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pft

Posted by Paula on 9/18/00 at 15:17 (028536)

i would get the PFT if you think someone who is almost totally immobilized by tendonitis, pf and wobbly painful ankles with almost no range of motion can benifit at this point. keep in mind i've spent enough on shoes, inserts etc to get 3 eswt treatments at this point, but dr z say the word and i'll get the PFT. and by the way standing up from wheel chair is a great idea. i find that i can stand without pain and after a while took a baby step. pitiful to say i felt i had a great victory today and am standing up every hour.!

Re: pft

Dr. Biehler on 9/18/00 at 19:19 (028581)

I would recomend you try the PFT. Remember, from your discription you are suffering from tendonosis not tendonitis. This implies a difference in how it is treated. After you try to off load any biomechanical stresses and let your tendons recoup, you then need to start to do eccentric strenghthening exercises to try to stimulate your mechanoreceptor in your tencytes to start producing collagen. Collagen production is probably the key that determines your recovery from tendonosis. At this point, although tendonosis is a non inflamatory situatuion, icing still has been show to help by reducing the abnormal neovascularization which is a feature of this pathology.

Re: pft

Paula on 9/18/00 at 21:41 (028599)

i have tendonosis? not tendonitis? o.k. can you put that sentence about off loading biomechanical stress in simpler words or maybe say a few more sentences? remember i am new to all this. how often do you suggest icing and for how long. it sure does help. but i thought just in pain control .. i didn't know it it helps produce collagen. i am very motivated by what you just said to ice as often as you suggest. so i want to build collagen, eh? didn't i read somewhere that vit. c and bioflavonoids build collagen?.. and why do i have tendonosis and what is that? and why can't i find a dr. in atlanta like you or z? my doctors wouldn't know a tencyte from a hole in the wall.

Re: dr b

Paula on 9/18/00 at 21:47 (028601)

dr b , i'm ordering the PFT tomorrow. even if i have no idea what your explanation means. maybe i'll smack myself in the head with it and see if it makes me smarter. bless you docs you are our guardian angels

Re: dr b

Dr. Biehler on 9/19/00 at 07:30 (028629)

In reality over use tendonitis is rare and the recover period is up to 2 weeks to 6 weeks treated with anti-inflamatory modalities. Over use tendonosis is the more commom and takes 10 weeks to 6 months to usually heal if there is encouragement of collagen- synthesis and strenghth. In this damaged tendon there is loss of collagin an increase in ground subsatance, vascularity cellularity , but not inflamatory cells so treating it like an inflamatory disorder does not help. The problem starts as collagen degeneration from a too great of a biomechanical load. NSADS inhibits collagen formation although it does help with the pain. It is tenocytes that produce collagen. These get stimulated threw eccentric exercises, but you have to be very carefull not to over stain the tendon when you start to do the exercises.

Re: dr b

JudyS on 9/19/00 at 10:33 (028656)

Dr. B - I don't know if I'm reading you right....are you saying that some use of the affected tendon is necessary in order to encourage healing collagen? You may recall that we periodically have a discussion here regarding the pros and cons of rest. Some have found that too much rest can be damaging, some have found that at least some 'exercise' seems to promote healing. Is that what you're saying?

Re: dr b

Dr. Biehler on 9/19/00 at 11:03 (028662)

When there is no longer a tendonitis which is inflamatory, but it has changed into a tendonosis which is non inflamatory and starts the begining of a collagen break down cycle, then exercise is nessasary to trigger the mechanoreceptors to start repairing the collagen. While you start doing the exercises you have to make sure you are not biomechaicaly over using the tendon in the mean time.

Re: dr b

JudyS on 9/19/00 at 11:12 (028664)

Thanks, Dr. B, for your response. One more question? How do you know when the affliction has graduated from being an inflammation (tendonitis?) to the non-inflamed tendonosis? (it all seems to hurt the same!)

Re: dr b

Dr. Biehler on 9/19/00 at 11:48 (028666)

Short of a histopathologic comparison, a tendonitis recovers in a few days to 6 weeks. If you are not better by then the odds are you have tendonosis.

Re: pft

Dr. Biehler on 9/18/00 at 19:19 (028581)

I would recomend you try the PFT. Remember, from your discription you are suffering from tendonosis not tendonitis. This implies a difference in how it is treated. After you try to off load any biomechanical stresses and let your tendons recoup, you then need to start to do eccentric strenghthening exercises to try to stimulate your mechanoreceptor in your tencytes to start producing collagen. Collagen production is probably the key that determines your recovery from tendonosis. At this point, although tendonosis is a non inflamatory situatuion, icing still has been show to help by reducing the abnormal neovascularization which is a feature of this pathology.

Re: pft

Paula on 9/18/00 at 21:41 (028599)

i have tendonosis? not tendonitis? o.k. can you put that sentence about off loading biomechanical stress in simpler words or maybe say a few more sentences? remember i am new to all this. how often do you suggest icing and for how long. it sure does help. but i thought just in pain control .. i didn't know it it helps produce collagen. i am very motivated by what you just said to ice as often as you suggest. so i want to build collagen, eh? didn't i read somewhere that vit. c and bioflavonoids build collagen?.. and why do i have tendonosis and what is that? and why can't i find a dr. in atlanta like you or z? my doctors wouldn't know a tencyte from a hole in the wall.

Re: dr b

Paula on 9/18/00 at 21:47 (028601)

dr b , i'm ordering the PFT tomorrow. even if i have no idea what your explanation means. maybe i'll smack myself in the head with it and see if it makes me smarter. bless you docs you are our guardian angels

Re: dr b

Dr. Biehler on 9/19/00 at 07:30 (028629)

In reality over use tendonitis is rare and the recover period is up to 2 weeks to 6 weeks treated with anti-inflamatory modalities. Over use tendonosis is the more commom and takes 10 weeks to 6 months to usually heal if there is encouragement of collagen- synthesis and strenghth. In this damaged tendon there is loss of collagin an increase in ground subsatance, vascularity cellularity , but not inflamatory cells so treating it like an inflamatory disorder does not help. The problem starts as collagen degeneration from a too great of a biomechanical load. NSADS inhibits collagen formation although it does help with the pain. It is tenocytes that produce collagen. These get stimulated threw eccentric exercises, but you have to be very carefull not to over stain the tendon when you start to do the exercises.

Re: dr b

JudyS on 9/19/00 at 10:33 (028656)

Dr. B - I don't know if I'm reading you right....are you saying that some use of the affected tendon is necessary in order to encourage healing collagen? You may recall that we periodically have a discussion here regarding the pros and cons of rest. Some have found that too much rest can be damaging, some have found that at least some 'exercise' seems to promote healing. Is that what you're saying?

Re: dr b

Dr. Biehler on 9/19/00 at 11:03 (028662)

When there is no longer a tendonitis which is inflamatory, but it has changed into a tendonosis which is non inflamatory and starts the begining of a collagen break down cycle, then exercise is nessasary to trigger the mechanoreceptors to start repairing the collagen. While you start doing the exercises you have to make sure you are not biomechaicaly over using the tendon in the mean time.

Re: dr b

JudyS on 9/19/00 at 11:12 (028664)

Thanks, Dr. B, for your response. One more question? How do you know when the affliction has graduated from being an inflammation (tendonitis?) to the non-inflamed tendonosis? (it all seems to hurt the same!)

Re: dr b

Dr. Biehler on 9/19/00 at 11:48 (028666)

Short of a histopathologic comparison, a tendonitis recovers in a few days to 6 weeks. If you are not better by then the odds are you have tendonosis.