Common Conditions:    • Tendonitis/Tendinosis     • Sprains and Strains

Tendonitis/Tendinosis
The advances in the understanding of tendon injury indicate that conditions that have been traditionally labelled as Achilles tendonitis, patella tendonitis, lateral Epicondylitis (tennis elbow), and rotator cuff tendonitis are in fact TENDINOSIS. Although the word “Tendonitis” is often still used, it is actually an out-dated term. The suffix “itis” in tendonitis means inflammation, however, research has shown that it is really a build up of scar tissue, and decrease in tissue collagen that is the problem, not inflammation. Therefore, the newer term that replaces tendonitis is “Tendinosis”, which denotes the scar tissue accumulation, and change in tendon tissue composition.

This condition is most common in athletes of jumping sports such as basketball and volleyball, but it also occurs in soccer, track, long distance running, cycling and tennis athletes. The symptoms of a tendinosis injury include pain at the tendon site which is worse with particular movements, reduced range of motion due to scar tissue accumulation and relative relief of pain with rest. The symptoms will depend on the severity of the injury and the length of time the injury has been present. Scar tissue accumulation can build up over a long period of time before symptoms appear. Once symptoms develop, they may come and go with time but the root problem will remain if left untreated. Those patients most at risk for re-injury are those that have symptoms of short duration and are still able to “warm up” the injury and engage in sports. They are the most likely to try to continue playing without undergoing appropriate treatment, and thus worsen the tendinosis.

Because tendinosis results from collagen degeneration and generally, mechanical overload, it is vital to establish why this occurred. Training errors are a common cause, but in some instances a more subtle mechanism underlies tendinosis. Thus, it is important to assess any equipment being used (eg. running shoes, tennis racquet, bike), examine movement biomechanics (eg. running, throwing motion, stroke pattern), and diagnose and treat any muscle imbalances. The importance of biomechanical correction cannot be overemphasized in treatment.

Effective treatment of any tendinosis injury requires an alteration in tissue structure to break up the cross-fibre adhesions. Targeted soft tissue therapy and Acupuncture can be used to restore normal function to the affected soft tissues, Physiotherapy and Chiropractic to restore normal motion and alignment to the involved joints. Functional Rehabilitation, emphasizing eccentric strengthening will be necessary to restore the long strength to the involved tissues. back to top

Sprains and Strains
A SPRAIN is a tear in a ligament and a STRAIN is a tear in a muscle. Sprains and strains are graded into categories depending on the severity of the tear. The three classifications are – mild (1st degree), moderate (2nd degree) and severe (3rd degree). A mild sprain or strain refers to a tear of up to 20% of the fibres (micro-tear); moderate refers to a tear of 20-75% of the fibres (partial tear); and severe refers to a tear of 75-100% of the fibres (complete or full tear).

Factors that contribute to ligament sprains include a sudden movement beyond the normal range of motion, muscle imbalances, prolonged alteration of posture, poor proprioception/balance and altered biomechanics. Contributing factors for muscle strains include overuse or repetitive micro-trauma, contraction of a muscle while it is in a stretched position, un-preparedness for activity, violent contraction, excessive forceful stretch or a sudden movement.

Common areas to sprain include “rolling” the ankle (“inversion sprain”) and knee. These injuries are more frequent in runners, soccer players, tennis players, skiers and snowboarders. Common areas to strain include the adductors (inner thigh muscles, ‘pulled groin”) and the hamstrings. These injuries are more frequent in athletes who are involved in kicking, sprinting, skating, water skiing, or jumping (high jump or hurdles).

There is usually local tenderness in the area. There may be some swelling and/or bruising depending on the severity of the tear. Stretching the area tends to cause more pain and discomfort. The pain, swelling, bruising and tightness are correlated to the degree of the tear. A severe (3rd degree) sprain is often associated with a subluxation or dislocation of the joint. If the sprain is not treated properly, a chronic instability can form in the joint, leading to additional or continual sprains. Similarly, if a strain is not treated properly, scar tissue can form in the muscle and limit the range of motion, which can contribute to further damage.

Once you have sustained a sprain or strain it is important that you receive the appropriate care as quickly as possible. Begin with RICE (rest, ice, compression, elevation) and then make an appointment at the clinic. Treatment at the early stages will focus on decreasing pain, minimize swelling and inflammation and promote healing with Targeted Soft Tissue Therapy and Acupuncture. As the tissues heal treatment will shift focus to re-establishing the appropriate strength and balance of the muscles and proprioception with Functional Rehabilitation. Long term goals are a safe return to activity and prevention of re-occurrences. back to top