Tendonitis is now considered a relatively rare condition.1 The good news is that with the diagnosis of tendonitis, patients were expected to get well in a short time, but with the realization that it is really tendinosis, more time is required (six weeks to six months, depending on the chronicity) for treatment and healing. In many cases such as Achilles tendonitis, patellar tendonitis, lateral epicondylitis and rotator cuff tendonitis, a good percentage of cases do not get well as soon as we might desire. We do not have to blame ourselves. What we have to do is explain to the patient the underlying tissue damage that exists. Corticosteroid injections and NSAIDs cannot really heal a noninflammatory condition.
In my article "Is It Really Tendonitis?" which appeared in the January 12, 2000 issue of Dynamic Chiropractic, I quoted Boyer et al.,2 who stated: "Signs of either acute or chronic inflammation have not been found in any surgical pathologic specimens in patients with clinically diagnosed lateral tennis elbow syndrome." Maffulli3 states that "tendonitis" or "tendinosis" should only be used when the microscopic diagnosis of the condition has been confirmed.
Evidence is currently on the side of tendinosis over tendonitis. According to Bonar,4 tendonitis is symptomatic degeneration of the tendon with vascular disruption due to a partial rupture of the fibers. Most of the chronic conditions we see are not traumatic enough to cause a vascular disruption necessary for the creation of an inflammatory response. What we really are seeing is an intratendinous degeneration due to aging, and microtrauma where there is collagen disorientation, disorganization and fiber separation by increased mucoid ground substance. Tendinosis results from collagen degeneration and mechanical overload.1
Our treatment should emphasize the prevention of collagen breakdown, which requires rest and strengthening (especially the eccentric type). Elbow and ankle supports, for example, take on a new meaning. Warming up before activity and paying attention to correct biomechanics required for particular sports takes on a new emphasis. We must prevent collagen damage and, most importantly, stimulate collagen synthesis. Again, the knowledge that friction massage stimulates fibroblastic proliferation, which synthesizes new collagen, proves again why this method has proven so effective over the years.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
