The primary law with tendons is first clinically (not via imaging) ruling out that it’s not a joint problem masquerading as a tendon problem. Joint misalignments (spine and extremities) can cause pain in tendinous areas and inhibit muscles, which unfortunately leads many clinicians to treat innocent tendons. If the “tendon” is taking forever to heal, it’s likely not the tendon. Tendon/muscle pathology comprises a small proportion of problems.
When it’s indeed a tendon, rehabilitation is relatively straightforward. A tendon’s collagen often needs to be remodeled to become functional again. This is accomplished by regularly (several times per day) loading the tendon for a few months. It may never look normal again, however. Causes why the tendon became dysfunctional initially should be addressed, and proper spine and extremity mechanics should be ensured.
The load a tendon needs is individual-specific. I find the load that creates pain (about 6/10) for 15-20 minutes following the exercise - which may be isometric, concentric, eccentric, or ballistic. Once a load doesn’t meet that criterion, the load is increased so it’s effective. Tendon rehabilitation is largely about 1) ensuring it’s a tendon, 2) educating the patient, and 3) encouraging briefly painful self-management with limited office visits. -- Laura
Ever wonder why, with all the technological medical advances in orthopedics, our population doesn’t seem better? In conservative care, there’s been electric stimulation, ultrasound, laser, and less techy modalities such as tape and soft tissue tools. Outside conservative care, we’ve gone so far as to make injecting steroids, fusing spines, electrifying nerves, and removing and replacing whole joints commonplace!
Perhaps the worst offender is the MRI. Imaging is certainly warranted in a few situations (as is surgery), but it’s current widespread use isn’t. Not only is this expensive for society, but overreliance is bad medicine: MRIs cannot reliably demonstrate cause and effect regarding symptoms and they often create needless fear in patients’ minds that they’re degenerating.
The human body has an amazing capacity to heal itself; orthopedic issues such as fractures, tears, disc herniations, sprains, etc. are regularly alleviated with time, not medical intervention. However, when a body’s independent healing falters, learning the right movement (and learning which to temporarily avoid) is key. Immobilization is rarely necessary. A clinician who uses her ears and brain to thoughtfully understand a patient’s problem should realize that a self-management protocol based on movement – nature’s best remedy – is almost always the best medicine. -- Laura
Check out this short article at Time.com. It emphasizes the point of seeking opinions from several medical professionals if you are not improving.
A Nebraska Woman Thought She Had a Runny Nose. It Was Actually Fluid Leaking From Her Brain
A mechanical examination begins with a methodical verbal history, typically producing one or two diagnoses to prove or disprove during the examination. Key information I elicit includes location of all/any symptoms, mechanism of injury, injury duration and trend, and activities that worsen/improve symptoms.
In the mechanical exam, I care precisely about tests’ effects. I examine the effect of upright posture. I check active and passive movement at the affected joint(s). If the patient has an extremity complaint, I always look at spine motion too. I often check nerve tension (arm or leg). The patient performs something that generates symptoms, such as squatting or lifting a bag - a “functional baseline.” Strength is also tested: for all upper body complaints I test roughly 8 arm muscles. With all lower body complaints, I test 6 leg muscles. With distinct extremity problems, I additionally strength test the specific muscles at those joints.
Next, most importantly, the patient performs repeated movements in the direction I have determined and we reassess relevant findings (symptom behavior, motion, nerve tension, strength, and/or functional baseline). Based on cause/effect, other directions may be tested. Before leaving, one specific movement is chosen for the patient to perform frequently at home. --Laura
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