They say the future of healthcare is integrative. And at chit.chaat.chai, we could not agree more! When we come across doctors using a pluralistic approach to understand, treat and heal, we can’t wait to share their wisdom. Meet Dr. Sarah Kucera, a Chiropractor, Ayurveda Practitioner and soon to be published author from Kansas City, Missouri. In our recent chit-chaat, we talked about tendinosis, a chronic tendon injury often misdiagnosed as tendinitis. We wanted to learn more about this common condition, and how Dr. Kucera fuses together chiropractics and Ayurveda to treat tendinosis.
Q & A with Dr. Sarah Kucera, DC, CAP, 500 E-RYT
What is tendinosis?
Tendinosis is the degeneration of a tendon that occurs in response to overuse. It’s a chronic condition that develops over time, as repetitive use causes strain and injury when there is not a proper time for rest and healing. In the case of tendinosis, there is a breakdown of collagen that leads to a misalignment of collagen fibers—when they can’t align, they can’t be linked together to bear the load. Ultimately, this results in pain, swelling and more than likely, modified movement.
As a chiropractor, with a certification as a practitioner of Ayurveda, where getting to the root cause is the goal, how do you approach tendinosis?
With a background in Ayurveda, you can’t ignore that there are certain doshas and dhatus (tissues) involved. As tendinosis results from excessive movement and degeneration, you must consider that the patient potentially has an increase in the vata dosha. Inquiring about associated symptoms (dry skin, constipation, insomnia, anxiety, etc.) and potential causes (dry foods, increased movement, and exercise, disrupted schedules, travel, etc.) can help trace back to the root cause. And understanding that small tendons are a byproduct of mamsa dhatu (muscle tissue) and larger tendons a byproduct of meda dhatu (fat tissue), it’s also worth a more in-depth patient history to have a full grasp of the health of these tissues.
Is tendinosis the same as tendinitis?
Aside from both involving pain and injury to a tendon, tendinosis and tendinitis aren’t quite the same. As you likely know, the suffix “-itis” is used when there is inflammation at play. Tendinitis is acute and specifically involves inflammation, whereas tendinosis is chronic and is not categorized as an inflammatory condition.
How common is tendinosis and what are some of the symptoms?
Symptoms of tendinosis include pain, loss of strength, swelling, and can include secondary injuries such as nerve impingement. The prevalence varies based on the region of the body, but generally speaking, it is a common condition. Additionally, it has been researched that more often than not, tendinosis is misdiagnosed as tendinitis.
How do you integrate Ayurveda and Chiropractor in the treatment for tendinosis?
If treating only from a Western perspective, the course of action for tendinosis would include stopping the injurious cycle, improving biomechanics, using massage or other soft tissue therapies, and ice. Pieces of this are similar when integrating Ayurveda, in that you still want to stop the cycle, correct movement, and use massage, however, you would omit ice. Instead, moist heat would be applied—preferably after a massage with oil, such as sesame or Mahanarayan.
Another layer of care may be added with herbal and dietary support that addresses the affected doshas and dhatus (tissues). Western medicine suggests adding vitamin C, zinc, and manganese, while ashwagandha, bala, and boswellia are a few ayurvedic herbs that can aid in soft tissue healing. And though collagen seems to be more of a wellness trend, Ayurveda would fully support the addition of collagen into one’s diet. When trying to repair a specific tissue, you typically nourish with that same tissue or something that comes close. For example, meat is used medicinally in Ayurveda to heal mamsa dhatu or muscle tissue, and if not meat, you’d use another protein source such as lentils or mung beans. As with tendinosis, we are talking about damaged collagen fibers, having collagen through meat or bone broth is a way to directly fuel the repair.
Another way Ayurveda is integrated into care, which may be less expected, is the communication with the patient. When you’re delivering a diagnosis, it has to be succinct and clear for vata constitutions who can have difficulty focusing. When talking with pitta constitutions, it is helpful to use lots of details and to make sure there is space for questions. And with kapha constitutions, it is helpful to give them a boost with emotional support. If you’re assigning at home recommendations, you have to account for the fact that vata types aren’t usually structured enough to complete them daily, pitta types tend to do more than you suggest, and kapha types are right in the middle, but can have difficulty getting motivated.
Are there some professions you find in your practice that are more prone to tendinosis, and what are some that can be taken to strengthen our tendons?
Nowadays, we spend so much time on smartphones and laptops that we are all prone to overuse injuries. It doesn’t take manual labor to acquire a condition like tendinosis. As such, it’s essential that we all weave dynamic movement, including both stretching and strengthening, into our daily routines, along with giving our body an adequate amount of rest. All around, digestion should be healthy, and we shouldn’t skimp on oils and proteins. This ensures mamsa (muscle) and meda (fat) dhatu (tissue) remain strong and that production of these tissues results in healthy byproducts.
In general, how important is it we nourish our tendons, and what are some basic ways to give our tendons some love?
Not only is nourishing our tendons important for pain-free movement, but it is also essential for overall health—all tissues must be healthy for us to feel our best. As abhyanga is a form of self-love, it is also one of the best ways to give our tendons some TLC, too. Warm, herbal oil keeps our tendons, fascia, and muscles toned and supple. Even if you can’t do a daily self-massage, taking one day a week for this type of care will keep you active and able to participate in all that feeds your soul.
Dr. Sarah Kucera is a NAMA-certified Ayurveda Practitioner, Chiropractor, and yoga teacher in Kansas City, Missouri. She owns a healing arts center called Sage in the heart of downtown, where she integrates these practices together and is the author of the soon to be released book, The Ayurvedic Self-Care Handbook: Holistic Healing Rituals for Every Day and Season.