Here is an old post form the TPS newsletter on ART. It's good!
Ask Dr. Brady
We premiered the ‘Ask Dr. Brady' column in February and many of you have commented on your own battles with scar tissue and the relief ART (Active Release Therapy) has brought you.
This month, Dr. Bill Brady and his colleague, Dr. T. Grace Steinley, of the Soft Tissue & Diagnostic Treatment Center here in Boston , ( http://www.softtissuetreatment.com/ . ) have been kind enough to help us out with some information on tendonitis.
If you'd like to consult with Dr. Brady, he does come here to TPS on Wednesday afternoons in addition to his normal office hours at his Downtown Boston location. For an appointment at either location, please call his office at 617-367-3110.
Q: My shoulder's been hurting for months. I've been diagnosed with tendinitis, but the pain isn't going away. What's the deal?
A: To lead you in the proper treatment direction, we need to determine if tendinitis is what's actually going on. If the problem is has been present for several months, the chances you are suffering from tendinitis is low. Tendin osis is likely the culprit for your aching shoulder. Semantics aside, this distinction is important for finding effective treatment.
Tendons, structures that connect muscle to bone, become inflamed and painful when injured. The body responds to injury with inflammation. Various cells are sent to an area to destroy injured tissue and set the stage for healing. Standard treatments include rest, ice, and anti-inflammatory medication to combat excess inflammation. The catch – inflammation is rarely present in cases of chronic tendon pain. In fact, tendinitis is a relatively rare condition.
Tendinosis, on the other hand, is common. In 1979, surgeons Robert P. Nirschl and Frank A. Pettrone removed sections of injured elbow tendons from patients and examined them under a microscope. Remarkably, they found no inflammation. Instead, they found that the tendons were degenerated, swollen, grayish rather than white, and soft. Tendinosis is the correct name for this condition, which has for years been mislabeled as tendinitis.
What causes these tendons to degenerate, you might ask? Repeated or sustained muscular contraction associated with activities such as lifting weights, playing tennis, and keyboarding causes a decrease in blood flow to the working muscles and tendons. This lack of blood flow then causes an accumulation of waste products. These waste products are very similar to those produced when a muscle is torn. The waste products in turn attract the cells that produce scar tissue. This is helpful if indeed you have torn a muscle, but in the case of overuse injuries, the body is signaled to repair muscles that are not really damaged. The body is thus fooled into thinking there has been an injury and tries to repair it. The result is an accumulation of scar tissue in otherwise healthy muscles and tendons. The scar tissue increases stress on the tendons and they begin to degenerate.
Visualize pouring glue on a healthy tendon; this is the effect that scar tissue creates. It prevents normal stretching and limits muscle contraction. This can cause a decreased range of motion, pain with use, decreased strength, and early fatigue. In fact, pain is often the last symptom to show up. Overuse injuries usually start with one muscle or tendon developing scar tissue. The involved muscle is then weakened, requiring neighboring muscles to become overworked. With continued use and the passage of time, the neighboring muscles begin to develop scar tissue. This cycle of increasing stress, buildup of scar tissue, and degeneration continues until the body can no longer compensate. At this point, the system has broken down and chronic pain sets in.
Creating scar tissue is the only mechanism that muscles have for healing. The development of scar tissue, therefore, is the body's fairly universal response to stress and injury. If you are experiencing pain from overuse, there is a high probability that scar tissue and degeneration are occurring. Scar tissue does not go away by itself. If you take time off and feel better but find that pain returns to the affected area once you resume activity, it is likely that scar tissue is present. In contrast, an inflammatory problem resolves with rest and does not return.
With the understanding that overuse injuries are most often degenerative-scar-tissue problems rather than inflammatory problems, treatment strategies must change accordingly. Over- prescribed rest, ice, anti-inflammatory medication, and electrical stimulation are no longer the treatments of choice. Active Release Techniques (ART) is the best treatment for the reduction of scar tissue and reversing degeneration. The procedure is as revolutionary as the realization that overuse injuries are not the result of inflammation. As an article in the June 1999 issue of the Journal of Occupational Rehabilitation reported: "Results [with ART] demonstrated a 71 percent success rate, which, when compared to similar studies in the literature, was superior." Doctors trained in ART are able to locate scar tissue by touch. The characteristics they look for include increased tension, abnormal texture, and restricted movement. The treatment involves soft-tissue manipulation done exclusively with a doctor's hands.
Although tendinitis and tendinosis sound similar, they are two very different problems with two very different treatment strategies. The first step to finding effective treatment is finding an accurate diagnosis.
Dr. Bill Brady