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Tendonitis, a common diagnosis, is the
Inflammation ("itis") of a tendon. It is defined in Mosby’s Medical Dictionary,
14th Edition, as "an inflammatory condition of a tendon, usually resulting from
strain." A tendon is the end portion of a muscle where it attaches to the bone
in the joint, allowing movement. A person can get tendonitis in any joint in the
body. Some common areas for tendonitis are elbows (tennis elbow, golfer’s
elbow), the shoulder (rotator cuff, biceps), and ankle (Achilles
tendon). However, any
tendon has the potential to become inflamed and irritated, especially in sports
where overuse can occur. In most cases, in a healthy, non-stressed, non-smoking
person, that area will usually heal in 4 to 6 weeks, depending on severity.
However, in some cases the tendons do not heal, causing long lasting and chronic
pain. This condition is usually referred to as chronic tendonitis.
In recent years, the word "tendonosis" ("osis"
meaning diseased or abnormal condition) is being used in the medical literature
to describe chronic tendonitis, and some authors believe that it is more common
than chronic tendonitis, and may be a more accurate diagnosis. In this type of
tendon irritation, inflammation is no longer occurring and
collagen breakdown is
the primary problem. Therefore, treatment should target the stimulation of
collagen production rather than the elimination of inflammation, which may not
even be present (Khan, etal., "Overuse Tendonosis, Not Tendonitis", The
Physician and Sportsmedicine, 2000; 28(5)). What causes tendonitis or tendonosis?
You may recall that the muscle has a reddish color, while the tendon part which
attaches to the bone is a whitish color and made of a more fibrous material.
This is because muscles have a good blood supply, however tendons do not. When a
tendon gets pulled or strained beyond its normal range of motion, either
intentionally through exercise, or unintentionally through accident or trauma,
that tendon stretches. However, it will stretch only so far, and if
overstretched doesn’t spring back, much like taffy would be if you pulled on it
too hard. In many cases there are "micro-tears" that occur as a result of this
overstrain or pulling. The tendon needs to heal and in order to do that the
blood has to get in to rebuild the injured tissue. How does the body get blood
into the injured tendon? Inflammation is how the blood gets into the area.
Inflammation consists of several phases, which start with swelling and ends with
the development of new cells in the injured area. First, the injured area
swells, much like you may have seen when someone sprains their ankle; the ankle
swells in order to bring blood in to start the healing process. This healing
process can take several weeks, but after the healing cycle of 4, 6 or even 12
weeks, if the body has not healed that area, the stimulation to heal is
drastically diminished or gone.
This is because the body responds in a
stimulus-response basis. For example, if you cut yourself today, your body
starts the healing process to heal immediately. However, after a period of time,
the stimulus to heal is gone and the body does not respond in the same way. This
is what happens with tendonitis which has gone on too long without healing. The
body's natural stimulus to heal is gone and there is just low-grade
inflammation, but not enough to effectively heal that area. Or, in the case of
tendonosis, there is no inflammation and collagen breakdown is occurring faster
than it is being rebuilt. So what now? Sometimes
physical
therapy can help to
strengthen the muscle around the joint, which can indirectly help to give
stability to the joint. However since the blood supply is so poor in the tendon,
exercise, as a therapeutic remedy does not do much for the actual tendon.
Anti-inflammatory medication work by decreasing inflammation, thus decreasing
blood flow to the injured area. But inflammation is how your body heals. So
these kind of medications slow the natural process of healing. And in the case
of tendonosis, where there is no inflammation, studies provide little evidence
that
NSAIDS (non-steroidal anti-inflammatory medication) and corticosteroids are
helpful (Almekinders and Temple, "Etiology, diagnosis and treatment of
tendonosis: an analysis of the literature." Medicine & Science in Sports and
Exercise 1998;30(8)). So what can you do?
Prolotherapy (short for "proliferation
therapy") is a treatment which stimulates the proliferation (growth, repair) of
injured tendons which have not yet healed. It is a natural treatment that
irritates the tendon, stimulating a repair cycle to occur, even if the injury is
years old. It does this by stimulating the body to send blood and
repair-building cells to the injured areas. Prolotherapy has a high success rate
and is a safe, in-office procedure. On the average, a person needs between four
to six treatments, spaced out anywhere from two to six weeks. Some people need
less treatments, some people more. It can be done at any age as long as the
person is generally healthy. My youngest patient was 13; my oldest patient was
100. I treated my own mother, who was in her early 70’s at the time, for an injured knee ligament. Ligaments are much like tendons in composition, and respond to Prolotherapy as well. Ligaments hold one bone to another bone in joints. My mother was an avid walker, walking an average of 5 miles per day, until one day she overdid it and had knee pain that did not go away. She had to stop walking, and was miserable because she had planned a trip to Europe that involved a lot of walking and was worried she might have to cancel it. My mother is a conservative, retired RN, and originally was not very open to alternative treatments. She saw her orthopedist, her internist, and even spoke to my brother, a kidney doctor, before she talked to me. She was indeed skeptical of this "voodoo" I do. However, she wanted to get better and wanted to keep her vacation plans. Her other doctors told her she would just have to live with the pain and restrict her activity, which she was reluctant to do. So I did Prolotherapy on her knee, and two weeks later she called me up, exclaiming: "It’s a miracle!" and that the pain she had been suffering with for many months was gone. She headed for Europe as planned, had a great trip and did a lot of walking there without problem. The bottom line is, Prolotherapy is not for every injury, but it can be a tremendously successful treatment for the right problem. In my experience, chronic tendonitis, and/or tendonitis, as well as chronically sprained ligaments, in general, respond very well to this treatment because it stimulates the repair and rebuilding of collagen fibers, making the area stronger, strengthening the joint and reducing or eliminating pain |
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Prolotherapy is a medical
technique. As with any medical technique, results will vary among
individuals.
Prolotherapy may not work for you and as with all medical
procedures there are risks involved. These risks should be discussed with a qualified
health care professional prior to any treatment.
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PROLOTHERAPY FOR CHRONIC TENDONITIS/TENDONOSIS