Monday, April 05, 2004

Tendonosis, not tendonitis

Ignorance is everywhere, and society expects you to be responsible for compensating for the blissful ignorance of others. This is all very well for the one or two who are clever and bright enough to do so, but the rest of us delude ourselves that we are genius enough to escape the failing intelligence of our civilization. (There lies another case for the limitation of liberalism. We cannot allow anyone to pursue lives of untrammelled blissful ignorance, because beyond some point such a single individual will adversely affect someone else.)

And so especially to the people from whom we seek help, the ones who are employed to completely reject ignorance in their field of specialty. Doctors, once treated as god-like figures of authority. We now understand them to be human beings, and we don't expect too much from a General Practitioner. In Newham, we have many Third-world immigrants who still worship them and expect divine salvation, and their naivete is a scary reminder of the knowledge gap on planet Earth. We slide into the clinics (often just called "surgeries" in Britain) and have to wait patiently amongst the cowed hordes: pamphlets offer advocacy services and interpreters in 30 languages. When finally we take our turn in front of a GP, who has chosen or been driven to work amongst the disadvantaged for some mixture of Hippocratic duty or Race Politics or less-than-average-competence, we note that they are drained and pained, and we spare them more desperation. Rationality and science and reason for five minutes is the minimum respite that such a GP can hope for. So in full understanding of the healthcare process, we ask for a referral to a consultant specialist and duly receive one.

It is the consultants that we must not forgive so kindly. Which brings me to tendonosis. You will have noticed that one of the big differences between the young and the old, are that the young can bounce around and fall off skateboards and still feel no enduring aches and pains. All those scary old people that seem to struggle along the pavement (translate to sidewalk in US) hardly stretching their legs, what is the matter with them? Could it be arthritis, could it be rheumatism? Could it be bad diet, lack of exercise, or penance for youthful sins? Why don't they just pour themselves the trite panaceas of Western culture - perhaps a couple of whiskies or pints of Guinness - and at least block the pain, and laugh, laugh, laugh. Or take a few aspirins.

Athletes and professional sportspersons learn about injuries and have access to the finest resources, medical and those complementary. We cannot hope for these, as our own entire bodies are worth less than a toenail on David Beckham's right foot. Then still, athletes age, and the likes of footballer David Seaman and long-jumper Jonathan Edwards are still forced to retire from their passion before the crucial age of 40.

Can we not at least hope, then, that a consultant rheumatologist, such as the one I experienced at Newham General Hospital, should at least know what any experienced physiotherapist understands? That tendonosis is not tendonitis, that the majority of aches and pains and loss of athleticism are due to ageing, and their care is not improved by "trying aspirin for a month". I quote the following from Patella Tendonosis, but you can find more technical medical references on the Web: we get older the healing response of our body is diminished and damaged tissue may not completely heal. When it affects tendon tissue this degeneration is known as tendonosis. ..

Tendonosis is not an inflammatory condition, anti-inflammatory treatments, such as ice packs and NSAID
(Non-Steroidal Anti-Inflammatory Drugs) medication, are not appropriate. In fact, NSAIDs may be counter productive as they inhibit natural chemicals that can promote a healing response.

The key to treatment of tendon degeneration is three months rest from sporting activities to allow regeneration to take place. Research has shown that the collagen scar tissue that the body lays down to heal damaged tendon, takes three months to mature to the point where it can cope with increased loads. Treatment by a Chartered Physiotherapist to promote this healing response may include heat treatments or friction massage. Once the pain has settled and enough time has been given to allow the scar tissue to mature, more active rehabilitation can be initiated.

I should also point out that Osteopaths I have encountered do not know this.

On the average body, long before something as critical as arthritis normally appears, the enduring aches and pains that will be experienced are the accumulating results of tendonosis. They accumulate early enough that well-paid famous athletes still have to retire before 40.

No comments: