Category: Tendonitis or tendonosis?

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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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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.

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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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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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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.