Inflammation… What’s going on?

Inflammation is part of the body’s response of vascular tissues to harmful stimuli. Signs of acute inflammation are pain, heat, redness, and loss of function. Inflammation is a protective attempt by the organism to remove the stimuli and to begin to heal (if something hurts there is a reason and you should fix it). Progressive destruction of the tissue would compromise the survival of the organism. For that reason, inflammation is closely regulated by the body (Our bodies are capable of a great deal of pain… if you feel it, your body is SCREAMING at you that something is wrong).

Prolonged inflammation, or chronic inflammation, leads to a change in the type of cells at the site of inflammation. There is a simultaneous destruction and healing of the tissue from the inflammatory process because your body is attempting everything possible to remove the harmful stimuli.

Tendinitis, or inflammation of a tendon, should be reserved for tendon injuries that involve larger-scale acute injuries accompanied by inflammation (common ones include achilles tendinitis, patellar tendinitis). Tendinitis injuries are common in the arms and legs (including the rotator cuff attachments for all of you shoulder pain athletes), and are less common in the midsection. Research has shown that there may not be an actual “inflammation” of the tendon and therefore a better term would be tendinosis, which is damage at the cellular level caused by microtears in the connective tissue in and around the tendon. Characteristics of tendinosis include degenerative changes in the collagenous matrix, hypercellularity, hypervascularity, and a lack of inflammatory cells. Symptoms vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Tendons are very slow to heal if injured. Partial tears heal by the rapid production of disorganized type-III collagen, which is weaker than a normal tendon. Recurrence of injury in the damaged region of tendon is common (give it time to heal). Treatment of tendon injuries is usually conservative (physical therapy, rest and gradual return to exercise). Resting assists in the prevention of further damage to the tendon. Ice/heat, compression and elevation are also frequently recommended. Initial recovery is typically within 2 to 3 days and full recovery is within 4 to 6 weeks.

It is thought that tendinosis is NOT due to an inflammatory disorder; therefore, NSAIDs would be non effective. Research has shown that steroid injections have not been shown to have long term benefits. If it is NOT an inflammatory issue, then a mild pain reliever would be just as effective in reducing pain and allowing an injury to heal as steroids and NSAIDs. Instead of medication, Vitamin E has been found to increase the activity of fibroblasts, leading to increased collagen fibrils and synthesis, which seems to speed up the regeneration and increase the regenerative capacity of tendons. Soft Tissue Mobilization (manual therapy) has been shown to speed the healing of tendons by increasing fibroblast activity, also. One case study showed STM resulting in full recovery of an athlete suffering from chronic ankle pain and fibrosis, after an unsuccessful course of surgery. The most conservative and perhaps most successful treatment is eccentric strengthening which aids in remodeling damaged tendon tissues.

Eccentric strengthening focuses on slowing down the lengthening phase of the muscle process (action of lowering the dumbbell in a bicep curl, slowly) in order to challenge the muscles, which leads to stronger muscles, faster muscle repair and increasing metabolic rate. Eccentric movement provides a braking mechanism for muscle and tendon groups that are experiencing concentric movement (shortening) to protect joints from damage as the contraction is released (protecting joints in the down phase of a pull up, setting down heavy groceries without breaking the eggs, etc). Eccentric training is good for casual and high performance athletes, patients looking to rehabilitate certain muscles and tendons, and the elderly.

Take care of your tendons. This is a ruptured Achilles. Notice how thick the tendon is… takes a lot of poor mechanics to do something like this!

For more information about tendon injuries or how to repair and heal damaged tissues contact Laura at pediatricandsportspt@gmail.com