Forums >Health and Nutrition>Tenex proceedure
Been dealing with PF for going on 11 months now, already had 2 cortisone shots, 4 different pairs of orthotics, my podiatrist is suggesting I get the Tenex procedure done, has anyone had that done before for PF? Really want this over with..
thanks in advance,
I had Tenex done for my Achilles, 8 1/2 weeks ago. Two weeks in a boot, several more weeks of recovery, then I could start running at surgery + 6 weeks. I thought everything was going OK, until I developed a DVT (blood clot) a few weeks ago. Gotta be aware of that risk if you are inactive after surgery. In my case, though, it turns out I had a genetic predisposition (Factor V Leiden). Fortunately it appears to be under control now (though I'll be on blood thinners for a long time).
I've been running again for 2 1/2 weeks now. Unfortunately I can't say there's any improvement yet in the Achilles; if anything it's worse. I'm now told it may take a few months for there to be any positive effect.
I hear you on wanting it to be over with. Sorry I can't offer you much positive, but if I were you I might still give it a shot. For surgery, it's pretty noninvasive, with not a lot of down time. If you're not running anyway...
I had Tenex done for my Achilles, 8 1/2 weeks ago. Two weeks in a boot, several more weeks of recovery, then I could start running at surgery + 6 weeks. I thought everything was going OK, until I developed a DVT (blood clot) a few weeks ago. Gotta be aware of that risk if you are inactive after surgery. In my case, though, it turns out I had a genetic predisposition (Factor V Leiden). Fortunately it appears to be under control now (though I'll be on blood thinners for a long time). I've been running again for 2 1/2 weeks now. Unfortunately I can't say there's any improvement yet in the Achilles; if anything it's worse. I'm now told it may take a few months for there to be any positive effect. I hear you on wanting it to be over with. Sorry I can't offer you much positive, but if I were you I might still give it a shot. For surgery, it's pretty noninvasive, with not a lot of down time. If you're not running anyway...
Thanks Bob, have been thinking about having it done, saw a few posts on RWOL with mixed results, and not much else. Hope you have better results on your recovery.
http://community.runnersworld.com/topic/tenex-fast-procedure-for-plantar-fasciitis?reply=131628889590053289#131628889590053289
runktrun
Hi Irishguy, sorry to hear of your woes. I haven't had tenex done, but I did a lot of research into the procedure last summer when my hamstring tendons (at ischial tuberosity) kept blowing up...and, well, there wasn't must research out there, so I decided to skip the procedure and keep trying different core and strength exercises. I think the mixed results from tenex have to do with peculiarities with how individuals develop and lay down new collagen. Some people have a genetic predisposition to heal with "bad," brittle collagen (I forget the type, type I or II?), in which case puncturing the tendon to get it to "heal" and lay down new collagen will just result in the same brittle collagen that was there before. Also, heavy NSAID use interferes with collagen. Bottom line: I wasn't confident enough in the existing research about the procedure.
Have you tried PRP? That may be a slightly less irritating procedure for your foot with less possibility of more damage. I don't believe that a PRP treatment punctures the fascia as much as tenex. The main point is to deliver the blood to the tissue.
Good luck.
Not running for my health, but in spite of it.
Sounds like you did your homework more than I did, kilkee. Can you point me to any useful references your research turned up?
You might remember some of my posts about Ehlers Danlos hypermobility type, which my cousin definitely has, and my brother and I might have. Google EDS and collagen and you'll get a wealth of information. One symptom of EDS is shit collagen, and thus tendons and ligaments that are brittle or stretch out of shape. My doc suspects that's why my hammies were so painful for so long. A bad experience with indomethacin got me researching... Here's a quick overview of nsaids & collagen http://www.ncbi.nlm.nih.gov/m/pubmed/21681568/
if you dig around for other similar studies, you'll find the same conclusions.
as for Tenex, what I found seemed mostly proprietary, which scared me since there was not a lot of peer reviewed info. The general medical procedure is a tenotomy. The Achilles is tricky, too, since it has a paratendinous sheath instead of a synovial sheath, like most (all?) other tendons. The tendon, the sheath, or both could be in various stages of inflammation or degeneration. So when people say they popped Advil for a month and felt no better, and are at their wits end, it makes sense because all that Advil could have completely hindered any tendon regeneration. Most of the research about sports tendon injuries points to eccentric loading as the best therapy. Of course, sometimes people really are so broken that no amount of pt will fix things...
pubmed is a fantastic resource; I just make sure to look at the sample size and controls to see if it really might be applicable in the real world. Eg: A lot of tenotomy research focuses on tennis elbow. I had a hard time finding studies or even anecdotal results about hammy tendon procedures.
SMART Approach
I had chronic bilateral upper hamstring tendonosis and pain for 7 yeatrs. I tried most everything. I then considered Tenex but doc recommended PRP with tenotomy first. I think it helped. After 6 months I was improved 30-50%. After doing some further research, I started high doses of Vit D3, K2 and Magnesium (chelated not oxide) and 12 months later I felt great and I have had no major issues for the last 12-18 months. Last summer I had some of my best race times in 7-8 years at age 49. I still know where the discomfort is but I am smart about my training, core, glute work, proper warm up, more hamstring stretching now that I can do it without pain. I don't know if there was a cumulative effect of PRP or the supps, but I am 98% healed and continue to take the supps and do everything else. It takes work, but it is worth it if you want to continue to run.
Run Coach. Recovery Coach. Founder of SMART Approach Training, Coaching & Recovery
Structured Marathon Adaptive Recovery Training
Safe Muscle Activation Recovery Technique
www.smartapproachtraining.com
Tchuck, sounds like your issues were more complicated than simple overuse and, though you haven't pinpointed the cause, seems like nutritional support has helped immensely! I'm not surprised; I've seen a few studies linking magnesium deficiencies to tendon changes in dogs, as well as Vit C to support Achilles tendon repair in rats. I don't think that my diet is deficient in anything, by normal standards, but I conjecture that I've got something else going on that requires supplementation to get back to almost optimal functioning. I pop Vit C regularly (it's water soluble, weeee!) and watch my Vit D and B12 levels. My B12 plummeted last year for no APPARENT reason and did not restore with oral supplements so I went to shots, indicating that I had an absorption issue. B12 can screw with muscle recruitment and pain sensations as well.
Thanks, kilkee.
The Achilles is tricky, too, since it has a paratendinous sheath instead of a synovial sheath, like most (all?) other tendons.
Huh. I've got books on muscle and tendon structure that live on my nightstand, and I did not know this. Oddly, I have been diagnosed with tenosynovitis for my Achilles before -- an inflammation of the synovial sheath.
Funny, Google finds this, just posted today, that looks useful.
http://www.drpribut.com/sports/tendinopathy-science.html
Most of the research about sports tendon injuries points to eccentric loading as the best therapy.
Yeah. Frustrating thing for me is that my two different Achilles docs tell me two different things. One is one of the foremost guys in this field, Amol Saxena. He's treated lots of Olympic athletes. He is skeptical that eccentric loading does much, and in particular says don't do it while your Achilles is injured. Whereas the doc who did my Tenex surgery says do them 3x daily as your primary recovery / remodeling work.
One thing has always puzzled me here, that I've never been able to get a good answer to. Eccentric / concentric refers to whether the muscle is lengthening or shortening as it works. At the myosin / actin level they are two very different things, and have different effects. But what does a tendon care about that? It's a cable. Tension is tension. So if you make your calf work eccentrically, how exactly is that supposed to help the tendon? I'd think it should just be the tension itself that stimulates appropriate remodeling to get the new collagen aligned correctly.
as for Tenex, what I found seemed mostly proprietary, which scared me since there was not a lot of peer reviewed info. The general medical procedure is a tenotomy.
Yeah. Saxena tried to talk me out of Tenex when I told him I'd decided to do it, precisely because there is little established science on whether it has any benefit. He had been treating me with EPAT, which definitely helped, but was not a permanent solution. I decided to try Tenex anyway, because I was ready for some downtime after a big training and racing year last year, and I figured it couldn't hurt to try. If I'm going to sit around on my butt for a few weeks, might as well kill two birds with one stone.
I had chronic bilateral upper hamstring tendonosis and pain for 7 yeatrs. I tried most everything. I then considered Tenex but doc recommended PRP with tenotomy first. I think it helped. After 6 months I was improved 30-50%. After doing some further research, I started high doses of Vit D3, K2 and Magnesium (chelated not oxide) and 12 months later I felt great and I have had no major issues for the last 12-18 months.
FWIW I also did PRP for my upper hamstring tendinosis / partially torn tendon. I think it helped, or maybe I just stopped running long enough for it to heal anyway. I got back to 100%, with religious daily deadlifts. Then I slacked off on the deadlifts, and started to feel it again. For over a year now it's always the same, in my long runs / races: it starts to hurt about 10 miles in, but fades by 30 or so, and doesn't bother me again after that. If it stays that way I can live with it. But maybe I should check my vitamin levels.
Good article...though it stopped short of recommended treatments! Bah.
I agree with your "tension is tension" assessment. It does seem like it should be that simple. It's hard to consistently get good eccentric contraction in the high hammies (esp without hurting them more or engaging tons of other muscles), so I've just been spending time "sitting" in a squat. I think it's working. It certainly is providing the lengthening stimulus through tension.
I've thought about PRP for my hammies, but they are manageable now and I couldn't bear it if a treatment set me back. Plus, I only ever seemed to get worse after rest. And I mean serious rest. Full weeks of doing nothing but walking. Weeks in a row of only light biking. Weeks of running 1-2mi every other day. So the down time that coincides with a PRP treatment sounds risky.
Good article...though it stopped short of recommended treatments! Bah. I agree with your "tension is tension" assessment. It does seem like it should be that simple. It's hard to consistently get good eccentric contraction in the high hammies (esp without hurting them more or engaging tons of other muscles), so I've just been spending time "sitting" in a squat. I think it's working. It certainly is providing the lengthening stimulus through tension. I've thought about PRP for my hammies, but they are manageable now and I couldn't bear it if a treatment set me back. Plus, I only ever seemed to get worse after rest. And I mean serious rest. Full weeks of doing nothing but walking. Weeks in a row of only light biking. Weeks of running 1-2mi every other day. So the down time that coincides with a PRP treatment sounds risky.
My issues were actually caused by stupidity. I overtrained for a half back in early 2007. I was so focused on getting my best time that I continued to push through soreness to stay on "the plan". One month before the half I had to back off because of pain. I ran it and had an awesome time (PR) but it wasn't worth it. I was in agony and couldn't sit for months (which sucks because I am on the road in sales, weeks of NSAIDs, therapy, phonoohoresis, ART etc did not work for my severe tendonitis/bursitis. I was forced to do bilateral cortisone shots which helped immensely. It was a total relief. I then had a relapse the following year and more cortisone. I then said, "no more cortisone", cranked up my core work, glute work, prehab, icing and managed it for years but the soreness never went away which was basically the diseased tendons/tendonapathy. This is what led me to PRP to correct the soreness issue. I am in orthopedic sales so I had these conversations with docs regularly and finally took the next step with PRP. The doc said I only needed to take off a week from running. I took off 2 weeks and came back easily and have things under control now and CAN SIT!!!
I haven't been able to sit for about 18 months... BUT, I can run almost normally, except for my loose hip socket! And my discomfort is very manageable now. My only true fix is surgery.