A chiropractor who gets it right

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.

The zeitgeist of the lemmings

Alvin Toffler once wrote the following:

“A lot of what we call truth us assumed to be correct because of consensus. It is conventional wisdom. Everyone “knows” X to be true, therefore, it must be true. We absorb consensus truth from family, friends, co-workers and the surrounding culture, usually without thinking twice. It forms the zeitgeist of the lemmings.”

I love that quote. How does it apply to the subject of this blog? Well, the word “tendonitis” has been given such widespread use for such a long time, people (even doctors) tend to just accept the word when it comes to tendon pain, even when the indications don’t support the idea. Got tendon pain? Hey, it must be tendonitis. Everyone says so. If you tell your friend that you have it, there is no puzzled look or moment of incomprehension. He or she “knows” exactly what you’re talking about.

Too bad that 95% of the time it’s not really tendonitis at all, but tendonosis. There has been no shock or trauma involved, just a slow progression of pain that eventually became unbearable. The pain isn’t short term, and it doesn’t necessarily go away once it’s been “fixed”. Despite this, people still say “tendonitis”. Inflammation.


Don’t be a lemming.

Do you really even have tendonitis?

Below is the text of an online article I wrote not too long ago. If you’re under the impression that you have tendonitis but it seems like it’s taking an awfully long time to get better, have a look and see what you think. (Or you can just take my quick and easy tendon test.)

Tendonitis is one of the most common ailments around. According to Bureau of Labor statistics, tens of thousands of workers suffer from tendonitis and Repetitive Stress Injuries (RSIs) like carpal tunnel syndrome every year.

The “itis” in tendonitis actually is a medically precise term that means “inflammation”. Here are some quick and easy tests to determine if you have tendonitis, or if it’s really another condition like tendonosis (which means degeneration of the tendon).

1. Did you have some injury/trauma at the location of your pain? Or has your pain developed slowly over time? Example: If you fell and banged your knee and then experienced pain in the joint, you may have tendonitis there. But if you’re a runner and started noticing a slight pain that has gradually become worse over the course of months, then most likely you’re suffering from tendonosis, not tendonitis.

2. Is the pain recurring? Have you “fixed” it once, only to have it come back a few weeks or months later? Inflammation is generally a short-term response to some sort of injury or infection in the body. If you hurt yourself or become sick for some reason, inflammation helps your body to heal. But once the job is done, the inflammation goes away. (Think about the last time you got a splinter in your finger.) If you have taken aspirin or some other pain medication, rested the affected area, and thought that it was healed only to have the pain come back once you started back at your activity, you probably do not have tendonitis.

3. Has the pain been there constantly for a long time (more than a few weeks)? This is very similar to the above point. If you are suffering from long-term pain in your wrists, shoulder, knee, etc., and especially if you have not experienced any injury or infection in those places, odds are that you do not have tendonitis, but tendonosis.

4. Is the area hot to the touch? Is it red? Is there any swelling? These are three of the five classic symptoms of inflammation, and have been known since ancient times. If the painful area isn’t hot, or red, or swollen, it’s likely not inflamed, which – again – means you don’t have tendonitis. At the risk of boring you, the odds are overwhelmingly that it’s tendonosis, which requires a whole different approach to treatment.

There are some legitimate cases of tendonitis out there, but most people (doctors included) tend to confuse tendonitis with tendonosis. Think about the above points and decide for yourself which one you have.

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