Tendinitis? Tendinosis? LDL?

from this forum:

BrukBallenger

12-14-2004, 07:48 PM

The first thing to do is get past the misdiagnosis of "tendinitis," and realize that it is now likely "tendinosis." Treating it as an inflamed tendon will be, for the most part, useless. An "-itis" will typically resolve with rest. Yours has been around for far too long, and with most cases of chronic achilles "tendinitis," it is acually tendinosis. Tendinosis is usually a focal degeneration of the fibers and/or cells of the tendon that decreases the tendon's ability to withstand normal forces. This may in turn cause inflammation, but studies show that a chronic achilles tendinopathy usually shows little or no inflammation at all.

I have treated a lot of patients with this problem including myself. The treatment is usually fairly simple with one disclaimer (later). Since I have not had the opportunity to evaluate your injury I will give you my most basic recipe for treatment;

Stair-step heel raises (working the calf); Stand on a stair-step on the balls of your feet, slowly lower heel below step, then raise heel as high as you can.
- Work in entire range of motion of the ankle.
- Use a slow and controlled motion, pausing for 2 seconds at the top and bottom of the motion.
- Start by using both feet at the same time.
- Start by doing repetitions until you feel a good amount of muscle fatigue. If you can do 20 repetitions, add a second set.
- Start with only one session per day max, ever.
- When you can do 2 sets of 20 reps using both feet, start doing the first set on one leg only, then the second set with both feet.
- You may experience increased calf/tendon soreness for the first week or so, it will get better.
- Finish with easy 30 second calf stretches for the gastroc and soleus.
- It is best to put other stressful activities on hold for the first 2-3 weeks at least, this means running. Cycling may be ok, but keep the gears high resistance low, and cadence slow (75-90 rpm), ensure that cycling does not impair your recovery from the heel raises.
- When you can do 20 reps on one leg without undue soreness or fatigue, then start doing short, easy runs. Gradually start to increase your running workloads.
- As you resume your running and cycling workloads, decrease the frequency of the calf work to 2-3 times per week, but keep them up.

The disclaimer:
You may have biomechanical or other musculoskeletal issues that are overstressing your achilles, these may need to be addressed before you acheive full recovery.
A skill deficit may also propagate this injury. If you have even a small flaw in your running pattern or pedalling stroke, for example, then you may be overstressing the tendon there also.

As someone else mentioned, tendinosis may be a precursor to rupture, so be dilligent with your treamtent. It is probably not wise to run through the pain.

Good luck!

Elsewhere I read use cold on tendinitis, hot on tendinosis.

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