Below is a textbook case:

Hi Alex, I had severe tendonitis in both elbows, with the left one being quite a bit worse. It struck for no apparent reason and I had it from May to end of November. I stopped pretty much all activity except running. I did read your book and while I didn’t follow the protocol per se, the fact that I could use some resistance training made sense. The only thing I hadn't tried was that. In fact, it was the first thing I stopped when the tennis elbow struck. Within a few days of using weights in the manner you directed, the pain in my right elbow was gone. It took another week for the pain in my left elbow to go away. I still feel twinges in my left elbow but it is for all intents and purposes healed.

Thank you,

Marilyn Mitchell

"May to November" is over half a year. Far too long for Marilyn's tendon pain to be any kind of inflammation, which is why it didn't respond to the layoff. But when she tried a different, scientifically verified approach that was designed to actually fix the underlying problem, her tendon pain resolved itself very quickly.

If you've had pain for longer than about two weeks, you owe it to yourself to try something different (and more effective). The Target Tendonitis ebook now comes with a series of videos that will show you exactly what to do, no matter what part of your body your tendon pain occurs in.

Hi Alex

I am really pleased to be able to say after two long years of tendon pain I am 98% recovered. After trying every treatment possible from acupuncture, massage, glucose injections, dry needling and so many more expensive treatments I thought I would never find a cure. I followed your program for 2 months and for the first time in 2 years I actually was able to start running again. My tendon problem was the hamstring attachment at the ischial tuberosity, and it took a while to find the best exercises for it. I started with [list of progression of exercises]. Still doing exercises most days. Always do a set before I run. Still have a tiny bit of tenderness after I run [which] disappears soon as I stretch my hamstrings. I'm back running 3-4x a week now, slowly building my distances feels great. Thank you so much, the best $24NZ dollars I ever spent.

Regards, Mary-anne

I will say thank you and congratulations to Mary-anne, who didn't give up and persisted long enough to find a treatment that actually worked. I can't imagine how much tendon pain she must have had to have actually tried glucose injections (I'll have a post up on this method of treatment soon)...

To everyone else, Target Tendonitis is only going to be US$19.97 until the end of this month. After that the price is going up to US$29.97 due to the tremendous added value of the series of videos that now comes with it. So if you're thinking about ordering, this is the last week that you'll be able to get it for the same price that Mary-anne paid - and the videos will be thrown in for free!

So about a year ago I started to put together a companion video that would go with the ebook. When I started the project I figured it would take a month–at the most–to film a bunch of sequences showing people how to go about rehabbing their tendons, and giving them specific examples of what to do and maybe discuss a little theory about tendon degeneration and treatment along the way as well.

Turns out I was, um, somewhat naive. Sure, the video filming didn't take that long (once I learned how to light it...and bought a decent microphone...and mastered all the various settings on the camera...and got reasonably comfortable in front of it...), but the editing? And then figuring out how to deliver it to customers? The sheer amount of content turned out to be a problem: what I thought would be maybe a half-hour turned into a behemoth three times that long, and let me tell you, an hour and a half of video is a big file. Too big, really, to send over the internet, especially when some of your customers are in places that still use dial-up connections.

Anyway, long story short I solved the various technical problems and am now officially launching the third edition of Target Tendonitis. People who buy now will get not only the ebook, but access to 90 minutes of detailed video demonstration of exercises for pretty much any bodypart that might be affected by tendon pain. Been using your iPhone or Blackberry too much, and have tendon pain in your thumb? No problem. Are you a guitarist with pain in your arm or wrist? I've got you covered. Tennis elbow, golfer's elbow, runner's knee? There are exercises specifically for those conditions, and much more as well. You'll also learn about special resources that can help to speed up recovery even beyond what's possible with just the ebook (and remember, the ebook has proven to be VERY effective already).

And now for the really big news: for a short time, in the holiday spirit, I'm going to be selling the new and improved TT for the same low price that it's always been: $19.97, still with a full, 100% 60-day guarantee. Only now you're going to be getting the video absolutely free along with it.

I want to be clear here: the price WILL be going up soon, and once it does, it's not coming back down again. This isn't a marketing gimmick; I put a lot of time and effort into the video and I feel like it raises the value of my product enough that I'm completely justified in charging more money for it. (Haven't quite figured out how much more yet.) But for the moment, it's still $19.97.

So if you're on the fence about ordering, there's never going to be a better time. Target Tendonitis, still less than twenty bucks, and you get 90 minutes of video completely for free. Get it now or kick yourself all through 2012!

- Clint Shelton, 35, weightlifter, via Facebook

If you've been suffering from tendon pain for more than a couple of weeks and are still hoping to get better using icing and aspirin, stop wasting time. Take the free Tendon Test to find out just what kind of tendon pain you have (hint: it's probably tendonosis, not tendonitis) and choose the best method of rehabilitation. All tendon pain is not created equal.

Of course, it's helpful to know what is and isn't a vegetable. Recently, the US Congress showed just how difficult making this determination can be by deciding that pizza is now legally to be considered a vegetable.

Apart from the blatant political self-serving--and the complete disconnect from reality that politicians apparently experience--no one should be fooled into believing that pizza will actually serve to replace a vegetable. But if you suffer from tendon inflammation, adding more (real) vegetables into your diet is a good step to take. Another would be adding a good supplement or two, which you can read about here.

Basically, pattern overload occurs when you perform too many repetitions of a particular movement. You don't necessarily need to be using a lot of weight to have pattern overload occur; your own bodyweight is more than enough…as is a one-pound dumbbell if the number of repetitions is high enough. Typing can even become a problem if you never change your hand/wrist/chair/keyboard position.

Most of the time pattern overload isn't too much of an issue, because even with high-rep activities like running or swimming, each time your foot strikes the ground or your hand cuts through the water, your body is going to use a slightly different "groove" to accomplish the movement. If you're a highly trained athlete you might be performing in more or less exactly the same groove for a while, but eventually, as you begin to fatigue, your groove will start to become looser and while this means that your efficiency of movement will go down, it's one way the body helps to prevent itself from getting injured.

But certain modes of exercise can be worse for pattern overload than others. One example is using gym machines too much. People who work out with free weights have a much lower incidence of pattern overload than those who work exclusively on machines. The reason is that when you're using a barbell or dumbbell the weight moves according to your body, but when you're working on a machine your body moves along the machine's predetermined and set path. Even something like a Smith machine, which incorporates a small degree of leeway, is much more limiting and allows for less "natural body adjustment" as you go through your sets than a free-weight barbell.

On the opposite end of the spectrum, there is Crossfit. I'm not a Crossfit hater. I think that the main idea of Crossfit - to do something different each day, and keep good track of your rest times - has merit for those who simply want to "be in shape", and certainly the training is fun. But there are some drawbacks as well, especially when you look at Crossfit in relation to tendon injuries.

Basically, a Crossfit exercise session involves choosing two or three distaff exercises, and then doing a lot of those exercises using a set weight for time. The rest time between sets is usually about ten seconds, and you alternate exercises. To give an example, one of the videos on the website shows three women doing bodyweight squats, then pull-up/press on gymnastic rings, then hang cleans with a barbell.

If you just plain do too much of a movement, even if that movement is something completely "free", like swimming, you can develop tendon problems if your exercise volume exceeds your capacity to recover from it. This is where I have an issue with Crossfit. I know that on their site they place a lot of emphasis on not doing too much and using good form, but in practice they use technically difficult movements (like cleans) and push well past the point where good form completely breaks down.

Of course, you have to push yourself to a certain extent if you want to improve your body. But the question of degree is very important. Without getting into a long discussion about exercise theory, the bottom line is that quite a few people order my ebooks, and lately a lot of them are complaining about injuries received from Crossfit training.

So if you're suffering from tendon pain and are using an exercise program (or doing some kind of work) that incorporates too much pattern overload, either through limited and unnatural movement or by simply having too much volume, think about ways that you can reduce or get around the problem. You don't have to quit exercising, but you may well be better off if you can find ways to vary your routine.

UPDATE: Scott Abel has written a critique of Crossfit that, while it won't win any awards for style, makes several excellent points about the dangers and limitations of the training. You can find it here.

Dear Alex:

The book has been very beneficial. I have suffered from stubborn tendinosis three times. The first two ones were elbow tendinosis. I simply did too many pullups. These were not mere "tendinitis" . I aggravated the tendinitis because I didn`t rest enough. The point is I felt it in the morning only, but every morning was worse. So I had to quit pulling for months-well, more than a year-till I decided to perform [the recommended exercises].
I am currently curing from another one in my Achilles tendon. Now I´m better, but I had to stop running from last November to June. It was when I bought your book that I began doing [the recommended exercise], which improved my Achilles a lot.

To summarize : this stuff works and is very practical and easy to implement.

Thanks a lot, man. Tendinopathies really suck, and your book can help many people.

Santiago Ces Garcia
P.D. : Feel free to use my humble review.

There are more testimonials on the sidebar to the right, but if you're suffering from long-term tendon pain, what are you waiting for? Take the free, one-minute Tendon Test and find out what to do to get started on your healing.

Dear Alex,

Thanks for checking in. I'm sorry I haven't kept you updated, especially considering your very conscientious and generous communication. Since my last email we've been traveling. You're entitled to some much deserved kudos!!

I feel I made tremendous progress, despite the "pep talk" (not!) the ortho gave me when I told him I was going to follow your protocol. I started with virtually no range of motion and tremendous pain in the elbow & shoulder to full range of motion and completely pain free for normal day to day activity in two weeks. I haven't started working out yet. When we get home I'll test it out on some light weights. Of course, I'm a bit nervous. I am a little confused to what my new regime will be. I do enjoy cross fit and wish my gym environment and trainer would be more supportive of what I need to do to modify.

Now, that I understand the idea of healing and maintaining tendon health, I'm excited to work on other areas (knees, back). Although, I am confused about how to target the back...

When we get home, there are many people I'm looking forward to recommending your book. I've seen a couple of msg boards out their full of people who could use your help. It's quite sad to realize how many people have really been suffering for a long time. I won't give away the secret but will definitely send them in your direction.

Thanks so much! Besides the healing, you've also provided me w/a tremendous amount of empowerment.

Sincerely,
Bobbi Casellas

Bobbi is a 42-year-old weight trainer, crossfitter and generally very active. A testimonial like this speaks for itself. I have nothing to add, except to say congratulations to Bobbi for taking matters into her own hands and deciding to try something new--despite the advice of her orthopedist!

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.

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.

One technique that I have been having some (very limited) success with is lowering the intensity of the exercises given in my book. The usual prescription is for about a 2-3 on a scale of 0-10, 10 being extreme pain, but if you've got Levaquin in your past it seems to work better if you just aim for a "1", at least at the beginning. Over time, and with proper nutrition and exercise, you may be able to strengthen your tendons, even if they've been damaged by this drug, but you're probably going to have to start out from a lower threshold than someone who has not had this particular sort of debilitation.