Properly Treating Tendon Injuries

Since tendinosis is not considered an inflammatory condition (in case you missed my piece about tendinitis, visit this post), the question arises as to the role of conventional treatment like: corticosteroid injection, and anti-inflammatory drugs (NSAID's). Studies show that corticosteroids directly inhibits the making of collagen fiber, as a result, tendon atrophies (aka shrinkage.) The one benefit of an injection is the "trauma" of the needle to the tendon, in all probability stimulates a healing response by the body onto the tendon. Oh, there's usually lidocaine mixed into the injection, so the pain could dissipate... but we already know that pain-free doesn't necessary mean problem-free. And the NSAID's, well... if there's no inflammation, there's nothing for the drug to work on... except desensitizing the pain receptors?!

What's the solution?
Recall the earlier years of our lives when we run & bump into things, or the older sibling beatings. The first thing we did (aside from crying) is to rub it. Well, that intrinsic know-how is the proper way to nurture soft tissue wounds. In the rehab world, the technical term is Mechanical Loading.

Mechanical Loading ~ Huh?
The therapeutic principle of mechanical loading (ie. weight bearing exercises) has proven to be quite valuable to bone health (eg. prevention of osteoporosis). It stimulates & facilitates the growth and development of the (bone) tissue. This principle can be applied to healing wounded soft tissues (muscle, tendon, ligaments, & fascia.)

Introducing a mechanical load/pressure to a tendon, stimulates the formation of cells in the area to lay down new collagen fibers (biological description: proliferation of fibroblasts & initiation of an inflammatory cascade, aka mechanotransduction). And with the proper component of the mechanical load in this micro-environment, these new collagen fibers can be organized along the pressure load (ie. the concepts of Piezoelectric effect & Tensegrity), and be incorporated into the tendon. In simpler words, rubbing it properly will make it better.

Mechanotransduction, Piezoelectric effect, Tensegrity, and other concepts/principles are not often saught after by clinicians. I'm one that's quilty of that ~ it's just too difficult to keep up with both the practical aspect with the research principles.

Let's break from the technical stuff. Here's a list of the more common techniques/methods that have been successful with treating soft tissue injuries:

• Crossed-fiber friction
• Active Release Technique®
• Graston® Technique - Instrument-assisted soft tissue mobilization (GT-ISTM)
  
• Traction
• Strain-Counterstain
  
• Nimmo Technique®
• Rolfing
• Sound Assisted Soft Tissue Mobilization® (SASTM)
• ASTYM System®

If you know of any other techniques/method out there, don't hesitate to share with me. I'll be glad to add it to the list.