JULY 11, 2012

Time wounds all heels

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dr daveThetis, a gorgeous Greek goddess of the sea, was courted by several high-ranking gods including Zeus, Poseidon and Gordo son of Bacchus. But due to your basic Greek curse-de-jour she was condemned, like most women, to marry a mere mortal man. Not terribly pleased about this, Thetis made the life of her mortal hubby, poor Peleus, a living hades.

Each time Peleus tried to hold Thetis, she had the irritating habit of transforming herself into a tree or fire or a tiger, earning her the title of goddess of PMS. Finally the odd couple did manage to have a little bouncing baby demigod, Achilles. Wanting him to be immortal, Thetis (not exactly being the brightest lighthouse on Olympus) held Achilles by the heel and dipped him into the river Styx, immortalizing all but his heel. Achilles went on to become the hero of the Trojan War against the Sheiks. But eventually, archenemy (heelenemy?) Paris, shooting with the accuracy of a Lord of the Rings elf, landed an arrow smack dab into Achilles’ heel, mortally wounding him and proving the old adage, “time wounds all heels.”

Achilles’ heel didn’t, and as a result he passed into Greek mythological death, ensuring himself a lucrative deal as a constellation, a sports shoe or a tendon. A tendon is that tough sinewy end of a muscle that connects the muscle to a bone. (A ligament connects a bone to a bone.)

Painful tendons are commonly caused from overuse. Athletes (be they competitive, weekend warriors or the New York Rangers) commonly overuse a tendon until it develops wee cracks and tears and starts to degenerate. Most doctors do not know the difference between a tendonitis and a tendinosis. Fortunately, most physiotherapists do.

“Itis” refers to inflammation of a particular organ or tissue. Meningitis, appendicitis, bursitis, arthritis, tonsillitis, hepatitis, colitis, etc all refer to swollen and inflamed organs. But tendons rarely get inflamed. Tendonitis therefore is as mythical as Thetis, Zeus or Bertuzzi. Instead, a sore tendon is commonly a tendinosis, a painful degeneration of the tendon caused by microtrauma, aging or poor blood flow. Anti-inflammatory pills do not help! But I guarantee that 8.7926 doctors out of 10 will recommend anti-inflammatory pills for what they perceive is tendonitis. Treatment, however, should be geared towards both preventing further collagen degeneration in the tendon as well as stimulating collagen synthesis. Treatment includes specific strengthening, deep friction massage, laser, appropriate rest (may take months), surgery and more recently the use of Botox.

Five tendons that commonly get into trouble include the:

Achilles Tendon: Achilles tendonitis refers to pain in the calf as a result of overuse, usually in runners. This is the only tendinosis that does not occur where the tendon attaches to the bone, but rather where the tendon connects to the muscle. Hence pain is not at the heel but more towards the lower calf. If allowed to continue to degenerate, this tendon can rupture with devastating results.

Patellar Tendon: Just below the kneecap, the patellar tendon can be worn out through extensive jumping or squatting. Known as jumpers’ knee.

Tennis Elbow: Tennis elbow is a tendinosis of the top of the elbow (hold your arm out straight with palm down and press the top of your elbow). It is actually caused by anyone who overuses the wrist, not the elbow! So named because it occurs in a tennis player who snaps the wrist backwards for a backhand shot or a backhand slap across their doubles partner’s skull.

Rotator Cuff: Occurs in the shoulder of swimmers, pitchers or in older folks who fall on the shoulder. This tendon can easily progress to a tear causing the shoulder to hurt all night. Surgical repair is necessary.

Golfers Elbow: The bottom of the elbow is sore, again from overuse of the wrist. So named for the strain put on the tendon by golfers constantly bending their clubs around the neck of the nearest tennis player.

Learn more and meet Dr. Dave or contact him at www.wisequacks.org.