Tendon Degeneration

I got a very interesting question the other day from someone who saw one of my videos on YouTube. He asked: “How can there be a quick recovery for tendonosis, which is tendon degeneration, if it takes collagen (what tendons are made of) 100 days on average to regenerate?”

This is a really excellent question, maybe the best one I’ve ever gotten. To begin with, it’s important to remember that “degeneration” doesn’t always mean “destruction”. Degeneration in the context of tendonosis can mean several things, one of which is destruction of the collagen fibers (such as is sometimes seen in the case of Levaquin patients, and in those cases recovery generally does take several months, if it happens at all), but most of the time it simply implies a degeneration in function or ease of movement rather than actual damage to the collagen fibers themselves.

What happens is this: in much the same way that adhesions affect muscle tissue, tendons that are affected by tendonosis develop points or sections along the fibers that begin to stick together. With muscle fibers, the mechanism is pretty clearly understood: tiny fibers are grouped into bundles to create larger fibers, which are in turn grouped into still larger bundles, until you have a three-tier structure.

These bundles slide along each other at every level when a muscle is functioning normally, but when adhesions develop they stick at certain points, which then causes pain during movement. A good physical therapist can usually find these points simply by feeling along the muscle, and then use finger pressure to break up the adhesions and get the muscle back into good working order.

With tendons, the situation isn’t as clear. For one thing, tendons don’t contract…but they do stretch. Perhaps because of this, generally speaking simple finger pressure or massage is not enough to break up the adhesions that form. This is partly because collagen isn’t as flexible as muscle fiber, and partly because the location of the tendon itself can be harder to get at. Also, since tendon fibers don’t slide along each other the way muscle fibers do, the theory is that the collagen fibers somehow get intertwined, developing what might be visualized as “crosshatches” of collagen. What’s needed is a way to re-align the fibers so that they no longer interfere with each other.

If you could somehow run a comb through the collagen and “comb it out straight”, that would be ideal. But since that’s not possible, the next best thing is specialized exercises that, over the course of a couple of weeks, will usually accomplish the same effect. This does not need to cost a lot of money; there is a large body of research that shows that simple tendon strengthening and rehab exercises done at home can be just as effective as platelet-rich plasma and other such “cutting-edge” treatments.

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.

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.

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 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.

The Most Important Thing

The new year is here and since this month also marks the one-year anniversary of this blog, I thought I’d start things off by reiterating the most important single thing I can tell you about tendonitis. So here it is: if you’ve had tendon pain for more than a couple of weeks and have been faithfully applying the usual doctor’s prescription of rest, icing and NSAIDs, without much effect…you probably don’t have tendonitis.

Any kind of “itis” is inflammation. If you really do have inflammation, chances are excellent that it will get better with the above treatment. So it stands to reason that if you’ve tried the treatment for a while and your pain doesn’t get better, you didn’t actually have inflammation in the first place. (You can take a quick, one-minute test here to see which condition you have.)

Estimates range anywhere from 50% to over 90% that most diagnosed cases of “tendonitis” are actually tendonosis. This means that whatever problem you have with your tendons, it has gone beyond inflammation and now involves actual degeneration of the tendon itself. If this is the case, you’re not going to experience much relief with rest, ice and aspirin, because none of that is designed to repair your tendon.

To get better, you’re going to need a fresh approach. One part is good nutrition; either clean up your diet or else get some supplements that will give your body the building blocks it needs to heal. The other part is a set of exercises that will signal your body to start repairing itself. Particularly in regular exercisers and older people, the usual repair mechanisms often need an extra boost to get the upper hand against degenerative tendonopathy.

Target Tendonitis gives advice on both of these topics. It spells out the types of exercises you need to fix your tendons, and also gives specific recommendations about the sort of food and supplements that you need to help your tendons function free of pain. At less than thirty bucks (still!), it’s the best tendon-healing value on the market today.

Menthol and Tendon Pain

Let’s talk about menthol.

Menthol is a naturally occurring compound that comes from mint plants. It produces a cooling effect by stimulating the cold receptors that people have on their skin, sort of a mirror image of how capsaicin stimulates the heat receptors. Capsaicin doesn’t actually raise the temperature of anything, but if you have a mouthful of hot peppers it sure can feel like it. In the same way, menthol doesn’t actually lower the temperature, it just makes your skin feel like it’s gotten cold.

What does this have to do with tendon pain? Well, there are a lot of tendonitis “treatment” products out there, generally sprays or creams, that contain menthol. These products often claim to provide “instant relief” from tendon pain with just a quick application of the product, and usually have lots of great testimonials from people who say that it’s the best thing since sliced bread. Admittedly, it does feel a little like putting ice on your problem area. There is a cooling sensation, which is pleasant, and after a while the area will become somewhat numb. So you feel better – at least for a while. (The critical difference here is that ice, by actually producing a lower temperature, has a beneficial effect on inflammation, whereas menthol has no such effect.)

But these sprays and creams can actually do more harm than good. For one thing, menthol has never been shown to have any real effect on the structure of tendons themselves. In other words, there is no healing action. None. If you get “relief” from the pain but still have the underlying problem, it becomes that much easier to ignore your body’s warning signs (which is what pain really is) and do something that’s really going to injure you. If that happens, you can easily go from having a painful – but healable – tendon to a ruptured tendon. And if that happens the only option is surgery.

Also, since you’re not actually treating the condition, you have to keep buying the spray or cream in order to continue to experience relief. I don’t know about you, but I much prefer to actually fix the problem so I don’t become a financial slave to some company that’s putting out a “feel good” spray.

Menthol can be great for providing temporary relief for temporary conditions like sunburn, and of course it makes chewing gum, toothpaste and so on taste better. But if you’re looking for tendon pain therapy, any product that has menthol in it should be avoided. Every one that I’ve seen so far has been a scam.

Blackberry Thumb, iPhone Thumb…

I ran across an interesting (and slightly horrifying) article in the Calgary Herald a couple of days ago (text and link are below). People usually think of tendon pain as something that happens in the larger joints, the elbows, knees, ankles and so on. But it can happen anywhere that there is a repetitive stress and pattern overload. Here’s an extreme case:

Banker undergoes ‘BlackBerry thumb’ surgery because she used her iPhone too much

By Katya Wachtel, Business Insider August 29, 2010

A mortgage banker just had to have surgery on her thumb because she was using her iPhone too much, according to WTSP.

The hospital says her condition is best known as “Blackberry thumb.” However, since she was using an iPhone, “iPhone thumb” is obviously more appropriate in her case.

Symptoms of Blackberry thumb include pain, inflammation, numbness and tingling.

The Philly woman might have realized she felt some of the symptoms had she not spent up to 12 hours a day in communication with clients on her iPhone.

The tendons in her thumb became so severely inflamed, they required removal.

Her need for surgery would (almost?) be funny, but apparently surgery on the hand is very serious and it’s going to be a long time before she can use her phone again. Recovery time for tendon surgery can be up to two months or longer.

“Most hand tendon injuries take longer to recover than most other operations elsewhere in the body,” according to the American Society for Surgery of the Hand

Read more: http://www.calgaryherald.com/technol…#ixzz0y2Lt9Vag

I have complete confidence that the techniques I explain in my book will cure most people, but in this case I wouldn’t be completely positive. I’m fairly sure that with the amount of stress this lady placed on her tendons she’s gone beyond tendonitis (simple inflammation) and well into tendonosis (actual damage to the tendon itself). But if you’ve got tingling and numbness you’re probably experiencing some nerve damage along with the tendon problem, and that’s frankly beyond my expertise. Still, I think that if it were me I’d invest thirty bucks–especially since there’s a money-back guarantee–and see what happened before I opted for surgery.

For those who are experiencing some pain (but not as severe as the lady in the article), there is a quick and accurate tendon test on this page that will tell you what sort of pain you have, and what you can do about it.

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.

De Quervain’s Syndrome

I’ve been getting some questions about De Quervain’s Syndrome lately, so I thought I’d answer a few of them here.

First, De Quervain’s Syndrome is neither tendonitis nor tendonosis. That’s right: there are still more kinds of tendon pain. In this case, what you’re looking at is something called paratenonitis.

Tendons are covered with sheaths, called the peritendon, and when you have problems with the peritendon, you get paratenonitis. Paratenonitis can occur by itself, or in conjunction with problems with the tendon inside, which makes things complicated when you try to diagnose it and/or cure it.

Since paratenonitis usually has a large component of inflammation, if you suffer from De Quervain’s Syndrome my first line of defense would be NSAIDs, ice, stretches and rest. If that doesn’t get rid of the pain within a week or two, then it’s likely that you’ve also got some tendonosis going on, and perhaps some actual degeneration of the peritendon as well. In that case, you might want to give the techniques in my book a try. Among the videos that come with the book is one that shows the exact exercise you should do to get rid of De Quervain’s.