Shockwave Treatment of Erectile Dysfunction

Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED). Unlike other current treatment options for ED, all of which are palliative in nature, LI-ESWT is unique in that it aims to restore the erectile mechanism in order to enable natural or spontaneous erections. Results from basic science experiments have provided evidence that LI-ESWT induces cellular microtrauma, which in turn stimulates the release of angiogenic factors and the subsequent neovascularization of the treated tissue. Extracorporeal shock wave therapy (ESWT) has been clinically investigated and applied in several medical fields with various degrees of success.

Signs Your Plantar Fasciitis is Healing

Signs Your Plantar Fasciitis is Healing

By Vessel Crew

Intro

If you have plantar fasciitis, you know the pain that can come with every step and how it can negatively affect your life. It is almost impossible to avoid using your feet, and the recovery process can be long and frustrating.

Luckily, your plantar fasciitis will heal, and you will eventually take a pain-free step. You may not realize the progress at first, but slowly you will have fewer plantar fasciitis symptoms. Is your plantar fasciitis healed? Is it ok to start jumping back into activities that you had previously stopped? Can you start wearing less supportive footwear? Starting activities too early and wearing unsupportive footwear can be risky and set back your recovery if your plantar fasciitis has not fully healed. It is essential to know the signs of a healthy plantar fascia and signs that you need a little bit more time and rest.

Below are some key signs your plantar fasciitis is healing and some tips to help you in the recovery process.

What is Plantar Fasciitis?

First, what is plantar fasciitis? Plantar fasciitis is a widespread cause of heel pain that affects about 10% of the U.S. adult population. The plantar fascia is a long flat ligament on the bottom of your foot. It connects your heel bone to your toes to support the arch of your foot. Like other ligaments in your body, it can stretch within limits and then return to normal.

If too much tension and stress are applied, small tears can form in the fascia, and it becomes inflamed. Unfortunately, we rarely give the fascia enough time to properly heal, so the body patches the inflamed fascia with scar tissue.

Repeatedly doing this over months or years causes more tears and scar tissue until your fascia is in a state of degeneration with chronic pain. Those small scar tissue areas have formed a large area of scar tissue, a disorganized mess of collagen, nerves, and blood vessels. This disorganized tissue inhibits your body from healing the injury and causes chronic pain.

Symptoms of plantar fasciitis can include:

    • Sharp, stabbing pain in your heel
    • Radiating pain in the heel and ankle
    • Reduced range of motion in foot and ankle
    • Bruising or swelling on the bottom of your foot
    • Difficulty walking, standing, or running
    • Dull aching pain or cramp through your arch or from your heel to your toes

We will discuss common treatment options later, but first, let us talk about a few signs your plantar fasciitis is healing.

Signs your Plantar Fasciitis is healing

Knowing the indicators of plantar fasciitis healing are important for recovery. Some of the key signs that your plantar fasciitis is healing are listed below.

1. Your First Steps in the Mornings Are Easier

One of the most prominent signs of plantar fasciitis is a sharp, stabbing pain you may feel with your first steps in the morning. A lack of pain when you get out of bed is one of the first signs that your plantar fasciitis is healing. Why does it feel better? A lack of pain in the morning indicates a reduction in inflammation.

Be careful to keep up the therapeutic activities that got you to this point. For example, keep wearing your supportive shoes or orthotics that help provide cushioning and support to the fascia.

2. Your Pain is Becoming More Localized

Plantar fasciitis pain can radiate from your foot and heel into the ankle and calf. This pain can affect how you walk, leading to pain in your knees, hips, and lower back.

If you notice a reduction in pain in these areas, this is a good sign that your plantar fasciitis is healing. With a reduction in pain, you have probably started walking more normal, thereby reducing stress on your knees, hips, and back. You may still have localized pain in your foot, but reducing the radiating pain is a good step forward.

3. Your Range of Motion is Improving

Stretching is an often overlooked but necessary plantar fasciitis treatment. Stretching can be painful because the fascia is inflamed, but stretching can help strengthen and elongate the fibers to handle stress better.

If you notice that your foot and calf stretches are becoming easier, this is a sign that your range of motion is improving and that healing has begun. Your ability to move your toes and foot through a broader range of motion is a good sign your plantar fasciitis is healing.

4. Swelling and Bruising are Fading

If you suffer from severe plantar fasciitis, you may have noticed swelling or bruising around your arch or heel. These symptoms indicate that your plantar fascia is inflamed and most likely has microtears. Not everyone experiences these symptoms, but do not get frustrated if you have. If you noticed your foot is less swollen or bruised, that is a good sign that you are on the way to recovery.

Healing plantar fasciitis takes time and rest. It is a relief when your foot is starting to feel better, and you see signs of healing, but be careful to keep up the stretches and therapies that get you to this point. While the facia heals, patience can be difficult, but it is necessary as healing requires time and rest. How long does it take to heal plantar fasciitis?

How Long Does Plantar Fasciitis Last?

Plantar fasciitis is most often a result of years of stress that damage the plantar fascia. Healing plantar fasciitis can take a long-time, often because it is challenging to stay off your feet and give them the rest necessary for healing. There is a range for recovery times, but for those that catch it early and follow self-care or doctor-directed treatments, the average time is six months.

A pound of prevention is worth an ounce of cure, even for plantar fasciitis. Understanding what causes plantar fasciitis may help you prevent this painful condition. To learn how to prevent plantar fasciitis, you can read our blog here. While six months seems like a long time, ignoring plantar fasciitis may make a recovery a lot longer. The following are some common plantar fasciitis treatments.

How Long Does Plantar Fasciitis Last?

For most people suffering from plantar fasciitis, recovery is about 6-months with conservative treatments. These plantar fasciits treatments range from therapies you can do at home, such as icing and rest, to treatments your doctor may recommend, such as physical therapy.

Most people start with icing, rest, and nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease inflammation and reduce pain. 

Utilizing supportive footwear and orthotic inserts is an excellent way to decrease your foot’s stress by providing cushioning and support.

A doctor may also recommend physical therapy or night splints to stretch and strengthen your fascia. A steroid injection may also be considered to reduce inflammation and relieve pain. Be careful, though; multiple injections may weaken the fascia and cause additional damage.

If you have done all these conservative treatments but still have plantar fasciitis pain, your doctor may recommend plantar fasciotomy surgery or non-invasive High-energy Extracorporeal Shockwave Therapy treatment.

OrthoWave® is an FDA-approved, High-energy Extracorporeal Shockwave Therapy (HeSWT) treatment that is a non-invasive alternative to surgery. Only a single session of OrthoWave® is needed, and there is no downtime after your treatment, unlike surgery. Since 2010, HeSWT is recommended over the surgery by the College of Foot and Ankle Surgeons because it is exceptionally safe and highly effective.

Conclusion

Plantar fasciitis is painful, and the road to recovery looks a little bit different for each person. There are a few common signs your plantar fasciitis is healing and knowing these are important. If you do not see signs of healing, you do not have to live with the pain of plantar fasciitis. There are numerous treatment options when others have failed, including surgery or Orthowave HeSWT. The important thing is that you get you back on your feet and doing the things you love again, pain-free.

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6 Steps to Fixing Tennis Elbow Pain

6 Steps to Fixing Tennis Elbow Pain

By Vessel Crew

“Tennis elbow….but I don’t even play tennis?” Tennis elbow is a tricky injury that might or might not go away on its own. It is often caused by things other than playing tennis such as jobs or hobbies that require gripping and twisting. Unfortunately, the injury is often ignored early on or the pain is “played through” until the pain starts affecting routine activities like opening doors or simply grasping a cup. The good news is that fixing tennis elbow pain can often be done with self-care or conservative treatments and rarely requires surgery.

What is Tennis Elbow?

Tennis elbow, or lateral epicondylitis, is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm. Despite its name, athletes are not the only people that develop tennis elbow. People whose jobs feature the types of motions that can lead to tennis elbow include plumbers, painters, carpenters, and butchers. The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to a bony bump on the outside of your elbow. The pain can also spread into your forearm and wrist.

Fixing Tennis Elbow Pain

First, the good news. Tennis elbow will usually heal on its own. If you catch it early enough, simply resting your elbow and giving it time to heal will fix your tennis elbow. It is probably safe to assume that if you are reading this blog, resting did not work and you are looking for some additional treatments to help. The following are six steps to fixing tennis elbow pain:

1. Ice

Ice is a great first step in fixing your tennis elbow. As soon as you notice pain, apply ice or cold packs for 10 to 15 minutes and do this several time per day. Always be sure to put a thin cloth between the ice and your skin to prevent damaging your skin. The ice helps reduce the pain and inflammation caused by the damaged tendons.

2. Strap or Brace

There are numerous types of straps and braces for fixing tennis elbow but they all generally work the same way. By applying pressure to the muscles and tendons attached to the lateral epicondyle, they absorb some of the forces being transmitted through the tissues. Additionally, they change the angle of the tendons and the forces applied at the attachment giving the injured portion some relief to heal. A strap or brace can also help prevent your tennis elbow from reoccurring.

3. Pain Medication

If ice and straps are not enough to alleviate your tennis elbow pain, NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve) can ease pain and reduce inflammation. There is emerging evidence that NSAIDs may hinder the healing process so you may want to use these sparingly. If you must take them for more than a week, it is time to call your doctor.

4. Physical Therapy

The first thing your doctor will likely recommend is physical therapy (PT) for fixing tennis elbow pain. The goal with PT is to improve your forearm muscles’ strength and flexibility. Normally it will start with pain relief where the therapist will try things such as ice massage, ultrasound, muscle stimulation, etc. Once you have some relief, you will be eased into exercises and stretching. Exercises include wrist turns, forearm strengthening, and eccentric movements. Stretching will include wrist extensor, wrist flexor, and finger stretches. Even if PT fixes your tennis elbow pain, you may be told to continue with the routine in order to avoid re-injuring it.

5. Steroid Injections

A steroid injection may be recommended after these other treatments have failed or it may be recommended initially if the pain is severe enough. Usually known as a cortisone shot, steroid injections provide short-term pain relief but are not a long-term solution. Cortisone is a powerful anti-inflammatory that significantly reduces or eliminates pain. It may be given initially to allow you to work with a therapist on stretching and strengthening your injury. It is important to note that Cortisone shots do not cause or speed healing. In fact, frequent use of them can cause tissue damage or tendon rupture, which is why its use is limited.

6. Surgery or High-energy Extracorporeal Shockwave Therapy

Usually, the previous conservative treatments are sufficient at fixing tennis elbow pain. But, if your tennis elbow does not respond after several months, you may have a severe case that requires surgery. The surgery is an outpatient procedure where the surgeon debrides the damaged tendon(s). You are often put to sleep, a surgeon makes an incision, and then scraps away (debrides) the scar tissue on the tendon. The surgeon may also reattach surrounding tendons and sew together healthy tendons. It normally takes 6 to 12 weeks before you can use your elbow for routine activities again and 4 to 6 months before exercise and sports.

Shockwave Therapy

If you would like to avoid the risks and downtime of surgery, your tennis elbow can also be treated with a single session of High-energy Extracorporeal Shockwave Therapy (HeSWT). HeSWT is an FDA approved, non-invasive alternative to surgery for numerous musculoskeletal injuries, including tennis elbow. It uses powerful, focused acoustic waves from outside the body to break apart the scar tissue, increase blood flow, and stimulate the body’s natural healing process. There is no downtime after being treated but you have to avoid high-impact activities for 30 days as your tendons heal.

Final Thoughts

Fixing tennis elbow pain is relatively easy if caught early. The problem is that the pain from tennis elbow is often “played through” and the body is not given enough time to heal. This sometimes leads to moderate to severe cases of tennis elbow that require medical attention. Self-care includes ice, straps, and NSAIDs. Your doctor may recommend physical therapy and/or a steroid injection. These conservative treatments often work but occasionally tennis elbow may require surgery or High-energy Shockwave Therapy, a non-invasive alternative to surgery. The good news is that self-care and medical treatments often work but if they do not, you have a non-invasive option to surgery that will get you back to work, on the court, or in the gym pain free.

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6 Best Foods for Knee Pain

6 Best Foods for Knee Pain

By Vessel Crew

Food is everywhere. It is common knowledge that an apple is better than a slice of cake, but what are the best foods for knee pain?

Best Foods for Knee Pain

Listed below are the six best foods for knee pain. These foods were chosen for their anti-inflammatory properties, high vitamin and mineral content, and/or high antioxidant properties that can help you control or reduce knee pain.

Even if you do not enjoy eating all of these foods, you may be able to reap many of their benefits with supplements. Most supplements can be bought online or at your local grocery store.

1. Cherries for Knee Pain

If you have shoulder tendonitis, it is critical to start self-care immediately. These treatments help prevent further damage and allow your body to initiate healing. First and foremost, rest the affected shoulder.

Overuse of the arm and shoulder caused the tendonitis in the first place, so taking a break from the repetitive movement that caused the injury will give it time to heal. To reduce inflammation, apply ice three to four times daily for the first 48 to 72-hours and take a nonsteroidal anti-inflammatory drug (NSAID) like Advil or Aleve or a natural anti-inflammatory like curcumin.

Other important things you can do throughout your day are using good posture and avoiding carrying heavy objects with the affected arm and shoulder. Avoiding heavy items includes moving a book bag or purse from your affected shoulder to the other so that the shoulder gets maximum rest. If you must carry something heavy, hold it close to your body and not to your side. Lightly stretching the shoulder throughout the day is also helpful in reducing stiffness but not to the point that it causes pain. At night, try not to sleep on the painful side.

2. Fish for Knee Pain

Fish is full of fatty acids (otherwise known as Omega 3’s), protein and minerals. Fatty acids help inhibit your inflammation by interfering with cells that are key players in your body’s inflammatory process.

If you already have arthritis, consuming fish on a regular basis may help reduce your joint swelling and pain. The fatty acids found in fish also contain natural chemicals that can restore and lubricate your joints.

More lubrication in your joint means less friction and rubbing together, which minimizes knee pain. Fish is also high in vitamin D, which can help relieve your joint pain. Most people are deficient in Vitamin D, even without realizing it, which can contribute to their joint and muscle pain in the knees.

Do not like fish? You can get the same natural benefits by taking a fish oil supplement. You can find fish oil supplements online, in a vitamin store or in your grocery store.

3. Turmeric for Knee Pain

Turmeric is a spice that is common in Indian cuisine. In addition, it is one of the spices that has anti-inflammatory effects that is perfect for helping your chronic joint pain.

This is due to curcuminoids, which is a chemical found in turmeric and contributes to the spice’s yellow coloring. Curcumin acts as a blocker to NF-κB, which is a molecule that controls the inflammatory proteins in your body.

This spice is most effective when eaten with black pepper. Studies have shown that two grams a day is as effective as 800 mg ibuprofen for pain relief during walking and climbing stairs.

Not a fan of Indian food? You can take turmeric as a natural supplement and still receive the same benefits. Turmeric is found with other vitamins either online or in your grocery store.

4. Garlic for Knee Pain

Garlic has the dual benefit of scaring away vampires and reducing joint inflammation.

This anti-vampiral contains diallyl disulfide, an anti-inflammatory compound that limits the effects of cytokines (a pro-inflammatory cell found in your body). In addition, selenium is found in garlic.

Selenium has been found to have an antirheumatic effect, which can be helpful if you are suffering from arthritis. Garlic is also rich in flavonoids, which are plant chemicals that clean-up damaging free radicals and fight inflammation.

One flavonoid, quercetin, limits leukotrienes, prostaglandins, and histamines (inflammation causing chemicals). Consuming garlic regularly can potentially prevent cartilage damage as well.

A study was shown that eating five grams (about one teaspoon) of garlic paste twice a day improved joint pain. Garlic also stimulates your blood circulation which can potentially help improve knee pain.

5. Spinach for Knee Pain

Do you know why Popeye never had knee pain? The man ate a lot of spinach. Spinach is rich in vitamins and nutrients, with one cup of spinach containing 56% of your recommended daily amount of Vitamin A and 181% of Vitamin K.

Vitamin K is a fat-soluble vitamin that is essential for your bone health and can help offset osteoarthritis. Vitamin K is involved with the production of proteins in bone, including osteocalcin, which prevents the weakening of your bones.

Spinach also has large amounts anti-inflammatory compounds and antioxidants, one of the largest being kaempferol. Kaempferol has been proven to decrease inflammatory agents associated with arthritis, reducing knee pain.

Spinach is also a good source for Vitamin E, which acts to protect your body against inflammatory cells and for Vitamin C which helps your body make collagen.

Collagen makes up a large part of cartilage, which keeps your joint flexible and mobile. A flexible joint is a pain free joint.

6. Bone Broth for Knee Pain

Bone broth is nutrient dense and full of iron, vitamins A and K, fatty acids, and other minerals. It also contains high amounts of gelatin, which is then broken down into collagen.

Collagen supports your joint and cartilage health, which can reduce knee pain and stiffness. Bone broth also contains amino acids, which act as building blocks for proteins for muscle and bone health.

Glutamine is one of those amino acids that contributes to your joint health. Bone broth also contains proline and glycine which is used in your body to build connective tissue, including tendons and ligaments.

Also, bone broth is full of glucosamine and chondroitin, which make up the building blocks for your cartilage. They have also been found to help decrease joint pain.

There is no such thing as a magic food that cures all ailments, but these are some of the best foods for knee pain. These foods have strong anti-inflammatory properties or help with your bone and/or cartilage health.

In addition to eating these foods, be sure you eat a well-balanced diet and get plenty of exercise. Living a healthy, active lifestyle is the best medicine.

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How To Get Rid of Tendonitis in the Shoulder

How To Get Rid of Tendonitis in the Shoulder

By Vessel Crew

Like most people, you have probably experienced some shoulder pain or nagging shoulder discomfort, but how do you know if it is just a sore muscle or tendon or something more serious? Shoulder tendonitis affects millions of people in the U.S. every year, and it is easily treatable if caught early. This article will help you learn what shoulder tendonitis is and, even more importantly, how to get rid of tendonitis in the shoulder before it turns into something worse.

What is Shoulder Tendonitis?

Shoulder tendonitis, also known as rotator cuff tendonitis, is an overuse injury causing inflammation and irritation of the shoulder tendons and muscles. Impingement syndrome often causes it, where the top bone of your shoulder (the acromion) and part of your shoulder blade (scapula) pinch (impinge) the rotator cuff tendons, resulting in a limited range of motion.

Repetitive overhead movements during activities such as swimming, volleyball, baseball, or tennis increase your chances of developing shoulder tendonitis. Thus, it is also referred to as swimmer’s shoulder, pitcher’s shoulder, and tennis shoulder. Likewise, if you are a painter, carpenter, or have a job that requires a lot of overhead movement, you are more likely to develop this painful condition.

Shoulder tendonitis symptoms include pain when you raise or lower your arm, pain and swelling in the front of your shoulder or side of your arm, and a clicking sound when raising your arm. Other common symptoms include loss of mobility and pain when trying to reach behind your back or sleeping at night. Shoulder tendonitis symptoms may get worse over time if not treated. Additionally, if tendonitis is not treated, it can result in a degeneration of the tendon that becomes tendinosis. You can learn more about what happens if tendonitis goes untreated in our article here. It is essential to know how to heal your shoulder tendonitis early so it does not turn into a more severe injury.

Shoulder Tendonitis Treatments

Shoulder tendonitis is very common, and there are well-established guidelines for getting rid of tendonitis in the shoulder. Treatments range from self-care remedies to physical therapy and injections. If these conservative treatments do not provide relief, surgery and High-energy Shockwave therapy are additional options.

1. Self-Care

If you have shoulder tendonitis, it is critical to start self-care immediately. These treatments help prevent further damage and allow your body to initiate healing. First and foremost, rest the affected shoulder.

Overuse of the arm and shoulder caused the tendonitis in the first place, so taking a break from the repetitive movement that caused the injury will give it time to heal. To reduce inflammation, apply ice three to four times daily for the first 48 to 72-hours and take a nonsteroidal anti-inflammatory drug (NSAID) like Advil or Aleve or a natural anti-inflammatory like curcumin.

Other important things you can do throughout your day are using good posture and avoiding carrying heavy objects with the affected arm and shoulder. Avoiding heavy items includes moving a book bag or purse from your affected shoulder to the other so that the shoulder gets maximum rest. If you must carry something heavy, hold it close to your body and not to your side. Lightly stretching the shoulder throughout the day is also helpful in reducing stiffness but not to the point that it causes pain. At night, try not to sleep on the painful side.

2. Physical therapy

Physical therapy is an excellent next treatment option. In addition to the self-care remedies listed above, physical therapy will include stretching and passive range of motion exercises to restore mobility and reduce pain. Once the pain is under control, the therapist will often add arm and shoulder strengthening movements.

3. Steroid injection

Your doctor may recommend a steroid injection after these other treatments have failed or initially if the pain is severe. Usually known as a cortisone shot, steroid injections provide short-term pain relief but are not a long-term solution.

Cortisone is a powerful anti-inflammatory that significantly reduces or eliminates pain. The doctor may utilize it to decrease the pain, so you can work with a therapist on stretching and strengthening your injury. It is important to note that cortisone shots do not cause or speed healing. In fact, frequent use of steroids can cause tissue damage or tendon rupture, so their use is limited.

4. Surgery

Usually, conservative treatments are sufficient at fixing shoulder tendonitis. But, if you do not heal after several months, you may have a severe case that requires surgery. The surgery is an outpatient procedure where the surgeon debrides the damaged tendon(s). You go under general anesthesia for the surgery, and the surgeon makes an incision, and they scrape away (debride) the scar tissue on the tendon. Then, your arm is in an immobilizer for several weeks.

5. Alternative to Surgery

If you would like to avoid the risks and downtime of surgery, High-energy Extracorporeal Shockwave Therapy (HeSWT) is an effective treatment for your shoulder tendonitis. HeSWT is an FDA approved, non-invasive alternative to surgery for numerous chronic overuse injuries, including shoulder tendonitis. It uses powerful, focused acoustic waves to break apart the scar tissue, trigger the development of new blood vessels, and stimulate your body’s healing response. Only a single session of OrthoWave® is needed, and there is no downtime after your treatment, unlike surgery.

Conclusion

Healing shoulder tendonitis is relatively easy if caught early and properly treated. Unfortunately, it is difficult for most of us to stop doing what caused the injury, and the condition can worsen. The treatment options for how to get rid of tendonitis in the shoulder range from self-care to physical therapy and steroid injections. Conservative treatments work in most cases, but occasionally shoulder tendonitis may require surgery or High-energy Shockwave Therapy, a non-invasive alternative to surgery. The good news is that self-care and medical treatments often work, but if they do not, you have a non-invasive option to surgery that will get you back to doing what you love pain-free.

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How to Prevent Osteoarthritis

How to Prevent Osteoarthritis

By Vessel Crew

What is Osteoarthritis?

Osteoarthritis is a total joint injury where the cartilage in your joint wears away, causing pain and inflammation. The bone under the cartilage, the subchondral bone, is also damaged causing boney growths called osteophytes.

While osteoarthritis can affect any joint, it is most common in the hands, hips, knees, back and neck. Osteoarthritis affects more than 27 million Americans and is more common as we age. While osteoarthritis is widespread and often associated with aging, there are several things you can do to help prevent osteoarthritis and delay its progression.

How to Prevent Osteoarthritis

An old saying goes, “an ounce of prevention is worth a pound of cure.” This saying is very fitting for osteoarthritis because although it is a prevalent condition with no cure, there are many things you can do to help prevent it. Research has shown that the following recommendations will help you avoid or delay osteoarthritis.

Be Active

Physical activity and daily exercise are some of the best ways to prevent osteoarthritis. By being active for as little as 30 minutes per day, five days per week, you will be able to keep your muscles healthy and your joints flexible. Keeping your muscles strong helps take some of the stress off your joints and makes a difference.

Exercise also strengthens the heart and lungs, lowers diabetes risk, and is a critical factor in weight control. Exercise options range from working out at a gym to walks around your neighborhood. Some of the best exercises are swimming and biking because they put very little stress on your joints. If an activity causes your joints to ache, rest, so your joints heal and try to find another activity.

Maintain a Healthy Body Weight

Healthy body weight is critical to reducing stress on your joints and is one way how to prevent osteoarthritis. Your joints are your body’s natural shock absorbers, and less weight means less stress they must absorb during every activity.

With your knees, every 1 pound of weight added means your knees must absorb an additional 2-4 pounds of pressure.

Research has shown that being overweight (having a BMI of 25 or more) increases osteoarthritis chances. The additional weight puts additional stress on joints.

Overweight women have a 4x higher probability of developing osteoarthritis, and it is 5x higher for overweight men. That is significant. On the flip side, maintaining a healthy body weight reduces your chances of developing osteoarthritis dramatically.

In one study, researchers found that women that lost 11 pounds (or about 2 BMI points) decreased their osteoarthritis risk by more than 50%. Extra weight not only puts added stress on your joints, but the associated fat tissue produces cytokine proteins that cause inflammation throughout your body.

In your joints, cytokines can even destroy tissue by altering the function of cartilage cells. Maintaining a healthy body weight is essential to reduce joint stress and inflammation. Daily exercise, a healthy diet, and a good blood sugar range help maintain a healthy body weight.

Control Your Blood Sugar

Maintaining a good blood sugar range is another way to prevent osteoarthritis. High blood sugar levels trigger inflammation and create molecules that stiffen your joints.

Suppose you have diabetes or have an elevated blood sugar level. In that case, it is vital to get your blood sugar levels checked regularly and to talk with your doctor about blood sugar management.

Eating a healthy diet is a great way to manage blood sugar.

Eat Healthily

Certain foods and nutrients are helpful in osteoarthritis prevention. You may have heard how Omega-3 fatty acids, also known as healthy fats, can help reduce joint inflammation. Fish, walnut, canola, soybean, flaxseed, and olive oil are great ways to add Omega-3s to your diet. Studies show that Vitamin D decreases osteoarthritis pain. A great way to add more Vitamin D to your diet is to include fish such as salmon, mackerel, tuna, and sardines. Other tips for preventing osteoarthritis include not smoking and staying well hydrated.

Prevent Injury to Your Joints

Another critical way to prevent osteoarthritis is to prevent musculoskeletal injuries. You may be asking, “How do I prevent an injury that has not yet occurred?” That is a good question, and the answer is surprisingly simple. To start with, be careful with your daily activities. Whether you are exercising or just working in your yard, it is essential to warm up your muscles, ligaments, and tendons with simple stretches. Also, try to use different parts of your body at times so that repetitive motions do not continually stress a joint. Regardless of your activity, there are several things that research has found that it is important to do. These include:

    • Avoid bending knees past 90 degrees
    • When jumping, land with knees bent to absorb the stress
    • Wear proper-fitting shoes that provide shock absorption and stability
    • Exercise on shock-absorbing surfaces when possible; avoid running on hard surfaces such as concrete or asphalt

These tips are essential not only for adults but are also crucial for children. A knee osteoarthritis study found that young people who suffered a knee injury were 3x more likely to develop arthritis, and adults were 5x more likely. Avoiding a joint injury makes a significant impact in preventing osteoarthritis.

Osteoarthritis Treatments

While there is no cure for osteoarthritis, there are treatments that help manage the symptoms. Conservative treatments range from medications and physical therapy to injections that can help decrease pain. If these do not provide relief, your doctor may recommend a joint replacement. There is also a non-invasive option for mild to severe osteoarthritis, High-energy Shockwave Therapy.

For many people with osteoarthritis, conservative treatments and resting the joint provides some relief typically. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin are popular for decreasing inflammation and reducing pain. Steroid injections can also reduce inflammation and relieve pain but may weaken the joint and cause additional cartilage damage. Other treatments include physical therapy and bracing the joint. Of course, decreasing your body weight and eating a healthy diet are also recommended. When conservative remedies fail, your doctor may recommend a joint replacement when parts of the joint are removed and replaced with a plastic, ceramic, or metal prosthesis. While these surgeries are successful most of the time, there is an extensive recovery period.

Osteoarthritis Treatments

High-energy shockwave Therapy (HeSWT) is a non-invasive option that provides long term relief with no injections or medications.

OsteoWave® HeSWT is an evidence-based osteoarthritis treatment proven to decrease pain and increase function.

It does this by improving the health of the subchondral bone that is essential for the adjacent cartilage’s health and by causing your body to heal the inflamed soft tissue throughout the joint.

Conclusion

The best defense against any disease, even osteoarthritis, is a healthy lifestyle. Even though osteoarthritis can be a normal part of aging, there are several things you can do to prevent osteoarthritis. Armed with this information, you know how to prevent osteoarthritis.

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6 Ways to Test for Tennis Elbow at Home

6 Ways to Test for Tennis Elbow at Home

By Vessel Crew

Introduction

“I have never played tennis, but I think I have tennis elbow. How do I know?” If your forearm muscles and tendons are painful where they connect to your elbow, you might have Tennis Elbow. Also referred to as lateral epicondylitis, tennis elbow is an overuse injury that affects people who use their forearms in repetitive motions during work or daily activities. The pain extends at or from the outside bony area of your elbow, the lateral epicondyle. The pain comes from inflammation or degeneration of the tendon. You can do several simple tennis elbow tests at home to determine if you have this painful condition.

Simple At-Home Tennis Elbow Tests

The following are some preliminary tennis elbow tests that you can do at home. You should always follow up with your doctor to see if you need additional testing or there may be other causes for any of your symptoms. The doctor can also discuss your treatment options. Pain during any of these tests is an indication you may have tennis elbow.

1. Palpating

Palpitating is a self-test where you touch the affected area and note any pain, tenderness, or swelling. It is best to sit at a table or desk and extend your forearm out in front of you. Using your other hand, gently touch the bony upper knot outside your elbow, the lateral epicondyle. Slowly increase the pressure until there is pain or you determine there is no pain.

2. The Coffee Cup Test

This tennis elbow test is a simple one. For the coffee cup test, you check for pain while grasping a cup of coffee or any other object. This grasping motion engages the forearm muscles and loads the tendon that attaches to your lateral epicondyle.

3. Resistance Test: Palm and Finger

There are two types of resistance tests for tennis elbow. They focus on either stretching or extending the wrist and forearm muscles that may be affected. For the palm resistance test, stretch your affected arm straight out in front of you with your palm facing down. Your arm should be parallel to the floor. Next, place your other hand’s palm on the top of the extended hand. With the bottom hand (affected arm), try to bend your wrist backward while applying resistance with the palm of your top hand. This action engages the muscles that flex your wrist and attach near your elbow.

You can do this same test but only with your middle finger. Set your arms and hands up the same way, except your affected arm is palm-up this time. Instead of moving your wrist, use your opposite hand to pull your middle finger upward, toward your forearm. At the same time, try to resist the movement of your middle finger.

4. Chair Pick-up Test

For this test, you will need a typical wood or metal chair. Make sure it is light and has a high back. You will try to pick up the chair with just your thumb, pointer finger, and middle finger. With your arm extended and palm down, grasp the back of the chair. With just the three digits, try to lift it off the ground.

5. Mill’s Test

Mill’s test is a test that your doctor will most likely do in the office. This test will have you straighten out your affected arm, so it is parallel to the floor. You will flex the wrist down with your elbow straight, bending your hand down towards your forearm. This movement engages your forearm muscles.

6. Cozen’s Test

Cozen’s test is a second test that your doctor might perform to test for tennis elbow. It is like the Resistance Test. With your arm on a flat surface, like a table, you will make a fist with the hand on your affected arm. You will then rotate your arm inward and bend your wrist upward away from the surface. While you are moving your wrist upward, the doctor will put pressure on the tendon and provide some resistance to your wrist movement or possibly bend your wrist the opposite way lightly. The doctor may ask you to change directions in bending your wrist while he/she gives resistance.

If any of these simple tennis elbow tests cause pain, you most likely have tennis elbow. Your doctor may require further testing to rule out other things, such as arthritis or nerve problems. An X-ray would help identify arthritis. Electromyography (EMG) would help diagnose a nerve problem. Your doctor will most likely order a magnetic resonance imaging (MRI) scan that will ‘see’ the soft tissue of the tendons if you fail to respond to conservative treatments.

Treatments

You have done your at-home tests, and your doctor confirms you have tennis elbow, so what are your treatment options? Luckily, there are several ways to manage and treat your tennis elbow pain at home.

The most important thing you can do to heal your tennis elbow is to stop doing the stressful or repetitive activity that caused the injury. Listen to your body and if it hurts, try to give it some rest. You can use a brace, apply ice, or take nonsteroidal anti-inflammatory drugs (NSAID), such as aspirin, ibuprofen, or naproxen to help manage the pain and inflammation. Steroid injections, such as cortisone, are popular because they help to temporarily reduce the pain and inflammation. But be careful, research shows that they also disrupt the healing process. There are also stretching and strengthening exercises you can do on your own but your doctor will most likely prescribe physical therapy.

If you have tried these conservative treatments and are still suffering from tennis elbow, your next option may be surgery or High-Energy Extracorporeal Shockwave Therapy (HeSWT). With surgery, your doctor will scrape away (debride) the scar tissue that is inhibiting the healing of your tendon. Your elbow will be immobilized for a period for the tendon to heal and physical therapy is often required.

Alternative to Surgery

OrthoWave® is an FDA approved High-energy Extracorporeal Shockwave Therapy (HeSWT) treatment and a non-invasive alternative to surgery. The energy from the shockwaves breaks apart the scar tissue, causes new blood vessels to form, and stimulates your body’s healing response to heal the injury, for long term results. Only a single session of OrthoWave® is needed, and there is no downtime after your treatment, unlike surgery.

Conclusion

Tennis elbow is painful and can affect many aspects of your daily life and work. Hopefully, these tennis elbow tests will help you identify the cause of your pain. As always, visit your doctor for an official diagnosis. Tennis elbow may be common, but it is also preventable and treatable.

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What Happens if Tendonitis Goes Untreated

What Happens if Tendonitis Goes Untreated

By Vessel Crew

Doc, I used to get tendonitis in my knee, but ibuprofen would take care of it in a few days.

Now, no matter what I do, it hurts.

What’s frustrating is that I took a couple of months off, did some physical therapy, and it was feeling good, but as soon as I started ramping back up, the pain returned.

Why isn’t my tendonitis going away this time?

Unfortunately, I hear complaints like this often. The short answer, it is not tendonitis; it is likely tendinosis. This is what happens if tendonitis goes untreated. Their difference requires a longer explanation, but I think it is essential to understand if you want to avoid chronic tendon pain and possible surgery.

Tendonitis vs Tendinosis

I will not bore you with a bunch of medical terms, but It is probably best to start with the meaning of “itis” and “osis.” “Itis” indicates an inflammatory process while “osis” indicates a degenerative process. Tendonitis is an inflamed tendon, while tendinosis is a degenerated tendon. I do not have to tell you which one is worse.

When you overload a tendon with repetitive motions or too much tension, tears form, and you feel pain. Tears range from micro-tears that you may barely notice to complete ruptures that you will definitely notice. Let us focus on the micro-tears. With micro-tears, you will likely have some pain, but it is often one of those “sore in the morning” types of injuries. Your body initiates an inflammatory response when the micro-tear occurs.

Acute Inflammation

Now, I know what you are thinking; inflammation is terrible. Actually, an acute inflammatory response is good because that is your body trying to heal the injury. Blood rushes to the area, which causes swelling, and your body begins repairing the damage. Full recovery from a minor injury typically takes anywhere from a few days to a few weeks, depending on the severity. Still, the tendon fully heals most of the time with the proper rest and treatment.

But be honest, most of us do not give a “tweaked” tendon enough time to heal. We may take a couple of days off, pop some ibuprofen, and slap a brace on before returning to activities because “it doesn’t hurt THAT bad.” The continued stress and possibly additional trauma to the tendon causes a prolonged inflammatory response, or tendonitis.

During this prolonged response that can last weeks or months, your body cannot properly repair the injury. Instead of fixing the micro-tear with healthy tendon tissue in uniform strands, you get disorganized collagen bands, blood vessels, and nerves. This tissue is more like scar tissue and provides no tensile strength.

What Happens When Tendonitis Goes Untreated

It is just a micro-tear; what is the big deal? The problem is that this cycle repeats over the years. Those small scar tissue pockets start adding up to a large area of scar tissue that your body essentially gives up trying to heal. Bam, it is now tendinosis. This is what happens when tendonitis goes untreated.

Tendinosis, the degeneration of a tendon, consists of changes in tendon structure and composition, and no inflammatory response. Instead of white organized fibers, your tendon has disorganized fibers and is thicker with a brownish appearance. What is even worse is that your tendon is now weaker and more susceptible to rupture.

Remember those disorganized blood vessels I mentioned earlier? Well, tendons receive poor blood flow. The disorganized blood vessels further decrease blood flow to the injured area and impede healing.

Tendinosis Treatment

The good news is that tendinosis usually responds to non-surgical treatments such as physical therapy, bracing, and rest. Recovery can take four to six months, but severe cases sometimes require surgery to debride the tendon or High-energy Extracorporeal Shockwave Therapy.

A tendon debridement is when an orthopedic surgeon exposes the tendon and literally scrapes away the scar tissue. I often get asked what it looks like. Well, it kind of looks like snot. After the short surgery, your joint is typically immobilized for six to eight weeks to allow your tendon to heal properly. The total recovery time is four to six months. The results are generally good, but some patients are unable to return to sports activities.

Non-invasive Alternative to Surgery

High-energy Extracorporeal Shockwave Therapy is a non-invasive alternative to debridement surgery and the treatment we specialize. The treatment uses powerful acoustic shockwaves that are focused on the damaged portion of the tendon. The shockwave’s energy breaks apart scar tissue, causes new blood vessels to form, and stimulates the body’s healing processes to repair the damaged tendon.

You can return to routine activities right after your treatment but will have to avoid high-impact activities for about 30 days as the tendon heals. I am a surgeon, and most people think surgeons want to operate on everyone; but even we like having a non-invasive option that is extremely safe and highly effective.

Conclusion

So now you know tendonitis is an inflamed tendon and tendinosis is a degenerated tendon, and what happens when tendonitis goes untreated. I hope you also learned the importance of rest and proper treatment after even a minor injury. Early intervention helps keep your acute tendon injury from turning into a tendonitis and your tendonitis into tendinosis.

Tendinosis requires months to recover and sometimes surgery or High-energy Extracorporeal Shockwave Therapy. Both conditions are preventable. It is best to see your healthcare provider sooner rather than later to save yourself from months or years of pain and frustration if they do occur. Playing through the pain may not seem like a big deal now, but years from now, it may land you in an office like mine.

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Plantar Fasciitis: Symptoms, Causes, Diagnosis and Treatments

Plantar Fasciitis: Symptoms, Causes, Diagnosis and Treatments

By Vessel Crew

Plantar fasciitis is a widespread cause of heel pain and affects about 10% of the U.S. adult population. With such a high prevalence, it is important to understand the symptoms and causes of plantar fasciitis while also looking at what a plantar fasciitis diagnosis means and treatment options.

What is Plantar Fasciitis

The plantar fascia is a long flat ligament on the bottom of your foot. It connects your heel bone to your toes to support the arch of your foot. Like other ligaments in your body, it can stretch within limits and then return to normal.

Foot Plantar fasciitis If too much tension and stress are applied, small tears can form in the fascia. When the condition is new or acute, it causes inflammation of the plantar fascia and is called plantar fasciitis. Of course, many people push through the discomfort. They rarely give the fascia enough time to properly heal, so the body patches the inflamed fascia with scar tissue.

Repeatedly doing this over months or years causes more tears and scar tissue, until your fascia is in a state of degeneration with chronic pain. Not only do you have an area of significant scar tissue now, but the blood vessels in that area are disorganized. These inhibit your body from healing the injury and causing chronic pain.

plantar fascia is a long flat ligament on the bottom of your foot
These are common plantar fasciitis symptoms

Plantar Fasciitis Symptoms

Help! My foot hurts!

If you have felt stabbing pain on the bottom of your foot when taking your first steps in the morning or during activities, then you know plantar fasciitis can be very painful.

You may feel a dull or sharp pain in your heel or the arch of your foot. It may also feel like the bottom of your foot is bruised with a deep ache. The pain is usually worse when you first stand up after sitting, but it may start feeling better as you begin walking and warm up the fascia. These are common plantar fasciitis symptoms. We will talk next about the causes of plantar fasciitis.

Causes of Plantar Fasciitis

Why does my foot hurt so much? Your feet take a pounding every day with the stress of every step, skip, and hop. The plantar fascia is a ligament in your foot shaped like a bowstring that connects your heel to your toes. It supports the arch of your foot and acts as a shock absorber while walking, running, stepping, and exercising.

Small tears form when there is too much tension on this bowstring. The repeated over-stretching of the plantar fascia causes irritation or tiny tears and leads to plantar fasciitis, the plantar fascia’s inflammation.

Plantar fasciitis is one of the most common injuries affecting millions of Americans. Understanding the common causes of plantar fasciitis and risk factors is essential to preventing it. If you are between the ages of 40-60 and are overweight, you are much more likely to develop plantar fasciitis.

Exercises and occupations that put excessive stress on your feet can also cause plantar fasciitis. For example, plantar fasciitis is prevalent in runners, nurses, mechanics, teachers, and other occupations that require much time on their feet. These risk factors, combined with foot mechanics and non-supportive footwear, are among the most common causes of plantar fasciitis.

Common Causes of Plantar Fasciitis:

    1. Age
    2. Foot mechanics
    3. Overweight
    4. Certain types of exercises & Certain occupations
    5. Non-supportive footwear

1. Age

Plantar fasciitis is most common in middle-aged and older adults between the ages of 40 and 60, affecting women slightly more than men. As you age, your feet may flatten, and you may notice a drop in your arch. With this change in foot mechanics, the plantar fascia becomes increasingly unable to absorb and distribute each step’s shock. It becomes stressed and small tears form.

When you are younger, the plantar fascia can quickly repair itself, and your feet can maintain a better arch. With age, the plantar fascia cannot preserve its shape as well, the bowstring relaxes, and your foot arch drops. This does not happen to everyone but is more prevalent with age.

2. Foot Mechanics

Foot mechanics, the foot structure, is another common cause of plantar fasciitis affecting people of all ages. For people with naturally flat or even high arches, the plantar fascia may not effectively support the arch and absorb each step’s shock. Overpronation (foot rolls in), supination (foot rolls out), and abnormal walking patterns can affect weight distribution in your feet and put added stress on the plantar fascia.

Walking with a slight limp due to back, hip, or knee pain can affect your feet as well. For example, some people notice that their feet start feeling better after they treat a problem with their knees. A podiatrist may recommend a pair of orthotics to fit into your shoes for those with low arches. This helps support the foot, improve the foot mechanics, and improve plantar fasciitis symptoms.

The extra pounds put additional stress on not only your heart and joints but also on your feet

3. Overweight

Another common cause of plantar fasciitis is having a high body mass index or being overweight. The extra pounds put additional stress on not only your heart and joints but also on your feet. Since the plantar fascia is a shock absorber, the additional pressure applied in each step from extra weight requires the plantar fascia to absorb more shock. This additional stress and pounding on the feet are a prevalent cause of plantar fasciitis. There is a documented correlation between obesity and plantar fasciitis. Doctors often speak to their patients about the role of weight loss in plantar fasciitis treatment.

4. Certain Exercises and Occupations

Certain types of exercise and occupations also lead to an increased risk of developing plantar fasciitis. Activities that put a lot of stress on your feet, such as long-distance running and ballet, commonly lead to plantar fasciitis. The same is true for jobs that require long periods of standing or walking. Teachers, nurses, mechanics, and other occupations that spend hours on their feet can often develop this painful condition. Whether it is due to exercise or work, these activities can easily overstress your plantar fascia and cause this painful condition.

Activities that put a lot of stress on your feet

5. Non-supportive Footwear

Your choice of footwear can put you at a higher risk of developing plantar fasciitis. Improper shoes put additional and/or unbalanced stress on your feet. The shape of your footwear and the type of footwear chosen for a prolonged activity can negatively affect your foot mechanics and lead to unneeded stress on the plantar fascia.

It is essential for runners that you have good shock absorbing shoes that support your arch and are frequently changed out based on your mileage. If you walk a lot as part of your job or stand for extended periods on hard surfaces like concrete, supportive cushioned shoes are necessary.

Sorry, high heels and flip flops are popular but are non-supportive shoes. High heels are not good because they put your feet in an unnatural position and cause uneven weight distribution. The lack of arch support and heel cushion can put excessive stress on your plantar fascia with flip flops.

plantar fascia is a long flat ligament on the bottom of your foot

Plantar Fasciitis Diagnosis

Suppose you have experienced the plantar fasciitis symptoms listed above and are in a high-risk category. In that case, it is essential to see your family doctor or podiatrist. It would be best if you did not try to self-diagnose your pain as numerous other injuries have similar symptoms.

Doctors base their plantar fasciitis diagnosis on a physical exam and a review of your medical history. While examining your foot, locating the area of pain helps rule out other injuries like Achilles tendonitis. Your doctor might also recommend an X-ray or MRI to ensure that no other problem, such as a stress fracture or nerve entrapment, is a cause of your pain.

Depending on the length of time you have experienced plantar fasciitis symptoms, a doctor will give either an acute or chronic plantar fasciitis diagnosis. It is essential to know and understand the difference between the two because your treatment plan’s effectiveness depends on an accurate plantar fasciitis diagnosis.

Plantar Fasciitis Treatment

If you have experienced plantar fasciitis symptoms for fewer than six months, you most likely have acute plantar fasciitis. If your symptoms have persisted for more than six months, there is a high likelihood that you have chronic plantar fasciitis.

Plantar fasciitis treatments range from conservative therapies, such as icing and rest, to surgery or a non-invasive High-energy Extracorporeal Shockwave Therapy treatment.

For most acute plantar fasciitis sufferers, conservative treatments and rest usually work. Most people start with rest and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, to decrease inflammation and reduce pain. A steroid injection can also reduce inflammation and relieve pain, but multiple injections may weaken the fascia and cause additional damage.

Other treatments include physical therapy and night splints to stretch and strengthen your fascia. Orthotics may help provide support and evenly distribute pressure on your foot. A change of footwear to shoes that provide cushioning and support to the foot is often necessary.

Of course, decreasing your body weight and modifying activities to reduce your fascia stress are also recommended. When conservative treatments fail and you have chronic plantar fasciitis, your doctor may recommend plantar fasciotomy surgery or non-invasive Extracorporeal Shockwave Therapy treatment.

Alternative to Surgery

Conservative treatments may help reduce symptoms of chronic plantar fasciitis, but sometimes the fascia is too degenerated. Your doctor may recommend plantar fasciotomy surgery where the fascia is partially cut to release the tension. You also have a non-invasive option.

OrthoWave® is an FDA approved High-energy Extracorporeal Shockwave Therapy (HeSWT) treatment and a non-invasive alternative to surgery. Only a single session of OrthoWave® is needed, and there is no downtime after your treatment, unlike surgery. Since 2010, HeSWT is recommended over the surgery by the College of Foot and Ankle Surgeons because it is exceptionally safe and highly effective.

Conclusion

Plantar fasciitis is painful and can affect every aspect of your life. Hopefully, this has helped you better understand the symptoms, causes, diagnosis and some treatment options. Plantar fasciitis may be common, but it is also preventable. Listen to your body and take care of your feet to reduce your risk of getting this painful condition. You do not have to live with the pain of plantar fasciitis as there are numerous treatment options to get you back on your feet and doing the things you love again pain free.

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Is Running with Patellar Tendonitis Recommended?

Is Running with Patellar Tendonitis Recommended?

By Vessel Crew

What is patellar tendonitis?

Patellar tendonitis, otherwise known as jumper’s knee, is an inflammation of the tendon that connects your kneecap (otherwise known as the patella) to your shin bone. This inflammation is usually brought on by overuse of your knee from activities like jumping or running. Patellar tendonitis is usually associated with pain with jumping or running, pain around your kneecap, or behind the lower part of your kneecap. You may also have swelling around the knee and pain with bending/straightening of your knee. Other symptoms can be present, as everyone is different. There are different grades of patellar tendonitis ranking the severity, with Grade 1 being the lowest and Grade 4 being the most severe. Grade 1 is mild patellar tendonitis, with pain present only during certain activities like running or jumping, and Grade 4 is severe patellar tendonitis, with pain being constant and severe. Only a healthcare provider can make an official diagnosis.

Running with Patellar Tendonitis

Running is not recommended when you first injure your patellar tendon. However, once pain has become mild or completely reduced, it is appropriate to begin a modified running regimen. If pain is noticeable when you run in shoes with a bigger ‘drop’, which is the height difference between the heel of the shoe and the forefoot, you can switch to a more minimal type shoe to help offload the knee. The minimal and barefoot style shoes remove the load from the knee and place more of the load to the foot and ankle. You can also slightly increase your running cadence, or steps you take in a minute, which can help reduce load from the knee. Also, improving your running form by running tall to prevent over striding and utilizing the piston cue technique can also be beneficial to preventing additional stress to the knee. It is best to keep in mind that if your pain level goes above 4 out of 10 and does not settle within 24 hours of exercise, it is best to stop running with patellar tendonitis.

Ok, I have it. Now what?

Typically, conservative treatments are effective at fixing patellar tendonitis. This includes applying ice for 10-15 minutes several times a day to reduce swelling, resting your injured knee and temporarily stopping activities that cause pain, taking nonsteroidal anti-inflammatories (NSAIDs) as needed for pain, and incorporating stretching and strengthening exercises. You can also wear a brace to help support the knee while running with patellar tendonitis. If the pain continues, you can seek additional help from a physical therapist. They will be able to show you different stretches and strengthening exercises that will help strengthen the muscles around the kneecap, reducing the strain and improving pain. Once the pain has stopped, you can gradually begin running again but keep in mind to ease back into your exercise routine slowly as to not reinjure your tendon. If conservative treatments have failed and you continue to have pain, surgery or non-invasive High-energy Extracorporeal Shockwave Therapy may be required. With surgery, your knee is put in an immobilizer for 6 to 8 weeks and recovery time can take 6 to 12 months. With High-energy Extracorporeal Shockwave Therapy, there is no downtime after the procedure buy you must avoid high-impact activities for at least 30 days before easing back into those activities.

Stretch, stretch, stretch

There are several exercises that can help stretch and strengthen the muscles and tendons around the patellar tendon. The four common stretches are the standing hamstring stretch, quadriceps stretch, side-lying leg lift and the rectus femoris stretch.

    • The standing hamstring stretch helps the hamstring muscles become less tight, which can reduce the pulling of the knee. Tight hamstrings also contribute to low back pain. To do this exercise, put the heel of the leg on the injured side on a solid, stable surface that is about 15 inches high. This can be a stool, a box or a chair. Keep your leg straight and lean forward, bending at the hips, until you feel a slight stretch in the back of your leg. Hold this position for 15 to 30 seconds and repeat several times.
    • The quadriceps stretch helps loosen the quadriceps. When the quadriceps muscles become too tight, they can pull on the patella, causing pain. This is a standing stretch, so be sure to have a wall or stable surface to hold for support. Stand on your uninjured leg, with the same hand holding the wall or stable surface for support. Grab your leg on the injured side, near the ankle if possible, and pull the leg towards your buttocks. You should feel a slight stretch in your quadricep muscles. Hold this position for 15 to 30 seconds and repeat several times.
    • The side-lying leg lift is a body weight exercise that helps strengthen the hip adductors and glutes. Hip instability can increase risk of injury for runners. Lie on your uninjured side and tighten the front thigh muscles on your injured leg and lift 8-10 inches away from the other leg. Be sure to keep the leg straight and to have slow, controlled movement. Do 2 sets of 15.
    • The rectus femoris stretch stretches the rectus femoris muscle which is a part of the quadriceps muscle. This muscle is responsible for knee extension and when it becomes overly tight, can lead to knee pain. For this stretch, kneel on your injured knee on a padded surface, and place your other leg in front of you with your foot flat on the floor. Keep your head and chest forward and upright and grab the ankle behind you. Slowly pull your ankle back towards your buttocks until you fee a stretch in front of your thigh. Hold for 15 to 30 seconds and repeat several times.

Before running with patellar tendonitis, it is recommended that you see your primary care physician if pain continues despite rest and self-care treatments. They can appropriately diagnose and provided alternate treatments and medications for your patellar tendonitis that would not be available to you otherwise. It is best to treat patellar tendonitis before it escalates and becomes too severe for conservative treatments.

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