Archive for May, 2010

A couple of testimonials

Monday, May 24th, 2010

Got a couple new testimonials this past week, so I thought I'd share them here.

One is from Bob, who had wrist pain from overuse of his computer and who got a copy of Target Tendonitis. His response:

I used the techniques in your report, and my wrist pain went away within a week.

And from snowcat2, an internet acquaintance who has acute Achilles tendonitis, plus complications from mononucleosis:

Your information was really helpful. Thanks! I'm taking it slow.

These two responses show just how diverse tendon pain can be, and how much of a range there is in recovery time. Robert's case was resolved unusually fast; it's going to take snowcat2 a little longer. Both of them, though, are obviously happy with the way my techniques worked for them.

(By the way, if you're wondering why these testimonials aren't of the usual, superlative-laden, "OMG your book changed my life/enabled me to quit my job and make millions in my underwear while watching Baywatch reruns/got me dates with 187 Playboy playmates in just one night" sort, there's a very good reason: they're real.)

If you're suffering from tendon problems, what are you waiting for? Target Tendonitis costs less than twenty bucks (still!), and fully guaranteed at that. Other than your tendon pain, you really don't have anything to lose.

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Tendonitis and Tendonosis – Can I have both?

Sunday, May 16th, 2010

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.

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Runner’s knee

Friday, May 7th, 2010

I spend a lot of time talking about what tendonitis and tendonosis are, but in this post I'm going to talk about one case of what they are not. Runner's knee is a sort of catch-all term for pain experienced in the knee, and the people who suffer from it aren't limited to just runners. Cyclists, weightlifters, hikers... the list goes on and on. Basically, anyone who walks can get "runner's knee", but the knee is a complex joint and there are a lot of different ways that the pain can manifest.

Today, let's talk about what happens when pain is experienced on the outside of the knee. This is a sub-category of runner's knee, and the technical term for the condition is Iliotibial band syndrome (or ITBS). The iliotibial band stretches from the outside of the hip, down the thigh and past the outside of the knee, finally inserting into the top of the tibia. People can experience pain anywhere along it, but we're going to focus on pain that occurs right next to the knee itself.

Iliotibial band

Two views of the iliotibial band

Sooo... If you have pain on the outside of your knee (not in the front, or directly below, or inside or anywhere else), chances are good that you have ITBS. Is this a tendonitis or tendonosis?

Although the IT band is, in fact, a tendon, ITBS is most likely not a form of tendonitis or tendonosis. Contrary to the traditional view that the IT band "rubs" across the lateral femoral epicondyle (a bony knob on the side of the knee) during walking and running and is thus irritated into a tendonitis condition, current research shows that it's more likely the uncomfortable compression of a pocket of fat that lies beneath the IT band that accounts for the pain. (See, for example, The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome, by Fairclough et al, published in the Journal of Anatomy, March 2006, for a nice discussion of the issue.) Since most health care professionals hold the old view, unfortunately most of the advice given about how to take care of this problem is wrong. Go to massage therapist and you will most likely receive a vigorous "stretching" of the IT band; talk to a doctor and s/he might recommend training the quadriceps muscle; a physical therapist will likely make noises about the tracking of the patella... None of it is particularly effective.

So what should you do? Probably the best home treatment available is to get yourself a $10 foam roller and just roll the affected area a couple of times a day on a regular basis. If you don't know how to do this, check around the Net - there are lots of videos out there that will show you the basics. If that (along with some rest) doesn't work, you can try icing the area, and/or contrast baths (basically alternating icing and heating the area for 10-15 minutes at a time, doing three "sets" in all). If that doesn't work either, then you probably will need to see a doctor for MRIs and so on to determine if there's a real problem with your knee. Sorry. But at least you'll know that you've tried the best current science has to offer, unlike this poor fellow who is relying on [snort, chortle] Wikipedia :rolleyes: for his information.

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A chiropractor who gets it right

Sunday, May 2nd, 2010

I was surfing around the Net today and found a chiropractic site that gets the whole tendonitis/tendonosis issue exactly, 100% right. Now among the people I talk to, chiropractors aren't generally known for having the strongest scientific background. And on most chiropractor internet sites it's true that you'll be hard-pressed to find much in the way of scientific references. But this one has four, and if the entries are a bit dated (1998-2000), the information given is good.

In a post called "Goodby Tendonitis, Hello Tendonosis", Doctor of Chiropractic Warren Hammer posts the following:

Tendonitis is now considered a relatively rare condition. The good news is that with the diagnosis of tendonitis, patients were expected to get well in a short time, but with the realization that it is really tendinosis, more time is required (six weeks to six months, depending on the chronicity) for treatment and healing. In many cases such as Achilles tendonitis, patellar tendonitis, lateral epicondylitis and rotator cuff tendonitis, a good percentage of cases do not get well as soon as we might desire. We do not have to blame ourselves. What we have to do is explain to the patient the underlying tissue damage that exists. Corticosteroid injections and NSAIDs cannot really heal a noninflammatory condition.

There is so much good information in that paragraph it's just amazing. The acknowledgment that "tendonitis" generally isn't tendonitis at all, but tendonosis. That it's not going to get better with just a shot of cortisone. That there is actual tissue damage. That the usual anti-inflammation protocols simply aren't going to work.

Despite the fact that Dr. Hammer's article is short (just four paragraphs), he has several scientific references at the bottom (including two from KM Khan, who has to be my all-time favorite when it comes to debunking the terminology associated with tendon conditions). When you compare this to some of the more popular "health" sites out there - most of which are full of self-serving ads and don't bother to look at even a shred of real science - well, I hope the difference is obvious.

I really have to emphasize this point. No matter what word you use, chronic tendon pain is a medical condition, and if you want to get the best results you'd better be working with real, scientifically proven methods. Not doing so is like needing an appendectomy and choosing some jungle-dwelling witch doctor over a Johns-Hopkins trained surgeon. Silly!

Dr. Hammer goes on to say:

Our treatment should emphasize the prevention of collagen breakdown, which requires rest and strengthening [...] We must prevent collagen damage and, most importantly, stimulate collagen synthesis.

Again, right on target. Chronic tendon pain is not inflammation, but actual degeneration of the tendon itself. As such, your first priorities should be to (a) prevent further damage and (b) start exercises to make the tendon regain its lost strength. (Target Tendonitis explains how to do this in detail.) Done right, it shouldn't actually take more than a week or so to start seeing really significant results. Two months (not the six given by Dr. Hammer; there have been some advances in knowledge since the year 2000) and you should be pretty much back to 100%.

That said, please don't just run out and buy yourself a pair of dumbbells. Traditional exercise will only make the problem worse. But there are ways of structuring your rehab to get the benefits of strengthening exercise without causing further damage. So no matter how many useless cortisone injections you've received, no matter how much unnecessary frostbite your elbows and ankles have suffered from icing to get rid of misdiagnosed "tendonitis", don't give up hope! There is actually a method of treatment that you can do at home, on your own time (and for free!) that will work.

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