Chockstone Forum

      Sponsored By
      ROCK
   HARDWARE

Chockstone Photography

Australian Landscape Prints

Chockstone Forum - Accidents & Injuries

Report Accidents and Injuries

Author

Tendonosis of long head of biceps

Wendy

20-Apr-2012
6:49:50 AM

Ok, enough of this bickering about bolts, I need some helpful information here!

This is the latest in my fortunately not too long list of climbing injuries. Sadly, it's still ruining my whole life 3 months after it first flared up. The most common piece of medical advice is that unmentionable 4 letter word starting with R. I also have a referral for cortisone injection. Which i'm mildly scared of getting.

Anyone else dealt with this?


Groveller

20-Apr-2012
7:35:55 AM

I work in the health care sector, I wouldn't be afraid of a cortisone injection. They work well, are lots better than surgery and help your injury improve faster. Good luck!


tnd

20-Apr-2012
8:55:31 AM

I had a lot of problems at the other end of the bicep with my distal biceps tendon - the one joining the bottom of the biceps to the forearm - several years ago. Ultrasound showed it to be frayed like an old rope at the insertion point. It responded really well to a cortisone injection (ultrasound guided).

*However*, cortisone weakens the tendon initially and I had to basically keep my hand in my pocket for a few weeks - I was told that even slamming a door vigorously could tear it. Mikl told me to drink middies instead of schooners.

After that it was as good as new.

Unfortunately my AC joint is stuffed with osteo-arthritis now from an old motorcycle racing injury and cortisone hasn't helped that. Surgery here I come.


Sonic

20-Apr-2012
11:53:39 AM

I mildly tore my long-headed bicep tendon a couple of years back and it was freaking agonizing, I rested for about 3 months and it took me about another 6 months after that to get full strength back. I never got any shots, but if you want to get back sooner that might be a good option

Edit - by rested I mean climbed really easy stuff. I cant sit still for that long - until I broke my arm. That made me sit still for a while!

widewetandslippery

20-Apr-2012
2:13:44 PM

I have spoken to people who have kept active by using excentric exercises that focus on the tendon as opposed to muscle therapy. They kept active during self treatment.

I self treated achillies tendonitis using the same idea and it worked.

I expect a cure for sciatica in return!

Mr Poopypants

20-Apr-2012
8:34:43 PM

Hey Wendy

I had tendonosis in my long head bicep a few years back. Real bugger. Ice during day, heat when asleep and gentle stretching. Have you tried the stretch where you face away from open door and reach back, hook hand on handle and crook elbow up in air, move body to stretch longhead bicep, sqatting slightly. I found that brought relief pretty quickly. Still use it. Good luck.
G


BoulderBaby

20-Apr-2012
9:26:51 PM

Heat, Ice, Dry needling, Deep soft tissue.

Mr Poopypants

20-Apr-2012
10:13:55 PM

Dry needling sounds painful. Deep soft tissue, I've got plenty of! :-)


BoulderBaby

20-Apr-2012
11:59:40 PM

dry needling is often less painful than deep soft tissue!!

Wendy

21-Apr-2012
6:51:16 AM

Well, at least mine isn't torn! I managed a whole 2 weeks of complete rest. Then I keep trying to stick to easy climbing (it rarely bothers me on stuff up to 20) and strangely enough I can do everything but the start and the crux on the Ogive without hurting it, but still, i get sucked into the odd harder thing and seem to twinge it enough it's not getting better.

How technical are ultrasound guided cortison injections? I have a referal to get it done by the sonographer in Horsham - or should I find a shoulder specialist?


IdratherbeclimbingM9

21-Apr-2012
9:10:44 AM

On 21/04/2012 Wendy wrote:
>I keep trying to stick to easy climbing (it rarely bothers
>me on stuff up to 20) and strangely enough I can do everything but the
>start and the crux on the Ogive without hurting it, but still, i get sucked
>into the odd harder thing and seem to twinge it enough it's not getting
>better.
>
Us oldies keep using that excuse all the time. If you are not feeling that old, then you will have to be more original!
Heh, heh, heh.

pecheur

21-Apr-2012
9:40:22 AM

Fixed that for you ;)

On 21/04/2012 IdratherbeclimbingM9 wrote:
>On 21/04/2012 Wendy wrote:
>>I keep trying to stick to easy climbing (it rarely bothers
>>me on stuff up to 20) and strangely enough I can do everything but the
>>start and the crux on the Ogive without hurting it, but still, i get
>sucked
>>into the odd harder thing and seem to twinge it enough it's not getting
>>better.
>>
>Us oldies and us weaklings keep using that excuse all the time. If you are not feeling
>that old, then you will have to be more original!
>Heh, heh, heh.


IdratherbeclimbingM9

21-Apr-2012
9:51:57 AM

On 21/04/2012 pecheur wrote:
>Fixed that for you ;)
>
>Us oldies and us weaklings keep using that excuse all the time.

I hear you pecheur!
~> I have also found that diversifying the outdoor interests helps mask the old/weak symptoms too!!

elaine stevenson

21-Apr-2012
5:27:05 PM

Hi Wendy,

If you're going to proceed with cortisone, then I'd certainly be advocating for use of imaging to make sure it gets the right area.

That said, I think you've probably got number of other options you should try out before heading down the cortisone path. Cortisone can be very effective, but repeated use actually weakens soft-tissue structures and as you're a climber I'd argue (as a fellow climber, epidemiologist and manual therapist) that's not at all where you want to head unless you absolutely have to.

Is there a good manual therapist (ie physio, myo, or osteo) in Nati or Horsham that you can see? Cortisone can be helpful in really tough cases, but it's invasive and can cause harm, not to mention potentially quite painful too (when they inject it), so give other things a go first.

The suggestions you've been given - dry needling, soft-tissue manipulation (ie massage PLUS other stuff), heat, ice etc are all good, but they need to be used appropriately, and with due consideration to other things you've got going on that are almost certainly contributing to the condition (biceps tendonosis often arises in response to or along with other other issues - eg shoulder impingement, muscle imbalances, issues with supraspinatus etc - and treating the biceps alone (possibly because that's what has shown up on an ultrasound) may leave you open for ongoing recurrences down the track).

Chances are you'd probably benefit from a combination of manual therapy - to biceps AND related structures, dry-needling, ice - for when it hurts and after exercise, along with some prescribed exercises - ie individually set by a physio, myo or osteo with specific training in rehabilitative exercise prescription that are specifically tailored for your specific presentation, ie not pulled out a book or taken from the internet. An exercise physiologist may be able to set you in the right direction too but I think you'd still need to see a physio, myo or osteo as you'll almost certainly need some level of palpatory assessment and hands-on treatment too, at least initially.

NSAIDS (eg ibuprofen etc) can also be helpful, in the short term to settle things down, but again, if you're to go down that path, do so with the involvement of a tertiary trained manual therapist (ie who understands tendon issues and pharmacology). There's lots of new thinking in this area (by people like Jill Cook, one of Australia's leading physio researchers) and I'm not sure whether that knowledge has made it's way into general practice land yet. Opinions vary considerably in terms of how long you need to take them for - some say one week, some say longer - and what you should be doing (eg rehab wise) while you're taking them.

As for Cortisone, you'll find heaps of posts here about it, both for and against. It's a treatment that many would argue has been overused in the past, particularly in general practice settings, and, in my opinion, should be set aside until such time as other less invasive options have been given due chance to work. Cortisone can be helpful - when accompanied by a physical therapy program which takes due advantage of the temporary pain relief it brings - however there are plenty of studies which show that repeated use of Cortisone is harmful (ie weakens the very muscles and tendons you're trying to fix) and therefore it's something we generally recommend people avoid wherever possible. (one shot is probably ok, however if one shot isn't enough then repeated treatments do happen (sometimes down the track) and as few as three or four treatments is felt by some to be sufficient to significantly increase the chance serious damage (eg ruptures) later on. In my practice, for example, we view it as being a significant risk factor when people present with muscle issues, especially nasty rupture, and therefore it's something we always ask about.

The other thing to note with Cortisone is that it involves injecting a foreign substance into the body with a reasonably sized needle and therefore is not without some risk (eg infection, damage to nearby structures, etc).

That said, dry needling also involves putting a needle into the tendon through the skin however the needles we use are tiny by comparison and often you don't feel them going in. They're solid, so it's only the needle, and the effect we get from comes both from direct stimulation of the affect tissues (which promotes healing) and centrally mediated pain relief triggered by stimulation of the local neuroreceptors which communicate via the spinal cord and facilitate the release of chemicals which desensitise the area. Even dry-needling has it's risks - infection being the most obvious (any injection or cut into the body carries risk which is why nurses etc will always swab an area first before injecting into it) - and therefore it's something I prefer to use sparingly in my practice and only when I feel it is the most appropriate technique for the condition I'm treating.

Taping may also be an option too. One of the more specialised taping techiniques that I use was developed for the Australian Ballet (lots of tendon problems there). It's called Functional Fascial Taping, and gets really good results, (there's a blurb on our website that gives details if anyone wants to check it out. see here for more info). Other taping techniques which may also be useful include KinesioTaping and Dynamic Taping. These techniques all revolve around reducing pain and facilitating rehabilitative/functional movement rather than restricting it in the way traditional ankle or shoulder taping would.

Hope that helps.

Cheers!
Elaine.

nb - To pick up on comment below re dry needling - those who've climbed with me, and /or been treated by me, will probably remember that as well being a manual therapist, I'm also an infectious diseases epidemiologist (specialist in population health), who specialised in blood-borne viruses all of which means that my perspective on the safety of needling (and anything that punctures the skin for that matter) is possibly a bit more on the conservative side, compared to others who haven't worked in those environments.

nnb - Wendy - please think carefully if you're going to take up the Cortisone option. Given the scenario you've painted, I really don't think it's the best option for you at this point. Have been reading up on the latest thinking re tendon issues these past few days (ie after writing the initial post) and would strongly suggest you get a second opinion, ideally from a Sports or Musculoskeletal Doc, if there's one available, alternatively from a specialist Musculoskeletal Physiotherapist or Sports Physiotherapist (probably more likely than the others I mentioned to be up to date in the latest research). I'm not sure if there's one in Nati or Horsham. If there's not, **email** me and I'll give you the name of someone who consults remotely and should able to help you out.


BoulderBaby

22-Apr-2012
10:15:49 PM

On 21/04/2012 elaine stevenson wrote:
>
> Even dry-needling has it's risks - infection being the most obvious (any
>injection or cut into the body carries risk which is why nurses etc will
>always swab an area first before injecting into it) - and therefore it's
>something I prefer to use sparingly in my practice and only when I feel
>it is the most appropriate technique for the condition I'm treating.

Which is why you do swab before dry needling - If Wendy was post-operative that would be the main contraindication to infection, however otherwise it is quite a safe and effective form of treatment.

The key thing with dry needling, as well as being analgesic is that does increase metabolic stimulation - Blood to the area and promoting healing :D
I personally don't have issue with my biceps, however I do have rotator cuff problems, and I have found the best and least painful results have been from dry needling.

Wendy, if you're concerned about dry needling, I do recommend you see a Clinical Myo as they do 2 years of dry needling at university as a part of their course, however there are many practitioners who have done the additional training to dry needle effectively.


Capt_mulch

23-Apr-2012
1:39:19 PM

Wendy, My Mum the Physiotherapist says there is another 4 letter work to go with R - Time. It only gets worse as you get older too - I'm having great fun with my body changing Tendonitus sites every couple of years. My inner elbow tendons on my right arm were so bad a couple of months ago that I couldn't lift my laptop out of a backpack - luckily that's been going away. Tendonitus in your fingers makes for better slide guitar playing though - so there are some benefits.

Elaine Stevenson

24-Apr-2012
12:58:36 AM

Quick query, and off topic too (please forgive) Could someone advise the name of the university which is teaching Clinical Myotherapy these days. I know about the course at the Southern School of Natural Therapies where Olivia (BB) studies, but they're a private institute/college, like Endeavour etc, as are most of the places where Myo is taught. The only universities I know that are teaching Myo are RMIT and VU and both of those currently teach the government-accredited 2+ yr program.

Cheers!


JamesMc

24-Apr-2012
6:33:37 AM

No Ogiving for a month then.

Doctor's orders.

widewetandslippery

24-Apr-2012
9:34:46 AM

On 24/04/2012 Elaine Stevenson wrote:
>Quick query, and off topic too (please forgive) Could someone advise the
>name of the university which is teaching Clinical Myotherapy these days.
> I know about the course at the Southern School of Natural Therapies where
>Olivia (BB) studies, but they're a private institute/college, like Endeavour
>etc, as are most of the places where Myo is taught. The only universities
>I know that are teaching Myo are RMIT and VU and both of those currently
>teach the government-accredited 2+ yr program.
>
>Cheers!

So what you are saying is that this myo lot sticking needles in you have the training level of a beauty therapist?

egosan

24-Apr-2012
9:40:55 AM

On 24/04/2012 widewetandslippery wrote:

>So what you are saying is that this myo lot sticking needles in you have
>the training level of a beauty therapist?

Wow! Sign me up!

There are 27 messages in this topic.