Customer Testimonial for Target Tendonitis

So guy down in Mexico, Carli, who is a life coach and in amazing physical condition, wrote and asked for help resolving a tendonopathy (just a fancy word for an unspecified tendon issue). He knows a lot about bodies on his own, does Ironman races and so on, and had taken the Tendon Test on this website to determine what his problem actually was. The indication was not tendonitis at all, but seemed more likely to be tendonosis.

Still, after trying some of my exercises for a couple of weeks, Carli wasn’t seeing the results he’d hoped for. So he sent me a message and asked for some specific advice. Customer support is part of selling a product, and I don’t mind giving individual advice (within reason!) if someone has a question about the content of my ebook or videos. And I mind even less if they’re not getting the results they want, because what I want is happy customers! After all, the whole point of my putting up this website and writing the ebook is to help people. If I can’t do that, there’s no reason to stay in business.

It turned out that I needed Carli to make a video of the exact exercises he was doing for his de Quervain’s Syndrome problem. With today’s technology, a lot of times it’s just easier to show me what the problem is than try to describe it in an email or text. After reviewing his video, I gave him my opinion about what was going on with his body. Basically, I suspected that his problem may not be tendon issue at all, and so I recommended that he see a medical specialist for a professional opinion. While I don’t have a super-high opinion of how doctors generally approach tendonopathies, there is no question that they have excellent specialized knowledge of conditions that can be mistaken for a tendon problem (like nerve impingement, arthritis, cartilage degeneration, etc.) by a layperson. Carli sent me back this very nice reply:

That’s great feedback, Alex. I’ll try an appointment with a MD and see what they say. I’ll also continue with the exercises and monitor any change. And yes, I’m 43 (thx for the “late 30’s” guess hehe), so even though I’m in top shape the body doesn’t take what it could at 25.

I’m determined to get better, so I’m sure I will, one way or another.

Thank you once again for taking the time to read, watch, and reply. It really shows you’re passionate about what you do and that you care for your clients & readers. I’ll be sure to point anyone with similar troubles your way.

Blessings, and have a great week!
Carli

The jury is still out on what exactly Carli’s issue is. But I’ll be here to help as much as I can, and between my knowledge and the help of an MD, there is every chance that he’ll fix his problem once and for all.

It pays to know what the real problem is

I had 3 years of grief 2006 to 2009 but I’m committed to [the exercise program] and 4 weeks in there’s good progress.

– Mark

Comments like the above really piss me off. Don’t get me wrong – I love getting emails that tell me my program has helped someone who wasn’t getting helped before. But to spend THREE YEARS of one’s life in pain? What a shame, and what a huge waste of time.

The real problem, as I see it, is that the medical community simply isn’t bothering to keep up with the ongoing march of information. In a way, this is understandable. In The Checklist Manifesto (which is a really interesting book), author and surgeon Atul Gawande makes the point that medical knowledge is now roughly doubling every single year. And no doctor can keep up with all that. But you would think that someone in the AMA or CDC one of the government’s alphabet soup departments that are tasked with overseeing the medical industry, SOMEONE would realize that what is commonly called “tendonitis”…isn’t.

Matrix tendonitis

After all, the research has been there for a decade and a half now. It was back in the year 2000 that a scientist named K. M. Khan and his colleagues made the point that there can be no tendonitis (or any “itis”) without inflammation, and there can be no inflammation without the four classic symptoms (which have been known since antiquity). These are: pain, redness, swelling and heat. Any layperson can very easily do a self-check to see if they have them or not. How a doctor, a person trained in medicine and supposedly a specialist in the field, can look at a patient and, NOT seeing all of these signs, still make a diagnosis of inflammation is really puzzling.

Matrix Tendonosis

Tendonitis is inflammation, and if you are in basic good health inflammation will generally go away on its own within about two weeks. But tendonosis is a different story. In medicine, an “osis” indicates a degeneration of the tissue involved. With tendonosis, the collagen fibers that make up your tendon are developing knots, breaking down, and generally not performing correctly, thus causing you pain. You can fix tendonosis you take the right steps, but it is a much more serious condition than tendonitis, and left untreated can result in having to have surgery to repair what will ultimately be a ruptured tendon. And nobody wants that.

So if you’ve been told that you have “tendonitis”, but rest, icing, aspirin and so on aren’t making it go away, do yourself a favor and take my free, one-minute tendon test and see what’s really going on. Just answering a few easy questions about your condition will tell you what your tendon problem actually is. And that could literally save you years of frustration and pain. Because it’s very hard to treat a condition that you don’t even know what to call, and when you don’t understand the real problem in the first place.

What does tendon inflammation really look like?

I make a point of distinguishing between tendonitis (which is inflammation) and tendonosis (which is an actual degeneration of the tendon itself).  If you’ve taken the Tendon Test, you can find out very quickly which one you have.

But I do get questions from people who think that they might have some inflammation and want to know how to tell for sure.  Inflammation has four classic markers: pain, swelling, redness and heat.  Pain and heat aren’t things that I can advise you about via a blog, and most everyone knows what the color red looks like.  But swelling is another matter.  Lots of people with tendon pain feel around the area where they have pain and think that they might also have swelling…but they’re not really sure.

I recently received a picture from a client who definitely had swelling.  Here it is:

Swollen tendon
Swollen tendon

As you can see, the tendon leading into the base of the thumb is much larger than it should normally be.  (Go ahead and cock your wrist back so that it’s in the same position as the hand in the picture.  Does your thumb tendon look anything like that?  I hope not.)  Admittedly, this is a particularly bad case, but it just goes to show what a really swollen tendon looks like.

Here’s another example, this time from the lower body:

Inflamed achilles tendon
Inflamed achilles tendon

This one isn’t nearly as severe as the first picture, but the swelling is still bad enough that you can visually detect the size difference between the right and left achilles tendons. In cases like these, there’s no room for doubt.

So if your tendon looks something like the first or second picture, then yes, you definitely have swelling.  If it looks normal but feels a little larger than normal (especially compared to the same tendon on the other side of your body), then you might have a little swelling.  Just make sure to be honest with yourself, and don’t fall prey to thinking that you have a swollen tendon when you don’t.  (Sort of a reverse placebo-effect.)  Finally, if you don’t have any discernible swelling, it’s a pretty good bet that you don’t have tendonitis…although tendonosis is still very much a possibility.  Again, the best and easiest way to tell is simply to take the tendon test.  It’s completely free and will only take a minute (literally!) of your time.

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.

Another testimonial

The following is a testimonial that was freely given by a client named Jan Manzanero. It highlights the problems that can occur when a tendon issue is misdiagnosed as inflammation – usually the doctor tells you it’s “tendonitis”, but in this case the verdict was tenosynovitis, which is inflammation of the sheath around the tendon. Of course, estimates by people who study this problem say that the chances are up to 95% that it’s really tendonosis if you’ve had the pain for more than a few weeks and it hasn’t responded to NSAIDs, icing and rest.

But I’ll let Jan speak for herself:

Hello, Alex. I have intended to write you back for some time.

I found your book through a search when I didn’t like the direction my care was going. An orthopedic doctor had diagnosed me with de Quervain’s tenosynovitis of the right wrist, and had given me a cortisione shot. He also prescribed a gel that made me dizzy, and I went to three sessions of physical therapy. The therapist applied heat for 30 minutes while she chatted with other clients, and then made a wrist brace to immobilize the joint. That was the plan: completely immobilize it. She said she had had the same condition, and had recovered by this method. By the third session, it was no better, my hand was getting alarmingly weak, and I was in tears. This seemed to alarm her, as well, and she recommended I return to the doctor. The doctor had already given me the protocol: try the cortisone shot, gel, and physical therapy, and if none of that works, surgery. There was no way I would consent to surgery, so I began an internet search…

Through continued searching, I found your book and felt improvement almost immediately using your methods. I continue to use the principles for occasional flare-ups of right wrist pain, as well as problems in several other areas, as needed. It has been a great help! The best part is that I am avoiding unnecessary therapies and pain killers, and — worst of all — surgery! Thank you so much for the book. I wish more medical professionals would employ these methods.

Sincerely,
Jan Manzanero

Deep down, people generally know when something isn’t working for them. Presented with a therapy plan that clearly didn’t work for her, Jan was courageous enough to take matters into her own hands and searched until she found a real answer.

If you’re suffering from long-term tendon pain, it’s critically important that you understand the real nature of your condition. To help out with this, I’ve put together a tendon test that can help diagnose your problem in less than a minute.

Not only is it completely free, it might actually save you quite a bit of time and money that would otherwise be wasted on pursuing useless therapies that result from a misdiagnosis. So take a minute of your time and see how much useless pain and suffering you can save yourself.

An amazing testimonial

If you’ve read much of this blog, you know that I sometimes (okay, fairly often) take issue with the diagnoses that physicians give to their patients. Doctors will routinely call any sort of tendon pain “tendonitis”, even though that term only applies to a very specific sort of tendon problem (inflammation).

But doctors generally think they know what’s going on, and so I don’t very often have them buy my ebook. August 23rd, however, was different. I got a “sale” message and noticed that the email address was from a senior physician employed at a well-known major pharmaceutical company. (I can’t mention the name here, but trust me, you’ve heard of it.) I thought, “Huh” and then more or less forgot about it after that. But two days later, I got the following email:

Dear Alex,

Purchased Target Tendonitis 2 days ago – started the exercises (for my shoulder) and they seem to be working already! I will let you know more after a few weeks.

Thanks,

Allen H Heller, MD
Vice President, Medical Science
[Company name]

So, not only a doctor, but a VP at a major health-care company. Dr. Heller was also nice enough to include the abstract of a new study that supports the techniques I reference in Target Tendonitis, so we talked shop a bit via email. Then came the following message:

Started the protocol on Weds, and the improvement is truly remarkable. I had had symptoms for more than 6 months and began working with a local PT about 4 weeks ago with only modest improvement. I would say subjectively that I’m about 80 per cent better after 3 days. The improvement was so dramatic that this is why I searched the literature to see to what extent this approach was generally known. (My background is in internal medicine, clinical pharmacology, and statistics -not PT or sports medicine.)

Best,
Allen Heller

I’ll say here that my approach is very well-documented, scientifically speaking, and also has a lot of anecdotal evidence going for it. Yet health care professionals seem to be almost completely unaware of it. It’s really strange.

Anyway, we exchanged a few more emails and then the correspondence dropped off. On October 11th (about seven weeks into Dr. Heller’s recovery program) I emailed him to follow up. This is the reply I got:

Alex,
My symptoms are about 98 per cent gone. It’s really quite remarkable. I was about 80 per cent better after the first week, and in fact, stopped going to my local PT at that point because your program was so effective and better than the less targeted program I was doing there. The very minor symptoms that remain are barely perceptible and don’t interfere with any activities. I confess that they are so minor that I stopped doing the routine – I suspect that if I continued the program they would be 100 percent resolved. It also seems that what’s left is improving on its own. So I expect symptoms will be 100 percent resolved with a little more time.

Warm regards,

Allen

I mentioned that even though the symptoms had more or less disappeared, throwing in a couple of “maintenance sets” of the exercises would be a good idea simply for the preventive effect. (Once a tendon has been injured, there is a tendency to develop tendonosis in that location again.) Here is the final email I received from Dr. Heller:

You suggested the value of continuing the exercises as a preventive measure. I did so, and at the same time returned to my pre-injury arm and shoulder weight work-outs. I can now say that my previous symptoms are essentially undetectable.

The close temporal relationship between your exercise sets and the dramatic improvement (after months of symptoms) is highly convincing. The causal relationship is also supported by at least one well-designed randomized trial in the literature. The efficacy of your approach is quite remarkable.

Warm regards,
Allen

So there you have it. If you have been waiting for a certified medical professional’s opinion on Target Tendonitis (and by that, I mean someone who is not only familiar with the research but has actually tried the program), I can’t give you anything better than the above. If you’re still on the fence about ordering, Dr. Heller’s testimonial, plus the 100% money-back guarantee that I offer, should help you make up your mind. But before you order, do us both a favor and take the tendon test that I have on this page. It will tell you what sort of tendon pain you have, and whether or not Target Tendonitis is the right thing for it.

Another unsolicited testimonial

Got this in the mail a couple of days back:

Subject
THANK YOU!
Message
Hi Alex. I’m a 54 yo man who enjoys light weight lifting, playing guitar (a lot) and I use a computer at work quite a bit. I developed elbow pain over 5 years ago in my left arm and recently have been experiencing sharp pains in the base little finger knuckle of my left hand. The doctor only said that non use and NSAIDS would cure the problem. Well, that didn’t cure the problem (I can’t tolerate NSAIDs for more than 3 or 4 days anyway) and I had pretty much accepted the fact that I would not be able to do the things I enjoy. I figured it was just the price of getting old. After using your exercise for 3 weeks the pain in my elbow is nearly gone as well as the knuckle pain. I’m back at the gym and happily shredding away again! It seems you get a lot of positive feedback, but I just wanted you to know how grateful I am. Sincerely, Jay

Just goes to show that it doesn’t matter how old you are, if you approach things in the right way you can heal just as quickly as when you were a teenager. (Okay…maybe not quite that quickly.)

Also goes to show that doctors don’t know everything. The fact is, most commonly available NSAIDs don’t even start working on inflammation unless you take them continuously for a month or two. To give an example, Ibuprofen requires a month and a half at cumulative dosages of around 2100mg per day (spread out over three or four times, of course). You’ll do better with prescription anti-inflammatories, but even the newest, most effective drugs like Bextra and Celebrex require a week to a week and a half. So for someone like Jay, who can’t tolerate them more than three or four days, they’re basically useless. Sure, they’ll provide some pain relief, but they won’t do anything to actually cure the problem if you have tendon pain.

In any case, congratulations to Jay for refusing to settle into middle age, refusing to take the doctor’s diagnosis at face value, and for searching out the information that could put him back on track. If you’re frustrated and would like to have some ammunition to talk to your doctor with, I have a seven-minute video up here that will tell you everything you need to know to get to the bottom of your tendon pain.

Supraspinatus tendonitis

Most people have never heard of their supraspinatus muscle (much less the supraspinatus tendons that attach to it), but it’s one of the small cookie-cutter muscles located in the upper area of the back. If you take either hand and reach up to grab the area between the side of your neck and your opposite shoulder (like you’re giving yourself a little massage), your fingertips should be resting more or less directly on it.

It’s part of the rotator cuff, which helps stabilize the shoulder and keep it in the right position, and the function of the muscle is to help the shoulder raise your arm out to the side and overhead. Contrary to what a lot of people think, the supraspinatus is only the prime mover, so to speak, for the first few degrees of the motion when you raise your arm away from your body. (Beyond about 15 or 20 degrees, it’s mostly the deltoid that performs the action.) Athletes like pitchers who do this motion a lot tend to develop tendon pain in the supraspinatus tendons, which is usually diagnosed as supraspinatus tendonitis.

I’ll discuss whether or not this pain is actually tendonitis or something else a bit later down the page, but first, let’s take a look at the supraspinatus itself.

Supraspinatus muscle

As you can see, the muscle isn’t very large, and the tendons that attach to it aren’t either. In fact, one of the most common types of rotator cuff tears is a tear in the supraspinatus tendon, which comes right over the top of the shoulder. Due to its position, along with the fact that it helps to stabilize the shoulder and hold it in place against the constant drag of gravity on the attached arm, it’s at quite a bit of risk, especially as you get older. Overall, most tears are experienced by people 40-70 years old.

Supraspinatus tendon

The shoulder is a complex joint, and I’m not going to try to get into all the possible problems that can occur with it here. If you’re experiencing pain, it could be anything from a muscle imbalance to an overgrown bone protrusion to something wrong with one of the tendons. There’s really no way to tell without seeing a specialist, so if you have pain anywhere in the rotator cuff, I suggest that you go consult one. Again, this would be a specialist, not a regular doctor. You want someone with a lot of experience dealing with shoulders, and you should be able to tell whether or not your doctor knows what’s going on by the variety of tests s/he performs. It’s difficult to diagnose a supraspinatus problem as opposed to any of the three other muscles of the rotator cuff, and it takes testing from various angles to do it right.

As far as the supraspinatus tendon goes, the tendon doesn’t have to actually tear in order to experience pain. Just overuse and pattern overload can cause it to become inflamed (tendonitis) or, in cases that last longer than a couple of weeks, actually cause clumps to appear in the collagen fibers that make up the tendon (tendonosis). This second condition is much more common than most people (even doctors) realize; it’s been estimated that as much as 95% of long-term “tendonitis” cases are actually tendonosis.

If you have a full tear of the tendon, you’ll need to see a specialist for treatment. But if you’ve been experiencing pain that (a) isn’t a tear, or is only a minor tear (get an MRI to make sure) and (b) doesn’t seem to be responding to the usual icing, rest and NSAIDs, then it’s very likely that you have tendonosis rather than tendonitis. In that case, a program of specific exercises that target the supraspinatus is your best bet to get at the collagen fibers and straighten them out.

The Target Tendonitis ebook gives a thorough explanation of the best way to approach this, and the companion videos that come with it show how to do exercises for all the various parts of the body where tendonosis is likely to occur. For the supraspinatus tendon, take a look at the shoulder exercises that involve lateral motions and you’ll be on your way to recovery.

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.

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.