Survival of the Fittest

[From left to right: what a tendon is supposed to look like; one with tendinitis; one with tendinosis. Credit: Vicky Earle]

Did you know that most athletes who believe they’re plagued by tendinitis (also spelled tendonitis) actually have tendinosis (also spelled tendonosis)? Stupid athletes.

Just kidding — in many instances, a doctor or physical therapist misdiagnosed the problem, and that misdiagnosis can mean wasted treatment time, prolonged pain and lost sports seasons. Stupid doctors. (Kidding again!)

But there are some pretty important distinctions. Tendinitis involves inflammation of the tendon, doesn’t last longer than a couple weeks and heals just as fast, while tendinosis involves degeneration and can go on and on (and on), until you’re able to stimulate collagen regeneration in the injured area.

As far as treatment options go, while tendinitis responds well to ice, rest and anti-inflammatories to treat the inflammation, tendinosis does better with therapeutic exercises — mainly of the eccentric, or negative, variety.

Had I known that five years ago, I might have had a less irritating relationship with my knees. Some of the same strengthening therapies would have held true, but I wasted an awful lot of time treating inflammation that wasn’t there.

The differences between the conditions, as well as some of the best treatment options, are covered in more depth in the May Experience Life article “Tendon Trouble,” which, if you’ve ever struggled with a case of tennis elbow or runner’s knee that you can’t shake, is worth a read.

I also really like this article at Runnersweb.com. Some highlights:

• At least 25 percent of athletes treated for knee problems at major sports clinics are typically diagnosed with tendonitis, but there is strong evidence that the majority of athletes diagnosed with tendonitis are not really suffering from the disorder.
• The “tendonitis plague” may actually be a severe outbreak of tendonosis, not tendonitis.
• A reasonable course of therapy for tendonitis, an inflammatory condition, would involve the use of anti-inflammatory drugs; in fact, non-steroidal anti-inflammatory medications have become the mainstay of treatment for so-called “overuse” injuries to tendons. The trouble is that there is evidence that anti-inflammatory drugs can actually have a negative impact on the progress of tendonosis, in effect retarding the healing process.
• It is clear that a tendon [suffering from tendinosis] needs to be mechanically stimulated in order to begin the process of activating its fibroblasts and synthesizing significant quantities of new collagen fibers; complete rest would prevent this from happening.
• One tried-and-true treatment for tendinosis involves the deliberate, eccentric loading of a painful tendon and its muscle, a process which seems to accelerate strengthening of both the tendon and its associated sinew.

In other words, rather than endlessly icing, resting and popping anti-inflammatories, those of us with suspiciously long-lasting “tendinitis” might be better served by adjusting our routines and doing eccentric exercises to stimulate healing.

In February 2003, having just returned from an intense (but incredible) 18-day tour of Fiji and New Zealand with the U.S. women’s 7s rugby team, I started to develop sharp, stabbing pain just below my left kneecap when I ran.

We were leaving for the Hong Kong 7s tournament less than a month later, so I got into physical therapy right away. I was first diagnosed with tendinitis, and later tendinosis and chondromalacia. (Look for an article on the difference between tendinitis and tendinosis in the May 2008 issue of Experience Life.)

As recommended, I worked on strengthening my vastus medialis obliquus (VMO) muscles, and though the pain diminished somewhat, it by no means went away.

It wasn’t until two years later, when my right knee developed the same condition and I resorted to getting regular hyaluronic acid injections to lubricate my knee joints, that the other cause of my predicament was properly diagnosed.

That cause turned out to be weak and inactive gluteus muscles. I’m probably oversimplifying matters, but essentially, having weak glutes meant I didn’t have full control over my femurs, leaving my knees to dive in toward one another when pushing off or landing.

Due in part to our skeletal structure, women are more prone to this condition, called valgus knees, than men. (Lucky us!) But all is not lost — there’s plenty you can do to fight nature on this point, as Krista Scott-Dixon explains in EL’s September 2006 article “Weak in the Knees.”

Bottom line is, strong glutes are a must when it comes to femoral control, and I have to say doing exercises that activated my glutes made a world of difference in my recovery. I won’t regain the cartilage I lost to chondromalacia (R.I.P., old friend), but I’m pretty sure I stopped digging out brand-new grooves.

YouTube link tolink to http://www.youtube.com/watch?v=T5kUsOQWKjo

The video above, graciously provided by my friend Aaron Manheimer of Body By Manheimer, shows a couple of rugby dudes demonstrating how to do my all-time favorite glute exercise, the lateral band walk.

Done properly, it activates your gluteus medius quite nicely. (If you prefer a written description of how to do this exercise, check out “Band Practice,” available in the October 2007 EL archives.)

Aaron also suggested something called a “retro cowboy” to activate lazy bums, and although that phrase conjures up all sorts of stylish images, he really just means you should walk backwards with a resistance band tied around your lower legs. Cowboy hat optional.

If you’re interested in learning more, check out “Go-To Glutes” in the current issue of Experience Life.