Tendonitis

[CANOPY SAM]

Fargo is 2 hours from home. Grand Forks = 1 hr. Bemidji an hour and a half. Find someone I can work with up here and I'll give em' a call. Thanks.

[JigginGopher]

I sincerely hope DrJuice is not referring to the ARPwave machine. The ARP is the biggest scam in medicine today. When it was first introduced they actually claimed athletes with torn ACLs could use the ARP and heal the torn ACL!!! Not to mention the money scam behind it. The ARP people charge a ridiculous amount of money to buy or rent a machine then charge you for every protocol! So if i purchased an ARP machine to treat my knee but later injure my wrist and want to use the ARP on it, the ARP people will not tell me how to use my machine on my wrist until I buy the wrist protocol from them. Its a joke. Put it on the shelf next to the snake oil.

[DrJuice1980]

That is 100% false. You are given access to all protocols online, 60 hours of support, and the rental amount is more than reasonable. The reason for complaints is that it is intense and not everybody has the gonads to put up with it and they want a quick fix pill rather than something that requires hard work and dedication. Time and dedication is required and too many people dont want to help themselves out. Your statements about it are 100% wrong in every way.

Why would all these athletes trust their multi-million dollar contracts with us? Why would the Vancouver Canucks invest tens of thousands of dollars on our system/program? Why would Tim Thomas, while receiving his Vezina trophy talk about how it got him back on the ice? Why would Dwight Freeney endorse us on Mens Health? I know, because he was able to play in the superbowl 3 yrs ago because of it, youtube it.

http://www.menshealth.com/mhlists/Dwight_Freeney_Workout_An_Inside_Look/printer.php

Why would all this happen if it was a scam? Look at Mike Green's (NHL) season last year, in and out in and out of the line up until he came to MN, then what happened? Oh yeah he got back out on the ice and inked an extenstion for 3 years $18.25 mil. Huh, weird.

http://www.usahockeymagazine.com/article/2008-09/wave-future

ACL:

http://www.arpwave.com/orthopedic1.htm

ACL:

http://www.altoonamirror.com/page/content.detail/id/553276.html

weird

ACL recovery study:

http://www.arpwave.com/media/docs/ARP_Abstract.pdf

weird

Nobody is charged for protocols unless you want a custom strength program with the POVSport. All rehab/injury protocols come with the license. And if you rent one, not only you can use it on your issues but others in the home can.

Did you know there are many high level athletes that have played without ACL's? John Elway, Dejuan Blair, Hines Ward just to name a few.

You can have your opinion but come with facts next time pal.

[DrJuice1980]

Nothing can heal a complete tear and there was never a statement made about complete tears. Partial or ruptures is what it was referring to because it has happened in many documented cases.

Have you ever even tried it? Probably not, probably just read a bunch of banter online. You could probably google any med-large scale company and find complaints. You cant please everybody. And when relying on others to do the work they need to that is difficult. Would $750 be an unreasonable cost to fix your tendinitis? I think most would agree that is reasonable.

[nofishfisherman]

There appears to be some anecdotal evidence that the ARP therapy can work. However, there seems to be a lack of actual medical research supporting the claims. The one linked above is all that I could find and it only talks about using the treatment to strengthen one muscle after an ACL surgery. There appears to be no research on its effectivness on tendonitis or anything else. Also it appears at least one person involved in the research is employed by ARPWave. I'd like to see a study conducted without anyone having ties to the company that might skew results.

I certainly don't think it does any harm. If a pro athelete wants to throw a few of their millions of dollars at it so be it. There is no real financial risk for them. If it gets them on the field a day sooner its probably worth the $10,000 they plunked down.

It is also true that an ACL isn't entirely necessary. My dad torn his over 30 years ago and has lived without it. Although now he's looking at a total knee replacement because believe it or not the ACL is meant to be there supporting the knee. If its not there the rest of the joint and muscles have no choice but to compensate for it which leads to a break down in other areas.

[nofishfisherman]

Nothing can heal a complete tear and there was never a statement made about complete tears. Partial or ruptures is what it was referring to because it has happened in many documented cases.

Have you ever even tried it? Probably not, probably just read a bunch of banter online. You could probably google any med-large scale company and find complaints. You cant please everybody. And when relying on others to do the work they need to that is difficult. Would $750 be an unreasonable cost to fix your tendinitis? I think most would agree that is reasonable.

I think you're getting a little defensive. You may believe in the treatment and thats fine. But if we look at the info that is out there most of us can't help but be skeptical about it. And yes, $750 is a lot of money for something that we have reason to be skeptical about.

[DrJuice1980]

In reponse to that, what in the medical field would you not be skeptical of? This is not your only means of recieving the therapy. There are many Chiropractors that have licensed and use. We also gained clearence for insurance billing and it will soon be more mainstream and your insurance can pick up the bill. Also the $750 is for in-home use and allows you to fully conduct the protocols and eliminate the compensation for many of ailments rather than visiting a Dr and getting 3-5 treatments per month because your schedule makes it difficult to be there on a consistant basis. Only getting defensive because the claims jiggingopher made are 100% false in every way.

[DrJuice1980]

Nofish, you can come see me for no charge and I will clear your skepticism. Just keep it down about me posting while on the clock....

[CANOPY SAM]

Although now he's looking at a total knee replacement because believe it or not the ACL is meant to be there supporting the knee. If its not there the rest of the joint and muscles have no choice but to compensate for it which leads to a break down in other areas.

Well there it is then! Your Dad just needs neurological muscle retraining! Who knew?

[JigginGopher]

"Why would athletes trust there multimillion dollar contracts with ARP" is a pretty poor argument. Athletes are not educated in medicine and can be very impressionable when a good sales pitch is thrown at them. Deer antler spray and holographic stickers anyone??? I'm very familiar with the fact that high level athletes have played sports while being ACL deficient. To my knowledge it is only for short periods of time however and more damage to the knee is usually the outcome. In addition to nofishfishermans comments regarding the studies, the ACL recovery study is a poor model. One group had the ARP/exercise protocol while the control had "traditional rehab and physical therapy" performed. Who determined what "traditional rehab and physical therapy" was? Why not state what the control group actually did for rehab? If the ARP group did their exercises while the control group just did straight leg raises or something then the same results would be seen and the ARP would not have been the difference. Seems pretty brainless to me that a better model would have been for both groups to do the exact same exercises while adding the ARP to one of the groups. Not completely discounting the ARP and its claims but ARP definitely has put the chart in front of the horse in regards to the claims it has made and the research it has to back them up.

[DrJuice1980]

Referrals from other athletes that have used it for recovery and had great outcomes is not a sales pitch. Being brought through a strength program and seeing/feeling the benefits is no sales pitch. I offer anybody out there that wants to try it to come in and see for themselves. How can a sales pitch deliver pain relief and an increase in mobility? It can not, but the treatment can. There will be zero pressure, your results will close the deal, not me.

[JigginGopher]

DrJuice - In regards to you calling my statements about the ARP business model 100% false, those statements were made based on what some athletes that have tried the ARP relayed to me. That was 2-3 years ago now so perhaps your business model has changed. If so, i apologize for putting a negative spin on how you make a buck.

[graf703]

This one certainly got fun rapidly. ARP is pretty controversial amongst my patients that have tried it. One can't disconnect the bare truth that there is never a cure all for every individual.

ARPwave is just one of the many tools that chiropractors may choose to use. Personally, I'm a hands on guy and I enjoy my results with hand on techniques. One other thing to consider is a chiropractor that also looks outside the spine. I've had several patients with damaged wrists leading to elbow problems. I could adjust their spine forever and never fix tennis elbow if it is caused by a wrist that can barely move. The resistance of the wrist's range of motion led to the overuse and irritation of the origin of the wrist extensors.

[DrJuice1980]

I'm sure it was more like 4-5 years ago because it hasn't been that way while I've been there. And I would most likely feel the same. Its not all about making a buck, I enjoy helping people and I have seen the system do amazing things, from rapidly healing a bad sprain to helping someone avoiding a joint replacement, just finished with a gal who was facing double knee avoid it and is now walking on the beach everyday wet and dry sand. Working with RSD/CRPS patients as of late and dramatically increasing their quality of life is rewarding. Graf, you are correct, there is no such thing as a cure all. Bone spurs/impingements suck. The ARP is a hands on approach that you should look into more if you are an ART guy you would love it. It will also boost you patient load and retention and allow you to bill insurance for 20 sessions.

Sorry if this has hijacked the topic, I didn't want that to happen. I didn't want to bring the system up, all I wanted to do was share opinions and facts. Read the thread and you will find others brought the attack to me. Seems like a lot of over opinionated outdoorsman on the site that look for help but only talk about what they think. Ironic. I keep an open mind and you all should too, Canopy Sam did, others just look for debate, seems like everybody wants to be a Skip Bayless.

[delcecchi]

Gee, no wonder DrJuice was so reticent about his medical training and background.

FDA approval looks more like safety, with a bunch of devices all lumped together as "substantially equivalent"

ARpwave is based in Apple Valley, and they seem to have had an occasional problem with overpromising.. consent agreement

[DrJuice1980]

More so an attorney issue with typing up a contract and looking into each states rules and regs. As well as an individual who thought they really didn't need to lift a finger to work. Delcecchi, do you really have that much hate in you that you troll forums to bash people. You seem like a pretty sad individual with too much time on their hands. I never had to pay a dime, certain individuals can prove them selfs, I guess I did that. Good research, I'm sure all the positive things you saw didn't make it on here cause youre a miserable negative person. The FDA comment was good too, did you happen to read others? That term comes up quite often but only a narrow minded person such as yourself would see it that way. I feel bad for your wife.

[CANOPY SAM]

C'mon guys. This isn't necessary. I was likely the cause of some of this controversy, at least on FM, because some of the "science" behind this technique didn't really add up in my head. Some of it still doesn't.

All of that aside, if this procedure works, and provides pain relief or complete resolution to some (but not all) it's a successful procedure. Insults and demeaning comments aren't welcome here.

What Juice says a few posts back is absolutely true. He/she (I don't know which) tried to keep the details of the procedure off the site. He didn't overtly try to sell it to anyone, and still hasn't. He was simply offering a possible solution for tendonitis....that's what this thread is about.

Emailing, blogging, whatever, is a poor way to communicate very detailed information, and it too often results in misunderstood emotions. Or perhaps too often people attempt to interject emotion into the conversation, and end up failing miserably, like I so often do.

Either way, let's please keep it civil. It's been a very interesting conversation, and honestly, I'd try just about anything to alleviate my issues with pain, and tendonitis. I appreciate the open candor. I don't like to see the discussion get ugly.

[delcecchi]

Other than asking for some indication of knowledge in the form of training or credentials, I wasn't the one with personal attacks. But to get things back to a more knowledge based thing, here is an article about a new study on "tennis elbow"

The article is from "Medpage today" and the link is to the original study in the JAMA.

Tennis Elbow

Quote:

(from medpagetoday. I posted the whole thing since I think you need to register to get access.

Corticosteroid injections and physical therapy, either individually or in combination, failed to help patients with "tennis elbow" except for a short-term benefit seen with the steroids, a randomized trial showed.

Steroid injections improved pain and overall joint function when evaluated at week four, either alone or combined with physical therapy, but no therapy in the four-arm trial outperformed a placebo injection alone at later follow-up, according to Bill Vicenzino, PhD, of the University of Queensland in St. Lucia, Australia, and colleagues.

Improvements from baseline at weeks 26 and 52 were effectively the same in 165 patients receiving steroid injections alone, steroids plus physical therapy, placebo injections plus physical therapy, or placebo alone, the researchers reported in the Journal of the American Medical Association.

And in the two groups receiving steroids, symptom recurrence was more common than in patients assigned to placebo injections.

"There was a worse clinical outcome 1 year after corticosteroid injection compared with placebo, despite its short-term benefits," Vicenzino and colleagues wrote.

They also concluded that physical therapy did not show "any significant 1-year differences" in outcomes.

Known technically as lateral epicondylalgia, tennis elbow is a common orthopedic complaint. Steroid injections, once a mainstay of treatment, have lost popularity in recent years after it became apparent that the effects do not last long, Vicenzino and colleagues indicated.

But many physicians have continued to give them in combination with physical therapy in the hope that the latter would improve long-term outcomes. This strategy had not been tested in an adequately powered prospective trial, leading Vicenzino and colleagues to conduct the current study.

They randomized 165 patients to the four treatment arms between 2008 and 2010, with follow-up in 2011. Although patients and treating physicians were aware of the physical therapy assignments, outcomes assessments were performed by blinded evaluators.

Those assigned to the steroid injections received a single dose of 10 mg of triamcinolone acetonide and 1 mL of 1% lignocaine.

Physical therapy consisted of eight weekly half-hour sessions of local elbow manipulation and exercise. The first session preceded the first injection of steroid or placebo. Therapists individualized the treatment according to patients' abilities and progression, seeking to increase the exercise level as time went on without worsening pain.

Patients in the physical-therapy groups also were instructed to perform a twice-daily exercise regimen at home, involving grip retraining and exercises for the wrist extensors involving elastic bands.

Improvement was scored by patients on a scale ranging from "much worse" to "complete recovery" at weeks four, eight, 12, 26, and 52. Recurrence was defined as scores of "complete recovery" or "much improvement" at weeks 4 or 8 followed by worse reports at any of the later evaluations.

Patients also reported pain on a standard visual analog scale and completed questionnaires on pain and disability, health-related quality of life, use of painkillers, and adverse events.

Results at week four greatly favored the two steroid groups. The percentage of patients reporting complete recovery or much improvement was 71% (95% CI 52% to 85%) in the group receiving the injections alone and 68% (95% CI 47% to 83% ) for those assigned to steroids plus physical therapy.

In contrast, only 10% (95% CI 2% to 28%) of those receiving placebo injections alone and 39% (95% CI 22% to 59%) of those receiving placebo plus physical therapy reported the same degrees of improvement.

Similarly, mean worst-pain scores reported at week four in the two steroid groups were close to 0, whereas in the placebo-alone group the mean was 56 on a 100-point scale (95% CI 30 to 70), and 35 in the placebo-plus-therapy group (95% CI 15 to 45).

By week 26, however, the advantage for steroid injections had vanished or, by some measures, reversed.

Reports of complete recovery or much improvement came from 56% and 54% of the steroid-alone and steroid-plus-therapy groups, respectively, compared with 83% and 89% of the placebo-alone and placebo-plus-therapy groups, respectively. Mean pain scores did not differ among the four groups at week 26.

Symptom recurrence was also more common in the two steroid groups (55% and 54%), versus 20% with placebo alone and 5% with placebo plus physical therapy.

Vicenzino and colleagues calculated a relative risk of 0.79 (95% CI 0.62 to 0.99) of complete recovery or much improvement at week 26 for steroid injections versus placebo, irrespective of physical therapy assignment. At week 52, the RR was 0.86 for steroid versus placebo (95% CI 0.75 to 0.99).

The risk of recurrence was cut nearly 80% in the placebo groups relative to steroids (RR 0.23, 95% CI 0.10 to 0.51).

The same overall pattern of results was seen in other outcome measures, such as scores on the quality-of-life and pain and disability questionnaires. Patients receiving the steroid injections tended to report better improvement early in the study, but steroid treatment had no advantage or produced even worse scores at later evaluations. Physical therapy showed little or no benefit regardless of whether it was provided with placebo or with steroid injection.

An exception to the latter was that use of analgesics and anti-inflammatory drugs was significantly lower in patients receiving physical therapy: 20% in those groups compared with 40% of the patients receiving injections alone (P=0.008).

Adverse effects "were minor, transient, and not significantly different between injection and physiotherapy factors," Vicenzino and colleagues indicated.

Limitations to the study included the enrollment restrictions to patients with unilateral symptoms and those without recent treatments or history of repeated steroid injections, and the lack of patient and therapist blinding to physical therapy assignment.

The researchers also noted that the results should not be generalized to all clinical situations involving lateral epicondylalgia, such as patients not recovering after physiotherapy.

The study was funded by the Australian National Health and Medical Research Council.

I take this to mean that in the long run treatment doesn't make much difference. In the short run, shot makes you feel better. But of course interpret it for yourself.

[amateurfishing]

on a personal level i can agree with those findings. i still do excersises occasionally when pain flairs up along with ibuprofen/acedomedaphin. cortizone has never worked for me and on a few occassions actually made me/problem worse. to date, i just deal with it on a daily basis as i need to and have even canceled a fishing outing (when bad enuff) if necessary.

[DrJuice1980]

Short term care of injections that mask pain tend to mean damage is continuing to happen, it is just not felt. Symptom recurrence was also more common in the two steroid groups (55% and 54%), versus 20% with placebo alone and 5% with placebo plus physical therapy.

Injections/Pain meds are not a fix, it actually will make things worse in the future both to the site and to internal organs. Then you will see a Dr for that and you will require additional services that cost money. Kind of a cycle isnt it? Seems cash driven instead of patient outcome driven. The all mighty dollar rules all.

[TR21HP]

I have had excellent results with active release therapy, graston technique and stretching with treatment on plantar fascitis as well as elbow tendonitis to the point now that I have no pain at all if I follow the stretching exercises and don't go nuts with too heavy lifting. The chiropractor that I go to has an entire wellness approach that not only targets the specific injury but what triggered the injury as spoken about by several members here. You can quote all sorts of studies but personal experiences and their success are whats important.

[PierBridge]

Quote:

on plantar fascitis

Can you, Doc or Sam give me a rundown on what you have done with Plantar problem's.

I had some heel problems that started 2 summers ago... I originally noticed it at the end of the day when I was reaching down to untie my shoes. It basically felt like I had a piece of glass or a neeedle in my heel. I did a little research and found a couple of things that seemed to help. One was rolling a tennis or golf ball in the arch and heel area and the other was to put the front of my foot up in the air against something and stretch the foot.

That seemed to take care of the problem for the most part along with some New shoes and arch supports.

I do a lot of sports officiating on different surfaces and I'm on my feet a lot so thats one of motivators in my new found training regime. I have lost 20 plus pounds so that will help. My problem now is I have a real tender heal bone area where if anything touches the back of my foot it really hurts even putting on a shoe carelessly can hurt pretty bad, if I bang in on something it's excruciating pain... I'm wondering if thats Plantar related or maybe an Achilles problem.

Great thread and thanks much to all participants!

Pier~

[DrJuice1980]

It sounds like the compensation that you had stemming from your plantar issue is showing itself in another area, you have developed a new pattern due to adaptation. It is most likely all related. You may also be developing RSD/CRPS (I sincerely hope not). Other than banging it on something is there a certain active movement that triggers it as well? What have you done for relief? Do you also have hammer toes?

Try this:

put a pencil or pen on the ground (carpet preferred) keep your foot flat and always pointed straight ahead. Be seated in a chair, 90 degrees at knee and pointed straight ahead. pick up the object with your toes, lift object off ground bringing your toes and balls of feet off ground and keep heel down. Do not compensate by moving any other part of your body. only your toes should curl in and ball of foot lifted up.

Without knowing more this is what I would tell you.

[PierBridge]

Thanks Doc.

I don't have hammer toes.

I still have some soreness after work-outs on the treadmil, I'd say more of a mild overall heal mid arch soreness very manageable pain wise but not the pain I get when I whack the bone. Also I don't seem to have any more of an issue with it if I am running or walking on the treadmill. I do roughly 150 Broomball games a season and I have noticed my feet feel great if I wear my Rocky boots, which I do when its cold versus the Broomball shoes which are basically 2 inch thick rubber souls.

I was thinking it was probably all related to but I haven't had the needle glass feeling for a long time. In the summer if I'm real sore I'll ice on occasion and that seems to help.

I'm not totally alarmed at this point but I'm just hoping it doesn't deteriorate from where I am at right now.

I'll give your suggestions a try. I know trying to fix stuff on the internet or phone is nearly impossibly but thanks much for the direction and tips!

[TR21HP]

Pierbridge, what kind of arch supports did you get?

I got mine custom made by good feet that are fitted to your feet through a mold. It really makes a huge difference versus some store bought ones.