it is the long head bicep tendon that is the issue. When aggravated the pain runs from the shoulder down the bicep to the elbow. From my reading while unusual this injury can cause elbow pain, and that is what through me for a loop. My doc was able to ID the issue by applying pressure to the tendon while having me move my arm around.

[Suezee]

I was not clear enough, it is the long head bicep tendon that is the issue. When aggravated the pain runs from the shoulder down the bicep to the elbow. From my reading while unusual this injury can cause elbow pain, and that is what through me for a loop. My doc was able to ID the issue by applying pressure to the tendon while having me move my arm around.

I am still a little confused about the exact source of your injury...typically, the long head of the biceps tendon hurts when you do that anterior-delt but palm-up isometric...it's called Speed's test. The other one for long head biceps is pain when reaching across your body (Hawkins-Kennedy). It still might be the long head, but also involve other portions of the muscle as well. Maybe there's fibrotic tissue in the whole muscle. That's what I like about the ASTYM: the injured/fibrotic tissue has a very characteristic feel which helps me, as a therapist, to better understand the problem. IF you decide to get the ASTYM, and IF the therapist thinks that it is the long head biceps but your progress plateaues, have them call the ASTYM office. I was not getting the expected results for treatment of long head biceps pathology, and they helped me with some other tips that were not discussed in the course that made a difference for me. In addition, I have found that short pecs can keep the humeral head in an anterior position, which keeps that long head tendon irritated. I really hope this helps you...good luck.

[Ekie]

I am still a little confused about the exact source of your injury...typically, the long head of the biceps tendon hurts when you do that anterior-delt but palm-up isometric...it's called Speed's test. The other one for long head biceps is pain when reaching across your body (Hawkins-Kennedy). It still might be the long head, but also involve other portions of the muscle as well. Maybe there's fibrotic tissue in the whole muscle. That's what I like about the ASTYM: the injured/fibrotic tissue has a very characteristic feel which helps me, as a therapist, to better understand the problem.

Am sure your confusion is due to my ignorance of the subject. It may not be the long head, guess it could be the short head. Am sure it is at least a tendon connecting the bicep to the shoulder. If aggravated the injury is most noticeable in that it hurts to lock the elbow. This clears up quickly and then the pain is mostly isolated to the front of the shoulder and radiates down the bicep, especially when I reach behind the back to touch the opposite shoulder blade.

My Doc may not be the greatest, but he is an excellent troubleshooter. Within a few minutes after telling him the symptoms he had found the aggravated tendon. He pressed it against what felt like bone in the shoulder while I moved my arm and OWEEEE that was it. He said it was the bicep tendon, but did not say if it was long head or short head (did not know there was two till a few minutes ago).

This injury can cause elbow pain, as described here:


http://emedicine.medscape.com/article/96521-overview

Pain related to biceps tendonitis is usually felt over the front of the shoulder, often with some radiation to, but not usually beyond, the elbow. Typically, the pain is aggravated by overhead activity and is worse at night. People may report a clicking or popping sensation in the affected shoulder.

IF you decide to get the ASTYM, and IF the therapist thinks that it is the long head biceps but your progress plateaues, have them call the ASTYM office. I was not getting the expected results for treatment of long head biceps pathology, and they helped me with some other tips that were not discussed in the course that made a difference for me. In addition, I have found that short pecs can keep the humeral head in an anterior position, which keeps that long head tendon irritated. I really hope this helps you...good luck.

That is a good tip, not sure what direction I am going, however my Doc said to give his treatment two weeks, then if not better he would get me a shot or refer me to a therapist.

In addition, I have found that short pecs can keep the humeral head in an anterior position, which keeps that long head tendon irritated. I really hope this helps you...good luck.

That is interesting, in addition my reading has indicated that an upper bicep tendon injury is usually accompanied with a rotary cup problem. Have made mental note of both of these issues, though I don’t know what it means.

Your help is most appreciated, thank you.

[Suezee]

No...thank you. In reading these posts, I'm finding that body builders have injuries that are sometimes different from the other athletes I treat in my practice. Hearing your symptoms and stories help my with my problem-solving abilities. I am learning too and hope to see more serious weight lifters coming through my door.

[chodan9]

certified physical therapist means nothing to me, I would crap on their sandwich and make them eat it if I could.

This dumb ass had me doing back strengthening stuff for my physical therapy for degenerative disc, even though i told her it was aggravating my back. She said if I strengthend my back, it would get better..hahahahahahhahaha

My nuero surgeon took one look at me, then looked at my MRI and said.. "why the hell was she having you do lower back work, as it is right now, your muscles in your back are so far developed and thick, I can not even do a fusion in the normal manner on your back, I simply couldnt cut thru all of it"

I feel kind of like that about Chiropractors
they kept telling me "we can adjust the rupture away from the nerve"
but to me that doesn't fix the issue, it just means they have a repeat customer every time the rupture moved back to the nerve.
I had to have the rupture removed, when that happened the pain went away and never came back.

[filipino_muscle]

I've rested it. (or maybe not enough) Even though I've thoroughly 'foam rolled' my legs routinely, sometimes after playing basketball - my tendon will be achy at the lower edge of my kneecap and medially.

Also, if I drive long enough. The same area will ache and the medial region of my thigh. It's probably my vastus medialis muscle since it inserts with the rest of the quadriceps via the patellar tendon.