By Michelle on Sunday, November 23, 2003 - 01:59 am:

I came across some information some time ago regarding eccentric exercise as an effective treatment for tendonosis. I'd heard of tendonitis before (been diagnosed with it) but not tendonosis. Tendonosis, in contrast to tendonitis, is not an inflammatory process but degeneration of the tendon. The causes are unknown, but repeated injuries and microtrauma combined with poor healing are known factors. MRI's and other imaging tests show, that in people suffering from tendonosis, collagen breakdown is present. Researches found that tendonosis is more common than tendoitis, since inflammation is rarely present except in cases of acute injury. To me, that sounds a lot like HMS, except that HMS is like having tendonosis in every joint.

What I find most interesting is the success some doctors have had when they treat tendonosis, instead of trying to treat inflamation that isn't present. They aim instead to help collagen synthesis, maturation, and strength. They do it primarily through patient education, correction of biomechanical factors, ice therapy if there is inflammation, braces to decrease loading, and appropriate strengthening. Sounds like standard care for HMS, right?

The difference is in what they consider appropriate strengthening. The found that eccentric exercise (lowering under weight) results is better and faster collagen synthesis than concentric exercise (raising weight). Since greater loads can be done eccentricly than concentrically, they only advise eccentric exercise. So if you have tendonosis in your left knee, you go down into a squat on only your left knee, then push up only with your right leg, then repeat. They further advocate doing the exercises under the heaviest load you can manage, which increases pretty rapidly. And once you can manage some weight added to the exercise, they have you do the exercises relatively fast.

I imagine that sounds too agressive for HMS people to you. But my rheumy wanted me to do squats for my knees awhile back, and it was around this research that I built my knee strength training around. It made my quads sore as heck for about two weeks, but my tendons and the joint stopped hurting pretty quick. I could walk a lot more, and I've been able to maintain it for some time now.

What do you think of this? Am I crazy to be doing such agressive strength training? I want to really try it for my upper back, but haven't found a way to do that yet that I'm not too scared of. I'd absolutely love it if you could take the time to read a couple articles on this, and give me some feedback. here's some links:

Time to abandon the "tendinitis" myth
http://bmj.bmjjournals.com/cgi/content/full/324/7338/626#B2

Pain in the Achilles Region - Chapter from Clinical Sports Med
http://www.clinicalsportsmedicine.com/chapters/28b.htm - second part of chapter, this will explain a bit of what they think tendonosis is and how they test for it
http://www.clinicalsportsmedicine.com/chapters/28d.htm - shows two strength programs studied and the results

What got me to try it was the results they saw -
one study was a decrease in pain from mean 6/10 to 1.3/10 where 1 represents no pain, the other with a decrease in pain scale from mean 81/100 to 5/100 where 0 represents no pain. THAT'S impressive.

What do you think?
Michelle