Masahiro Tanaka back from tendon injury

Ran across this story this morning as I was browsing the web for tendon pain information. (Yes, I actually do that…) Back at the end of April, the Yankees put pitcher Masahiro Tanaka on the disabled list due to some tendon pain in his wrist. It wasn’t a bad case, but when you’re subjecting your arm to the stress of major league pitching, slight injuries can become severe injuries very quickly.

What I found interesting was that the Yankees knew he was going to be okay in only a couple of weeks. From the start, he was only supposed to be on the DL for about 15 days. And sure enough, he’s made a more or less full recovery as of today (May 12th). If you take a look at the video of his pitching practice linked above, you won’t see anything in his form that would indicate lingering pain or a lack of joint mobility.

So why were they so confident? It’s because the Yankees have access to the best doctors and trainers, and with millions of dollars riding on their winning baseball games, they can’t afford NOT to keep up with the latest, most effective methods of rehabilitating their athletes.

Tendon pain is more or less unavoidable if you play sports at a high level, so the Yankees (along with every other professional sports team) know that they’re going to have to deal with it. And so they hire people who understand what to do when something goes wrong. And they have every confidence that their players will get better if they have the right regimen of nutrition and rehab exercise, and so can make predictions (that turn out to be true) about how long it will take before, say, a wrist tendon is ready for action again.

If you’re reading this blog, you probably have a tendon issue of your own. Think about it for a few moments. Are you as confident that you know what to do to get yourself off the DL and back into the game of life? Or are you slowly starting to feel overwhelmed, and getting to be afraid that this tendon problem you have is going to permanently affect your life?

If it’s the latter, it doesn’t have to be that way. There is good scientific evidence, supported by over a hundred human (not animal or “in vitrio”) studies across the entire globe, that certain types of exercise and nutritional supplements can completely reverse tendon pain in most cases. It’s what I write about in my ebook. Chronic tendon pain, usually called “tendonitis” but more accurately referred to as “tendonosis”, doesn’t have to affect you forever…as the Yankees well know.

Recognized by the mainstream media

Last time out I posted a series of emails from an MD that were very complimentary toward Target Tendonitis. Now it gets even better; now the mainstream media is starting to catch on. A little while back Business Insider quoted the very same blog that you’re currently reading.

If you aren’t familiar with Business Insider, it’s one of the leading websites for pretty much everything related to business. But why would a business website feature information on tendon pain?

It has to do with today’s “keyboard culture” (specifically, iPhones, Blackberries and the like) and the nature of tendon pain. People who order my ebook and video products range from stay-at-home moms to professional bodybuilders to business managers and executives. The unfortunate fact is: tendon pain can affect absolutely anyone. And once you have it, it doesn’t matter what your job description is. You want to get rid of it (even if it occurs in a small tendon like those that attach to your thumb).

Anyway, here’s the article. Take a look and see for yourself.

Keeping it real: magnesium and tendonitis

There’s been a lot of talk lately around the internet about taking magnesium for tendon pain, specifically tendonitis. Let’s take a (scientific) look at the facts about magnesium and tendons, and see if we can come to any firm conclusions about this stuff.

First, let me say that a search of PubMed turned up nothing for the keywords “magnesium” and “tendonitis”. There was one hit for “magnesium” and “tendons”: a study done on dogs that showed a severe lack of magnesium can (and probably will) lead to problems with your tendons much like those caused by Levaquin and other quinolones. (If you’ve never taken Levaquin and/or don’t know what a quinolone is, don’t worry. They’re prescription drugs that have been implicated in causing some really horrific tendon destruction in certain patients. You can read a little more about it here, but for the purposes of this post just know that they’re very bad drugs for some people, and can cause tendon damage that in some cases is impossible to repair.) While I think that the study was good, it’s still just one study. And not one that shows that supplementing with magnesium will help to cure tendon pain, only that having an extreme deficiency in magnesium will probably cause tendon issues. These are not the same thing.

So, not much in the way of real research. But there’s quite a bit around the internet. Let’s start with one guy who calls himself an “expert” on tendonitis. His argument is this: Lots of people are magnesium-deficient in western society, mostly because of the crappy food that they eat (more on this in a moment). Further, while calcium is necessary to contract a muscle, magnesium is necessary to release that contraction. (This part is true.) So, according to him, if you exercise or perform repetitious movements like knitting on a regular basis, you’re using up both calcium and magnesium. Combine this with a supposedly magnesium-deficient diet, and you have a recipe for muscle tightness (all contraction, no release), which — again, according to him — is inextricably connected to tendon pain, because “If you have tendonitis pain, then you have muscles that are chronically too tight.”

Let me detour here for just a moment to address this last point. If, in fact, tightness really were a precursor to tendon pain, then you would expect athletes who are flexible and do lots of stretching not to suffer from tendonitis, tendonosis, or any other tendon condition. But the reality is different. Ballet dancers, for example, certainly some of the most flexible athletes around, have lots of tendon issues. In fact, according to the British Journal of Radiology, tendonitis accounts for 9% of all ballet injuries. Rock climbers get tendon conditions, gymnasts get them…the list really goes on and on. About the only group that doesn’t get tendon issues is the yoga folks, and it’s pretty obvious that this is because they don’t do a lot of repetitious/impact type exercise, not because of their flexibility.

Okay, anyway. Back to magnesium…

If you look at the Wikipedia entry for magnesium deficiency, it says a couple of interesting things. One, about 57% of the US population doesn’t meet the US RDA for magnesium. Aha! Deficient, right? well, not necessarily. The US RDA is just a number, and a very broad one at that. It is ONE NUMBER that tries to say how much of a certain vitamin or nutrient is “necessary” for everyone in the entire United States of America. That’s right, over 360 million people…all described by one single number.

Does anyone out there really believe that a 250-lb man needs the same amount of any nutrient, much less magnesium, as a woman who weighs half that? I hope not. Does it make sense that two people of the same size and gender need the same amount of a given nutrient if one of them is a triathlete and the other sits in an office all day? How about if one of them is pregnant and the other isn’t? If one is 20 years old and the other is 70…?

I hope you see my point. The US RDA is, for all intents and purposes, a useless number for any given individual. (Unfortunately, lots of bloggers pick up on that one number and use it to try to prove things.) But fortunately, Wikipedia gives you a much better way to judge whether you have a magnesium deficiency in your own body. It gives a long list of symptoms that typically are seen when someone really isn’t getting enough of the metal in their diet. To wit:

Symptoms of magnesium deficiency include: hyperexcitability, dizziness, muscle cramps, muscle weakness and fatigue. Severe magnesium deficiency can cause hypocalcemia, low serum potassium levels (hypokalemia), retention of sodium, low circulating levels of parathyroid hormone (PTH), neurological and muscular symptoms (tremor, muscle spasms, tetany), loss of appetite, nausea, vomiting, personality changes and death from heart failure. Magnesium plays an important role in carbohydrate metabolism and its deficiency may worsen insulin resistance, a condition that often precedes diabetes, or may be a consequence of insulin resistance. Deficiency can cause irregular heart beat.

(Notice that there’s nothing in there about tendonitis. Hmm…)

I’ve taken out the references, but if you check out the actual Wiki page they’re all listed. The above is supported by science, not just some blogger’s fantasy. So if you think that you have a magnesium deficiency, you might want to see if you have any of these symptoms. If you don’t, there’s probably no need to worry.

So here’s the wrap-up. As shown immediately above, most people (given that they don’t exhibit any of the Wiki-symptoms above) actually do NOT have a magnesium deficiency of any importance. If you take a multivitamin, you can be even more sure that you’re okay in this area, since most formulations include 50mg of magnesium in addition to whatever you’re getting from your diet. Further, there’s nothing in the scientific literature that shows going overboard and taking extra magnesium helps with tendon pain. Yes, if you’re chronically deficient, if you never eat any leafy greens, or drink coffee or tea, or use spices, or eat chocolate, or nuts, or frickin’ bread, then maybe you need some extra help, and a supplement might do you some good. But unless you’re getting muscle spasms and cramps along with your tendon pain, it’s a pretty safe bet that your magnesium levels are okay.

Magnesium food chart
Some values for common, high-magnesium foods

If you’ve had tendon pain for a while, do yourself a favor. Stop placing your hope in exotic remedies and take the free, one-minute tendon test located here. It will tell you, in plain English, what sort of tendon pain you have, and what you can do about it.

A short video about long-term tendon pain

A while back I put together a short video that gives a quick overview of what you need to know about long-term tendon pain. It’s a little over seven minutes, and deals with the differences between tendonitis and tendonosis.

If you’ve been going to a doctor or other medical specialist and think that the advice you’ve been getting is wrong, this video will tell you exactly what questions to ask, and why.

This video is a little dated, because Target Tendonitis now comes with an hour and a half of video that shows you exactly what sort of exercises to do for your tendon pain, no matter what area of the body you might have it in. The price has gone up a little – it’s now $29.97 – but it’s still the best deal out there and far less than a visit to the doctor is going to cost.

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.

The structure of muscle fiber and tendon attachment

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.

Doctors are starting to catch up with the research

A reader sent this link in to me a few days ago. (Thanks, James!) It’s from a fairly hard-core weightlifting gym that has a website and forum attached. There’s a pretty good discussion of tendon pain, but the part that I wanted to show you is the following. It’s a summary of what a doctor said when he visited the gym to do a presentation on tendonopathy:

The common view of tendon injuries was once that the majority of the time a patient comes in with a tendon problem, it must be a tendonitis. Tendonitis implies that there is an inflammation of the tendon which needs to be decreased, and then the problem will go away. A typical true tendonitis will resolve in 2-4 weeks if it is a new onset, and if it is a longer standing tendonitis it should be better in 4-6 weeks – recovery rate from a “true” tendonitis is 99%. The common tendonitis treatment is anti-inflammatories, rest, and ice. Typically people who have had long term problem and go in for treatment with this protocol will not respond very well and will become quite frustrated…

…New research has lead medical professionals to realize that in the majority of patients (about 90%) who come in with “tendonitis” the problem is no longer tendonitis, but tendonosis which is a degenerative condition of the tendon.

There you have it; as good a summary as I’ve seen. (For the entire thread, click here.) If you’ve been diagnosed with tendonitis but it hasn’t gone away after a few weeks of aggressive icing and so on, chances are about 99% that it isn’t tendonitis at all.

If your doctor doesn’t understand this distinction, or if he pays lip-service to the idea of “tendonosis” but still insists on treating you with ice, NSAIDs and the rest of the usual prescription, you owe it to yourself to get better information. Trying to treat a tendon degeneration problem with protocols designed to combat inflammation is just asking for failure.

A REAL Cell Phone Problem

I’ve written about cell phones before and the tendency for power users to develop tendon problems in their thumbs. But my friend Mike Geary has put together an article about another problem that men who keep cell phones in their pockets may develop, and believe me, it’s a lot worse than a sore tendon!

Mike is the guy behind The Truth About Abs, which has been sold in something like 160 countries (if you’re interested in firming up your midsection it’s an excellent program), and he’s been delivering good information about fitness and health for over half a decade now. The article on the other side of this particular link is based on some information given by Tim Ferriss, (of The Four-Hour Workweek fame) in his new book The Four Hour Body. Ferriss enjoys using himself as a human guinea pig, and while his methods are certainly unorthodox, I can attest from personal experience that they work. If you carry a cell phone in your pocket, male or female, you definitely want to take a few moments and read what he and Mike have to say.

Capsaicin for tendonitis

I’ve been seeing a lot of talk around the internet lately about using capsaicin to relieve or cure tendon pain. The idea is that, applied topically, capsaicin 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, capsaicin for tendon pain is a bad idea. Icing a tendon can be a good therapy 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. Also, 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, 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.

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:…#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 twenty bucks 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.