Hi guys!
In this video, I'm going to talk about
the Tenex procedure for
ongoing tendon pain or tendinopathies or
tendonitis.
We're going to look at what they do
during the procedure,
why it should still be viewed as surgery,
and what you should be doing after
you've had the Tenex procedure to make
sure that your tendon recovers as best
as it can.
And then also, why it shouldn't be the
first option for treatment and what
things you need to be doing
before you consider going for the Tenex
procedure.
Now, for those of you who don't know me,
my name is Maryke. I'm one of the
physiotherapists from
treatmyachilles.com,
where you can get online physiotherapy
assessment as well as treatment for your
Achilles injuries.
So have a look at the description of
this video if you want a link to our
website.
Okay, so what is Tenex? Tenex uses
ultrasound technology to remove the
damaged tissue.
It's a minimally invasive surgical
procedure,
and I want you to take note that it is
still surgery,
although it's minimally invasive. Because,
when I was researching this condition
on the Internet, it was shocking how many
of these
orthopedic clinics that use this
procedure
on patients try to make it sound as if
it wasn't surgery -
as if it was something that is very easy
to do: "You don't really have to worry
about it,
just go in and have it and your pain
will all magically disappear."
And that is just not true. If you look at
the Tenex website themselves,
they are very clear about it that this
is minimally invasive surgery.
And the reason I'm on about that, is
because surgery changes the structure of
your tendon.
And that's why you need to consider
other things before you have this, and
I'll talk about that a little bit more
in detail later. So, let's first look at...
if we think of all surgical procedures:
What's the aim of it? Why would you have
it?
So, the tendons are made up of collagen
fibers - loads and loads of collagen
fibers
put in parallel, like that - and that's
what makes it so strong. So if you think
of a string that you can easily snap...
like a piece of thread, if you put a
lot, like 10 pieces of thread, together
and you try to snap it,
you can't really, because that makes it
really strong. Now
these collagen fibers are in bundles, and
the bundles
are grouped together, and then loads of
loads of little bundles together
make up the tendon. Now when you get a
tendinopathy or tendinosis or a
tendonitis, whatever you want to call it,
part of that tendon becomes injured and
those fibers
kind of become in a disarranged, so they
lose that parallel structure that makes
them so strong.
And the cells in between them also
change a little bit.
So essentially that part of the tendon
becomes weaker
and can't quite carry the loads that you
want to be putting through it, and that's
why the pain cycle continues there.
So when they do surgery, they go in and
they look at the injured part
and they cut that out. So they remove the
painful tissue and the painful...
and the... often also the little nerves and
things that go together with that.
Now, yes, it can decrease your pain.
But what the research is showing, is it's
not effective for everybody.
So even with the Tenex research that's out
there, and there's not a lot out of there
yet -
I'll talk about the research about it in
a minute -
shows that not all patients have
positive results from it. So I think it's
about 70 percent,
in the one study, of people who were
satisfied with their outcome after they
had this procedure.
Now if you think of it: So, you've got
your tendon and now they've cut part of
the tendon out.
So it's quite important that after
you've had the procedure,
you need to strengthen that tendon up
carefully to be able to cope with
your load. So even if your pain decreases,
you can't just jump into sport again.
You still have to go through progressive
rehab afterwards
to make sure that your tendon doesn't
become injured again.
Now with Tenex... so the traditional ways to
do surgery would be
open surgery. That was the first type of
thing where they make a big cut and they
go in with a scalpel and they cut things
out.
Now these days they luckily don't do
that that often anymore because
that type of surgery causes a lot of
scar tissue and
it has a big chance that you can get an
infection
in there. So they moved on to keyhole
surgery after that.
And that's a lot more common, where they
just make a small incision and they go
in through that
and they cut away the injured
parts. With Tenex
they make an even smaller incision - I
think it's about five millimeters that
they do - and then they stick the device
in there and the device uses ultrasounds
...ultrasound frequencies to cut away
the injured tissue. So if we look at
types of surgery,
Tenex is likely a really good option for
surgery because it
is less likely to cause a lot of scar
tissue, it's minimally invasive,
and you're out of the procedure within a
few minutes. So yes,
where surgery is concerned: brilliant. But
it is still surgery.
So if we look at what the research is
showing with regards to how effective it
is:
There are only two studies that I
could find on
Achilles tendinopathy at the moment and
they only enrolled...
the one study had 25 patients, the other
one 35 patients.
So the one thing to note of this, is
that there's not a lot of research out
there yet
to support this use and to show us
really how effective it is.
There was a recent review of the
literature that came out in November
last year - 2020 - where they looked at all
the research available, and again
they found that: yeah, there is some
research showing that
could help, but not for everybody, and
there weren't any long-term follow-up
studies. So these studies only
looked at patients' pain six weeks after
the procedure.
And we know that with Achilles
tendinopathies and things like that,
you may have an immediate good effect,
but then
what does this patient look like 12
months afterwards? Are they better off or
worse off after they've had that
procedure compared to somebody who
didn't have that
and rather did traditional methods? Now
if we look at the research
with regards to all treatment - all
surgery
options - what the research is currently
advising
is that you should try at least 12
months
of careful progressive strength training
before you opt for surgical methods.
Now, what I have seen, is that patients
come to me and they say, "Well, I've tried
rehab in the past
and it's not worked, it's made it worse.
So I was then stuck in a boot.
The boot didn't work and now I'm due for
Tenex surgery."
And then you listen to what rehab
they've done, and it's just not been the
right stuff.
They've either been given stretches, and
we know that stretching the Achilles
tendon when it's painful makes it worse
quite often.
And remember, that part of the tendon is
not as strong as it should be, it's lost
some of its stiffness because stiff
tendons are healthy tendons.
So stretching it is just going to make
it worse, it's not going to strengthen it.
So if you've been given stretches and
your pain's continued, that may likely be
a reason for it.
Second, often they've been given rehab
exercises to strengthen it
that's actually painful to do and it
increases more pain after they've done
that.
So, those exercises weren't right for
them, because remember
your rehab program, the load you put
through that tendon
in rehab, has to be at the level that the
tendon can actually
sustain. If the exercise is making it
feel worse,
it's either the load's too much or the
range of motion you're going through
could be too much - that gives it that
stretch effect and that could make it
more -
or it's just too often that you're being
asked to do it.
So if your rehab caused you pain,
it's likely the fact that the rehab
wasn't set at the right level.
Then also, you'll often see that
they've been given just one type of
exercise. So the
very commonly prescribed exercise regime
for Achilles tendinopathy
is the Alfredson... Alfredson method, or
just
eccentric. So you go up on two feet, lift
one up slowly, down on one,
and in all honesty I don't find that
program very effective for most people
because it only trains one part of the
action.
And we move and use the Achilles and
the calf in the up and downwards motion,
and if it's somebody who's not well
trained and quite sedentary,
that protocol often flares them up. And
the other thing with the
heel drops or the eccentric exercises is,
it drops
the foot over the side of the step, and
if your Achilles tendon is really
sensitive to being stretched,
that can make it feel worse as well. So
again, it's about:
Was the rehab actually the right type of
rehab for you?
So what else am I leaving out here?
Yeah, so to summarize: Tenex is a
brilliant
surgical option because it's very
little invasion into that. But, before you
consider it,
you have to make sure that you've been
on the correct rehab program
for at least 12 weeks to see a change in
it,
and your rehab shouldn't be causing you
pain after you've done it.
And you should also make sure that
you've tried all the other options of
things that's not as invasive. And then,
if you will have
the Tenex procedure, remember it is still
surgery.
You'll likely be wearing a boot or
something for the first two weeks after
that,
and then, when you come out of that, you
have to strengthen your Achilles tendon
up
to make sure that it can cope with all
the loads from the sports and activities
you want to be doing.
Very well! Let me know if you've got any
questions. And if you need more help with
an Achilles injury,
you're always welcome to consult us via
video call. The link is in the
description of this video.
Take care!