What is Tendonitis?

Tendonitis or its aliases: tendinitis, tendinopathy and tendinosis are all tendon injuries. 

Tendinopathy (tendon injuries) can develop in any tendon of the body.

Typically, tendon injuries occur in three areas:

• musculotendinous junction (where the tendon joins the muscle)
• mid-tendon (non-insertional tendinopathy)
• tendon insertion (eg into bone)

Non-insertional tendinopathies tend to be caused by a cumulative microtrauma from repetitive overloading eg overtraining.

What is a Tendon Injury? 

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of repetitive tendon overloading. Health professionals may use different terms to describe a tendon injury. You may hear:

Tendinitis (or Tendonitis): This actually means "inflammation of the tendon," but inflammation is actually only a very rare cause of tendon pain. But many doctors may still use the term tendinitis out of habit.

The most common form of tendinopathy is tendinosis. Tendinosis is a noninflammatory degenerative condition that is characterised by collagen degeneration in the tendon due to repetitive overloading. These tendinopathies therefore do not respond well to anti-inflammatory treatments and are best treated with functional rehabilitation. The best results occur with early diagnosis and intervention.

What Causes a Tendon Injury?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

Your tendons are designed to withstand high, repetitive loading, however, on occasions, when the load being applied to the tendon is too great for the tendon to withstand, the tendon begins to become stressed.

When tendons become stressed, they sustain small micro tears, which encourage inflammatory chemicals and swelling, which can quickly heal if managed appropriately.

However, if the load is continually applied to the tendon, these lesions occurring in the tendon can exceed the rate of repair. The damage will progressively become worse, causing pain and dysfunction. The result is a tendinopathy or tendinosis.

Researchers current opinion implicates the cumulative microtrauma associated with high tensile and compressive forces generated during sport or an activity causes a tendinopathy.

For example, in explosive jumping movements, forces delivered to the patellar tendon can be eight times your body weight. Cumulative microtrauma appears to exceed the tendon’s capacity to heal and remodel.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

• The pain may get worse when you use the tendon.
• You may have more pain and stiffness during the night or when you get up in the morning.
• The area may be tender, red, warm, or swollen if there is inflammation.
• You may notice a crunchy sound or feeling when you use the tendon.

The symptoms of a tendon injury can be a lot like those caused by bursitis.

Tendinopathy Phases

The inability of your tendon to adapt to the load quickly enough causes tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy

• Normal tissue adaptation phase
• Prognosis: Excellent. Normal Recovery!

2. Tendon Dysrepair

• Injury rate > Repair rate
• Prognosis: Good. Tissue is attempting to heal.
• It is vital that you prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinopathy

• Cell death occurs
• Poor Prognosis - Tendon cells are giving up!

4. Tendon Tear or Rupture

• Catastrophic tissue breakdown
• Loss of function.
• Prognosis: very poor.
• Surgery is often the only option.

It is very important to have your tendinopathy professionally assessed to identify it’s injury phase. Identifying your tendinopathy phase is also vital to direct your most effective treatment, since certain modalities or exercises should only be applied or undertaken in specific tendon healing phases.

How is a Tendon Injury Diagnosed?

To diagnose a tendon injury, your physiotherapist will ask questions about your past health, your symptoms and exercise regime. They'll then do a physical examination to confirm the diagnosis. If your symptoms are severe or you do not improve with early treatment, specific diagnostic tests may be requested, such as an ultrasound scan or MRI.

How is Tendinopathy Treated?

In most cases, you can start treating a tendon injury at home. To get the best results, start these steps right away:

• Rest the painful area, and avoid any activity that makes the pain worse.
• Apply ice or cold packs for 20 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
• Do gentle range-of-motion exercises and stretching to prevent stiffness.
• Have your biomechanics assessed by a sports physiotherapist.
• Undertake an Eccentric Strengthen Program. This is vital!

How to Return to Sport

It may take weeks or months for a tendon injury to heal. Be patient, and stick with your treatment. If you start using the injured tendon too soon, it can lead to more damage.

To keep from hurting your tendon again, you may need to make some long-term changes to your activities. These should be discussed with your physiotherapist.

• Try changing your activities or how you do them.
• If exercise caused the problem, check your technique with a coach or sports physiotherapist.
• Perform regular eccentric style exercises.
• Closely monitor and record your exercise loads. Discuss your loading with your physiotherapist and coach.
• Always take time to warm up before and cool down / stretch after you exercise.
   

This article originally appeared on physioworks.com.au and was written by Zoe Russell.

How to Overcome Rotator Cuff Issues

What is your Rotator Cuff?

Rotator cuff syndrome is very common shoulder injury. 

Your shoulder joint is a relatively unstable ball and socket joint that is moved and controlled by a small group of four muscles known as the rotator cuff.

The subscapularis, supraspinatus, infraspinatus and teres minor are your small rotator cuff muscles that stabilise and control your shoulder movement on your shoulder blade (scapula). 

As the name suggests, the rotator cuff muscles are responsible for shoulder rotation and form a cuff around the head of the humerus (shoulder ball).

What Rotator Cuff Injuries are Common?

Your rotator cuff muscles and tendons are vulnerable to rotator cuff tears, rotator cuff tendonitis and rotator cuff impingement and related rotator cuff injuries.

Rotator cuff injuries vary from mild tendon inflammation ( rotator cuff tendonitis), shoulder bursitis (inflammed bursa), calcific tendonitis (bone forming within the rotator cuff tendon) through to partial and full thickness rotator cuff tears, which may require rotator cuff surgery.

Some shoulder rotator cuff injuries are more common than others. 

These include:

• Rotator Cuff Impingement
• Rotator Cuff Tendonitis / Tendinopathies
• Shoulder Bursitis (fluid-filled sac that provides a cushion between a bone and tissues)
• Calcific Tendonitis
• Rotator Cuff Tears
• Bicipital Tendonitis

Where are your Rotator Cuff Muscles?

Your rotator cuff muscles hold your arm (humerus) onto your shoulder blade (scapula). Most the the rotator cuff tendons are hidden under the bony point of your shoulder (acromion), which as well as protecting your rotator cuff can also impinge into your rotator cuff structures.

What Causes a Rotator Cuff Injury?

Your rotator cuff tendons are protected from simple knocks and bumps by bones (mainly the acromion) and ligaments that form a protective arch over the top of your shoulder.

In between the rotator cuff tendons and the bony arch is the subacromial bursa (a lubricating sack), which helps to protect the tendons from touching the bone and provide a smooth surface for the tendons to glide over.

However, nothing is fool-proof. Any of these structures can be injured - whether they be your bones, muscles, tendons, ligaments or bursas.

Rotator cuff impingement syndrome is a condition where your rotator cuff tendons are intermittently trapped and compressed during shoulder movements This causes injury to the shoulder tendons and bursa resulting in painful shoulder movements.

What are the Symptoms of Rotator Cuff Injury?

While each specific rotator cuff injury has its own specific symptoms and signs, you can suspect a rotator cuff injury if you have:

• an arc of shoulder pain or clicking when your arm is at shoulder height or when your arm is overhead.
• shoulder pain that can extend from the top of your shoulder to your elbow. 
• shoulder pain when lying on your sore shoulder.
• shoulder pain at rest (in more severe rotator cuff injuries).
• shoulder muscle weakness or pain when attempting to reach or lift.
• shoulder pain when putting your hand behind your back or head.
• shoulder pain reaching for a seat-belt.

How is a Rotator Cuff Injury Diagnosed?

Your physiotherapist or sports doctor will suspect a rotator cuff injury based on your clinical history and the findings from a series of clinical tests.

A diagnostic ultrasound scan is the most accurate method to diagnose the specific rotator cuff injury pathology. MRI’s may show a rotator cuff injury but have also been known to miss them. X-rays are of little diagnostic value when a rotator cuff injury is suspected.

How to Treat a Rotator Cuff Injury?

Once you suspect a rotator cuff injury, it is important to confirm the exact type of your rotator cuff injury since treatment does vary depending on the specific or combination of rotator cuff injuries.

Your rotator cuff is an important group of control and stability muscles that maintain “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This prevents injuries such as impingement, subluxations and dislocations.

We also know that your rotator cuff provides subtle glides and slides of the ball joint on the socket to allow full shoulder movement. Plus, your shoulder blade (scapula) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence. 

These are:

• Early Injury Protection: Pain Relief & Anti-inflammatory Tips
• Regain Full Range of Motion
• Restore Scapular Control
• Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
• Restore Rotator Cuff Strength
• Restore High Speed, Power, Proprioception & Agility
• Return to Sport or Work
  
  This article originally appeared on physioworks.com.au and was written by Sam Moyle

Why Massages Really Do Keep You Healthy: A Cardiologist Explains

We've all seen it on TV or in a movie. The scene is tense and the patient is doing poorly. The doctor calls out urgently. Retractor! Scalpel! Suction! Massage Table!

Wait a minute .... Massage table?

Did Dr. House ever scream for body oil?

The good news is this: if you enjoy a massage, you just might be helping your heart and arteries stay healthy and youthful.

Scientific studies have shown benefits of massage therapy for insomnia, multiple sclerosis, anxiety, cancer pain, post-operative recovery and other conditions.

Several recent studies point to benefits of massage therapy that help heal the heart.

In 2008, researchers studied 263 volunteers who had a massage for 45 to 60 minutes. Average blood pressure fell by 10 mg Hg and heart rate by 10 beats per minute after one treatment. That's about as much as you might get from prescribing a new blood pressure medication for life!

Earlier this year, 50 people with mildly elevated blood pressure received a 15-minute massage, three times a week for 10 sessions, while a similar group just relaxed for the same amount of time. Blood pressure fell at the end of the sessions and remained lower for several days—but only in the massage group.

Another study this year examined 8 women with high blood pressure who'd had an hourlong massage each week for four weeks. At the end of that period, their blood pressure fell by 12 mm Hg systolic (top number) and measurements in the blood reflecting inflammation (specifically VCAM-1 if you like science) fell significantly. A control group just rested for the same amount of time and had smaller improvements in the same measurements. The drop in markers of inflammation is intriguing and suggests massage therapy may have a body-wide healing effect.

Why might massage therapy result in improvements in measurements of cardiovascular function?

Reductions in salivary and urinary levels of the stress hormone cortisol have been observed in several experiments in humans. In contrast, urinary levels of the stress hormones epinephrine and norepinephrine were not seen to fall during several studies.

Bottom line: not yet completely known and studies remain to clarify these pathways.

Is it time to chuck your blood pressure medication? Throw away your magnesium, CoQ10 and taurine blood pressure lowering supplements? Forgo your plant-based diets full of phytonutrient-rich leafy green vegetables and arginine rich pine nuts, arugula and watermelon?

No, it's clearly premature to consider massage therapy on par with those approaches. Furthermore, there are no studies showing a reduction in heart attack, strokes, and heart related deaths—and likely never will be due to the costs of such research projects.

However, given that tens of millions of people in the US alone grapple with high blood pressure, massage therapy can join acupuncture, yoga, meditation, and Tai Chi as complimentary approaches to maintaining optimal vascular health.

Buddha said that “to keep the body in good health is a duty, otherwise we shall not be able to keep our mind strong and clear.”

Maybe this is the week to schedule a massage treatment to move toward that goal?

This article originally appeared on mindbodygreen.com and was written by by Joel Kahn, M.D.

Massage Therapy With Our Student Massage Therapist

Tristen Threefingers, Student RMT

Offering therapeutic and relaxation treatments to help people get back in to balance with movement, function and sense of ease!

Our passionate student massage therapist, Tristen Threefingers, has returned to Reset Wellness to complete her second year practicum with Makami College. In early 2017, Tristen provided our clients with effective care and treatment, making a strong impact in the quality of life and health in our community. Her contribution to the clinic's environment and team had her being praised wide and far.

Tristen provides Massage Therapy treatments at Reset Wellness as a registered student Massage Therapist with the City of Edmonton and CRMTA. Since she hasn't graduated from her program yet, (not until April 2018), and her treatments cannot be claimed through insurance, but are offered at a discount rate--serving as an option for people who do not have insurance coverage or have none left!

Tristen is highly professional, up beat, caring and thorough. She specializes in deep tissue treatments, sports massage and hot stone massage. She enjoys tackling challenges and learning from them, and would like to further her skills in neuromuscular and orthopedic treatments. She is committed to sharing her knowledge and talent with individuals to relieve pain, stress and anxiety, and restore balance and harmony. 

We are so excited to have her back with us and hope to see you booking your appointment with her!

Student RMT Massage Therapy Pricing

30 minutes for $35
60 minutes for $55
90 minutes for $75