Tendon stem cells enhance regeneration(nature.com)
nature.com
Tendon stem cells enhance regeneration
https://www.nature.com/articles/s41556-019-0417-z
29 comments
In UK there was just recently published Guidelines for [1] Safe prescribing of fluoroquinolones.
'Do not use fluoroquinolones in patients with known aortic aneurysm, aortic dissection or history of serious side effects related to quinolone treatment (including tendon disease/disorder) unless there are no other treatment options available'
'Patients should be counselled to discontinue fluoroquinolone treatment and seek urgent medical attention at the first sign of:
- Tendon pain or inflammation (particularly in shoulder or ankle)
- Symptoms of neuropathy such as pain, burning, pins & needles, tingling, numbness or weakness
- Sudden-onset of severe and constant abdominal, chest or back pain
1. https://www.ncl-mon.nhs.uk/wp-content/uploads/Guidelines/5_F...
'Do not use fluoroquinolones in patients with known aortic aneurysm, aortic dissection or history of serious side effects related to quinolone treatment (including tendon disease/disorder) unless there are no other treatment options available'
'Patients should be counselled to discontinue fluoroquinolone treatment and seek urgent medical attention at the first sign of:
- Tendon pain or inflammation (particularly in shoulder or ankle)
- Symptoms of neuropathy such as pain, burning, pins & needles, tingling, numbness or weakness
- Sudden-onset of severe and constant abdominal, chest or back pain
1. https://www.ncl-mon.nhs.uk/wp-content/uploads/Guidelines/5_F...
As far as I am aware, the association with aortic aneurysm is weak ( I think a relative risk of 2) from an associate only study (ie no causation proven). So take these with a pinch of salt, especially for those with a penicillin allergy as covering some bugs without penicillins or flouroquinolones can be tricky.
So basically it fucks with your connective tissue?
> The histopathologic findings [of the tendons] include degenerative lesions, fissures, interstitial edema without cellular infiltration, necrosis and neovascularization [1]
Basically it dissolves, and the achilles tendon is the most common rupture, at least with cipro.
1. https://www.ncbi.nlm.nih.gov/pubmed/22035890
Basically it dissolves, and the achilles tendon is the most common rupture, at least with cipro.
1. https://www.ncbi.nlm.nih.gov/pubmed/22035890
You seem really knowledge about this. I'm 20 years deep into a tendon problem that has flowered into way too many parts of my body than it should be. Was just accepted into Mayo and going in early 2020. Could I chat with you about that experience?
How permanent is the levaquin (etc) damage supposed to be?
Honestly, nobody knows. The issue is severely under-diagnosed. I have been doing PT but it is very difficult when several tendons are involved. Specialists are baffled. I have talked to people who have been suffering for 20+ years, and those who mostly recovered in 1, 2, 3 or even 10 years to where they would rate their recovery at 90%.
However, it is believed that the muscles/tendons will never perform at the same capacity again. Recovery is mostly about getting to relatively pain free life and ability to work and do things.
I have been to mayo clinic, seen 30+ physicians, numerous specialists and ruled out every disease known to cause such symptoms. Only one physician said that my symptoms align with toxicity of that medication and none of the physicians reported it to the FDA. This is very saddening considering the amount of research and information from the organizations like FDA and EMA.
However, it is believed that the muscles/tendons will never perform at the same capacity again. Recovery is mostly about getting to relatively pain free life and ability to work and do things.
I have been to mayo clinic, seen 30+ physicians, numerous specialists and ruled out every disease known to cause such symptoms. Only one physician said that my symptoms align with toxicity of that medication and none of the physicians reported it to the FDA. This is very saddening considering the amount of research and information from the organizations like FDA and EMA.
Well I ask because I was prescribed Levaquin for sinus infection about 10 years ago, and read the warnings about fluoroquinalones with tendon degradation, so quit after one pill, and saline rinsed extensiely, which eventually worked.
I've rolled my ankle and had multple achiles strains since, which I'd never known before. Of course, one pill is not much dose.
Thanks for discussing.
I've rolled my ankle and had multple achiles strains since, which I'd never known before. Of course, one pill is not much dose.
Thanks for discussing.
Single dose is enough to cause problems. I had only two doses through the IV when I had kidney stones. I have read of people having mild tendon problems after a single dose of levaquin/cipro that lasted years and would flare up.
Thanks for posting this, I used to compete in bodybuilding and tore my left quad tendon 6 months ago. It's just now really starting to feel like a normal leg again. The recovery sucks, I wouldn't wish it on anyone.
Been fighting quadriceps tendinitis for 3 years, and there doesn’t seem to be a lot of quality research surrounding tendon regeneration. Living in the US with odd insurance limits for physical therapy has definitely set me back. If you run into issues with that, Martin Koban wrote a book on patellar tendinitis and has an updated online course with a recommended program for tendon strengthening. It’s the only thing that’s helped me so far
I've been struggling with chronic mid-portion Achilles tendinopathy for 13 months. Progressive loading, heavy/slow resistance work and your pick of eccentric, isometric or isotonic exercises are apparenlty the way forward. The biggest surprise has been the amount of quality information on Twitter; finding the people to follow is harder. If you're interested, good starting points are @SethONeill, @UDtendongroup, @kgSilbernagel, @tendonresearch, @TendonGlasgow, @IreneSDavis, @tendonpain, @ProfJillCook, @KFarnqvist, @lorenzo_masci, @sancho_igor and @pdkirwan. HTH!
I have also found success with high repetition (15-30 reps) slow eccentric work for tendinopathy in my fingers and elbow. So far it's really the only thing that helps besides making sure the surrounding areas are not overly tight with soft tissue work. This guide and the linked research have been very helpful. https://stevenlow.org/overcoming-tendonitis/
Thanks for the twitter recommendations. I made great progress with progressive loading with isometric exercises the past 9 months, so I'm transitioning to slow concentric/eccentric movement to increase range of motion and struggling. This stems from an improperly healed ankle injury causing low dorsiflexion ROM so finding the right combination of exercises is tricky.
It really blew my mind how much differently tendons recover and strengthen compared with muscles. I think step one is to consider them differently in terms of rest, loading, and lengthening.
Curious if you’ve tried any supplements?
Mixed viewpoints out there regarding supplements, but I take collagen, fish oil and vitamin C daily. I find that if I skip taking them for a week I notice a bit more pain / less resilience after a strength training session.
Can you recommend a brand of collagen?
I can't recommend any brand. The research is weak regarding oral collagen supplements. I'm planning to switch to vitamin C infused gelatin, as there's some research backing that up. https://www.ncbi.nlm.nih.gov/pubmed/27852613
Possibly placebo, but I felt like bone broth helped during my Achilles tendon recovery.
Go slowly getting back into things. I know you know that, but it's worth reiterating. Not because I'm worried you'll hurt yourself, if you've competed you know your body well enough to not to do that, but because I know how frustrating it can be coming back.
I tore one of my left biceps tendons training for an MMA fight about five years ago. When the doctors told me "six month recovery" I didn't understand that they meant six months to start working out like the average person again. That led me to have a lot of frustration during my recovery because I felt like it wasn't happening fast enough. It was closer to 18 months until I was able to perform at the level I did before.
Did you get a graft or just a repair?
I tore one of my left biceps tendons training for an MMA fight about five years ago. When the doctors told me "six month recovery" I didn't understand that they meant six months to start working out like the average person again. That led me to have a lot of frustration during my recovery because I felt like it wasn't happening fast enough. It was closer to 18 months until I was able to perform at the level I did before.
Did you get a graft or just a repair?
Sounds similar to when I tore my ACL. It was ~9 months until I was medically healed, but closer to 18 before I was fully back with strength and confidence in my knee.
I did a patellagraft.
I did a patellagraft.
Yeah, I had an anterior tibialis from a cadaver grafted onto my biceps tendon ("grafted" in this case really means stitched onto the remnants of mine with metal thread and then bolted into my radius bone). Recovery was long and brutal, but five years later I don't have any issues.
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As it might be of interest to someone suffering from tendonitis:
i've had pain in my right achilles tendon for well over a year now, and although i've never had any symptoms, i've been diagnosed with gout / high uric acid levels in the blood. I didn't know that urate crystals can deposit in soft tissues/tendons, causing inflammation.
I've been taking allopurinol for a few months now and the tendonitis seems to be slowly going away but i'm not recovered yet.
i've had pain in my right achilles tendon for well over a year now, and although i've never had any symptoms, i've been diagnosed with gout / high uric acid levels in the blood. I didn't know that urate crystals can deposit in soft tissues/tendons, causing inflammation.
I've been taking allopurinol for a few months now and the tendonitis seems to be slowly going away but i'm not recovered yet.
Is this the same thing as the stem cell treatments offered by various clinics today?
I have been dealing with widespread tendon issues for the past 7 years due to that medication. The black box warning reflects the issues somewhat. These should be last resort antibiotics but are given out in the US for suspected UTIs.