Pizza and Tendonitis

One thing that will help prevent getting tendonitis is a proper diet. And one of the basic components of good, anti-inflammation promoting nutrition is getting enough vegetables with every meal. Vegetables do a lot to push your body toward the alkaline side of the pH-scale, and can counteract (to a certain degree) the effects of eating too much acidic (and potentially inflammation-producing) red meat.

Of course, it’s helpful to know what is and isn’t a vegetable. Recently, the US Congress showed just how difficult making this determination can be by deciding that pizza is now legally to be considered a vegetable.

Apart from the blatant political self-serving–and the complete disconnect from reality that politicians apparently experience–no one should be fooled into believing that pizza will actually serve to replace a vegetable. But if you suffer from tendon inflammation, adding more (real) vegetables into your diet is a good step to take. Another would be adding a good supplement or two, which you can read about here.

Pattern overload

Let’s talk about pattern overload.

Basically, pattern overload occurs when you perform too many repetitions of a particular movement. You don’t necessarily need to be using a lot of weight to have pattern overload occur; your own bodyweight is more than enough…as is a one-pound dumbbell if the number of repetitions is high enough. Typing can even become a problem if you never change your hand/wrist/chair/keyboard position.

Most of the time pattern overload isn’t too much of an issue, because even with high-rep activities like running or swimming, each time your foot strikes the ground or your hand cuts through the water, your body is going to use a slightly different “groove” to accomplish the movement. If you’re a highly trained athlete you might be performing in more or less exactly the same groove for a while, but eventually, as you begin to fatigue, your groove will start to become looser and while this means that your efficiency of movement will go down, it’s one way the body helps to prevent itself from getting injured.

But certain modes of exercise can be worse for pattern overload than others. One example is using gym machines too much. People who work out with free weights have a much lower incidence of pattern overload than those who work exclusively on machines. The reason is that when you’re using a barbell or dumbbell the weight moves according to your body, but when you’re working on a machine your body moves along the machine’s predetermined and set path. Even something like a Smith machine, which incorporates a small degree of leeway, is much more limiting and allows for less “natural body adjustment” as you go through your sets than a free-weight barbell.

On the opposite end of the spectrum, there is Crossfit. I’m not a Crossfit hater. I think that the main idea of Crossfit – to do something different each day, and keep good track of your rest times – has merit for those who simply want to “be in shape”, and certainly the training is fun. But there are some drawbacks as well, especially when you look at Crossfit in relation to tendon injuries.

Basically, a Crossfit exercise session involves choosing two or three distaff exercises, and then doing a lot of those exercises using a set weight for time. The rest time between sets is usually about ten seconds, and you alternate exercises. To give an example, one of the videos on the website shows three women doing bodyweight squats, then pull-up/press on gymnastic rings, then hang cleans with a barbell.

If you just plain do too much of a movement, even if that movement is something completely “free”, like swimming, you can develop tendon problems if your exercise volume exceeds your capacity to recover from it. This is where I have an issue with Crossfit. I know that on their site they place a lot of emphasis on not doing too much and using good form, but in practice they use technically difficult movements (like cleans) and push well past the point where good form completely breaks down.

Of course, you have to push yourself to a certain extent if you want to improve your body. But the question of degree is very important. Without getting into a long discussion about exercise theory, the bottom line is that quite a few people order my ebooks, and lately a lot of them are complaining about injuries received from Crossfit training.

So if you’re suffering from tendon pain and are using an exercise program (or doing some kind of work) that incorporates too much pattern overload, either through limited and unnatural movement or by simply having too much volume, think about ways that you can reduce or get around the problem. You don’t have to quit exercising, but you may well be better off if you can find ways to vary your routine.

UPDATE: Scott Abel has written a critique of Crossfit that, while it won’t win any awards for style, makes several excellent points about the dangers and limitations of the training. You can find it here.

Bye-bye, Food Pyramid

In a long overdue move, the United States Department of Agriculture (USDA) has gotten rid of the famous Food Pyramid that for close to two decades was supposed to tell you how to eat. The new symbol is a plate-and-cup that will hopefully be easier to understand.

Michelle Obama, Agriculture Secretary Tom Vilsack and Surgeon General Regina Benjamin got together to announce the new paradigm, but the message seemed to be a little contradictory. According to Ms. Obama, parents “don’t have time” to measure out portions of food…yet, according to Dr. Robert Post, Deputy Director of the USDA Center for Nutrition Policy, “We know that with proper planning, you can get enough protein” from a vegan diet.

Hmmm. I can tell you from personal experience that, once you have the scale, it takes about ten seconds to measure out a portion of anything. On the other hand, I know very few vegans who actually (a) combine plant proteins properly on a regular basis and (b) get enough overall protein into their bodies (which is probably why so many of them start looking gaunt and eventually go back to eating animal sources). I have nothing against any particular diet plan, so long as it’s healthy, but let’s be clear about the realities of eating. Weighing food takes almost no time at all, and there is no better way of coming to grips with the reality of what you’re putting into your mouth–it’s just that it’s a bit of a hassle.

Anyway, time will tell if this new plate-and-cup idea takes hold. Meanwhile, if you have long-term tendon problems, here are some food-based issues to consider:

If you are overweight, the first thing to look at is losing the excess poundage.
If you are underweight, are you getting enough good fats in your diet?
For any American male, do you eat a preponderance of red meat versus fish and nuts?

Any or all of these can be (and probably are) contributing factors to your tendon pain. Fixing them is one step toward having healthy tendons and preventing recurrences of tendonitis/tendonosis. For more information about nutrition and supplementation as they relate to having healthy tendons, check out my book Target Tendonitis.

Levaquin and Tendon Problems

I am encountering more and more people who have taken Levaquin in the past and now have seemingly irreparable tendon damage. I’m going to do some research and write a more in-depth post about this topic soon, but for now let me just say that if you are suffering from tendon pain as a result of taking Levaquin, there unfortunately doesn’t seem to be much that you can to do about it.

One technique that I have been having some (very limited) success with is lowering the intensity of the exercises given in my book. The usual prescription is for about a 2-3 on a scale of 0-10, 10 being extreme pain, but if you’ve got Levaquin in your past it seems to work better if you just aim for a “1”, at least at the beginning. Over time, and with proper nutrition and exercise, you may be able to strengthen your tendons, even if they’ve been damaged by this drug, but you’re probably going to have to start out from a lower threshold than someone who has not had this particular sort of debilitation.

Sign Language Tendonitis

Tendon problems aren’t just for athletes and computer programmers. It can strike people who you would never think would get it. One such group is sign language interpreters. Yup, it’s true: sign language tendonitis is a thing.

Just like anyone else who performs excessive repetitive motions, sign language specialists can develop tendon issues. Common problem areas are the thumb, wrists (similar to carpal tunnel syndrome), as you might expect, but also in the elbow flexors. Although it might be thought of as a sort of niche condition, the remedy is the same as for any other situation: icing, rest and NSAIDs for the short-term inflammation, and in more advanced cases a structured set of exercises performed in a particular manner to help reverse any actual tendon damage. (In this case you will actually have tendonosis, although most medical professionals don’t bother to make the distinction.)

If you work with sign language regularly, it would pay to treat your hands and forearms in much the same way an athlete does. Be sure to stretch your fingers, hands and forearms after long signing sessions. Pay attention to your nutrition, especially aspects that help prevent inflammation and support tendon regeneration. And try if at all possible to take regular breaks during work. Five to ten minutes every hour is a good rule of, er, thumb.

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’ll probably 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 Tendons

I recently received a question from someone who purchased Target Tendonitis. He asked about the advisability of fasting if you have tendonosis, so I thought I’d talk a little bit about nutrition for tendons.

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.

Icelandic Sea Kelp for tendons

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

Capsaicin for tendon painOne thing about the internet, there are lots and lots of supposed cures for pretty much everything under the sun. Tendonitis is no exception; you can find bogus remedies like magnesium, bath salts and crystals with the click of a button. But lately, I’ve been seeing a lot of talk about using capsaicin to relieve or cure tendon pain.

If you don’t know what capsaicin is, it’s what makes hot peppers hot. The idea relating to tendon pain is if you apply capsaicin topically, it 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

Stretching for tendons. Let’s talk about it.

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 the opposite occurs. 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. And if you’re lifting heavy weights (close to maximal effort) like powerlifters and strongmen do, then stretching right before a lift can actually increase the likelihood of injury.

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 cheap 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.