Enthesopathy and Treatment

There are many bone attachment disorders that fall under the category called enthesopathy.

What is Enthesopathy?

Bone attachments, called entheses, can have various disorders (enthesopathies) associated with them. If they are inflammatory disorders, it is called enthesitis. There are many medical conditions that are associated with enthesopathies, such as ankylosing spondylitis, plantar fasciitis, spondyloarthropathy, Achilles tendonitis, rotator cuff syndrome, bursitis, and more.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. Workplace repetitive stress movements, infection, metabolic changes, and sometimes medications can cause these types of problems. Some other diseases can also trigger enthesopathy, such as 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 pain and swelling from enthesitis. This can impact the heel, fingers, toes, elbows, and chest.⁵

Traditional Treatments

There are traditional treatment options for enthesopathy. Afflicted patients may be told to rest or keep the affected area immobile. If the case is severe, patients may need to wear a brace. At times, the pain and inflammation may lead a doctor to prescribe analgesics and anti-inflammatory medications, as well as steroid injections.⁶ Some of the medications used by doctors to treat inflammatory conditions, such as psoriatic arthritis, can include NSAIDs (i.e., naproxen, ibuprofen), methotrexate, and TNF blockers (i.e., Enbrel, Humira, Remicade). Patients with foot conditions, such as plantar fasciitis, may also be given a heel insert.⁷ It is important to resolve enthesopathies so that patients can return to normal activities.

Chiropractic Care

Chiropractors see patients with many of the conditions associated with enthesopathy. They work to treat the underlying condition and to help patients avoid the side effects that can come with medications. Instead of masking the problem with pills, chiropractors can employ many different techniques, 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. Even though overuse and strain injuries are easier to treat (due to muscle elasticity) than enthesopathies (as tendons and ligaments are stiffer), chiropractic care can be a good option for patients seeking to avoid medication or surgery.⁸ Chiropractors can help patients recover from existing pain and prevent future recurrence of injury and inflammation.