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.

Yet Another Testimonial

Target Tendonitis has gone international. Each month I ask previous customers for feedback on the book, and this month I’d like to share a testimonial from one in Latin America…

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.

The Best Testimonial I’ve Received Yet

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.

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!

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.

Sign language tendonitis

Tendon problems aren’t just for athletes and computer programmers. It can strike people who you would never think would get it. One such group is sign language interpreters.

Just like anyone else who performs excessive repetitive motions, sign language specialists can develop tendon issues. Common problem areas are the thumb, wrists (similar to carpal tunnel syndrome), as you might expect, but also in the elbow flexors. Although it might be thought of as a sort of niche condition, the remedy is the same as for any other situation: icing, rest and NSAIDs for the short-term inflammation, and in more advanced cases a structured set of exercises performed in a particular manner to help reverse any actual tendon damage. (In this case you will actually have tendonosis, although most medical professionals don’t bother to make the distinction.)

If you work with sign language regularly, it would pay to treat your hands and forearms in much the same way an athlete does. Be sure to stretch your fingers, hands and forearms after long signing sessions. Pay attention to your nutrition, especially aspects that help prevent inflammation and support tendon regeneration. And try if at all possible to take regular breaks during work. Five to ten minutes every hour is a good rule of, er, thumb.

Nutrition for tendon pain

I recently received a question from someone who purchased Target Tendonitis. He asked about the advisability of fasting if you have tendonosis.

Although fasting can have some beneficial effects, I do not advise anyone who is suffering from tendon or fascia problems to do it. The reason is simple: your body needs nutrients to heal itself, and if you’re fasting you’re not providing it with the basic “stuff” that’s necessary to do the job. I recommend some nutritional supplements in the book, but these recommendations are based on the assumption that your basic nutritional needs are already being met. If they aren’t, the supplements aren’t going to do you much good by themselves. A diet that is lacking in vitamins, minerals or protein (to say nothing of all three at once!) is going to pose serious, serious problems when it comes to healing your tendons.

Assuming that your basic diet is okay, one thing you can do to help heal yourself if you have tendonosis or fasciosis is get a good kelp supplement and take it regularly. Kelp contains iodine, which is helpful for the formation of collagen, the basic building block of tendons and fasciae. My favorite out of the products listed on Amazon is Icelandic kelp, which is harvested during the cold months and washed in high-mineral fresh water, which adds further minerals to the already good mix that kelp naturally contains. (Collagen supplements, by the way, are totally ineffective.)

Note, however, that just taking a supplement isn’t going to be enough to cure yourself if you have long-term tendon pain. Anything over about two weeks is most likely going to be tendonosis, not tendonitis (I know, I know, but believe me, your doctor is wrong. Do the research yourself and see.), and in that case the collagen fibers in your tendon have become either bunched or damaged to the point that they are going to require actual realignment in order to work properly. This is what the exercises in Target Tendonitis provide (along with a lot more detail about the nutritional side of things), and why it has such a high success rate for people who haven’t seen much effect from nutritional therapies alone. A combined, holistic approach works much more quickly than any single measure.

A success story

I’d like to share a success story with you today. Jonathan, a 30-year-old football player, bought a copy of Target Tendonitis last month. Here is his email to me:

Hi, I bought your book today [Feb. 15th] and had a quick read on my kindle.

I have been having post tibial tendonitis for 7 months.. From what your book says it might not be the case and is probably tendonisis. I did an MRI back in January and it showed that my deltoid ligaments were still inflamed. I stopped exercising (running or football) for about 6 months although I did the elliptical once in a while but things got worse when I had to walk a lot for 1 week going up and down the stairs.

That made my ankle inflamed again . My doctor finally gave me a cortisone injection. It has been 4 days now and the pain has gone down a bit. I definitely have less pain although it is not 100% as i can feel that my tendon is somehow weak. I wanted to ask you if I can start [your recommended] exercises to start strengthening my tendons and also what kind of exercise I can do to treat Post tibial tendonisis. The book doesn’t show any examples for that.

Since working with Jonathan, I have received so many complaints about PTT, plantar fasciitis and achilles tendon pain that I created a new website specifically to talk about these problems. If you have any of these issues, I recommend that you check it out because it has a LOT more information about them than Target Tendonitis does. But at the time I gave Jonathan some specific movement patterns and asked him to try them for a couple of weeks.

On March 3rd, I followed up to ask how he was feeling. This was the unedited response:

Hi Alex, much better! I get no pain when sitting and almost no pain when walking, just some stiffness. I went to do some deep tissue massage last week… Boy did it hurt 🙂 I am still doing my exercises but i do them every 2 days and now I don’t feel any pain doing them but only some stiffness the next day which I usually tackle by stretching a little.

Congratulations to Jonathan for taking the time to try something new and on his speedy recovery. If you’ve been suffering from tendon pain in your feet/ankles for more than a couple of weeks and would like to experience similar results, Target Plantar Fasciitis and Posterior Tibial Tendonitis has information that can help you out.

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.

The most important thing

The new year is here and since this month also marks the one-year anniversary of this blog, I thought I’d start things off by reiterating the most important single thing I can tell you about tendonitis. So here it is: if you’ve had tendon pain for more than a couple of weeks and have been faithfully applying the usual doctor’s prescription of rest, icing and NSAIDs, without much effect…you probably don’t have tendonitis.

Any kind of “itis” is inflammation. If you really do have inflammation, chances are excellent that it will get better with the above treatment. So it stands to reason that if you’ve tried the treatment for a while and your pain doesn’t get better, you didn’t actually have inflammation in the first place.

Estimates range anywhere from 50% to over 90% that most diagnosed cases of “tendonitis” are actually tendonosis. This means that whatever problem you have with your tendons, it has gone beyond inflammation and now involves actual degeneration of the tendon itself. If this is the case, you’re not going to experience much relief with rest, ice and aspirin, because none of that is designed to repair your tendon.

To get better, you’re going to need a fresh approach. One part is good nutrition; either clean up your diet or else get some supplements that will give your body the building blocks it needs to heal. The other part is a set of exercises that will signal your body to start repairing itself. Particularly in regular exercisers and older people, the usual repair mechanisms often need an extra boost to get the upper hand against tendonopathy.

Target Tendonitis gives advice on both of these topics. It spells out the types of exercises you need to fix your tendons, and also gives specific recommendations about the sort of food and supplements that you need to help your tendons function free of pain. At less than thirty bucks (still!), it’s the best tendon-healing value on the market today.

Do you really even have tendonitis?

Below is the text of an online article I wrote not too long ago. If you’re under the impression that you have tendonitis but it seems like it’s taking an awfully long time to get better, have a look and see what you think. (Or you can just take my quick and easy tendon test.)

Tendonitis is one of the most common ailments around. According to Bureau of Labor statistics, tens of thousands of workers suffer from tendonitis and Repetitive Stress Injuries (RSIs) like carpal tunnel syndrome every year.

The “itis” in tendonitis actually is a medically precise term that means “inflammation”. Here are some quick and easy tests to determine if you have tendonitis, or if it’s really another condition like tendonosis (which means degeneration of the tendon).

1. Did you have some injury/trauma at the location of your pain? Or has your pain developed slowly over time? Example: If you fell and banged your knee and then experienced pain in the joint, you may have tendonitis there. But if you’re a runner and started noticing a slight pain that has gradually become worse over the course of months, then most likely you’re suffering from tendonosis, not tendonitis.

2. Is the pain recurring? Have you “fixed” it once, only to have it come back a few weeks or months later? Inflammation is generally a short-term response to some sort of injury or infection in the body. If you hurt yourself or become sick for some reason, inflammation helps your body to heal. But once the job is done, the inflammation goes away. (Think about the last time you got a splinter in your finger.) If you have taken aspirin or some other pain medication, rested the affected area, and thought that it was healed only to have the pain come back once you started back at your activity, you probably do not have tendonitis.

3. Has the pain been there constantly for a long time (more than a few weeks)? This is very similar to the above point. If you are suffering from long-term pain in your wrists, shoulder, knee, etc., and especially if you have not experienced any injury or infection in those places, odds are that you do not have tendonitis, but tendonosis.

4. Is the area hot to the touch? Is it red? Is there any swelling? These are three of the five classic symptoms of inflammation, and have been known since ancient times. If the painful area isn’t hot, or red, or swollen, it’s likely not inflamed, which – again – means you don’t have tendonitis. At the risk of boring you, the odds are overwhelmingly that it’s tendonosis, which requires a whole different approach to treatment.

There are some legitimate cases of tendonitis out there, but most people (doctors included) tend to confuse tendonitis with tendonosis. Think about the above points and decide for yourself which one you have.

Anyway, yes, I’m selling something. And here comes the pitch: If NSAIDs, ice and so on haven’t worked for you, maybe it’s because you’ve been misdiagnosed. Honestly, it happens a lot. If you’re sick of the pain and just want to get back to your normal life, have a look at the testimonials to the right and then click on this link. My ebook + video package is fully guaranteed to work within a couple of weeks or 100% of your money will be refunded with no questions asked.