Category: Around the internet

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Voodoo Floss for Tendonitis

I just want to post a quick update here about using Rogue Voodoo Floss for tendonitis. I may decide to expand this post later, but for now, I’ll just say that it didn’t work for me.

I’ve been lifting weights for over 40 years and still spend a lot of time in the gym. And while I know quite a bit about how to prevent and cure tendon pain, I’m in my upper 50’s and the body simply doesn’t work as well as it used to. So even being careful and with best practices, I still do occasionally get some tendon pain.

Of course I know how to fix it when it does occur. But this time around I wanted to try the Voodoo floss method and see how that worked. Long story short, it didn’t. I had some elbow tendonitis, on the inside (generally knows as Golfer’s Elbow, even though I don’t golf), and figured it would be easy to wrap with a Voodoo Floss band.

So I tried it, keeping the tension around 75%, which is what’s usually recommended, and gave it a couple of weeks. While my arm did feel a little better during the workout after using the band, the tendon pain slowly got worse. This is generally a sign that tendonitis is morphing into tendonosis (a much worse condition), so after two weeks I gave up and went back to the methods I explain in Target Tendonitis. And got better pretty quickly.

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First things first: you have to know your problem

Even the best method of treatment won’t work for a problem has been misdiagnosed. It’s like taking your car in for a noise coming from under the hood and having the mechanic replace a fan belt. If the problem was the fan belt, great. If not, you’re still going to have that noise.

“Tendonitis” has sadly become such a catch-all that people use it in cases where it doesn’t even exist. Take Nick Bryant, who writes the myrotatorcuffcure blog. Bryant, who seems like a regular guy, apparently tore his rotator cuff (a web of small muscles around the shoulder that helps keep the bone in the right place in its socket) a little while back. After a heck of a lot of pain, he went to see a doctor who told him that he had an impingement. He tried cortisone shots and “physio” (I guess this means physical therapy), but didn’t have much luck, so his doctor recommended surgery. Bryant didn’t want to go that route, so he found a book with some Pilates exercises, did them for a few weeks and got better. Now he’s become such a fan that he has a link to the book on his website.

First of all, congratulations are in order for Bryant, who didn’t just sit around waiting for a surgeon to cut him open needlessly. And it’s great that he found a method to heal himself. But let’s take a little closer look at the circumstances of his problem, because there are a few odd notes along the way.

First of all, a tear isn’t going to heal very quickly no matter what you do. Rest is definitely on the menu, although Pilates might not be. Second, Bryant says that he had an impingement. There are basically two types of impingement: one, the bones have grown so that they impede movement. This sort of impingement isn’t going to respond to anything other than surgery (shaving the bones down so they aren’t in the way as much anymore), and since Bryant says he’s better now, this probably isn’t what he had.

The other type of impingement occurs when the bones are okay, but the surrounding muscles have become imbalanced. The imbalance can be caused either by a lack of flexibility or else by one or another muscle being excessively strong or weak. Whatever the cause, something will be pulled out of alignment, causing it to rub against a bone or joint, which then causes pain. Given that Bryant fixed himself by doing some Pilates stretches and balancing exercises, it’s virtually certain that he had this second sort of impingement.

So what does this have to do with tendonitis? In reality, not much. But Bryant mentions at the bottom of his blog that the exercises in the book are good for relieving “torn rotator cuff, shoulder impingement or tendonitis”. Since the author of the book, Jennifer Adolfs, doesn’t make any claims on her website about the book’s ability to address tendonitis, it kind of makes me wonder where Bryant got the idea that it does. And I’m afraid we probably have to lay the blame at the feet of his doctor. Why would a physician give “steroid injections” to someone with a torn cuff or impingement? Sure, one might help with the initial inflammation a bit, but note the plural. The doctor gave multiple injections, which is one of the commonly accepted treatments for tendonitis. (Cortico-steroid injections certainly aren’t going to make the impinging bone shrink back to acceptable dimensions.)

Once again, we have a situation where any shoulder problem suddenly becomes “tendonitis”. If your doctor has told you that you have tendonitis but you haven’t been getting better with the usual regimen of NSAIDs, rest, ice and so on, you most likely do NOT have tendonitis. Your condition might be an impingement that can be cured by stretching and re-balancing the relevant muscles, like Bryant did. Or it might be tendonosis, which will require a very different approach. Whatever the case may be, the first thing to do is understand what your condition truly is. If you’ve been told that you have tendonitis but think that you might have been misdiagnosed, I have posted a self-diagnosis tool that will quickly allow you to see for yourself.

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New year, new look for Target Tendonitis

Well, it’s 2018 and the Target Tendonitis website, as you can see, has been redone with a completely new look. The old site was getting kind of stale, and some of the back-end tech stuff was out of date, so I hired a guy to come in and overhaul the whole thing. The site is still being built out; I’m in the process of porting over all the old blog posts and stuff, but the main part is here and done. Hope you like it!

In the same spirit, I am going to release the fourth edition of Target Tendonitis soon. It will have links to even more videos, an expanded FAQ section, and some updated nutritional recommendations. If you order the 3rd edition now, don’t worry; if you want the updates I’ll be happy to send you the new version once I get it done. Just shoot me an email (the address is in the ebook) and I’ll put you down on the list.

Finally, I’ve decided to start posting about topics other than tendon pain. I’ll still keep on with the tendon information, but there’s only so much that can be said about tendons, and I want to expand the blog to encompass some other topics relating to general health and fitness (especially for us older folks, those on the far side of fifty). So I’ll be talking about exercise, and nutrition, and body maintenance not only as they relate to tendons specifically, but on more of a general level as well.

Best wishes to everyone for the coming year (and beyond!), and I hope that this blog will become even more useful as time goes on.

Alex Nordach, author of Target Tendonitis

 

 

 

 

 

 

 

Alex

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Tendon Degeneration: What is it exactly?

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.

Here’s a picture of a healthy tendon. Note how the collagen fibers are basically nice and straight.

Healthy tendon

Here’s a shot of an unhealthy tendon. The arrows show some of the spots of adhesion, which show up as white in the picture.

Unhealthy tendon

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 a regimen of targeted, 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.

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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.

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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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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.