“We discovered that sub‐rupture fatigue damage can accumulate from just one bout of fatigue loading. Furthermore, any attempt to repair the fatigue damage diminishes as the severity of induced damage increases….. Damage accumulation ultimately leads to rupture that is characterized by formation of a mechanically inferior scar…”Taken from a bio-engineering collaboration between Cornell University and several surgical hospitals in New York, and then published a couple of months ago in the Journal of Orthopedic Research (Promoting Effective Tendon Healing and Remodeling) What doe we know for sure about tendinitis / tendinosis? We know that even though TENDINOSIS is largely a mechanical derangement and degeneration of tendons (a fraying or “SCARRING” if you will), there is usually varying degrees of inflammation present (HERE). We also know that as far as medical diagnosis is concerned, tendinosis is frequently used interchangeably with the term fascial adhesion — probably in most cases inadvertently (HERE). What I would like to do today is briefly discuss some of the newest research in tendons and TENDINOPATHY, starting with a warning about the effects that certain antibiotics have on tendons.
Firstly, there are few drugs more commonly used, with greater potential for DESTRUCTION OF YOUR HEALTH than antibiotics. As far as today’s topic is concerned, it’s because they tend to cause tendon damage. Secondly, nowhere in the antibiotic milieu is this more true than with the FLUOROQUINOLONE CLASS of antibiotics (ciproflaxacin, levoflxacin, etc). And thirdly, scores of studies have shown us that drug reactions in general are reported around 1% of the time (HERE). So it’s not a surprise that a Professor of Emergency Medicine at UAB, Dr Matthew C DeLaney, said in a scientific paper that he published in last month’s issue of the British Journal of Hospital Medicine (Risks Associated with the Use of Fluoroquinolones) that…..
“Fluoroquinolones are a widely used class of antibiotic….. Despite their popularity there is increasing concern regarding the potential complications associated with these agents. Patients who take a fluoroquinolone have an increased risk of developing tendinopathy, peripheral neuropathy, and aortic aneurysm or dissection. Providers should consider the risk of these potential complications before using these medications.”
Sometimes fluoroquinolone-induced tendinopathy gets better on its own if given enough time. I have, however, seen people’s lives turned permanently upside down by these drugs. And if it’s not being reported to the proper governmental authorities as stated above, it’s never counted as a side effect and the drug continues to be touted as both safe and effective. BTW, there is another drug (BESIDES STATINS) that’s being shown to cause tendinopathies as well; Slidenafil, otherwise known as Viagra.
A Brazilian study published in last week’s issue of Life Sciences (Chronic Treatment with Sildenafil Causes Achilles Tendinopathy in Rats) showed that after dividing rats into two groups — the control and sixty days of drug therapy —- “The animals exposed to sildenafil presented a much less organised tendon matrix, with reduced collagen I and non-collagenous protein content and a much higher decorin content. The results observed in the animals can be characterised as tendinopathy, a condition not yet described as a sildenafil side effect.” Decorin is indicative of the connective tissue “THICKENING” that occurs in their pathological states. Again, DRUGS ARE DANGEROUS whether pushed or prescribed!
As for those of you trying to heal your muscles and tendons while continuing to SMOKE — it’s like stepping into the batter’s box already two strikes down. This is at least partly due to the fact that hemoglobin, the O2-carrying, iron-containing molecule found in red blood cells has a several hundred times greater affinity for carbon monoxide than for oxygen, starving every single cell in your body of its air supply. This was verified yet again by a Korean study published in last month’s issue of the American Journal of Sports Medicine (Effect of Smoking on Healing Failure After Rotator Cuff Repair). The authors, not too surprisingly, concluded…..
“Current heavy smokers had a higher incidence of… poor tendinosis grade. After adjustment for the confounding variables, the matched smoker group showed a significantly higher healing failure rate than the matched nonsmoker group (29.4% vs 5.9%). Smoking affected healing failure after arthroscopic rotator cuff repair. Attention should be paid to smokers, especially current heavy smokers, in cases of rotator cuff repair surgery.”
The real question becomes what are we going to do about solving these problems? For starters, realize that an ANTI-INFLAMMATORY DIET (the “alternative anti-inflammatory and immuno-modulatory approach” seen below) is critical. Even though we know how scar tissue and FIBROSIS builds up in these tendons, we need to be reminded of the fact that fibrosis is always the result of inflammation (HERE). A failure to deal with underlying inflammation means that you can never really get ahead of the curve (HERE). Furthermore, trying to do this solely with the “BIG FIVE” class of drugs is why a recent study said that the failure rate for tendinosis is 25%. The study, went on to say of tendinosis / tendinitis….
“Historically, tendinopathy has primarily been considered a degenerative pathological process of a non-inflammatory nature as the presence of acute inflammatory cells in chronic tendinopathy has never been confirmed. However, thanks to the newer research tools, convincing evidence that includes an increasing number of inflammatory cells in pathological tendons has started to appear showing that the inflammatory response is a key component of chronic tendinopathy. For example, an increase in terms of cytokines, inflammatory prostaglandins, and metalloproteinases (MMPs) along with tendon cell apoptosis [pre-programed cellular death] seem to be provoked by continuing mechanical stimuli. In this context, an alternative anti-inflammatory and immunomodulatory approach that replaces the traditional anti-inflammatory modalities (i.e. NSAIDs) may provide another potential opportunity in the treatment of chronic tendinopathies.”
What’s being recommended as far as treatment and what works? The 13 member team of experts that creates “MEDICAL GUIDELINES” (ESSKA — the European Society for Sports Traumatology, Knee Surgery and Arthroscopy) shed some light on this subject about six weeks ago in a study (Current Trends in Tendinopathy: Consensus of the ESSKA Basic Science Committee. Part II: Treatment Options) published in the Journal of Experimental Orthopedics *(the quote above was taken from this guideline). What, however, was discussed as far as treatment options? Some mentioned included PRP INECTIONS, stem cell therapy, genetic therapy, UltraSound-guided Galvanic Electrolysis Technique (USGET), engineered tissues and biomaterials transplants and other various surgeries. Mechanical therapies of any sort were not mentioned; not surprising considering the name of the organization creating the guidelines.
While these might be eventualities, before taking routes that can be both invasive and expensive, I would suggest you at least look into tissue remodeling. Along with CHRONIC NECK PAIN, CHRONIC SHOULDER PAIN is probably the most common thing I treat in my clinic using tissue remodeling techniques, mostly for some sort of tendinosis or fascial adhesion. I frequently see other forms of tendinosis as well, mostly in the forearms and wrists, but sometimes in lower extremities as well (particularly in the HIP FLEXOR).
For those of you with SYSTEMIC TENDINOSIS or SYSTEMIC FASCIAL ADHESIONS, you’ll likely need a bit different approach. Start by taking this simple quiz to see if you are inflamed (HERE). Then proceed to this nifty (and completely free) blueprint for reducing systemic inflammation (HERE). While I would never hope to claim that it’s the solution for all of you, it’s simple, common-sense approach is going to help the majority of you start addressing your inflammation-related health issues. And if you enjoyed today’s post, be sure to like, share or follow on FACEBOOK as it’s a great way to reach the people you love and care about most.