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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.

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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.

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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!

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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.

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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.

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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.

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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.

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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.

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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.