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According to Dr. Murray Heber, "the term tendinosis was first used in the 1940s by a group of German researchers, however the term did not receive much attention until it was used again in the mid 1980s to describe a non-inflammatory tendon condition. The more commonly used term of "tendonitis" has since been proven to be a misnomer for several reasons. The first of which is that there is a lack of inflammatory cells in conditions that were typically called a tendonitis. Since inflammation is the key pathological process involved with that term, and the discovery that there in fact were no, or very few, inflammatory cells present in the condition. There is also said to exist a tendinosis cycle that must be broken before successful treatment and pain-free movements can be restored. The cycle of tendinosis is simplified and described as repetitive overuse activities or microtraumas causing microtears in the tendon creating a fibroblastic hyperplasia response, which then respond by increasing the amount of type III collagen within a tendon. This further weakens the tendon causing more microtears and prolonging the degenerative cycle. Treatment for this condition must first attempt to stop the degenerative cycle and then to restore proper collagen synthesis, strength and function". This has a much greater impact then just the name one calls a condition, it also has a profound impact on how the condition should be treated. According to Tendinosis Org, "understanding collagen healing states "Non-steroidal anti-inflammatories (NSAIDS) would not be expected to help tendinosis since it is an injury of chronic degeneration, not inflammation. Studies show that some NSAIDs actually impede the healing process, which is the last thing needed with tendinosis.[17] Long-term use of NSAIDs for tendinosis is probably not a good idea. Ascorbic acid (vitamin C) stimulates Type I collagen synthesis when used in cultures of healthy fibroblast cells. However, when ascorbic acid was added to cells from carpal tunnel syndrome patients, it did not stimulate the normal amount of Type I collagen, and the small amount of Type I collagen that was produced had an abnormally high alpha2(I) to alpha1(I) ratio.[1] Adding vitamin C to the injured cells simply made them produce more abnormal collagen, not normal collagen". Sports Injury Bulletin states "NSAIDS also have a track record of side effects; up to 25% of individuals taking NSAIDS develop peptic ulcers, and a rather astounding 5% incur renal troubles. There is also disturbing evidence that NSAIDS may interfere with the metabolism of articular cartilage and the repair of bone". Basically time, therapy, and good nutrition are the only true way to heal strained tendons. Collagen is a strange beast that grows according to a seperate set of rules than muscle and bone. In trying to help you may actually be preventing the injory to heal. TREATMENT <<<<======================= Int J Ther Massage Bodywork. 2012; 5(1): 14-17. Published online Mar 31, 2012. PMCID: PMC3312643 Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters Evelyn Bass, Tendinitis - The most prominent treatment goal for tendinitis is to reduce inflammation, a condition that isn't present in tendinosis. In fact, some treatments to reduce inflammation are contraindicated with tendinosis. Ibuprofen, a nonsteroidal anti-inflammatory, is associated with inhibited collagen repair(9). Corticosteroid injections inhibited collagen repair in one study, and were found to be a predictor of later tendon tears Tendinosis - 1.Rest. People with low-grade tendon injuries often find it difficult to rest as much as is necessary, especially as symptoms subside(3). With repetitive work tasks, the patient is recommended to take a break for one minute every 15 minutes and a five-minute break every 20-30 minutes(12). This reduction isn't much considering its role in preventing long-term pain and disability. Some people will need to rest even more than this at the start of treatment. The patient should be advised to stay aware of their body as it heals. If the activity they are engaging in is causing pain, then they are probably doing too much. 2.Adjust ergonomics and biomechanics. Small changes can make a big difference. With regard to ergonomics, for example, cashiers are encouraged to press the register keys as lightly as possible, and computer users should be sure their wrists are resting in a neutral position while typing. Larger companies and government organizations often have an ergonomic specialist available to consult with employees about their workstations. Physical therapists are experts at recognizing and adjusting improper biomechanics that might be causing injury. 3.Use appropriate support. Physical therapists can also recommend appropriate support to reduce tensile stress on the tendon, such as bracing or taping(3). 4.Stretch and keep moving, though conservatively. Lightly stretching and moving the affected area through its natural range of motion while minimizing pain will prevent shortening of the related muscles (preserving active range of motion and flexibility). It can also increase circulation, thereby assisting the healing process. Stretching can also elongate the muscle-tendon unit, reducing the tension placed on the tendon during activity, thereby reducing the chemical changes that cause degeneration(8,13,14). 5.Apply ice. Ice causes vasoconstriction and is thought to address the abnormal neovascularization of the tendon tissue(3). Clinical experience indicates that icing is helpful for tendinopathies even though the reason why it works is not yet fully understood(3). Use ice for 15-20 minutes several times a day (allowing for at least 45 minutes in between icing session), and after engaging in activities that utilize the tendon(7,15). 6.Eccentric strengthening. An eccentric strengthening regimen done 1-2 times daily for 12 weeks has been clinically proven to be a very successful treatment for tendinosis, especially when the exercises are performed slowly(2,3,5,16). Eccentric strengthening is "lengthening a muscle while it is loaded and contracting(17)." For example, lengthening one's bicep while holding a dumb-bell in one's hand would stimulate eccentric contraction. Eccentric strengthening effectively stimulates collagen production, improves collagen alignment, and stimulates collagen cross-linkage formation, in turn improving tensile strength(5). Eccentric strengthening might also help to reduce ground substance and tendon volume (swelling/thickening)(2). It has also been proposed that part of the benefit of eccentric strengthening is the stretching involved, as described above. It can be helpful to consult with a physical therapist to maximize the benefit of strengthening exercises and to minimize the possibility of re-injury. 7.Massage. Massage stimulates circulation and cell activity, especially when done at the appropriate depth. Deep-friction massage applied to the tendon serves to stimulate fibroblast activity and generate new collagen. Stasinopoulos and Johnson(18) report that applying deep-friction to the tendon for at least ten minutes after the numbing effect has been achieved results in reduced pain and increased strength and mobility. Lowe(11) states that he has found it effective to apply friction to the tendon in multiple short bursts of 20-30 seconds interspersed with other techniques; this strategy allows for mobilization of the tissue while minimizing discomfort for the patient. Myofascial techniques and trigger-point therapy can reduce fascial restrictions, scar tissue, and trigger points in the muscle connected to the tendon, relieving tension on the tendon. Myofascial techniques, lengthening deep-tissue techniques, stretching and active-release techniques can reset muscle memory to a more lengthened position, reducing the tension placed on the tendon during activity. A variety of massage techniques can decrease overactive pain messages from sympathetic nervous system firing, increase circulation, and improve overall tissue health(10,11,19). 8.Nutrition. Vitamin C, manganese, and zinc are all important for the synthesis of collagen production(20). Vitamin B6 and Vitamin E have also been linked to tendon health(21). Patients might benefit from talking with their primary health care provider or a nutrition specialist to be sure their intake of these nutrients is sufficient. BOTTOM LINE <==== Tendinosis is OFTEN self-diagnosed as Tendonitis simply because that is a more familiar term. More often than not it is actually Tendinosis. It may be difficult to do but stopping the repetitive activity, good nutrition, and motion therapy of the injured area, and patience are the things that are needed to cure Tendinosis. This product may actually impede the healing process vs help. So I gave it one star. NOT because I think this is a low quality product. Mainly because it may actually be causing a lot of people more long term harm than short term good. Just as with a broken bone tendons need time to heal and no magic ointment is going to make that happen. The ointment is actually slowing and/or preventing the real healing process which then makes people use the ointment for the rest of their life to mask the pain from the injury that was never allowed to heal. PLEASE NOTE: I am seeing a trend of when I give high ratings people appreciate my review. When I give low ratings where others (who don't do research) gave high ratings, people claim my review was not helpful. Why are negative "facts" not helpful just because most others gave positive "opinion"? I have no bias for or against any product. I simply try to state facts (in negative reviews) to help people make informed decisions.