How to tell the difference between Arthritis and Tendonitis

The initial symptoms of arthritis and tendonitis can feel very similar, so here’s an easy home-diagnosis way to tell the difference: try taking glucosamine for two weeks. If it helps, you likely have osteoarthritis. If not, it’s more likely a tendon problem.

What’s the reasoning here? Glucosamine (often packaged with MSM and/or chondroitin) has been shown in quite a few scientific studies to help with cartilage formation. Cartilage is what your joints are made of, and what arthritis attacks, so upping the rate of production in turn helps your joints. End result: you feel better…if you have arthritis.

On the other hand, glucosamine will not help with collagen formation, and tendons are made of collagen. So it stands to reason that if you feel like you have “joint pain”, take glucosamine, and don’t experience any relief, one very likely culprit could be your tendons. (Tendon insertion points are often very close to joints and it can be difficult to tell exactly where the pain is coming from.)

Taking NSAIDs, using ice and so on can provide temporary relief for either condition, but since both arthritis and tendonitis are both the result of inflammation, using these treatments won’t help you distinguish between the two. And knowing which one you have is of course very important if you intend to treat the condition yourself.

If you do decide that you have a tendon problem, however, and you’ve had your pain for more than a couple of weeks, I caution you against assuming that the issue is tendonitis. More likely it’s tendonosis, which is an actual degeneration of the tendon. (This is especially true if you take NSAIDs and they don’t help.) If you think that this might be your problem, have a look at my tendon test. It’ll only take a minute, is completely free, will tell you whether you have tendonitis or tendonosis, and give you some options about what to do about it.

Nutrition for Tendon Pain

I recently received a question from someone who purchased Target Tendonitis. He asked about the advisability of fasting if you have tendonosis.

Although fasting can have some beneficial effects, I do not advise anyone who is suffering from tendon or fascia problems to do it. The reason is simple: your body needs nutrients to heal itself, and if you’re fasting you’re not providing it with the basic “stuff” that’s necessary to do the job. I recommend some nutritional supplements in the book, but these recommendations are based on the assumption that your basic nutritional needs are already being met. If they aren’t, the supplements aren’t going to do you much good by themselves. A diet that is lacking in vitamins, minerals or protein (to say nothing of all three at once!) is going to pose serious, serious problems when it comes to healing your tendons.

Assuming that your basic diet is okay, one thing you can do to help heal yourself if you have tendonosis or fasciosis is get a good kelp supplement and take it regularly. Kelp contains iodine, which is helpful for the formation of collagen, the basic building block of tendons and fasciae. My favorite out of the products listed on Amazon is Icelandic kelp, which is harvested during the cold months and washed in high-mineral fresh water, which adds further minerals to the already good mix that kelp naturally contains.

Note, however, that just taking a supplement isn’t going to be enough to cure yourself if you have long-term tendon pain. Anything over about two weeks is most likely going to be tendonosis, not tendonitis (I know, I know, but believe me, your doctor is wrong. Do the research yourself and see.), and in that case the collagen fibers in your tendon have become either bunched or damaged to the point that they are going to require actual realignment in order to work properly. This is what the exercises in Target Tendonitis provide (along with a lot more detail about the nutritional side of things), and why it has such a high success rate for people who haven’t seen much effect from nutritional therapies alone. A combined, holistic approach works much more quickly than any single measure.

Capsaicin for Tendonitis

I’ve been seeing a lot of talk around the internet lately about using capsaicin to relieve or cure tendon pain. The idea is that, applied topically, capsaicin will activate the pain nerves, but then make them less sensitive (through an overload effect), so as to reduce the overall amount of pain.

For example, this site says :

Capsaicin “numbs” the sensation of pain in joints affected by tendonitis. This effect occurs from capsaicin blocking the production of a neuropeptide named substance P, which is responsible for the sensation of pain.

and then lists this study as their reference: Deal, C. L. The use of topical capsaicin in managing arthritis pain: A clinician’s perspective. Seminars in Arthritis and Rheumatism. 23(6):1994;48-52, 1994. I won’t comment on the blockage of substance P, but I will say that this site doesn’t know what it’s talking about when it comes to tendons. First, tendons aren’t joints; the structures are completely different (collagen vs. cartilage). So the fact that something that works in a joint has absolutely no bearing on tendons, and talking about “joints affected by tendonitis” is simply wrong. Second, the study is about arthritis pain, not tendon pain. Sorry, but those are different, too.

So, one argument down. Another is that applying heat to a painful area can produce relief. There may be some merit to this idea. After all, people use hot-packs all the time. But the problem (as I mentioned in my post about menthol and tendon pain) is that capsaicin doesn’t produce any real heat. Sure, you’ll feel like something’s on fire, but no actual increase in temperature occurs. The capsaicin just causes your body’s heat sensors to react as though there was real heat.

To put it bluntly, using capsaicin for tendon pain is a bad idea. Icing a tendon can be a good modality for tendon pain that’s not too severe and hasn’t been around for long, but even that won’t be effective for persistent tendon pain. Heat…well, heat just isn’t on the scientifically-verified menu — not even real heat. Finally, there is absolutely no research showing that topical capsaicin creams and so on are effective, and anecdotal reports of trying to rub chili powder and so on directly onto the skin usually end badly.

If you have persistent, long-term tendon pain, it’s a good bet that you don’t have tendonitis, but tendonosis (take my free, one-minute test to find out which you have), and neither heating nor cooling is going to help much. Long-term pain usually means tendon degeneration, and for that you’re going to need some targeted exercises and a good nutritional strategy to rebuild the affected area. Target Tendonitis provides both, and comes with a 60-day money-back guarantee.

Stretching for Tendonitis

Let’s talk about stretching.

Stretching your muscles regularly is just a good idea all the way around. But there are a lot of people out there who talk about stretching the tendons as well. With tendons the possible benefits are less clear, and unfortunately it’s pretty much impossible to stretch a muscle and not stretch the tendons that are connected to it at the same time.

Muscles work by contracting lots of fibers, each of which contains smaller fibers within them, and each of those smaller fibers contains even smaller fibers within them.

Furthermore, these fibers have a bit of elasticity to them. When you use your muscles, these fibers contract 100% (not all of the fibers at the same time, of course; just enough to get the job done) and then they relax. So you’ve got muscle fibers sliding along each other on at least three different levels of size if you’re doing anything more strenuous than lifting a piece of paper.

Sometimes your muscles develop adhesions, which is basically some of the fibers sticking together so that they don’t slide properly, and failing to release. These sticking points can get really painful if left untreated, and stretching after exercise (and just on a daily basis in general) goes a long way toward preventing this.

But now let’s look at tendons. Tendons are made up of collagen, which is a completely different structure. It attaches your muscles to your bones, and is less elastic. There have been a lot of studies done on the effects of stretching tendons before exercise, and the results are unclear. In some sports it seems to help performance and prevent injuries, and in others it doesn’t. Basically, it breaks down to the type of sport that you’re doing. If you engage in something like American football or soccer, which is pretty high-impact, stretching seems to help. If you’re doing something low-impact, like swimming or cycling, then it may actually detract from performance, because in these sports you want the muscle power to be transmitted directly to the pedal or whatever. Having a stretched and elastic tendon makes this less efficient.

So what should you do? Well, here are some recommendations:
1. Unless you’re doing something that’s high-impact, warm up by performing light movements of the same type that you’re going to be doing when you exercise. So for swimmers mimicking the arm strokes before you get into the water would be a good idea.

2. Include foam rolling in your warm-up. Foam rolling is great for breaking up adhesions in both muscles and tendons. Most gyms have those cheap blue ones, and if you’ve never foam rolled before they will do the job just fine. (Foam rolling will likely hurt the first time you try it, so go slowly and lightly.) For more advanced athletes and/or those who have really stubborn adhesions, you can get something like this monster:

It’s called the RumbleRoller and is a foam roller that’s specifically optimized for myofascial release.

3. Save the stretching for the warm-down. You’ll get all the benefits and none of the drawbacks doing it that way, and both your muscles and tendons will thank you.

Stretching is a great way to prevent tendon problems from occurring before they happen. If you already have tendonitis, however, much less long-term tendonosis, it won’t be enough to cure you. So get preventive and start doing it regularly today!

Writer’s Tendonitis

Nadia Lee, an up and coming writer of romance fiction, interviewed me a few days ago for her blog. She’d been suffering from wrist and forearm pain (mainly minor RSIs stemming from too much typing and mousing) for a few weeks and — after seeing a doctor and getting physical therapy for months — finally got sick of it. Since I know her in real life I gave her some advice on how to get rid of her pain, as well as tips on how to manage the cause of the problem in the future.

While I don’t give away any secrets in the interview, if you’re a writer it might be worth your while to check it out.

Forearm Tendon Pain from Weight Training

It’s actually becoming a little hard to remember at this point, but the fact is that before the mid-1970s or so, not many adults exercised on a regular basis. But then a guy named Jim Fixx started the jogging craze, and a few years later a woman named Jane Fonda started the aerobics craze, and a couple of years after that some Austrian guy named Arnold something-or-other hit the screen and made everyone want to have muscles. Far from being mere fads, these pursuits have been part of the Western lifestyle ever since.

And this is great. The benefits of consistent exercise, especially resistance exercise, are legion. Aside from the obvious looks and health advantages, a recent study by Barbara Strasser and her colleagues in the May 2010 issue of Sports Medicine gave some pretty convincing numbers regarding how much money the average 50-year-old would save by starting a weight-training program. Even counting the costs of gym memberships, workout clothes and so on, it’s pretty obvious that you’ll end up saving a lot on medical expenses down the road.

But as with every good thing, there are some drawbacks. One of the biggest with weight-training is the development of tendon pain in the forearms, mainly from gripping the bar over and over again in exactly the same way. Barbells and dumbbells in regular gyms are all exactly the same diameter, which can quickly lead to overuse pattern injuries such as tendonitis and tendonosis. (Click here for a quick, free test to find out which one you have.) Ask anyone who’s ever had forearm tendon pain: it’s difficult just to shake someone’s hand, much less hold on to a bar loaded up with weights.

Fortunately, there are some ways you can get around this problem. One is to use machines, which often come with pads that don’t require you to grip anything. Machines are not as good as free weights, though, because you don’t have to balance anything, and therefore those small-but-important stabilizer muscles in your body don’t get trained.

A much better solution has been provided by a company called Fatgripz. Fatgripz are devices that you can attach to a barbell or dumbbell to make them, well, fatter. Instead of the usual inch or so diameter of the bar, now you’re dealing with 2.25″ (5.7cm).[vc_single_image image=”3934″ img_size=”full” add_caption=”yes” alignment=”center” style=”vc_box_shadow”]

This means that your hand doesn’t close as much, which means that now you’re exercising with all the muscles and tendons in your forearm in different positions. The result? Less pattern overload, and less tendon pain. In fact, by using Fatgrips on a regular basis (not every workout, but maybe every other workout) before you develop tendon pain, you might just be able to prevent it altogether. But for those who do have forearm tendon pain stemming from their time in the gym, Fatgripz offers a convenient and economical solution.

They also come with a two-month money-back guarantee, so it’s hard to see a downside to getting a pair. If you decide to return them the company will even spring for the return postage. (You don’t see that every day!) But they’re quality goods, virtually indestructible, and I don’t know anyone who’s tried them and not liked them. When you compare the small chance of not liking these things to the potential for eliminating your forearm pain, it’s really a no-brainer.

Tendonitis and Tendonosis – Can I have both?

I make a big deal out of distinguishing between tendonitis and tendonosis, but it’s perfectly possible to have both at the same time. In fact, it’s likely. Here’s what happens:

You do some repetitive movement for a while and something is not exactly perfectly aligned in your body (i.e., your movement pattern is wrong, etc.) or else you just do the movement so often that your body can’t recover completely. (Recovery issues are particularly important for hard-training athletes and older folks.) This starts to wear down the tendon, causing micro-tears and fraying. This is the beginning of tendonosis, although you don’t notice it yet.

After the damage passes a certain point it triggers a “fix it” response. Your body, trying to repair itself, will cause inflammation to occur, which brings with it the pain that causes you to notice on a conscious level that Something Is Wrong.

This is the point where most people will say, “Hey, I’ve got tendonitis.” From here, a couple of things can happen:

(1) You try to ignore the pain and work through it. Although the most common response, this is doomed to failure and will eventually lead to (2) below.

(2) You take NSAIDs, use ice, rest the area, etc. (the usual prescription for tendonitis).

Now there are two possible outcomes:

(2a) You didn’t have all that much tendon damage to begin with, and what you did have has been repaired to the point that you no longer feel pain. Congratulations, you’re cured!
(2b) You (may) feel some relief from the reduced inflammation, but you still have a considerable amount of pain. This means that while your anti-tendonitis regimen is working on the inflammation, the underlying tendonosis condition is severe enough that it has not been, and still is not being, fully repaired.

At this point, further anti-tendonitis measures like NSAIDs and so on are probably not going to help. You need to actively repair the damaged tendons – which is what I cover in detail in my book.