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Posted by john h on 4/07/04 at 13:52 (148541)

This excert from an article is rather medically complex in nature but is worth a read:

3.1 Tendinosis

Although the term tendinosis was first used by German workers in the 1940s, its recent usage results from the work of Puddu et al. [21]. Tendinosis is tendon degeneration without clinical or histological signs of an inflammatory response. Tendinosis can be associated with paratenonitis (e.g., in the Achilles tendon [25]). Collagen degeneration with fibre disorientation, increased mucoid ground substance, and an absence of inflammatory cells was the characteristic pathology of the tendinopathies described in the previous section. Thus, it appears that tendinosis is the major, and perhaps the only clinically relevant chronic tendon lesion although minor histopathologic variations may exist in different anatomical sites. Paratenonitis is described in the Achilles tendon but is generally poorly documented and tendinitis appears rare, if it exists at all. 

The light microscopic findings of tendinosis occur in collagen, among tenocytes and also within the matrix or ground substance [81]. Some collagen fibres appear to separate giving the impression of loss of their parallel orientation, there is a decrease in fibre diameter, and a decrease in overall density of collagen. Collagen microtears also occur and these may be surrounded by erythrocytes, fibrin and fibronectin deposits. Within collagen fibres there is unequal and irregular crimping, loosening and increased waviness, in contrast to the normal tight parallel bundled appearance. There is an increase in Type III (reparative) collagen. These changes lead to decreased birefringence of the tendon under polarised light microscopy [81]. Special stains consistently demonstrate and increase in mucoid ground substance (proteoglycans) [33, 34]. 

There is great variation in cellular density in tendinosis. In some areas tenocytes are abnormally plentiful and have rounded nuclei and ultrastructural evidence of increased production of proteoglycan and protein which gives them a chondroid appearance. In contrast, other areas of the tendon may contain fewer tenocytes than normal and those remaining have small, pyknotic nuclei [81]. Rarely, there is infiltration of lymphocytes [81] and macrophage type cells, which may be part of a healing process. A characteristic feature of tendinosis is proliferation of capillaries and arterioles. 

Various morphologic expressions of tendinosis have been described: 

* hypoxic degeneration, 
* hyaline degeneration, 
* mucoid or myxoid degeneration, 
* fibrinoid degeneration, 
* lipoid degeneration, 
* calcification, 
* fibrocartilaginous and bony metaplasia [2, 5]. 

These pathologies can coexist and their prevalence varies, possibly depending on the anatomical site and the nature of the insult that caused them (e.g. hypoxia versus mechanical loading, acute versus chronic injury). Thus, tendinosis is the end result of a number of etiologic processes with fairly small spectrum of histological manifestations. The essence of tendinosis is degeneration in tendon cells, collagen fibres and the subsequent increase in noncollagenous matrix [5] (Table 2). Leadbetter has proposed a theoretical model to illustrate how tendon injury may precipitate tendinosis (Figure 2). 

Figure 2. A theoretical model of the tendinosis cycle (modified from Leadbetter [80]).

The finding that the clinical tendon conditions in sportspeople are due to tendinosis is not new. Writing about the tendinopathies in 1986, Perugia et al. noted the 'remarkable discrepancy between the terminology generally adopted for these conditions (which are obviously inflammatory since the ending 'itis' is used) and their histopathologic substratum, which is largely degenerative' [2]. 

3.2 Tendinitis

Tendinitis is a condition in which the substance of tendon exhibits an inflammatory response. Many knowledgeable tendon physicians and scientists understand that when the term 'tendinitis' is used in a clinical context it refers to a clinical syndrome and not a specific histopathologic entity [35, 73]. It could be argued that this 'accepted' misuse of the term does not warrant alteration. However, while the term 'tendinitis' remains in use for what is truly tendinosis, some clinicians, as well as athletes, coaches and patients, will underestimate the significance of the condition. Hence an increasing number of workers recommend that the misnomer tendinitis should be abandoned [12, 13, 21, 63, 69, 80, 82-84]. 

Although there has been no convincing evidence of the histopathology that would correspond to true 'tendinitis' in humans, it must be acknowledged that in studies where rabbit Achilles tendons were divided and then repaired, inflammatory cells including neutrophils were present at postoperative day 5 and then disappeared by day 18 [85]. Clearly this model does not replicate overuse tendinopathy, but until appropriate biopsies are obtained in humans the possibility of a brief period of true 'tendinitis' cannot be totally excluded. In clinical practice, most tendinopathies are chronic (i.e., tendinosis) when the patient seeks medical attention. 

Re: Tendonsis-Tendonitis

BrianJ on 4/07/04 at 13:55 (148543)

For those interested in a less complex explanation, check out tendinosis.org

Re: Tendonsis-Tendonitis

Dorothy on 4/07/04 at 14:15 (148545)

Dorothy, just visiting, but very interested: John H - from your reading of this and of what we have read here about what Michael Young does in his therapy practice, do you have the impression that his therapy would be effective? I have been viewing his VHS on PF (not finished yet) and am 1. impressed with his personal courage, down to earth style, and earnestness in what seems to be a sincere desire to help people be cured, not just relieved of symptoms; and 2. very intrigued with the techniques and ideas behind them that make sense to me.
I also think you have a good common sense down to earth way about you and would be interested in your comments.

Re: Tendonsis-Tendonitis

Dr. Z on 4/07/04 at 20:07 (148563)

Where do you get the video Dorothy.? I would love to view it

Re: Tendonsis-Tendonitis

Dorothy on 4/08/04 at 01:51 (148574)

Dr. Z ~ I did a search here just now under 'Michael Young' and found quite a few posts. One of them had his website: http://www.mrtherapy.com .
His videos and other products that he recommends/uses are available there.
As of tonight I have watched the entire PF video. From what other posters here have written and from Mr. Young's own information, he teaches workshops around the country, has a practice in Colorado and has produced some videos as well. He begins the PF video by telling viewers that he has a speech impediment and reminds them that the fact that he has a speech impediment does not mean he does not know what he is talking about. I liked him from the 'get-go' for his attitude and the information he shares. He doesn't say 'you must come and see me' or 'you must buy this or that'; he says, essentially, 'you can do this.' His style is plain-spoken, direct and straightforward. The video is not 'fancy' but it delivers on its promises and is appealing to me because it is informative, instructive, optimistic - and mostly because Mr.Young seems both kind and sincere. He demonstrates the massage techniques that one can do with a partner with 'some common sense', but he also demonstrates a stretching program to accomplish, or at least approximate, the same thing on your own. There is an honesty and sincerity about his manner that says more that he wants to help you and thinks he can cure you much more than he has things to sell to you. I was aware of feeling trust in him as I watched the video - and admiration as well because I really like people who forge ahead in spite of some issue or other (in his case his speech impediment)and who want to do some good in the world. So those are my initial reactions about the video and the style. As far as the program, my husband says he will learn it so we can do the partner type, and we are also going to learn the individual stretching program demonstrated. I wish I could visit Mr. Young's practice, but that may not happen. If you watch the video yourself, I hope you will post your reactions.
For those who are interested, he recommends the Wharton's Stretch Book. You can get that on Mr. Young's website and also on Amazon, Barnes & Noble or in other bookstores.
Another thing that Mr. Young tells viewers is 'keep an open mind' - which is always good advice. I liked what he teaches and I'm going to try it and I believe it will make a positive difference.