TENDINOSIS OR TENDINITIS?
IMPORTANT DIFFERENTIATION, OR MERE SEMANTICS?
"Tendinosis, sometimes called chronic tendinitis, tendinosus, chronic tendinopathy, or chronic tendon injury, is damage to a tendon at a cellular level (the suffix "osis" implies a pathology of chronic degeneration without inflammation). It is thought to be caused by microtears in the connective tissue in and around the tendon, leading to an increase in tendon repair cells. This may lead to reduced tensile strength, thus increasing the chance of tendon rupture. Tendinosis is often misdiagnosed as tendinitis due to the limited understanding of tendinopathies by the medical community. Classical characteristics of "tendinosis" include degenerative changes in the collagenous matrix, hypercellularity, hypervascularity, and a lack of inflammatory cells which has challenged the original misnomer "tendinitis"" - Wikipedia's entry on "Tendinosis"
It was Doctor Murrell's now famous article in a 2002 issue of the British Journal of Sports Medicine ("Understanding Tendinopathies") that said, "Tendinopathy may follow this pathway. An increase in the amount and duration of load that a tendon cell sees may result in activation of intracellular stress activated protein kinases, which when persistently activated cause the tendon cells to undergo apoptosis or programmed cell death. Increased cell death results in a collagenous matrix which is weaker and more prone to tearing. With time, this tendon may rupture." And the crazy thing is, this was not new information when it came out a dozen years ago. Enter Doctor Karim Khan (MD / PhD), currently of the University of British Columbia's School of Kinesiology (human movement).
After going on to talk about several differences in the cellular matrix of the damaged tendon as compared to the healthy tendon, Dr. Khan states that, "The most significant feature is the absence of inflammatory cells." Why is this a big deal? Why does it really matter in our advanced age of pharmaceutical intervention? Listen to his conclusions.
In the words of the acclaimed St. Louis physician, Dr John G Kellett (who passed away just a few days ago), "Use of these drugs [NSAIDS], if given, should be restricted to a maximum of three days following injury. Any anti-inflammatory action lasting beyond this period would, theoretically, at least be detrimental since the repair mechanism (phase 2 of healing) is itself an inflammatory process. Little data exist to support the routine use of NSAIDs in athletes with acute pain syndromes (despite advertisements extolling their benefits)" ("Acute Soft Tissue Injuries: A Review of the Literature" 1987). To get a better handle on why he says only three days tops for anti-inflammatory drugs, read THIS PAGE.
In light of the way that most of you have been treated by your physicians for your tendon problem, what does all of this tell you? Other than letting you know that EVIDENCE-BASED MEDICINE is a pipe-dear Only that most physicians are decades behind the most current research --- something I have talked about at length in the past (HERE). If you want to learn more about Tendinosis -vs- Tendinitis, please take a few minutes to take a look at my website on the topic --- www.DestroyTendinitis.com.
Tendonopathies (including Tendinosis) are a major reason for doctor's visits here in America. If you know people who could benefit from this information, pass it along. While you're at it, help us spread the word by liking us on FACEBOOK.