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Downplayed medical issue

Sports medicine specialist addresses tendon pain

Close-up mid section of a young woman with elbow pain over white background

MARQUETTE — Treating tendon pain doesn’t always get the proper respect in the medical field, but maybe it should.

Dr. J. Bryan Dixon, a sports medicine specialist with the Advanced Center for Orthopedics and Plastic Surgery in Marquette, spoke about “Ten Tips for Treating Tendon Pain” Wednesday at the monthly “Meet the Physician” series sponsored by UP Health System-Marquette and the Peter White Public Library.

“It’s a very common problem, a big problem, and it sort of gets downplayed in medicine,” Dixon said.

As a medical doctor, he knows that first-hand.

“M.D.’s — we like to do big things, life-saving things, dramatic things. Those are sort of what are prestigious in our profession,” DIxon said.

Prestige, however, isn’t always on a patient’s mind when pain is involved.

“Tendon pain is a tremendously painful, disabling condition, but the treatments aren’t really heroic,” Dixon said.

A patient could come into a doctor’s office with just “tennis elbow” and be told to undergo physical therapy with not a lot of discussion, he said.

A population shift could change that dynamic.

“As the Baby Boomers are getting older, they want to stay active,” Dixon said. “They want to stay involved in sports, in physical activity, and one of the limiting things becomes orthopedic conditions, particularly bone and joint problems, but also tendon issues.”

Tendons connect muscle to the bone, so it’s understandable why this type of pain is so bothersome to active — and even inactive — people.

Tendinitis, as defined by the Mayo Clinic, is” inflammation or irritation of a tendon — any one of the thick fibrous cords that attaches muscle to bone. The condition causes pain and tenderness just outside a joint.

“While tendinitis can occur in any of your body’s tendons, it’s most common around your shoulders, elbows, wrists, knees and heels.”

Dixon stressed that often a condition is called tendinitis, which implies inflammation, but actually it’s tendinosis. Often a tendon isn’t inflamed but is damaged from a chronic degenerative condition due to a failed healing response and tissue scarring.

Tendon problems, he pointed out, tend to be seen mostly in middle-aged people since they become stiffer with age and the ability to build up and repair collagen slows.

Tendons also have poor blood supply, meaning they’re harder to heal, he said.

“It’s a hard problem to treat,” Dixon said.

For some people with mild symptoms or who are willing to give up abilities, improvements can come on their own. However, Dixon asked: Are two years of pain acceptable?

In certain circumstances, it’s OK to take a “wait-and-see” approach. Other times, a proactive approach is needed.

“Extrinsic factors,” including walking on hard floors and wearing the wrong footwear, can be remedied, he said.

Variations in human anatomy — like having too high or too flat feet — put some people more at risk for tendon problems, he said. If the joint below an ankle is stiff, it can lead to damage, so reduced motion in that ankle can help.

“When we prescribe physical therapy or when you’re thinking about what sort of warm-up program you want to do, these are things that you can work to adjust or correct to try to get your body functioning as best as possible and reduce the risk of injury,” Dixon said.

Repetitive movements for at least two hours a day, such as those used in sewing and carpentry, can lead to epicondylitis — the tendinitis found in elbows.

“So, if you have the ability to break those tasks into smaller time intervals, to spread them out more, that can lower your risk of tendon damage,” Dixon said. “Also, managing heavy loads over 40 pounds has clearly been shown to increase the risk of tendon damage.”

A counterforce brace can be used for conditions like tennis elbow, and is a safe alternative, he said.

He noted fluroquinolone antibiotics have been associated with the increased risk of tendinopathy and tendon rupture, so he suggested patients ask their physicians for alternatives.

Rehabilitation such as the Alfredson Protocol for Achilles tendinitis also can help with certain conditions, Dixon said.

Although some of his patients have benefited from them, Dixon cautioned against the use of steroids, which could cause long-term damage in tendons.

“It can be a fantastic thing and really help,” Dixon said. “The issue is you need to be aware of the risk and benefits and you need to not rely on it as a repetitive thing to do.”

Dixon can be reached at 906-225-3892.

Upcoming “Meet the Physician” sessions, which are held at PWPL, will be June 14 with Dr. Brian MacFalda talking about strokes and July 19 when Dr. Maureen McNeely discusses anesthesia.

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