everyone read, tendonosis vs tendonitis

[Doc.Sust]

* You are very likely to develop a tendon problem if you lift weights. You currently are more likely to be diagnosed wrong by a physician about that tendon problem. Your whole lifting career can be ended because of an improper treatment plan. ARE YOU WILLNG TO TAKE THAT RISK?
The tendon is a very dense fibrous tissue that is formed from the connective tissue of the muscle. It allows for a very sturdy attachment to the bone. It is this tough nature that brings about an obvious problem. It heals very slowly once it is injured. If you rupture it, surgery is your only option.

If you have had tendon pain for a period of time longer than two weeks, you should be very aware that it is not likely tendonitis. That's right; your doctor may have told you for the past two years that your problem is an inflammatory condition requiring you to take NSAIDs (Non Steroidal Anti-Inflammatory Drugs)* You can be doing even more damage by following that dangerous course of treatment. Dangerous? Yes, because not only are you causing more injury to the injured tendon, the fact is that over 16,000 people die every year from taking Advil, Aleve, Nuprin, Aspirin, etc. They eat away at your stomach and your lining of your heart and can kill you

Tendonitis is actually very rare; the tendon is more likely to have a condition known as tendonosis. It may look like the same word, but it is very different and if you are confused at this point, then you understand why most doctors are lost too. Tendonosis is a degenerative condition that is treated completely different from its inflammatory misnomer, tendonitis. The itis is a suffix that means inflammation. We could go on about this all day- Take a look at the table below to grasp a comparison of the two conditions.
***
*Tendenososis
1 very common

2 requires months/years to heal

3 treated with rehab exercise

4 irritated my NSAID's

5 shows up black on MRI

6 Degenerative

7 feels better with movement

8 soothed by heat

9 worse with ice and rest

10 helped with massage

11 surgery offers no help

12 cool to touch


Tendonitis

1 very rare

2 takes 14 days to heal

3 made worse with exercise

4 helped by NSAIDS

5 shows up white on MRI

6 inflammatory condition

7 hurts with movement

8 irritated by heat

9 helped by rest and ice

10 massage irritates the condition

11no help with surgery

12 usually war to touch
************TRAINING FORTREATMENT
Consider using this approach only after confirming your proper diagnosis with your doctor. Tendon Pathology includes but is not limited to: tendonosisl tendinopathy, tenosynovitis and peritendonosis, partial and complete tears, subluxation and dislocation, and entrapment. The proper diagnosis is critical to determine your treatment success.

The treatment for tendonosis requires a varied step approach.
First: Find what area of the movement is affected by pain. Typically tendonosis does not limit your range of motion, except with pain. This means that if your lifting buddy can gently move the joint, then it shouldn't hurt as bad, as long are you are relaxed. You must find out what movement causes you pain.
Second: This is to warm Up. We are going to work on the area where the movement doesn't hurt. Now let's say that the painful part of the cuff is the part at the very bottom or the bench hurts when the bar is close to your chest. You should warm up using less weight (less than 20% of max). Perform 30-40 reps with a slow speed. If it hurts to move anything, use Isometric contractions and use six different positions in the range of motion, for 6 seconds at 60% of your max for squeezing the muscle, then repeat It 6 times.
Third: Please note; that this part is likely to cause pain, but not more than 60% or a 6/ 1O. Ten is like Emergency room pain. Using the lighter weight still, enter into that painful range of motion. Do 30-40 reps with a slow speed. Do only one set the first day. Two the next and Three the following and then move to the next step.
Fourth: Instead of lifting more weight, try to move the weight faster. you might need to alter your lifting style here and go to using bands. Day one; do the movement for 30,40 seconds, day two do 50-60 seconds. Over the course of the next couple of days use a friend to count the number of movements. Try to move faster and faster, until you are moving stupid fast.
Fifth: The next step is to slow down the movement again by 50% and increase the weight by 1-10%. Again, keep in mind that maximum pain is 60% and that speed helps this condition, not heavy weight.
Sixth: you will also note that the Weider pyramid principle is quite effective here. Begin your group of sets with increased speed and lighter weights more reps. Progress onto sets with heavier weight, slower speed and less reps. Finish by returning to the faster speed, lighter weight and higher reps. Continue to raise the weight on the lower rep sets until you have obtained 80% of your original strength or that of the opposite healthy side. As your speed Increases, you should note a decrease in pain. During this rehabilitation protocol you will have to back up to a previous step several times.
You can train more often, since you are at sub-maximal levels. It is like jogging everyday, you need to rest, but under most conditions you can recover quickly.
As time goes on, you will be able to return to your pre-injury weight. You will also need to consider that at least once or twice a month, you will need to use speed training plyometics to stimulate your tendons to thicken and promote proper collateral circulation around them. Have a great workout
*********TENDONOSIS REHAB SUMMARY
- Determine the painful movements
- Warm the area up with lighter weights/slower movements
- Train the painful motion using lighter weights/slow movements at first, then progressing 10 faster and faster movements
- Train at speeds to complete a movement at very high speeds for time intervals 01 15, 30, 45, 60 seconds. Special equipment may be required or use 01 therapy bands.
- Reduce the speed and use more weight (1-10%) still maintaining a slower speed at first. and then progressing to a higher speed.
- Use the Weider pyramid principle to include speed sets with heavier sets.
There are better choices lor exercises depending on your particular injury. Trial and error is the best way to determine which are best for your program.
Example* Bench Pressing for Max 150lb Bench'Press

******1*15 seconds = 30 reps high speed*45
******2*30 seconds = 60 reps high speed*45
******3*15 reps /2 seconds each way*50
******4*10 reps /2 seconds each way*60
******5*45 seconds = 70 reps high speed*45
******6*60 seconds= 100 reps high speed*45

thank you to david ryan D.C. for the information and expertise

[GunTotingHipGangster]

as always, great post doc. I believe that heavy dumbells will agrivate this problem more.

[zaggahamma]

i think heavy dumbells is how i developed the tendon injury

[Doc.Sust]

as always, great post doc. I believe that heavy dumbells will agrivate this problem more.

i agree. that why i just about never use them

[heybigdavies]

tendonosis has ruined my training. I got wrongfully diagnosed and the doctor spoke "rest ice rest ice and all that bullshit" 4 months later i got a 2nd opinion and a sports therapist was giving me a new type of massage therapy called active release technique/therapy...where they breakup scar tissue in the problem occuring area. The thing is with it, they can only do it so many times then if the problem has not been solved then you have to try a different method. Right now ive been out of any heavy "push" excersise (tricep/elbow tendon tendonosis) for almost a year. It ****ing sucks! ive had to postpone my cycle for over a year, and now its gonna be even longer.

[heybigdavies]

oh yeah..great article, i wish this was here when a year ago this time,
thanks doc sust

[pedro01]

Great article & has renewed faith in my doc who's always advocating heat treatment for my elbows.

[Doc.Sust]

glad to help!

[Rayna]

what about if you were to have Tendenososis in your hip due to over working those muscles. What would be the best way to heal this injury? I have left the area sore for a long time out of fear/denial to having to stop doing some sort of cardio.

[InsaneInTheMembrane]

No conclusive cure for tendonisis has been created, especially because it is one of those areas in medical science that needs further research. However, physical therapy is one way that has been shown to alleviate the symptoms. Often times, "rest" doesn't actually heal the problem (although it many cases it does) like it does for tendon-itis because tendon-osis is damage done to the tendons on a cellular level that potentially upsets the proportion of type I and type III collagen. Furthermore, adding anti-aging collagen enhancing compounds like hGH may exacerbate the situation because it is stimulating the wrong kind of collagen to grow (type III) instead of type I. As it stands now, light physical therapy is best to increase blood flow to the area and ease the pain...however, avoid placing too much weight on the tendon as it will further damage the cells (this applies to weight training)...I believe cardio can be considered light and therefore you don't have to give that up. One of the compounds showing promise in treatment of chronic tendonosis right now is surprisingly (nor not) IGF, which somehow directly stimulates the growth of type 1 collagen... I myself have tendonosis of the forearm at the moment (along with osteolysis on the shoulder of the same arm...dang my cursed fate!) and plan to to an IGF cycle soon to see if it actually does work.

[Narkissos]

interesting read..

I appreciate the bump

-CNS

[Rayna]

Thank you for your reply. I am so frustrated. I find that even doing light cardio (and I change it up from bike riding to walking even) is hurting my IT band, my hip flexors, all around my hip area (just on one side). So I wasn't sure if I should even keep doing that. I have taken two weeks off once and the day I went back and did cardio it was sore again. Not while doing cardio but later in the day and mostly at night, I can't even sleep on that side. HELP I know you understand how much of a setback this is. Thank you again.

[zygleth]

Rayna- I have the same problem but I'm much older than you. I have never experienced a hip problem until lately. It's also on one side- irritated by movement and pressure (can't sleep on that side). I finally went to a PT and we are working on the hip flexors with basic movements, ultrasound, and massage. My hip felt much better in 1 week but I have not pushed it hard since. We'll see...
I had to quit either weights or cardio as the hip couldn't take both- the cardio went for now.
So advice would be to see a good PT if your insurance covers it. Be prepared to take a step back before you go forward. If you're young you can bounce back quickly! Good Luck...

[Rayna]

thank you. I know I am told I should give it a rest. I just HATE to do that. Summers coming and I hate to go backwards after two years of hard work. I haven't been to a PT but I have been going for massage on it as much as I can. Im hoping that will get somewhere. I'm just scared that with rest and massage it will feel better and then I start cardio again and it's back. I have no idea how long something like that really needs to rest for.

[conehead]

i think i hav it it in my right forearm an mildly in my left.i was lifting to much weight with the straight bar an done the damage.i rested it for a while an then hit the gym again an same thing happened,an rested again etc etc.i went on the machines for a while an pulled something in my neck ,went to the doc an got anti-inflalmatreys for my arm an neck..it has set me back a few months ,fukin discusted ,i was even thinking of giving up ,any advise doc an can u put them excerices on you tube as its far better to c the movments than reading ,itll b a great help..

[conehead]

still f ukin sor ive took a couple of months out an the fukin pain is still there < an i think the doc is a .fo not sorting this prob by now

[j4ever41]

what else have you done besides taking time off to heal?

[Dobie-BOY]

I have developed what I believe to be tendonosis in my patellar tendons. I am currently on gh at 6.5 iu a day 5/2. I take my second gh injection before my workouts. after my workouts I am taking 12 iu of humalog. I am then applying moist heat to each knee for 20 minutes. My theory is that the gh should be converted into igf by this point and the moist heat will increase blood circulation around the tendon. I just started this today and plan on wrapping my knees with moist heat for 20 minutes about 4 hours after EVERY gh injection. Seems logical to me. I welcome any criticism (constructive) and will post results.
P.S. great read doc

[Psychotron]

I guess I am confused after reading the Heat/Ice part. I had shoulder surgery some months back and I am back into training (albeit light weight) and I think the bicep tendon that comes up into the clavical has gotten irritated. Anyways, the heat helps me prior to working out with loosening it up, but I always ice it afterwards. I don't notice any pain from either of those two actions.

I saw my doc today, they said they think it's just tendonitis, but I have had this mild irritation since I got out of my brace in May. I guess I need an MRI to confirm what it is.

[calstate23]

Very informitive. I am starting to think i might have a case of tendonosis. I have had this annoying pain in my left shoulder (between where my front delt and chest meet) for about a year now. Now it has started to switch off to both shoulders. Went to chiropractor, said it was tendonitis. Used massage therapy and strecthed me out. It helped a little. But its still there. Hurts mainly on shoulder presses and incline chest, sometimes to the point where i will not even be able to do the exercise (feels super tight and hurts). Its depressing, shit will not go away! If someone has ever experienced something like this let me know or if you think you might know whats up, let me know

thanks a lot

[midnight777]

ok went to the chiro I have tendonosis in my elbow. The prior doctors I went to always gave me the wrong things to do.
I should use heat prior to workout and should I still ice the elbow after working out... Because I was told to use heat instead of ice.

[goodlifting]

since your elbow is at the stage of tendonosis, you need to attempt to get as much blood to the degenerative tissue as possible. Keeping your elbow warm is best.

[oot]

Who do I see about my tendon problems in my elbow, a chiropractor, a physiotherapist?.... who I am not sure and I don't want to waste my money.

[goodlifting]

a sports medicine specialist is ideal. these people are more likely to understand your situation if your elbow injury is due to lifting or some competitive sport. chiropractors and pt's all usually know their stuff. if you have health insurance, more than likely you can go in to see a pt and get it covered.

if your elbow issues are due to some type of tendonitis, essentially, anything they are able to do for can be done on your own. so if you want to save time and money, go in once and get it thoroughly diagnosed by a professional then proceed to do the prescribed treatment on your own.

[oot]

Would I let them know of my intentions of only going in to get the prescribed treatment. I have made an appointment to see a chiropractor. I have a feeling my shoulder has a nerve problem as it has all the symptoms of impingement but no signs of it or any problems with an ultra sound scan.

[EddiePT]

shoulder's been hurting for over a month and half! so annoyed. Been icing it a lot too. This REALLY put things into perspective. THANKS SO MUCH!

[Daviid]

No conclusive cure for tendonisis has been created, especially because it is one of those areas in medical science that needs further research. However, physical therapy is one way that has been shown to alleviate the symptoms. Often times, "rest" doesn't actually heal the problem (although it many cases it does) like it does for tendon-itis because tendon-osis is damage done to the tendons on a cellular level that potentially upsets the proportion of type I and type III collagen. Furthermore, adding anti-aging collagen enhancing compounds like hGH may exacerbate the situation because it is stimulating the wrong kind of collagen to grow (type III) instead of type I. As it stands now, light physical therapy is best to increase blood flow to the area and ease the pain...however, avoid placing too much weight on the tendon as it will further damage the cells (this applies to weight training)...I believe cardio can be considered light and therefore you don't have to give that up. One of the compounds showing promise in treatment of chronic tendonosis right now is surprisingly (nor not) IGF, which somehow directly stimulates the growth of type 1 collagen... I myself have tendonosis of the forearm at the moment (along with osteolysis on the shoulder of the same arm...dang my cursed fate!) and plan to to an IGF cycle soon to see if it actually does work.

I´m curios about the IGF, did it work?
I have a problem with my shoulders, really need something to get me going again.
Have not been able to train for two years now, this is killing me, i´m so depressed of this.

[Break323]

No conclusive cure for tendonisis has been created, especially because it is one of those areas in medical science that needs further research. However, physical therapy is one way that has been shown to alleviate the symptoms. Often times, "rest" doesn't actually heal the problem (although it many cases it does) like it does for tendon-itis because tendon-osis is damage done to the tendons on a cellular level that potentially upsets the proportion of type I and type III collagen. Furthermore, adding anti-aging collagen enhancing compounds like hGH may exacerbate the situation because it is stimulating the wrong kind of collagen to grow (type III) instead of type I. As it stands now, light physical therapy is best to increase blood flow to the area and ease the pain...however, avoid placing too much weight on the tendon as it will further damage the cells (this applies to weight training)...I believe cardio can be considered light and therefore you don't have to give that up. One of the compounds showing promise in treatment of chronic tendonosis right now is surprisingly (nor not) IGF, which somehow directly stimulates the growth of type 1 collagen... I myself have tendonosis of the forearm at the moment (along with osteolysis on the shoulder of the same arm...dang my cursed fate!) and plan to to an IGF cycle soon to see if it actually does work.

I am extremely interested in how this worked for you? I've competed in various sports which have taken their toll on my body. I have increasing pain in my right shoulder and my left knee. I have been researching the use of GH to improve my healing but after reading this thread I am once again taken back to square one.

I'll have to admit this seems very complicated. After I get more research done I'd like to see what people think about gh and anything else to be used to improve my symptoms.

for the sake of anyone who might want to give me their input now I'll list what my problems are.

my right shoulder hurts when lifted straight out to the side either with my own force or by someone else and also if raised to the front. it hurts on top not the back.
In the gym, it seems strong but incline bench hurts and so does side raises. I've dislocated this shoulder a few times snowboarding and have been a little hard on it, but this problem has started in the past month.

As for my knee, I've never blown it out or hurt it bad, but ever since breaking my left ankle for the 3rd time when i sit for too long or use it for too long it hurts to the point that it inables me to crouch down. I've hyper-extended it a couple times but never a bad dislocation or any direct injury. I've talked to a few doctors and I have been told it could be the start of arthitis, or hurt tendons and ligaments. I have been to physical therapy a few times and their next suggestion is cortizone shots. I'm just affraid that will make everything worse if it dulls the pain to where i just use it more?

Any suggestions anybody? should I try GH or IGF, or both?

[Anonona]

No conclusive cure for tendonisis has been created, especially because it is one of those areas in medical science that needs further research. However, physical therapy is one way that has been shown to alleviate the symptoms. Often times, "rest" doesn't actually heal the problem (although it many cases it does) like it does for tendon-itis because tendon-osis is damage done to the tendons on a cellular level that potentially upsets the proportion of type I and type III collagen. Furthermore, adding anti-aging collagen enhancing compounds like hGH may exacerbate the situation because it is stimulating the wrong kind of collagen to grow (type III) instead of type I. As it stands now, light physical therapy is best to increase blood flow to the area and ease the pain...however, avoid placing too much weight on the tendon as it will further damage the cells (this applies to weight training)...I believe cardio can be considered light and therefore you don't have to give that up. One of the compounds showing promise in treatment of chronic tendonosis right now is surprisingly (nor not) IGF, which somehow directly stimulates the growth of type 1 collagen... I myself have tendonosis of the forearm at the moment (along with osteolysis on the shoulder of the same arm...dang my cursed fate!) and plan to to an IGF cycle soon to see if it actually does work.

Further to this, it would appear that IGF stimulates both type I and type III with the preference being type III. Not surprising considering you mentioned HGH isn't ideal due to it's stimulation of type III growth and HGH release IGF-1

Ref:
i'm a noob and can't post full urls pubmed/8853393
i'm a noob and can't post full urls pubmed/10347117

After this run of Thymosin Beta 4 I'll have my MRI redone, then likely try IGF-1 and then MRI again.

[manstrom]

Great read... I've had wrist issues for years and have been told it was tendonitis and arthritis (the later being in my thumb). I'll have to read more into the subject now....

[L8JM]

Hey guys, after reading these posts, I've seen some good knowledgeable posts and some posts that may be some peoples best effort to self diagnose via google and youtube. My advice for those who are having any issues that are not going away would be to see a 1. Certified Athletic Therapist 2.Physiotherapist with a sports background, or 3. Physio with over 5 years of experience (due to the practice it takes with thousands of assessments on postural imbalances, muscles pathologies, and in this case tendinopathies (ex; tendinosis) and everything in between..
But for blogging purposes I'll help how I can..
Example: lets use the shoulder, as it is a popular injury and joint that develops tendon issues with weightlifters
Just to clear things up.. The "Rotator Cuff" is not 1 structure.. it is composed of 4 different stabilizer muscles that surround the shoulder or even more, hold the humerus (upper arm bone) to the scapula (shoulder blade) (or even more clear.. hold the ball into the socket) for optimum strength and stability.. that being said, the "Rotator Cuff" or.. Suprapinatus, Infraspinatus, Teres minor and Subscapularis muscles all insert onto the humerus at different angles, therefore having different actions; 3 of them externally rotating the humerus and subscapularis internally rotating SOO.. Why you need to see a professional is because determining which muscle or tendon is causing your pain will determine proper rehab techniques.. if you have a Subscapularis (Internal Rotator) tendinosis and you are doing popular "Rotator Cuff" exercises from youtube (mostly External Rotation).. you will only be making matters worse.
To clear more up...
The usual cause of a tendinosis is repetitive movements (weight lifting, throwing, swimming etc).. this tendon becomes inflamed at first.. then over time degenerative changes occur causing changes down at a cellular level, which if not treated properly lead to thickening of the tendon or to paint a picture (fibers healing in all random directions->not as strong, will cause pain with movements). But in order to reverse the effects of tendon thickening, the fibers need to be broken up by some type of manual therapy (friction massage, active release or other techniques by a therapist) and then need to be stressed in the direction of pull (Wolfe's Law). But in order to strengthen fibers and get them to be laid down in a parallel fashion (optimum for function and strength), they must be stressed with tension by an exercise that isolates those muscle fibers.. SOO again, why it is so important to figure out which muscle is effected AND what its exact action is (ex; External rotation of the humerus/upper arm).. but you can't just start isolating this muscle in the same repetitive motion that caused the tendon issue in the first place. A popular and research based exercise therapy technique to achieve proper function of these effected muscles are light ECCENTRIC exercises (muscle lengthening, or usually the lowering phase of contraction).
When we "shorten" a muscle it is called a "CONCENTRIC" contraction (Ex; flexing your biceps during a biceps curl).. These CONCENTRIC contractions are usually what cause tendinopathies. Therefore by performing 12-15 reps x 3-5 sets of an ECCENTRIC (lengthening) contraction for about 3 seconds each rep, then assisting yourself through the CONCENTRIC phase of contraction, you will start to gain strength and put the appropriate stresses on the muscle and tendon fibers in order to change the cellular structure --> leading to a more organized parallel network of cells which in end over a period of time is how you treat and improve the injury known as a tendinosis. (100s of patients treated in the clinic with results to support my statement)
And lastly..
You will only achieve your goals of reducing shoulder pain if you work on scapular stability; the position of your shoulder is usually why you developed your tendon issue in the first place. 90% of the patients I treat in the clinic that come to me with shoulder problems is because their shoulders are sitting forward, due to over working the pects, or throwing (these movements cause tightness in your Internal Rotators, leading to a forward and internal migration of your shoulder--> which over time causes a narrowing of the Subacromial space (space in your shoulder for tendons, nerves, blood vessels to pass through in movements). which causes friction and impingement of tendons--> inflammation-->pain) That being said.. 90% of people in a clinical setting, and I'd say 99% of people on this forum need to work on Scapular stability (Serratus Anterior, External Rotators, Rhomboids, Lower Traps) to make sure there ball is sitting in the socket properly so it is operating at its most stable position, and you have enough room for structures to pass through during weight training.
SORRY for the longggg reply.. but this is extremely important when training and wanting to keep optimal strength and preventing injury in the future whether its acute or chronic. I treat too many people in their 40's right now that can't put their seatbelt on or grab a cup of coffee out of the cupboard because of there improper posture and muscle imbalances from many years of over training their chest and not enough time spent on the functional exercises. (Basically: strengthening shoulders to sit down and back will open up the space and allow for more room of tendons to pass through)
YOU WILL NOT get rid of your pain by ONLY icing, or heating or taking pills. you need to use it all together and STRESS the effected structure for a long period of time (6-12 weeks of rehab, personal results as an athletic therapist) to change the physiological makeup of the structure. Its simple physics..you have to literally change the shape of the tendon that you have effected over months/years of overuse that caused the injury in the first place.
Same goes for any other tendon in the body.. First fix posture/ strengthen/ correct muscle imbalances, then start your Eccentrics, and eliminate the cause (don't do it if it hurts)
I hope this helps guys and girls.. (PS look up the Anatomy of the shoulder complex if anything doesn't make sense)
Cheers!
CAT(C), CSCS

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[JKW]

great post I saw it and had to read. Been having shoulder issues and I don't lift heavy. Going to try doc's regiment. Thanks doc!!