An activity that is very repetitive or experiences high forces can lead to tendonitis, and in chronic cases, tendonosis.  Excessive or prolonged strain in a tendon or muscle causes micro-tearing in the tissue that leads to scar formation and pain. Over time, the tissue quality is poor and resists basic treatment protocols such as RICE (rest,ice, compression and elevation). The scar tissue that has formed from the chronic micro-tearing  is painful and unhealthy due to it having poor flexibility, poor capillary blood supply, and decreased tensile strength.

In climbers, extreme loads can be placed on the muscles and tendons in the forearm and elbow, leading to elbow tendonitis. Elbow tendonitis is also common in golfers, musicians, and tennis players. Achilles tendonitis and plantar fasciitis are common in runners and hikers. Patellar tendonitis and IT band syndrome are seen commonly in bicyclists, just to name a few examples.

Chronic tendonosis needs active management to ensure proper healing. Rest itself will rarely work, as the tendon is weak and will experience further micro-tearing  when you return to sport. I have found that Instrument Assisted Soft-Tissue Mobilization (IASTM) with the proper tool and technique is essential to treating chronic tendonitis. In addition, decreasing the load on the tendon through trigger point release, Dry needling, and active stretching are integral to the healing process. Proper loading of the tissue with functional strengthening and sport specific activity is also extremely important as it is a key component needed to help return the tendon to its proper strength.  Eventually the tendon will be able to handle the loads you wish to place on it with the sports you love.

Key Principles:

1. Remodel the scar tissue into a healthier alignment of collagen fibers with the use of scar remodeling (IASTM) tools
2. Treat trigger points in the muscles in order to decrease the load on the healing tendon
3. Work the tendon and muscle complex with eccentric muscle contractions, and use stretching to achieve a proper length-tension relationship
4. Progressively and carefully load the remodeled scar tissue  with sport-specific activities to improve tensile strength of the collagen fibers

In today’s eroding health insurance market, many clients find it is more cost-effective to pay out of pocket for quality care. Often, the insurance rate is more expensive (because it needs to be in order to run an insurance-based clinic),  and you may spend less one-on-one time with your therapist, and end up with more appointments to achieve your goals.  There is a trend towards cash-based PT clinics to help meet the demand of clients who want quality care, without the hassle of going through insurance.

At a traditional insurance clinic, you may see the PT for only 15-30 minutes out of your appointment, and depending on your plan, may pay a steep rate up front until meeting your deductible.   For example, if  you see a PT at an insurance-based clinic for 10 visits to achieve your goals, at $100 -$140 total per visit (includes co-insurance), this would equal $1,000 – $1,400 out of pocket (this also goes towards your deductible).  At Realign PT, with an hour visit of high quality one-on-one care, you may see the PT for 6 visits to achieve your goals.  At $90 a visit, that equates to $540.00 out of pocket.

It is unfortunate that health care costs are continuing to rise for everyone, and the system is quite broken.  Many times, someone is seeking therapy for a chronic injury, or acute back pain, and is not going to meet their deductible.  In that case, it may make more sense to pay cash and avoid dealing with insurance.   Additionally, the quality of care should play into the decision making when seeking out treatment.

At Realign PT, I offer quality one-on-one care at a reasonable price. Although Realign PT is out-of-network with insurance plans, I can give any patient a Superbill, which can be turned into insurance for reimbursement if you have met your out-of -pocket max for the year.  All Physical Therapy is not the same, and you deserve individualized superior treatment.