resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
July, 2001, Vol. 01, Issue 07
When Is It Tendinitis?
By Whitney Lowe, LMT
Tendinitis is one of the most common diagnoses for soft tissue pain resulting from repetitive motion. As repetitive motion disorders have dramatically increased, so has the incidence of tendinitis.However, recent investigations into the cellular nature of tendon pathologies have brought forth interesting discoveries that may alter the way tendinitis is treated. In this month's column, let's take a look at some of these fascinating discoveries.
The first stop along the way is to take a closer look at the anatomical and biomechanical characteristics of tendons. Tendons are connective tissue structures that are primarily composed of collagen and elastin fibers. Collagen fibers primarily give the tendon its strength, and elastin fibers give it a small amount of flexibility.
Since the tendon fibers are primarily designed to transmit a strong tensile (pulling) load from the muscle directly to the bone, the tendon is not designed to be very flexible. If it were very flexible, much of the muscle's contraction force would be absorbed by the tendon and not transmitted to the bone. It would be like trying to pull a heavy object across the floor with a bungee cord instead of a rope.
The tendon gets its strength not only from the quantity of collagen fibers it contains, but also from the arrangement of the fibers. In tendons, the collagen fibers are arranged mostly in a parallel direction, in line with the direction of the muscle fibers. This arrangement will give the tendon the greatest amount of strength in the direction that the muscle fibers are pulling. Ligaments, on the other hand, have a greater quantity of elastin. In ligaments, the collagen fibers are arranged in a slightly more random fashion to give the ligament strength against forces in several different directions.
Tendons throughout the body are surrounded by a thin connective tissue membrane called the paratenon. The paratenon is primarily designed to reduce friction forces between the tendon and other surrounding structures.7
Tendons in areas such as the distal extremities are exposed to much higher friction forces, as the tendons bend around the joints and are held closely by retinacula. These tendons are surrounded by an additional connective tissue layer called the epitenon. The epitenon is commonly referred to as the tendon sheath. Keep in mind that not all tendons have the tendon sheath, only those exposed to specifically high friction forces against adjacent structures, like a binding retinaculum. In some instances, an inflammatory condition will develop between the tendon and its sheath. This usually occurs from excessive friction. Adhesions may also develop between the tendon and the sheath. This condition is called tenosynovitis. However, in order for tenosynovitis to be present, the tendon in question must have an epitenon (sheath).
In some instances a diagnosis of tenosynovitis may be made because of an observed fibrous adhesion between the tendon and the paratenon but there is no tendon sheath. This happens commonly with the Achilles tendon.3 It does not have a synovial sheath (epitenon) but its paratenon is quite visible. Degeneration or adhesion of the paratenon or tendon fibers in this instance is not tenosynovitis. For many years, the term tendinitis has been used to describe painful overuse conditions of the tendon. It has been thought that the pathology involved the tearing of individual tendon fibers and a subsequent inflammatory response in the tendon. Treatment, therefore, has focused on the inflammatory nature of the problem. However, a number of recent scientific investigations into the nature of overuse tendon injuries have painted a very different picture.1,2,5,6
In these investigations, most tendinitis complaints have been found to be devoid of inflammatory cells. It appears that tendon fiber tearing is not the primary part of the problem. The main problem in these overuse tendon disorders appears to be collagen degeneration from overuse. It has also been suggested that this would explain the frequent lack of success in treating tendinitis complaints with anti-inflammatory medication. Numerous authors and clinicians have suggested that the term "tendinosis" (literally meaning "pathology of the tendon") is a much more appropriate term than "tendonitis," which specifically indicates inflammation.
So what does this mean for the treatment of tendinitis with massage? The good news is that these findings are an even stronger support for the benefits of massage for treating these overuse tendon injuries. Collagen degeneration is a primary part of most tendinosis pathology. Therefore, what is needed is a treatment that can help stimulate collagen production in the healing process.
Interestingly, several recent studies have found that the primary benefits of deep friction massage may be the stimulation of collagen production in damaged tendon fibers, rather than the breaking up of fibrous scar tissue in chronically inflamed tendons as previously thought.4 We have known clinically for years that massage works well in the treatment of tendinosis; now we may be closer to understanding why.
Click here for more information about Whitney Lowe, LMT.
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