Information on tendinitis that won't go away

[Suezee]

I am a practicing physical therapist with over 20 years of experience in the sports medicine setting. Throughout my career, I have seen alot of treatments come and go for tendon pain and I think the medical field is finally figuring out how to manage these problems.

We used to think that the pain was caused by inflammation of the tendons, and that treatments to decrease inflammation through rest, bracing, medication or cortisone shots would help. (Which it did sometimes, but not always consistently and permanently). As medical imaging has improved, we can now see that most of the time, the problem is not due to inflammation, but to a dysfunctional-healing process that happens within the tendon. As a result of repetitive strain, the body tries to heal itself, but it does so in an inferior manner. Healthy tendon tissue can be replaced by scar tissue, which is disorganized. Disorganized tissue is weaker and is more prone to future problems. Even the blood vessels are different in these tendons, not delivering healing products to the deep portions of the tendon.

Basically, to get better, we need to manage the dysfunctional scar tissue, get blood products to the interior portions of the tendon, then remodel the tendon into something strong and functional.

There are several treatments being performed and reseached that use the preceding facts as their base. One of these techniques is performed by certified physical therapists and is called ASTYM. Practitioners use special instruments to identify and treat the dysfunctional tissue described above. ASTYM stimulates the body's healing response, which results in resorption/remodeling of this scar tissue, and stimulates regeneration in these dysfunctional tendons. This is not some wacky treatment, but a technique that was developed and researched by physicians and physical therapists. They have published research on rat tendons that show what they claim actually occurs. They also have documented 90% success rates for tendon problems throughout the whole body.

I have treated my own patients with ASTYM for over 4 years, and have been getting great results. I see alot of young people with Jumper's knee and they have responded beautifully. If you or your skaters are having perisitent tendon pain, you might want to check out their website and see if there is a provider near you.

[rsk8d]

Hi Suezee!

Great suggestion- I use Graston tools (the original steel version of ASTYM) with my patients and have noticed a huge change in rehabilitation progress in comparison to deep tissue work. The tools are great!! The problem is, a set of Graston tools runs between $2500-3000 and not many practices will spend that much money. Luckily, the partners at our practice are ultra focused on patient well being! Just curious, how much do the plastic tools run for a set?

If anyone can find a clinic which uses these tools near them, they are VERY lucky! Google 'Graston tools' for more info.

[phoenix]

OMG, so that's what that instrument of torture is that my chiropractor uses!!

Yes, it seriously works; he was able to relieve hip pain from a terrible crash on the ice that left me w/ scar tissue in all those muscles. After 8 months I'd pretty much resigned myself to the idea that I'd be living in pain the rest of my life.

The therapy HURTS (maybe it was worse for me because it was an older injury by that point and the hip muscles go so deep), but I was so glad to do it because of the results!! It took almost a year of regular visits but I've been pretty good now w/o seeing him for more than a year. It does flare up occasionally but I can manage it myself w/ a tool he recommended for me (kind of shaped like a big sherpherd's crook that lets me push the end of it around & into all those muscles to work them out again).

[fsk8r]

Does this technique work for scar tissue in other parts of the body and not just tendons, ie muscles, etc?

[Suezee]

I just wanted to mention that ASTYM is a different approach from the tool-assisted friction massage of Graston or Sastm techniques. To my understanding, the tool-assisted techniques are designed to mechanically break down dysfunctional tissue, and both healthy and un-healthy tissue can be affected. In addition, I believe that their goal is to create a localized trauma, which is then purported to re-start the healing process.

In stark contrast, the goals of ASTYM treatment are to activate the body's healing mechanisms and stimulate the regeneration of tissue, and there is evidence to confirm ASTYM's effectiveness in the medical literature. ASTYM accomplishes regeneration by delivering measured doses of pressure and sheer forces in patterns particular for each diagnosis. In addition, because ASTYM is performed in rehabilitation settings, therapists can address compensatory and contributory issues throughtout the entire kinetic chain. (Biomechanical issues, tightness/weakness patterns, etc.) Remember, the third step to complete recovery in these problems is appropriately re-modeling the newly healed structures into something strong and functional.

In the early phases, it could be said that the techniques might have been similar. However, some of the early studies on rabbit tendons showed that too much pressure caused some damage, specifically, calcium deposits in the tendons. For that reason, the developers of ASTYM moved away from the early methods and refined the technique into what is being performed today. There is another difference that, as a physical therapist , I appreciate. The developers of ASTYM are physicians, researchers, and physical therapists, and they are still actively involved in the technique. That means that experts are continuing to refine the treatment as research and outcome measures emerge. In addition, if I have a question: for example, if a patient does not respond as expected or perhaps has a medical condition and I wonder if the treatment is appropriate, there's someone I can immediately contact and get answers. As a therapist, I want to know that my treatments are safe for my patients and are up to date, and this group has helped me with that.

I can understand that if you watched a video on You-Tube, that the methods might look similar. In my practice, I have treated several patients who previously underwent Graston technique, and they all have stated that the methods, their response, and the subsequent results were different.

[Suezee]

Does this technique work for scar tissue in other parts of the body and not just tendons, ie muscles, etc?

Yes. I have performed ASTYM on a variety of scars, which have included: a thick Achilles' tendon repair, post-surgical scars over a joint which interfere with range of motion, and post-op scar tissue in the foot which appeared to be irritating a nerve. It has been theorized that the process stimulates resorption of scar tissue. In fact, I am looking at that right now, as we used ultrasound to image that Achilles' scar before and after treatment with ASTYM and are currently in the data analysis phase.