Tendonitis is a very common term used to describe injuries affecting various tendons in the body. Specific examples include achilles tendonitis, bicipital tendonitis, extensor tendonitis (tennis elbow or lateral epicondylitis) and flexor tendonitis (golfer’s elbow or medial epicondylitis). There is now ample peer reviewed published research which tells us that it is an inaccurate term for most of these injuries, yet unfortunately, it continues to be used incorrectly by many healthcare and fitness professionals.

Common area for Tendinosis...the elbow!

Tendonitis or Tendinitis

Many tendon injuries that have been inaccurately called “tendonitis” are treated with ice, anti-inflammatories or various physiotherapy / rehabilitation modalities. The thought process in this approach is to reduce inflammation in the tendon (which is the “itis” portion of the term “tendonitis”). New research examining the tissue composition of chronically injured tendons has consistently found a lack of inflammatory markers. Instead, analysis reveals marked degeneration of the tendon and a change in fibre composition. In simple terms, these tendons aren’t inflamed but rather degenerated and frayed. A treatment approach primarily geared toward reducing inflammation can be then expected to have little to no effect!

Tendinopathy or Tendinosis

The reality is a true tendonitis (where inflammation of the tendon is the primary dysfunction) is a rare occurrence. “Tendinopathy” or “tendinosis” are now considered appropriate terms to describe the more common tendon dysfunction (described as degeneration above). Although this change in terminology might make you sound clever at your next cocktail party, it’s not just about semantics; it’s about choosing a treatment approach and management strategy that is most likely to deliver results.

RSI – Repetitive Strain Injury

Some authors suggest that tendinopathy is caused by repetitive use of a tendon leading to tiny tears (microtears) in the tissue. These tears cause a healing response whereby the body uses a poorer type of tissue (collagen) to re-build the tendon. This sub-optimal tissue type further weakens the overall tendon, leaving it more susceptible to further tearing and thereby creating a vicious cycle of injury. Logic would then dictate that breaking the injury cycle is necessary before proper healing can occur. Unfortunately, this may require discontinuing or altering an activity related to your job, your exercise routine, or a sport that you love to do.

Treatment for Tendons

Once the tendon is allowed to heal and prevented from further tearing, the goal is to realign and rearrange some of the disorganized, degenerated tissue. Our clinic has found great success using active release technique and graston technique for this purpose. Sometimes, we will use our bioflex laser to assist in healing and strengthening of the tendon. Of course, rehabilitative exercises (with a focus on eccentric contraction of the involved tissue) are usually part of the management plan.

Tips From Your Burlington Chiropractor…

So the next time you think you have a “tendonitis”, keep a few things in mind;

● Inflammation is unlikely to be the underlying problem. The more likely scenario is that tendon fibres are disorganized and disrupted.

● A true inflammatory condition affecting the tendon (which is rare) usually resolves fairly quickly (within a few weeks). A tendinosis or tendinopathy involves damage to tissue; tendon cells can take months to heal!

● “Working through the pain” will rarely help the injury but rather prolong the injury cycle (more microtearing of weakened tendon) and turn a small problem into a larger one.

Tennis elbow, golfer’s elbow, achilles tendonitis, lateral epicondylitis, medial epicondylitis,  patellar tendonitis, plantar fasciitis, bicep tendonitis, bicipital tendonitis and elbow tendonitis are all commonly diagnosed conditions that can be treated and termed incorrectly.  Call our clinic to have your condition diagnosed and treated appropriately!

References

Alfredson, H., Pietila, T., Jonsson, P., Lorentzon, R. Heavy load eccentric calf muscle training for the treatment of chronic achilles tendinosis. American Journal of Sports Medicine 1998; 26: 360-366.

Cook JL, Khan KM, Maffulli N, Purdam C. Overuse tendinosis not tendonitis: part 2: applying the new approach to patellar tendinopathy. The Physician and SportsMedicine 2000; 28(6).

Khan KM, Cook JL, Kannus P, Maffulli N, Bonar SF. Time to abandon the “tendonitis” myth. British Medical Journal 2002; 324: 626-627.

Khan KM, Cook JL, Taunton, J, Bonar F. Overuse tendinosis, not tendonitis: part 1: a new paradigm for a difficult clinical problem. The Physician and Sports Medicine 2000; 28 (5).

Kraushaar, B., Nirschl RP. Current concepts review – tendinosis of the elbow (tennis elbow) clinical features and findings of histological, immunohistochemical, and electron microscopy studies. The Journal of Bone and Joint Surgery 1999; 81: 259-278.

Maffulli, N., Ewen, S., Waterston SW., Reaper J., Barrass, V. Tenocytes from ruptured and tendinopathic achilles tendons produce greater quantities of type III collagen than tenocytes from normal achilles tendons: an in vitro model of human tendon healing. American Journal of Sports Medicine 2000; 28: 499-505.

Shalabi, A., Kristofferson-Wilberg, M, Svensson, L., Aspelin P., Movin T. Eccentric training of the gastrocnemius-soleus complex in chronic achilles tendinopathy results in decreased tendon volume and intratendinous signal as evaluated by MRI. American Journal of Sports Medicine 2004; 32: 1286-1296.

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With the new year upon us it’s time for some healthy resolutions. Since many of you will be ramping up your exercise programs, this blog is going to address some of the common training errors that bring injuries to our clinic.

Proper Squat Technique

Proper Squat Technique

Squats are a great exercise, but need to be practiced before weight is added. If done incorrectly they can easily cause knee injury or lower back injury. As a general rule, keep your knees from passing over your toes, keep your spine fairly rigid and exercise in a controlled, pain-free range of motion. If you’re unsure of your technique it may be wise to consult with a personal trainer who can give you the appropriate guidance.

Deadlifts and Back Pain

Deadlifts can be a great exercise for power and strength athletes. Since I’ve examined several patients who attribute their chronic back pain to this exercise, I sometimes wonder how necessary it is for the average person given the multitude of alternatives. From my experience, it seems that many people use too much weight or do not have the motor control to consistently perform this exercise safely.

Crunches for Back Pain

As mentioned in previous blogs, it is advised that you perform your sit-ups with a neutral spine. This means that you shouldn’t round out or flatten your back during abdominal exercises. Hold a weight on your chest and rotate at the top of the exercise and you could be playing with fire!

Neck Pain and Weight Lifting

This may be fairly obvious but worth mentioning; bringing a bar behind your neck can be linked to sprain/strain injuries in the neck. In most situations it’s a better option to keep the resistance at a comfortable position in front of you. For example, the shoulder press and lat-pulldown; moving the bar behind your neck is not a good idea.

Knee Extensions and Knee Pain

You’ll probably see that knee extension machines have been removed from many gyms due to its potentially harmful affect on the patellofemoral joint of the knee. An exercise such as a squat or a lunge is usually a better way to go.

Stretching Exercises

On a regular basis I hear that “tight” muscles are bad and “loose” muscles are healthy. I also hear that a person’s “tightness” caused their injury or painful condition and they need to stretch it out to make it healthy again. In general, for most conditions, this view is not really supported by peer reviewed published research. Surprising to some, stretching can actually cause certain injuries! To avoid this, consult with a suitable healthcare provider for your injuries instead of taking matters into your own hands!

Back Pain and Weight-Lifting

When doing an exercise like the seated leg press, avoid holding your breath, rounding out your lower back and pushing your back against the back rest. This is a quick way to injure your lower back. As mentioned earlier, you are probably better off with a closed-kinetic exercise like a squat, lunge or step-up.

Painful Exercise

Many patients continue to exercise despite persistent pain in a certain area. In some situations this is acceptable, but for most, it only prolongs the injury or turns a small problem into a large one. Choose exercises that don’t aggravate your injury. Unsure? Pick the brain of a knowledgeable personal trainer who can suggest ways to work around your injury.

Physiotherapy Exercises

Our Physiotherapy and Chiropractic Clinic in Burlington is affiliated with lots of great personal trainers. If you’re unsure of your exercise program or your technique, consider consulting with a good trainer who can ensure that you’re on the right path. If you have an injury, are in pain or are at risk of injury, our physiotherapist can help give you guidance. Burlington Sports Therapy – 905.220.7858 info@burlingtonsportstherapy.com

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In a previous blog we learned about the abdominal brace and the abdominal hollow as ways to stabilize (and not stabilize) our spines during different activities. This blog will take it one step further and teach you some lower back pain exercises that are supported by good spinal research. Before we do this, let’s address what proper spinal posture is. Take a look at the images below and decide which posture appears healthier for the lower back.   

Posture For The Spine

If you guessed the posture on the left, you are correct. Although optimal posture in the lower back may slightly differ between individuals, the person on the left is displaying a normal amount of curvature or “lordosis” in the lower back. When you “flatten” out your back (as pictured on the right) you are flexing the spine and moving away from a natural anatomical position. Specifically, the flexed position on the right can be injurious for the lumbar intervertebral discs.

Back Pain Prevention

In order to protect the spine during different activities we recommend the combination of a neutral spine posture as pictured on the left with a muscular “brace” (as discussed in a previous Burlington Chiropractor blog). This strategy should be helpful during most activities; at the workplace, while doing chores at home and also while driving your car. Quite often we have patients come to our clinic here in Burlington with lower back pain related to disc dysfunction (also referred to as disc herniation, sciatica or slipped disc) that was perhaps exacerbated by their choice of exercises. So what are the best exercises for strengthening the spine? The following suggestions for strengthening the lower back have good scientific evidence supporting them…

Crunches for Back Pain

If you’re doing your sit-ups with both feet flat on the ground, your spinal position probably looks like the picture on the right. Unfortunately, this is common. Repeatedly flexing the lower back as you would with this type of sit-up can contribute to injury of the lumbar intervertebral disc. There is a misconception that exercising on an inflatable ball ensures that the spine is in a healthy position; not true. It is easy to adopt a flexed spine (as pictured on the right) while doing abdominal exercises on an unstable surface.

Best Back Pain Exercises

At our Burlington Chiropractic and Physiotherapy clinic we usually recommend to begin exercises on a stable surface, combining a neutral spine posture with a muscular brace. Once this approach is mastered an unstable surface can be introduced, provided the patient can continue to maintain the same form throughout their exercises.

Abdominal Strengthening for Back Pain

There are many factors involved in deciphering what exercise posture is correct for you. As a general rule however, we recommend maintaining a neutral spine as described above (on the left). To replace your traditional sit-up exercise, we recommend the modified curl-up. To perform the curl-up, start with your hands under your lower back to maintain a neutral spine while keeping one leg straight and one leg bent. While performing an abdominal brace, slightly lift the scapulae (shoulder blades) off the floor in a slow, gentle, pain-free manner.

Treatment for Back Pain

Exercises for back pain should not be painful. If you’re experiencing back pain or back discomfort it would be advised that you seek the assistance of a professional. Our Physiotherapists and our Chiropractors place a large emphasis on proper exercise prescription for those patients with and without back pain. We encourage you to learn more about our clinic by checking out the various pages of our website. To schedule an appointment call 905.220.7858 or email us at info@burlingtonsportstherapy.com

REFERENCES

McGill S. Low Back Disorders. 2002 Human Kinetics.

McGill S. Ultimate Back Fitness and Performance 2nd Ed. 2006 Stuart McGill.

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Many patients come to our clinic with preconceived ideas of what a chiropractor is or what a chiropractor does. Surprising to some, every chiropractor has his or her own style, his or her own philosophies and his or her own business practices. Our clinic (Burlington Sports Therapy) is a Burlington chiropractic clinic that aims to adapt each treatment to the individuality of each patient; not just what their condition needs but also what suits their comfort level.  Our treatment style has been referred by some as “soft tissue chiropractic” or “chiropractic physical therapy”. At every visit we discuss your condition and your response to treatment with modifications being made to your care if necessary. A typical visit to our Burlington Chiropractic Clinic lasts approximately 15 minutes and usually incorporates some form of treatment to the muscles and soft tissues, most often using active release technique. Below is some information that answers some of the more common questions that new patients have for us. We also encourage you to view some other chiropractic websites to see what other chiropractors in Burlington offer so that you choose the best chiropractic clinic for your specific needs.

Burlington Chiropractors

ART Chiropractic – What is it?

ART chiropractic refers to a soft tissue treatment approach that is common among sports chiropractors. Also popular within sports medicine, the majority of professional sports organizations in North America have active release practitioners on staff. It is a hands-on soft tissue release technique designed to break down scar tissue in dysfunctional muscles, ligaments and tendons. The reason our treatment visits are usually around fifteen minutes is because most of our patients receive active release treatment which requires more than a few minutes.

Is Chiropractic Gentle?

At our Burlington Chiropractic Clinic we commonly use chiropractic adjustments as a part of treatment. Numerous studies have been published supporting the safety and efficacy of chiropractic adjustment as a treatment method for many different conditions affecting the musculoskeletal system. Chiropractic adjustments are utilized at our Burlington Chiropractic Clinic when a patient’s condition indicates it, when it can be considered a safe option for that patient and when that patient is comfortable with it as a treatment option. Not every patient at our Burlington chiropractic clinic receives chiropractic adjustments. We offer various methods for treating injuries, depending on the needs and comfort level of each patient.

Chiropractic Physical Therapy

Chiropractic is a great option for all your aches, pains, sprains and strains. Although chiropractic adjustments and treatment of the spine are fundamental to chiropractic, chiropractors can be considered experts in the diagnosis and treatment of many different injuries affecting the musculoskeletal system. Coming to our Burlington Chiropractic Clinic does not necessarily mean that your treatment will include spinal adjustments or treatment of the spine; we will diagnose your condition for you and suggest a number of different treatment options that are suitable for your condition and that suit your level of comfort. Some patients come to our clinic and may be better served by our physiotherapists. We have them on staff so that every patients individual needs are met.

The Value is Our Brains!

Many patients that come to our Burlington Chiropractic Clinic have been referred to us for our diagnostic opinion. Most patients come to see us to find out if our method of combining traditional chiropractic with modern soft tissue treatments (in the same visit) will help them feel better. Active Release Technique and Graston Technique give us more options for treating injuries and are often the reason that we have patients referred to us from various healthcare providers…including other Chiropractors in Burlington!

Do I need to be an athlete?

No. We are a Burlington Family Chiropractic clinic. We are Burlington Chiropractors who cater to patients of all abilities and we treat various physical injuries, not just those related to sports.

How Can I Book an Appointment?

We can usually accommodate a new patient appointment within a few days of contacting the clinic.  We can be reached at info@burlingtonsportstherapy.com or 905.220.7858.

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Pain in the bottom of the foot is very common, affecting both active and sedentary people.  Some of the conditions associated with this type of pain include tarsal tunnel syndrome and various nerve entrapments, stress fracture and fat-pad syndrome.  The most common condition affecting the bottom of the foot is plantar fasciitis (fash-ee-itis). Some authors estimate that plantar fasciitis affects 10% of adults and comprises 15% of all foot complaints that require professional care.

Plantar Fasciitis – What is it?

The plantar fascia is a strong, thick tissue on the bottom of your foot.  It runs from your heel to your toes, and is stretched when you pull your toes up toward your shin.  As previously mentioned, plantar fasciitis causes pain in the bottom of the foot.  It usually begins with no obvious cause and is often worse in the morning or after a period of non-weight bearing.  Similar to chronic tendon disorders, recent literature suggests that it is less likely to be a pure inflammatory condition but rather attributed to the degeneration of plantar tissues.  Due to this, the term plantar fasciosis has become common. 

Plantar Fasciitis – How Long Does it Last?

Plantar fasciitis is actually considered a self-limiting condition.  This means, eventually, it will heal on its own.  That being said, recovery without treatment can take a considerable amount of time…years!  Perhaps this can be expected as the injured person is putting their body weight through the damaged tissue with every step that they take!  This is why treatment for plantar fasciitis is very common and almost always a necessity!

Plantar Fasciitis – Risk Factors

Several authors have suggested that reduced dorsiflexion (bringing your toes toward your shin) is a risk factor for the development of plantar fasciitis.  Other documented risk factors include elevated body mass index, type and intensity of activity (workplace demands), micro-trauma, advanced age, abnormal foot mechanics and poor footwear. In most instances the cause of plantar fasciitis is multifactorial.

Plantar Fasciitis Treatment

There are many different options for treating plantar fasciitis.  Ultrasound, night splints and shockwave therapy are common treatments for this condition, all with varying results.  At our Chiropractic and Physiotherapy clinic in Burlington we have found great success in treating plantar fasciitis using one or more of the following;

Active Release Technique for Plantar Fasciitis – Plantar fascia release is a very popular method for treating this condition.  It involves a hands-on procedure in which the practitioner holds various muscles in the foot and lengthens the tissue at the same time.  Plantar fascia release is very effective for resolving plantar fasciitis, especially in chronic cases. 

Graston Technique for Plantar Fasciitis – The Graston Technique is a newer approach to treating Plantar Fasciitis.  It involves the use of stainless steel instruments that glide over the sole of the foot to assist in removing scar tissue.

Laser Treatment for Plantar Fasciitis – Laser treatment for plantar fasciitis has become very popular due to its reputation for being effective.  Laser treatment for plantar fasciitis is painless and usually requires approximately 8-10 visits over the span of 4 to 5 weeks.  At our clinic, laser treatment for plantar fasciitis can be provided through our chiropractors or our physiotherapists.

Taping Plantar Fasciitis – Taping plantar fasciitis can sometimes be helpful.  This depends on the presenting foot-type of the patient and whether they’ve tried this approach in the past.

Orthotics for Plantar Fasciitis – Our clinic has also found great success with the use of custom foot orthotics.  Although much of the literature reviewing the treatment options for plantar fasciitis is conflicting, there is good evidence to validate the use of foot orthotics.  From our experience, the success of orthotic intervention depends on the presenting foot-type of the patient…not all patients require prescription orthotics.

Acupuncture for Plantar Fasciitis – Acupuncture for plantar fasciitis is also an effective approach for treatment.  It involves the application of acupuncture needles to the various points in the lower limb related to plantar fasciitis.  Treatment lasts approximately 20 to 30 minutes and can be billed under most employee benefit plans as acupuncture or physiotherapy.

As with most of our blogs we try to offer some practical tips that you can immediately implement at home. Some patients with plantar fasciitis benefit from rolling a tennis ball or frozen water-bottle under the affected foot.  Wearing good supportive footwear around the house can also be helpful.  Given the evidence for limited dorsiflexion as a risk factor for plantar fasciitis, gentle stretching (as pictured below) or rolling of the calf muscles may assist in prevention.  If you’ve had plantar fasciitis (or plantar fasciosis) for over a month it is more than likely that these “home remedies” will be unsuccessful.  Want to discuss the best option for you? Feel free to call or email our clinic and speak to one of our professionals!  905.220.7858  info@burlingtonsportstherapy.com

References
League AC. Current concepts review: planar fasciitis. Foot and Ankle International 2008; 29 (3): 358-366.
Delitto S, Dewitt J, Ferland A, Fearon H, MacDermaid J, McClure P, Shekelle P, Smith AR, Torburn L. Plantar fasciitis – APTA clinical guidelines. Journal of Orthopaedic & Sports Physical Therapy 2008; 38(4): A1-A18.
Roos E, Engstrom M, Soderberg B. Foot orthotics & night splints for plantar fasciitis. Foot and Ankle International 2006; 27: 606-611.

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