Another unsolicited testimonial

Got this in the mail a couple of days back:

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.

Tendonitis and Tendonosis – Can I have both?

I make a big deal out of distinguishing between tendonitis and tendonosis, but it’s perfectly possible to have both at the same time. In fact, it’s likely. Here’s what happens:

You do some repetitive movement for a while and something is not exactly perfectly aligned in your body (i.e., your movement pattern is wrong, etc.) or else you just do the movement so often that your body can’t recover completely. (Recovery issues are particularly important for hard-training athletes and older folks.) This starts to wear down the tendon, causing micro-tears and fraying. This is the beginning of tendonosis, although you don’t notice it yet.

After the damage passes a certain point it triggers a “fix it” response. Your body, trying to repair itself, will cause inflammation to occur, which brings with it the pain that causes you to notice on a conscious level that Something Is Wrong.

This is the point where most people will say, “Hey, I’ve got tendonitis.” From here, a couple of things can happen:

(1) You try to ignore the pain and work through it. Although the most common response, this is doomed to failure and will eventually lead to (2) below.

(2) You take NSAIDs, use ice, rest the area, etc. (the usual prescription for tendonitis).

Now there are two possible outcomes:

(2a) You didn’t have all that much tendon damage to begin with, and what you did have has been repaired to the point that you no longer feel pain. Congratulations, you’re cured!

(2b) You (may) feel some relief from the reduced inflammation, but you still have a considerable amount of pain. This means that while your anti-tendonitis regimen is working on the inflammation, the underlying tendonosis condition is severe enough that it has not been, and still is not being, fully repaired. At this point, further anti-tendonitis measures like NSAIDs and so on are probably not going to help. You need to actively repair the damaged tendons – which is what I cover in detail in my book.