I was surfing around the Net today and found a chiropractic site that gets the whole tendonitis/tendonosis issue exactly, 100% right. Now among the people I talk to, chiropractors aren’t generally known for having the strongest scientific background. And on most chiropractor internet sites it’s true that you’ll be hard-pressed to find much in the way of scientific references. But this one has four, and if the entries are a bit dated (1998-2000), the information given is good.
In a post called “Goodby Tendonitis, Hello Tendonosis”, Doctor of Chiropractic Warren Hammer posts the following:
Tendonitis is now considered a relatively rare condition. The good news is that with the diagnosis of tendonitis, patients were expected to get well in a short time, but with the realization that it is really tendinosis, more time is required (six weeks to six months, depending on the chronicity) for treatment and healing. In many cases such as Achilles tendonitis, patellar tendonitis, lateral epicondylitis and rotator cuff tendonitis, a good percentage of cases do not get well as soon as we might desire. We do not have to blame ourselves. What we have to do is explain to the patient the underlying tissue damage that exists. Corticosteroid injections and NSAIDs cannot really heal a noninflammatory condition.
There is so much good information in that paragraph it’s just amazing. The acknowledgment that “tendonitis” generally isn’t tendonitis at all, but tendonosis. That it’s not going to get better with just a shot of cortisone. That there is actual tissue damage. That the usual anti-inflammation protocols simply aren’t going to work.
Despite the fact that Dr. Hammer’s article is short (just four paragraphs), he has several scientific references at the bottom (including two from KM Khan, who has to be my all-time favorite when it comes to debunking the terminology associated with tendon conditions). When you compare this to some of the more popular “health” sites out there – most of which are full of self-serving ads and don’t bother to look at even a shred of real science – well, I hope the difference is obvious.
I really have to emphasize this point. No matter what word you use, chronic tendon pain is a medical condition, and if you want to get the best results you’d better be working with real, scientifically proven methods. Not doing so is like needing an appendectomy and choosing some jungle-dwelling witch doctor over a Johns-Hopkins trained surgeon. Silly!
Dr. Hammer goes on to say:
Our treatment should emphasize the prevention of collagen breakdown, which requires rest and strengthening […] We must prevent collagen damage and, most importantly, stimulate collagen synthesis.
Again, right on target. Chronic tendon pain is not inflammation, but actual degeneration of the tendon itself. As such, your first priorities should be to (a) prevent further damage and (b) start exercises to make the tendon regain its lost strength. (Target Tendonitis explains how to do this in detail.) Done right, it shouldn’t actually take more than a week or so to start seeing really significant results. Two months (not the six given by Dr. Hammer; there have been some advances in knowledge since the year 2000) and you should be pretty much back to 100%.
That said, please don’t just run out and buy yourself a pair of dumbbells. Traditional exercise will only make the problem worse. But there are ways of structuring your rehab to get the benefits of strengthening exercise without causing further damage. So no matter how many useless cortisone injections you’ve received, no matter how much unnecessary frostbite your elbows and ankles have suffered from icing to get rid of misdiagnosed “tendonitis”, don’t give up hope! There is actually a method of treatment that you can do at home, on your own time (and for free!) that will work.