Effective stretching for tendons and fascia

There was a study that came out a few years back in the Journal of Bodywork and Movement Therapies. It was done by a couple of really smart Germans with lots of letters after their names and dealt with different kinds of connective tissue and how best to keep them healthy. This is going to be a little more technical than most of my posts here, but I thought I’d summarize some of the findings for you.

The first thing to realize is that different kinds of connective tissue have different collagen structures, and that means that they will respond to different kinds of treatments. If you look at Figure 1, reproduced from the paper, it shows that the four major kinds of connective tissues have very different fiber arrangements. Aside from just looking kind of cool, you’ll see that tendons, out of all of them, have the most linear fiber structure. If you’ve read some of my previous posts, you know that long-term tendon pain is due mainly to “knots” forming in the collagen fibers, which then hurt when you try to move that bodypart. It’s sort of like getting a knot in your hair; it’s agonizing to comb it out, but once you do, the pain goes completely away.

Types of connective tissue

Interestingly, the techniques I give in Target Tendonitis work on both tendons and the plantar fascia, and of all the connective tissues proper fascia is the least like tendons. They do not work on ligaments, even though ligaments have a more similar structure to tendons. I admit I have no idea why this would be, I just know that it is. It only goes to show that we don’t know anywhere near everything there is to know about the body yet.

(As a side note, I will say that while tendons and fascia can generally be repaired without surgery, ligaments often cannot. Once you stretch a ligament out of its natural range, it’s very difficult to regain the original structure. It’s sort of like a silk tie; silk is very strong and will endure a lot of abuse. Crumple it up and throw it in a suitcase, no problem. It’ll shake out very nicely. But if you stretch it too far, you will never get that tie back into its proper shape again. Just won’t happen.)

Anyway, if you already have tendon (or plantar fascia) pain you should order one of my books. If not, the paper gives some good techniques to help make sure you never develop it. So let’s get to those.

Everybody probably knows that stretching (within reason) is good for connective tissues. What you may not know is that different kinds of stretching reach different kinds of tissues. So the first overall recommendation is not to limit yourself to one type of stretching.

And just to be clear, by “stretching” I don’t mean just traditional ballet-bar type protocols. Weight training produces a stretch in some types of fascial fibers, Hatha yoga produces it in others. So you should, ideally, be doing both.

Second point: your connective tissue is in a constant state of flux. In other words, it is continually being repaired. You’ve probably heard that each cell in your body gets replaced every seven years. Well, with connective tissue the process is faster. In fact, half the collagen fibers in your body are replaced every six months.

So here are some concrete recommendations to keep your fascial tissues healthy:

1. About two-thirds of your collagen mass is water. Make sure you drink enough of it.
2. Relatively few reps are required to produce a beneficial effect on connective tissue. So you don’t need to spend hours a day on this stuff.
3. The single most bang-for-your-buck type of stretching you can do will be soft bounces at the end ranges of motion. (If you’re still stuck in the 1970s and think that bouncing stretches are bad, you’re wrong.) So for example, try to touch your toes. When you get down to the limit of where you can comfortably reach, try bouncing a little, and softly, a few times to help get that bit extra stretch.
4. As noted above, various different types of stretching will be complementary and beneficial. Static stretching, dynamic stretching, pandiculation (yawning and stretching in the morning, for example – https://www.ncbi.nlm.nih.gov/pubmed/21665102), and so on all have their place. I do, however, recommend that if you are engaging in serious athletic activity, you save the real stretching for after the event. And if you do stretch beforehand, make sure that you do some type of easy loading before you really test yourself. Going from a good strenuous stretch right into a maximal or near-maximal exertion is just a recipe for injury.
5. Foam rolling, which technically involves temporarily squeezing water out of a tissue before allowing it to flow back in, is a good idea. I personally like to do it before a workout, but anytime is okay. If you’re new to foam rolling, use a soft roller to begin with.
6. Total-body “cat stretches” – where you would for example grab a tree branch overhead and then slowly turn and twist your body like a cat clawing a rug – are very good for the overall fascial network that covers your body. A few minutes of this will make you feel looser and “longer” in several different planes, and should give you an increased sense of well-being. (Now you know why cats do it.)

There are more specific suggestions in the actual paper (here’s the link again: http://www.fasciaresearch.de/Schleip_TrainingPrinciplesFascial.pdf), but these are the most immediately constructive ones. The good news is that you only have to do the above a couple of times a week, for a few minutes each time, for stretching to be effective. The bad news is that it will take somewhere between six months and two of consistent application to really start to get the benefit. So this isn’t a quick fix by any means. But the reward is a more comfortable, healthier, less injury-prone body, and that’s definitely a goal worth working toward.

Best cookware and water bottles

This post doesn’t have anything to do with tendon pain specifically, but I figured I’d give my thoughts on what sort of cookware is best to use. Because what you put into your body matters, and any additional stress can, in fact, make other conditions (like tendonopathies) become that much easier to fall into.

Okay, so let’s get to it. I’m going to tackle the big one first: teflon. My opinion is: don’t use it. Ever.

While the jury’s still out on the effects of teflon and PFOA (perfluorooctanoic acid, which can actually kill any pet birds you might have around), I just can’t imagine why anyone would want to take any chance at all with their health when there are cheap cookware alternatives that have absolutely no questions or qualms associated with them. I mean really. You want teflon maybe possibly flaking off in your food? I don’t.

Yes, teflon is cheap and pretty much ubiquitous. So what? So is gasoline, and I don’t see too many people putting that into their bodies. Your health is your most important asset, and cookware is not the place to make the quick-and-easy decision.

Anyway, no teflon. Let’s look at the alternatives…

Stainless steel is a pretty good choice. It’s more or less indestructible, you can buy it in most cookware stores, and it looks good in the kitchen. However, unless you get surgical-grade stainless steel, there is a possibility (probability, really) that some of the chrome and nickel in the cookware will bleed out into your food over time. Also, even a normal-grade SS set (like this All-Clad one on Amazon) will set you back a lot of money. And you more or less have to deglaze the pan right after you cook stuff, which is kind of a hassle. But it does look good in the kitchen…

Copper is the standard for professional kitchens, but costs a lot. Also, copper can leach into your food, too. Unless you really just have to have it, there are cheaper alternatives.

Cast iron is great. There is evidence that some can come off in food (see for example this study), but iron isn’t a problem for menstruating women at all, and isn’t for men if they are either deficient in iron to begin with or give blood regularly. So if you’re a guy who cooks with cast iron a lot, look into your local blood-drive groups and get in touch with one. It’s a nice thing to do all on its own (hey, you might save a life), and in terms of selfish reasons, one of the leading theories about why people age has to do with the build-up of metals in the human body. Among these, iron is a prime suspect; one theory about why women generally live longer than men holds that it’s because women regularly purge a lot of the iron from their systems during menstruation.

Aluminum: bad idea, especially if Alzheimer’s runs in your family. Sure, aluminum is everywhere. It’s one of the most common chemicals around, and aluminum cookware companies take the stance of “Hey, you’re getting it anyway, and the amount that comes from cookware isn’t really much of the total.” This is very true, but why would you add anything at all to the total when you don’t have to? Much like running a risk with teflon, it just doesn’t make sense when there are safe alternatives.

Ceramic pans are a good middle ground, and what I personally use at home most of the time. (I do use a cast iron skillet for stuff like hamburgers, which absorb less iron from the skillet for some reason…maybe shorter cooking time versus a stir-fry or something.) Ceramic cookware has a lot of pluses. It’s relatively cheap, and will become cheaper over the long haul because you don’t need dish soap to clean the stuff (in fact, soap is not supposed to be used at all; just scrub with hot water and a stiff non-metal brush). It will also basically last until you break it. There are no real health concerns in the USA, where lead and cadmium have been phased out of the manufacturing process. (However, if you see a ceramic pan that says “Not for food preparation”, you would do well to obey the label!)

Be sure not to use metal utensils when cooking with any of the above, so as not to damage the finish of the pan. I like wood or bamboo spatulas myself, preferring them over the plastic models because there always seems to be a new study coming out about how some plastic that was thought to be safe suddenly isn’t. And then some are rated okay at certain temperatures but not others… It’s too much of a hassle to try to remember all that, so I just avoid the whole thing.

On a related note, plastic water bottles are not the best solution. I know, I know, they’re everywhere and it’s more or less impossible not to drink out of one if you buy any kind of drink from a convenience store or vending machine. But in order to limit damage, I ordered myself a glass drinking bottle for home use (which accounts for probably 70-80% of my total water intake). There are no carcinogen issues with glass; it’s been used for decades and the only real danger was that you might drop it and break the thing. With modern strengthening methods, though, even that has been addressed. I have a Soma water bottle that cost about thirty bucks and works great. Furthermore, it’s nice to look at and feels good in my hand. If you’re still using an old plastic bottle, do yourself a favor and get something that will make you and your kitchen look better.

Soma water bottle

How To Warm Up Correctly – Part 2

If you haven’t read How to Warm Up Correctly – Part One yet, you can find it here.

3. X-band sidewalks for the hips.

If you’ve never heard of this exercise, don’t worry. Not many people have. But it’s something that I incorporate whenever I train legs, and if you try it your hips will immediately feel looser and more functional.

I won’t try to describe the exercise. Just watch this video:

You can do this either with bent knees or straight, whichever you prefer. Give it a shot, ten steps one way and then ten the other, each step about a shoulder width, and I guarantee your hips will feel a decade younger.

4. Warm-up sets of three or fewer reps

Okay, so much for prep work. Now we go to the weights and start getting ready for the work sets.

Back in the 1970s, Joe Weider’s muscle magazines were in every gym and every gym rat’s home. And they advocated a pyramid type of warm-up. For a typical YMCA bench presser, the warm-up might have looked something like this:

135lbs x 10
155lbs x 10
175lbs x 8
195lbs x 4-5
WORK SETS at around 215-225lbs.

So what’s wrong with this? Well first, let me agree that yes, your joints will be warm when you get to your work sets. However, you’ll also be tired from all the effort you put in getting there – effort that not only wore you out, but did nothing to contribute to getting stronger (because it was performed at too low of an intensity). In other words, you’ve wasted some effort. That’s one thing wrong.

Since you did so much work getting to your “real” sets (again, the ones that will actually contribute to making you stronger), you won’t have as much energy to perform them. Thus, strength-gain progress won’t occur as quickly as it could otherwise. In other words, it’ll take you longer to get to your goals. That’s two.

Third–-and here’s the real problem in terms of tendon pain-–if you add up the number of reps in the warm up, you’ll see that the total comes to over 30. (And that’s not even counting the “bar only” warm-ups that a lot of people do before they start putting weight on.) 30 reps is way too much, and for someone who has had tendon pain (or might be susceptible to it in the future), it’s practically begging for an injury.

Now, take a look at this warm-up instead:

Joint mobility drills as described above
135 x 3, 3 (One set of 3, short rest, then another set of 3)
155 x 3, 2
175 x 2
195 x 1, 1

15 total reps – less than half of the traditional method. Trust me, this will have your joints just as warm and ready as with the first method. And you will be light-years ahead in terms of how fresh you feel when you get to your work sets. Not to mention that with less than half the wear-and-tear on the connective tissues, your chances of (re)injuring yourself are far less.

By now you’re probably wondering where the stretching is. After all, any good warm-up involves stretching, right?

Wrong. Stretching should come after the workout. Not before.

There are some good reasons for this. One, there are plenty of studies that show that stretching five or ten minutes before a workout has a negative impact on maximal strength. That’s right, stretching just prior to lifting weights makes you weaker. Not too many people go to the gym to lose strength rather than build it, so that’s the first reason to leave stretching for after the weight work.

Two, if you stretch a muscle and then lift heavy weights, that muscle is going to lose the extra flexibility you just gave it anyway. Think about it: you stretch the muscle, then do your best to contract it. Kind of counter-productive, if you ask me. But if you stretch after your workout, the benefits last for several hours. In fact, Tomas Kurz (see Part 1 of this post) recommends active stretching first thing in the morning to “set” your flexibility level for the day. So the effects of a good stretch can last all day…as long as you don’t do something immediately afterward to ruin the effect.

I’m all for morning stretches, because research has shown that stretching a muscle a few hours before a workout (as opposed to five or ten minutes prior) will actually help to make you stronger when you lift. And stretching is great for longevity in any sport or athletic activity, so it should definitely be part of your program. So I’m not anti-stretching at all. Just be careful where you put it in your program.

Finally, there is a lot of evidence that stretching right before you lift will increase the likelihood of a muscle tear. So if you absolutely insist on stretching right before a set, make sure to do a couple of light concentric contractions before you do a work set. For example, some light push-ups against a wall after a pectoral stretch. This will help prevent injury.

How To Warm Up Correctly

If you’re a weight trainer and are still using the old-school, 1970s-type warm-up – meaning starting with ten or more reps of a light weight and pyramiding up – this will help you to do things in a better way.

Warming up is very important, especially for the older crowd. But endless sets of light weights, while effective for getting the joints and muscles “warm”, also are a prime suspect when it comes to tendon pain. Almost any kind of tendon pain can be classified as a repetitive stress injury, so excessive numbers of reps during a warm-up aren’t really recommended – even if they’re done with light weights.

Below I’m going to give you a better way to warm up. Not only will this save you time and energy, but it will be just as effective (if not more so) as a traditional warm-up. As an added benefit, it will cut down drastically on the wear-and-tear that you’re imposing on your connective tissues before you even get to your real workout.

Here are the steps, in order:

1. Foam rolling

There are two types of people in the world: those who have tried foam rolling and love it, and those who haven’t tried it at all.

Now, by “tried” I mean that this person has incorporated foam rolling into his or her routine for at least two weeks. In other words, it’s been given a fair shot. I know lots of people who tried foam rolling once or twice and gave up because, well, it hurts the first few times. A lot.

But people who have gritted their teeth and stayed with it for a couple of weeks suddenly realize that they’re starting to move and feel better. (This is especially true for older folks.) Their range of motion increases, their joints don’t have as much pain…and then often the pain goes away completely. Bad movement patterns start to improve, and their bodies go back to moving in ways that they did ten or even twenty years earlier. The list goes on.

Foam rolling, either using one of those blue cylinders that most gyms provide nowadays or else just by putting a tennis ball under a pressure point, is nothing short of miraculous when done right. There are lots of free videos out now showing how to foam roll, so I won’t go into a long explanation about how to do it here. But I’ll give you some tips on how to get the most out of it.

* The point that hurts the most is the one you want to spend the most time on.
* If you’re really tight and simply can’t take the pain the first few sessions, don’t put all of your bodyweight on that particular pressure point. Use your arms and legs to take some of the weight off (so that the pain is merely agonizing, not unbearable).
* Expect consistent but gradual improvement.
* Make a commitment to foam roll a minimum of three times a week for at least a month.

I encourage you to spend “enough” time on foam rolling, especially when you’re first starting out. Depending on how stiff your body is to begin with, it can take up to half an hour to adequately address all the areas that need help. So take your time. The long-term benefits are definitely worth it.

2. Joint rotations

Probably the best book I’ve ever read on flexibility is Tomas Kurz’ Stretching Scientifically. Not only can Kurz do Van Damme splits with just his ankles supported, he can do them with a woman sitting on each thigh – and he has taught dozens of other people to do them as well. If you’re interested in increasing your flexibility, I can’t recommend this book highly enough.

As the title suggests, his main focus is on developing stretching, but Kurz also includes a section on warming up before a workout. One of the key components is joint rotations.

The way to do this is simply to take the various joints in your body and rotate them about ten times in one direction and then another ten in the other. The idea is to start at the extremities and move toward the core. So with the legs you start from the toes and move to the ankles, then the knees, then the hips and finally the waist/lower back. With the upper body you start with the fingers and move “inward” to the wrists, elbows, shoulders and neck before ending up at the waist again.

You can do more than one joint at the same time if you like. I usually begin this part of the warm-up by rotating both wrists and one ankle simultaneously, then rotating the wrists in the other direction while doing the other ankle.

Joint rotations for the entire body shouldn’t take more than about five minutes total.

Stay tuned for How To Warm Up Correctly – Part Two.

Doctors just can’t keep up

I read an article recently that said the amount of sheer amount of knowledge in the world doubles about every 12 months. The book Average is Over says that this applies to the medical field just as it does to every other area. So much new information is being generated that it’s literally impossible for any single human being to even pretend to keep up.

I’m interested in this because it’s always been puzzling to me how you can on one hand have a treatment that works well and has been documented in over a hundred different studies (which have taken place over more than a decade and in many different countries around the world) and still have licensed medical doctors who don’t know about it. They’re paid to be the experts, so they should know, right?

But when you think about it, it’s really impossible for them to keep abreast of all the changes. First, most doctors are so busy that they can only spend about eight minutes with any one patient (this is actually a rule in America). And let’s face it, they’re only human. Who wants to go home after a day spent dealing with all kinds of illnesses and conditions and then have to read more about the exact same thing? I certainly wouldn’t.

So while this lack of awareness of new procedures is understandable, from the point of view of the patient it’s a problem. If you have something go wrong with your body, you don’t want to be stuck with some treatment from back in the 1970s if there’s a better option available today (and usually there IS a better option).

When it comes to tendon pain, Target Tendonitis is that option. Since the early 2000’s, when Scandinavian researchers discovered a quick and non-invasive method of treating persistent tendon pain, there have been literally over one hundred follow-up studies done all over the planet. And the vast majority of them have shown the same thing that those Scandinavian scientists found: specific exercises, done in a specific way, will usually cure persistent tendon pain in a couple of weeks.

Of course, it’s not a miracle cure. If you’ve actually ruptured a tendon, surgery is the only way you’re going to repair it. And if you have poor nutrition along with a job or hobby that involves a lot of repetitive stress, you’re going to have ongoing problems no matter what method of treatment you use. But most people who have tendon pain aren’t at the point where the tendon is about to break, and most people who have suffered from tendonitis or tendonosis for a couple of months are very amenable to the idea of changing certain parts of their lifestyles. Their pain won’t let them continue down the wrong path.

Anyway, if you’ve gone to see a doctor for some kind of tendon issue and haven’t gotten better from the same old prescription of rest, icing and NSAIDs, don’t give up hope just yet. There is a better way. And best of all, unlike a doctor’s visit, if you don’t experience relief within a couple of weeks of trying the program, you can get your money back.

A Tendonitis Misdiagnosis – How Much Can It Cost You?

Although tendon pain is all pretty much lumped into one catch-all term – tendonitis – the fact is that it comes in a variety of forms.  How much could a misdiagnosis cost you?

Below is some information that I got from a woman who had knee pain for over ten years.  She tried virtually all of the conventional therapies for tendonitis.  These included icing, rest, taking NSAIDs like aspirin and ibuprofen, seeing a doctor (several times), seeing a gait specialist when her family doctor couldn’t make any headway with the problem, getting herself fitted with orthotics (recommended by the specialist), going back for adjustments, getting some custom-made orthotics, buying several pairs of special shoes so that the custom orthotics would fit correctly…

The list goes on and on.  In the end, she spent well over a thousand dollars…and this woman has some very good insurance that covered the bulk of her costs.  I don’t even want to think about how much the total would have been without it.

But that’s just the financial aspect.  How much time was spent on those doctor and specialist visits, on shopping for shoes and different kinds of NSAIDs (hoping that a new brand would finally work), on getting the orthotics fitted, on all the follow-up visits when the problem wasn’t corrected the first time around?  How exhausting and spirit-draining was it to try one thing after another, and have them all fail in the end?

The real cost of tendonitis
The real cost of tendonitis

All of this could have been avoided if this lady had just understood one simple fact: ninety-five percent of the time or more, tendon pain that lasts more than a couple of weeks–and doesn’t respond to icing and rest–is not tendonitis.

It’s a surprising thing to hear.  Even people who have never had a problem with their tendons at all know the word tendonitis; in fact it’s so common that pretty much any kind of tendon problem seems to get lumped in under the same term.  The ironic thing is, true cases of tendonitis are very rare, and generally resolve themselves within a week or two.  Tendon pain that lasts longer than that can be a variety of things, but by far the most common condition is tendonosis.

I emphasize this point over and over again, but it can’t be repeated enough.  Any kind of “itis” is a medically precise term that means “inflammation”.  An “osis”, on the other hand, means an actual degeneration of some body tissue.  So tendonitis is inflammation of a tendon; tendonosis – much more serious – means that the tendon is breaking down and can’t repair itself effectively.

Inflammation has been recognized and studied for centuries.  It has four indicators – pain, heat, redness and swelling – that always accompany it.  So it’s relatively easy to spot, and this makes it useful for people who think they might have tendonitis to decide for themselves and not rely 100% on a doctor’s diagnosis.  (I have a free and very quick tendon test on this blog that can help out with this.)

Tendonosis, however, doesn’t have the same symptoms because it’s not the same problem.  Usually it comes on more slowly, there is no redness or heat or swelling, and unlike tendonitis, which has a more or less constant level of pain, with tendonosis the pain gets worse and worse.  Of course, if you rest the affected area – in other words, if you don’t use it –  then the pain goes away.  But if your tendon has suffered some degeneration, even if you completely rest it for a week or two, once you start using it again the pain will immediately come back.  So unless you can afford to just not use that part of your body ever again, rest isn’t really a good solution to the problem.

Fortunately, there are specific exercises that can help damaged tendons to repair themselves.  Tendons are composed of collagen fibers, and sometimes those fibers get tangled up into knots (a lot like what happens to your hair if you don’t comb it for a while).  Once these knots develop, they prevent the tendon from functioning properly, and the result is pain.  Left untreated, these knots generally get larger and larger, generating more pain, and in extreme cases can lead to a complete rupture of the tendon itself.  At that point, exercises are no longer effective.  The only option remaining is surgery.

If you have persistent tendon pain, it’s silly to let things get to that point just because some doctor tells you that it’s “tendonitis” and tries to prescribe cortisone shots and ibuprofen.  There are other options, many of them surprisingly affordable and easy to implement, and you owe it to yourself to check them out.

Tendonitis…from having children?

Yes, today’s tendon topic concerns tendon problems that can come with having a baby.  I admit my title is slightly misleading; it’s not bearing the child that actually causes tendons to become painful (not the ones I can help you with, anyway), but afterwards there is at least one type of chronic tendon condition that is specifically associated with parents and newborns.  Naturally, it’s the parents who get it.

So what is this mystery condition?  It’s called de Quervain’s syndrome, and it has to do with your thumbs.

What happens is this: parents welcome a small new member of the family with (literally) open arms.  And at first there isn’t any problem.  The baby doesn’t weigh much and can’t move around very well.  But then that little guy or gal starts getting bigger.  And soon, s/he starts becoming mobile.  Even before the crawling stage, babies develop the ability to squirm around pretty violently, and will often do so when being picked up or held. And they have no idea that they might be causing someone else pain.

So here’s the scene: you pick your baby up. The standard grip is under the armpits, thumbs in front and fingers around the baby’s back.  The child squirms a bit, and twists in a way that puts unusual pressure on one thumb or the other.  Do this a few dozen times a day for weeks and months on end and you’ve got a perfect environment for a repetitive stress injury to occur.  In this case, it happens to a couple of the tendons that attach to the thumb.

If you want to see which tendons in particular, place your hand flat on a table and rotate your thumb out as far away from the fingers as it will go.  You should be able to see two tendons standing out at the base of the thumb, where it meets the side of the wrist.  (If you can’t actually see this, you should at least be able to feel the tendons by using the fingers of the opposite hand.)  The top one is the extensor pollis longus, which doesn’t concern us here.  But the bottom one is actually two tendons that split further up the thumb (you probably won’t be able to feel this).  These are the abductor pollicis longus and extensor pollicis brevis, and they are the culprits in de Quervain’s syndrome.

Tendons involved in de Quervain's Syndrome
Tendons involved in de Quervain’s Syndrome

Although de Quervain’s can affect both parents, mothers are especially prone to it (in fact, one of the colloquial names for de Quervain’s is “Mommy Thumb”).  Several factors contribute. First, they generally pick the baby up more frequently than the father.  Second, women’s hands and forearms usually aren’t as strong to begin with as men’s.  And third, after delivery women’s bodies are flooded with a hormone called relaxin.  As the name implies, relaxin helps women’s joints and connective tissues to “relax” and stretch out a bit during pregnancy – mainly around the hips, but the effect is present throughout the entire body – which of course is necessary for successful delivery.  The thing is, once Baby has made the journey out, Mommy’s relaxin doesn’t immediately shut off.  There isn’t a lot of good research on exactly how long relaxin continues to make a new mother’s connective tissues remain abnormally loose, but a good guess would be at least three or four months.  (Estimates – and different types of evidence – make the range anywhere from a couple of weeks to as long as a full year, depending on the particular circumstances of the birth.)

Up to now, I haven’t talked much about de Quervain’s on this blog because it’s actually a problem with the tendon sheath rather than the tendon itself, and so I wasn’t sure whether or not my techniques would work to help get rid of it.  But recently I’ve had several people order the Target Tendonitis ebook and video package for this purpose, and the feedback has been very positive.  And doing some research into the condition, I found that the same terminology problem that the medical community has with tendon pain also exists with conditions relating to their sheaths.  If you look at the Wikipedia entry for de Quervain’s, for example, it lists the condition as being a type of tenosynovitis. But then further down the page, it says “Evaluation of histological specimens shows a thickening and myxoid degeneration consistent with a chronic degenerative process.”(Here’s the link if you’re interested.)

As I’ve pointed out many times before, any kind of “itis” is inflammation, not degeneration.  However, despite the official classification, de Quervain’s is not primarily inflammation but actually a degenerative condition that changes the structure of the tendon sheath itself.  And that fits perfectly into what Target Tendonitis is designed to fix.



Target Tendonitis Goes International

People from over 40 countries have downloaded Target Tendonitis in the past year. They come from all parts of the globe – South Africa, Turkey, Hong Kong, Japan, New Zealand, North and South America… In order to serve them better I have begun work on translating TT into three more languages: Spanish, Portuguese and Japanese. These will probably be ready sometime around the New Year, so if you speak one of these languages better than English, keep an eye out. (I understand that if you’re reading this, you probably have tendon pain now and don’t want to wait for another three or four months. So if you order the English version now, I will be happy to send you one other language version when it’s ready. Just let me know via the email address given in the ebook.)

Free tendon mini-course

If you’re becoming frustrated with tendon pain that won’t go away, I have some good news. I’ve put together a free (yes, completely free) mini-course on long-term tendon pain that will show you exactly why you’re not getting better. If you’ve had tendon pain for more than a couple of weeks, the odds are very good that – despite what you might have been told – it’s not actually tendonitis, but tendonosis. My mini-course takes you through the difference, explains why the two are completely separate conditions, and gives you some advice about what you can do about it.

Obviously, if you think you have Condition A but you really have Condition B, you’re not going to make much progress trying to treat Condition A. You can take the Tendon Test (also completely free) to find out in about a minute which one you have, but if you’d like to educate yourself about what’s really going on inside your body, sign up for the mini-course (the sign-up form is on the right) and have a read. Again, it’s totally free and you can unsubscribe at any time.

Managing recovery

I just received a completely unsolicited email from a 66-year-old quilter who purchased Target Tendonitis a few days ago:

Alex – I purchased your ebook yesterday and viewed the videos today and am excited to begin the exercises tomorrow. Your explanations re bicep tendons were so helpful. Your reference to pronation and supination absolutely explained to me why my pain is so much worse after doing simple things like knitting/quilting. But I now realize the motions used are exactly what you describe and could explain the bicep tendon pain I suffer after doing these activities. Also I kept thinking my pain occurred on extension and not flexion, but after your explanation I can see that actually the pain is occurring with pronation of my arm.

Thank you ever so much for the information not only in your book but the videos – doubt if I could have understood the exercises and gotten the above explanation just from the book. After recently becoming very discouraged with the issues I’ve been dealing with for 6 months and trying most of the therapies you described [as being ineffective], your videos have given me hope that maybe this condition/issue WILL get better and possibly go away.

thank you!

Take Care, Jean

First, I’d just like to say that it makes me very happy to receive this kind of feedback about the new TT video. Makes all the effort of putting it together worth it. So thank you, Jean!

Second, as a general comment I think that as we age it becomes more and more important to manage recovery in an effective manner. It just takes longer to reap the gains that comes from an increase in exercise intensity, or duration, or frequency, etc. In a subsequent email Jean said that she found that upping her yardage in swimming was the immediate precursor to her injury, which frankly doesn’t surprise me. I see this sort of thing over and over again in my business. And I personally spent the first part of my 40s trying to convince myself that I was still in the middle part of my 30s, hahaha.

If you are a regular exerciser, or if you perform any sort of motion on a repetitive basis, it makes sense to take a step back every few years and re-evaluate just how long it really takes to recover from a session. If you’re in the gym, be sure to keep a good workout log that includes the time between maximal weight attempts. (If you’re not getting stronger, the culprit is very likely insufficient time between such attempts.) And if you’re a knitter or quilter, like Jean, try cutting back about ten percent per decade after the age of 50. Doing so will still allow you to enjoy your hobby, but will go a long way toward keeping tendon issues from becoming a chronic problem.