TENDINOSIS OR TENDINITIS?
IMPORTANT DIFFERENTIATION, OR MERE SEMANTICS?
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).
In the June, 1999 issue of a New Zealand medical journal (Sports Medicine), Dr. Khan published Histopathology of Common Tendinopathies. Update and Implications for Clinical Management. In this article he had some rather interesting things to say concerning this issue of Tendinitis or Tendinosis (these quotes are cherry-picked from the abstract). Tendon disorders are a major problem for participants in competitive and recreational sports. The literature indicates that healthy tendons appear glistening white to the naked eye and microscopy reveals a hierarchical arrangement of tightly packed, parallel bundles of collagen fibres that have a characteristic reflectivity under polarized light. In stark contrast, symptomatic tendons in athletes appear grey and amorphous to the naked eye and microscopy reveals discontinuous and disorganized collagen fibres that lack reflectivity under polarized light. There is more information and pictures of this phenomenon in some of THESE ARTICLES.
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).