Enthesopathy: Causes | Symptoms | Traditional Treatments

What is Enthesopathy?

There are many forms of bone attachment disorders that fall under the category known as enthesopathy. Bone attachments, called entheses, can have various disorders (enthesopathies) associated with them. If a disorder falls under the category of one of the inflammatory disorders, it is called enthesitis. Enthesitis and enthesopathy are only different in name, as they are two terms which are both used to define the same symptoms and the same condition. There are many medical conditions that are associated with enthesopathies. These include ankylosing spondylitis, plantar fasciitis, spondyloarthropathy, Achilles tendonitis, rotator cuff syndrome, bursitis, and a number of other similar conditions.¹ Enthesopathy, in a nutshell, is a “disease occurring at the site of attachment of muscle tendons and ligaments to bones or joint capsules”.²

Causes and Symptoms of Enthesopathy

The bones meet the ligaments or tendons (entheses), and sometimes there can be inflammation and degeneration. There may be many reasons for enthesopathy. Anything from regular daily habits, like workplace repetitive stress movements, to other factors such as infection, metabolic changes, and sometimes medications can cause these types of problems. Some other seemingly unrelated diseases can also act as the trigger for the development of enthesopathy. These include Crohn’s disease, Reiter’s syndrome, iliotibial band syndrome, and tennis elbow.³ Arthritic conditions associated with enthesopathy include rheumatoid arthritis, psoriatic arthritis, and osteoarthritis.⁴ Patients may experience debilitating symptoms like pain and swelling that occur due to enthesitis. This can impact the physicality and function of areas of the body like the heel, fingers, toes, elbows, and chest.⁵

Traditional Treatments

There are traditional treatment options that the patient’s doctor could recommend for enthesopathy. Doctors may advise afflicted patients to focus on resting or to keep the affected area immobile. In cases where the condition and its symptoms are more severe, impeding the normal function of the patient’s life even beyond what the condition usually affects, patients may need to wear a brace at the affected area for additional assistance. At times, the pain and inflammation may lead to conclusions where a doctor would want to prescribe analgesics and anti-inflammatory medications, as well as steroid injections to manage the bothersome symptoms.⁶

Some of the medications that doctors use to treat these types of inflammatory conditions, such as psoriatic arthritis, can include NSAIDs, such as naproxen and ibuprofen, methotrexate, and TNF blockers, like those that are under the common names of Enbrel, Humira, and Remicade. Patients who also suffer from painful foot conditions, such as plantar fasciitis, may also be given a heel insert. That’s because it is common for most patients to overlook the importance of proper support in their shoes. Strain and unbalance on the feet further contributes to developing or aggravating conditions in the rest of the body.⁷ It is important to resolve the onset of enthesopathies so that patients can return to normal activities. Like any other disorder, it is best to be caught sooner in its development and treated properly rather than being left undiagnosed and to worsen.

Chiropractic Care

Chiropractors already see and treat patients who have many of the conditions associated with enthesopathy. While chiropractors are unable to treat every ailment that might befall a patient, they do know effective methods for both the processes of rehabilitation and recovery from many conditions. The primary philosophy of chiropractic and other forms of complementary and alternative care is to work to treat the underlying condition as effectively and safely as possible. And they want to help patients avoid the side effects that can come with such traditional treatment options like medications. Instead of masking the problem with pills, which very often do no more than temporarily reduce the symptoms without addressing the real issue, chiropractors can employ many different techniques and treatment methods depending on the individual patient’s situation. Some of the options include Kinesio taping, light therapy, Active Release Technique (ART), myofascial therapy, exercises, stretching, and even nutritional recommendations.

Patients who take into consideration the recommended lifestyle changes, such as exercise programs, that their chiropractors suggest are more likely to see improvement and strengthening between visits. Patients should remember to balance their recovery effort between restoring strength and flexibility and the time that they should also spend allowing their body to properly rest to avoid overexertion and stress, especially early in the recovery process. The types of injuries that are found under the umbrella of overuse and strain are overall easier to treat, due to the natural elasticity of muscles, than enthesopathies because tendons and ligaments are stiffer structures. Despite this increase in difficulty, chiropractic care can still be a good option for patients who are seeking treatment for their enthesopathy but who also wish to avoid medication or surgery.⁸ Chiropractors can help patients both to recover from existing pain and prevent future recurrence of injury and inflammation.