tendonitis healing procedures
i have been suffering from tendonitis in my left wrist for at least two years now. I think a fall first initiated it, then washing dishes in a cafè job (holding plates in left hand at awkward position, over.. and OVER), then gazillions of pushups in tae kwon do training, then bench presses.
my understanding of the current recommended healing procedures are as follows (chronological):
1. ice and anti inflammatory (ibuprofen) medicine for minimum 7 days (correct?),
2. weight-free flexibility exercises (wrist rotation, assisted stretching, etc), ------- 7 days?
3. lightweight strengthening exercises, working up from e.g. 1kg to 2kg
is this correct? should i wear a splint or a brace at any stage in this procedure? perhaps in sleep to avoid any further tissue damage (propping head up comes to mind).
any other knowledge or suggestions will be thankfully accepted. no jokes about too much wanking please (however accurate they may be).
there are many ways to go and they depend on what you have. the first thing to do is stop all NSAIDS and real high intensity training, esp. after two years. then you must find a good specialist, prefreably a good ART/physiotherapist.
I can provide alot of info, but only after that option is exausted
well, i'm certain it's dequervains tendonitis.
i'm currently not doing any training because of this. opening doors is painful, let alone weights. i've tried three physiotherapists, all reputable, none helpful. i'm trying to find some more information on this topic, before considering joining a public hospital queue for surgery or getting a cortisone and restrengthening.
I had severe over-use syndrome of both of my left and right brachial radialus. I remember the exact moment they began to bother me, I was workink back and doing very heavy T-bar rows and I felt this uniform burning feeling in my upper/outer forearms all the way back to that little knoby bone on the outer forearm. It got so bad that that I first took off for about 5 weeks and the pain subsided, but as soon as I began to train, it came right back - only worst. I couldn;t lift a cup of coffee without pain. I took the bad advice of an orthpod and allowed him to inject cortisone in both elbows in an effort not to loose too much time in the gym (he also prescribed Vioxx for me on that fatefull visit that I chose not to have filled - ). The relief after a few days was very invited. I began to train hard again and all seemed fine, then about 4 weeks after the pain had stopped it came right back. This time I also noticed indications of muscle atrophy in both forearms. I began to do lots of reading on the subject. I tried deep tissue mesages performed by a mesage therapist who specialized in tennis elbow recovery. This too gave me limited - short lived results. The only thing that ended up working for me (and I saye resoundingly -ME) was near infrared light therapy. I stumbeld upon a technology while doing research for my diabetic father who had developed neuropathy. It seems that a company named Annodyne had received FDA approval to build and market these near infrared light units to diabetics (by prescription) suffereing from neuropathy. It seems that 890nm light liberates Nitric Oxide from the hemoglobin and that helps repair nerve endings. Another byproduct of this light therapy is new tissue deployment. It works with tedonitis as well as severe open wounds such as those from bed sores. Annodyne has a pattent on the technology and they charge $2,500 for the cheap unit. I built one for my dad and while I was at it, one for myself. I spent a total of $360 for the materials for both. I used it on both forearms a minimum of 2 and sometimes if I had the access 4 times a day for 30 minutes at a time. I also supplemented with plenty of L-argenine to keep my hemoglobin saturated with NO releasing potential. My tendonitis went away after about 3 weeks and has never come back. I train harder these days than I did back then and my elbows don't even give the hint of re-injury. I swear by this unit. This is my personal experience. You can do a search for Annodyne Technologies and check their resource page for studies related to near infrared light therapy and tendonitis.
hm, from what i've recently read about cortisone injections, they really don't do anything to solve the problem, and it sounds like it could do more harm than good. exactly what good can cortisone injections do? i had assumed that while 'numbed', one could strengthen without logistical barriers (pain).
i've also been through a series of anti inf. medication, however at the end of it and other procedures, bending my wrist (from neutral towards body) at anything over, say, 45 degrees, still caused excruciating pain. kinda hard to 'work on through it', as the wrist is so instrumental to so many weight lifting procedures, even in legs (putting plates on machines/barbell).
this light treatment is very intriuging, but without any electrician expertise, any physics knowledge, limited finances, and limited resources (live in perth australia, i doubt i could my hands on any of the required equipment), is it realistic for me to aim to build one of these machines? should i turn to crime and get the cash to buy one?
general route that should be tried before all else, and usualy works:
topical NO sinthase inhibitors
glucosamine+chondroitine, large dose
Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up.
Ohberg L, Lorentzon R, Alfredson H.
Department of Radiation Sciences, Diagnostic Radiology, Umea University, Umea, [email protected]
OBJECTIVE: To prospectively investigate tendon thickness and tendon structure by ultrasonography in patients treated with eccentric calf muscle training for painful chronic Achilles tendinosis located at the 2-6 cm level in the tendon. METHODS: The patients were examined with grey scale ultrasonography before and 3.8 years (mean) after the 12 week eccentric training regimen. At follow up, a questionnaire assessed present activity level and satisfaction with treatment. RESULTS: Twenty six tendons in twenty five patients (19 men and six women) with a mean age of 50 years were followed for a mean of 3.8 years (range 1.6-7.75). All patients had a long duration of painful symptoms (mean 17.1 months) from chronic Achilles tendinosis before treatment. At follow up, 22 of 25 patients were satisfied with treatment and active in Achilles tendon loading activities at the desired level. Ultrasonography showed that tendon thickness (at the widest part) had decreased significantly (p<0.005) after treatment (7.6 (2.3) v 8.8 (3) mm; mean (SD)). In untreated normal tendons, there was no significant difference in thickness after treatment (5.3 (1.3) mm before and 5.9 (0.8) mm after). All tendons with tendinosis had structural abnormalities (hypoechoic areas and irregular structure) before the start of treatment. After treatment, the structure was normal in 19 of the 26 tendons. Six of the seven patients with remaining structural abnormalities experienced pain in the tendon during loading. CONCLUSIONS: Ultrasonographic follow up of patients with mid-portion painful chronic Achilles tendinosis treated with eccentric calf muscle training showed a localised decrease in tendon thickness and a normalised tendon structure in most patients. Remaining structural tendon abnormalities seemed to be associated with residual pain in the tendon.
conectrate on acheiving joint stability before mobility - develop endurance each day wih isometrics/high reps, always "power grip" i.e use grip muscles, buy an office rubber band and do finger extensions, dont go to range of motion thats painfull
3 times a week - eccentrics - lift something with both wrist and lower slowly under complete control for the count of 4 with the injured (should be painfull but will get better) for 2-4 reps of 15 reps
ah, thank you. that has filled most of the gaps, i think i can manage the rest. thank you.
one thing though - what do you mean by topical no synthase inhibitors? wraps, no drugs? or creams no pills?
also, would you know if it's better to take gluco/chon mixes or separately. is there a difference?
i know i'm asking for babying here (forgive me, it's been a tough two years ), but the weight for the eccentrics, should this be increased over time?
i know i'm asking for babying here (forgive me, it's been a tough two years ), but the weight for the eccentrics, should this be increased over time?
yes, increase the weight
awesome, thank you friend.
i can't help but feel a little angry at spending hundreds of dollars on physio, and not receiving any of this kind of information. i guess it was in their best interests for me not to get better immediately, if at all. almost like keeping me under their control, as they would ease the pain, but not free me from it.
anyway, i'm off to the pharmacy wish me luck!
a few questions which i hope you can answer;
gluco/chon is primarily used for arthritis, why then is it recommended for tendonitis? seeing as tendonitis is purely soft tissue damage and not cartilage damage?
do you know of a brand/product which is a topical no synthase inhibitor? also, is there evidence which says that there is increased levels of nitric oxide with tendonitis sufferers?
man, the pharmacist and her twenty helpers didn't have a fucking clue. to make things worse, she kept suggesting i get a doctor to 'diagnose' what was wrong with the wrist (probably her defense mechanism when encountering things she has no clue about. there really should be a psyche/ethics test weekly on quacks). like a doctor would have a damn clue, in this foul country they're more interested in rushing you out of their office with any old prescription in your hand. the pharmacist also said that it wasn't serious enough to warrant an MRI scan (which she had suggested in the first place), and that i should 'rest' it. what the fuck. i almost expected her to suggest i take a year off work, seeing as money isn't an issue when you're 22, your degree is paid off, and you have your own chemist. typical liberal scum. i was so mad i forgot to get a new iron for my work shirts - now they'll be all crumpled tomorrow. not a bad metaphor for how i feel right now
cartilage remodeling mimics basicly tendon/ligament remodeling. with the difference being the type of collagem used (II in cartilage, I and III in tendon ligament) which have different functional properties. reagrdless of the macromulecules shape, the synthasation is (almost) the same. also in the wrist there is cartilage everywhere in the shape of bursae and synovial joints. also arthritis is a name for a chronic degenartive joint state, not just for cartilage conditions.
you can read all about different connective tissues and remodeling in Connective Tissue - by Elzi Volk On meso its very basic but non the less helpfull. it also tals about gln/cho.
what you have is not tendonitis but rather tendinosis - a more chronic injury sans the inflammation.
in tendinosis, the connective tissue is damaged and there is a pathological change in the way tissues are overloaded. the solution to that is to strengthen the tissues (and re-teach them) and return to normality but every overload will cause supranormal inflammation which will prevent mechanical properties improving as well as be painfull. in layman's term, inflammation is "the call for arms" for the prolifferation and signaling of the building cells to go to work, and is required in normal conditions, but all too often, the call is too strong and inhibits the workers. this is where the NOS inhibitors come to play.
regerdaing those NOSI, I'm searching for good topical ones myself. this field is just emerging. the best available one is curcumin powder, which can be taken orally, albeit you'll need to take more, and there maybe systemic effects (you'll not grow muscles like weed I gesss but thats not your priority anyway)
hope that helped.
found an informative essay re: traditional tendonosis treatment
yeah, that was helpful, but;
inflammation is "the call for arms" for the proliferation and signalling of the building cells to go to work, and is required in normal conditions, but all too often, the call is too strong and inhibits the workers. this is where the NOS inhibitors come to play.
but here you're saying that i need to treat the inflammation via nos inhibitors, right?
thanks for the link. i hope you don't mind my attitude towards this - it's just that i have an urgent need to actually understand what's going on in my wrist, as it has been such a long time and has cost me so much practically and financially - myself being a little bit of a chemistry newbie doesn't help.
i'm confident in the gluco/chon now, at least .
No probs, Im like this myself, and since its going to be my job, I better rehearse it.
you see, inflamation is a natural part of the remodeling of tissues, be it tendon, ligament, cartilage and even muscle as you (may) well know. the problem is that there is a very tight balance(common in our body), and the inflamation stage should just clear damaged tissue(which is why synthesis is inhibited in the inflamation phase) and send building/prolliferating signals to other cells, which in turn inhibit the inflammation, create building blocks/peoliferate and then finally synthesize new structural proteins (GAGs and GPs)
it often happens (such as in overtraining/overuse) that the constnat inflammation resulted by mechanical overload inhibits the chondorcytes beyond a level they can downregulate back. the balance is disturbed, and, the negative feedback loop begins. thus, chronic inflammation raises its ugly head. that can manifest itself in many tissues and many severities depeding on the mechanical properties of tissue and injury, and tendontits is a good example. once overload is removed from the tendonitic tissue, the mechanical promoters of imflammation are gone so the inflammation subsides, BUT - the tissue is in a pathological state. and here its where it gets tricky:
youre in a state where the inflammatory cells are no longer in the tendon(no need for them|) but your chondrocyte population is small and your excitory pain nerves are fucking puped and primed with glutamamte and ready to go. Curr Drug Targets. 2002 Feb;3(1):43-54. Chronic tendon pain: no signs of chemical inflammation but high concentrations of the neurotransmitter glutamate And becuase your tissue, (tendon) is weak, mechanical overload (even some mobility) is not handled properly, transferring load to tissues that shouldnt be laoded and causes pain (becuase of the pain priming even more so)
so you must: prepare thte tissue to be overlaoded again - pain free mobility and endurance exercise. now since the tissue is so weak you'll get alot of infalmation for starters - like getting the tendonitis all over again - inflammation is good for the needed proliferation and remodeling but if its not kept down in the initial stages, you'll just fall back on your ass to tendonitis and tendonisis.
so basically once you start rehab, NOSI will deal with that, because the tissue will be getting overlaoded everyday because its so weak(imagine training your chest with 1RM+ weights everyday... you'd think it hurt?)
so you should move slowly, not load your tissuesin ANY painfull position EXCEPT the eccentrics, do pianfree mobility everday and endurance for the muscles ()apin free) everdya, precisely to let the tissue recupearte and be overloaded onlyu when you want it to be, giving it ample time to strengthen and remodel.
hope this helps.
FYI: If you're interested I just posted in the "surgery this Friday" thread a standard supplement regimen that I use to speed healing and decrease inflammation. There is a link to the rugged forum where Tony has gotten good results with it on his tendonitis.