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.

Masahiro Tanaka back from tendon injury

Ran across this story this morning as I was browsing the web for tendon pain information. (Yes, I actually do that…) Back at the end of April, the Yankees put pitcher Masahiro Tanaka on the disabled list due to some tendon pain in his wrist. It wasn’t a bad case, but when you’re subjecting your arm to the stress of major league pitching, slight injuries can become severe injuries very quickly.

What I found interesting was that the Yankees knew he was going to be okay in only a couple of weeks. From the start, he was only supposed to be on the DL for about 15 days. And sure enough, he’s made a more or less full recovery as of today (May 12th). If you take a look at the video of his pitching practice linked above, you won’t see anything in his form that would indicate lingering pain or a lack of joint mobility.

So why were they so confident? It’s because the Yankees have access to the best doctors and trainers, and with millions of dollars riding on their winning baseball games, they can’t afford NOT to keep up with the latest, most effective methods of rehabilitating their athletes.

Tendon pain is more or less unavoidable if you play sports at a high level, so the Yankees (along with every other professional sports team) know that they’re going to have to deal with it. And so they hire people who understand what to do when something goes wrong. And they have every confidence that their players will get better if they have the right regimen of nutrition and rehab exercise, and so can make predictions (that turn out to be true) about how long it will take before, say, a wrist tendon is ready for action again.

If you’re reading this blog, you probably have a tendon issue of your own. Think about it for a few moments. Are you as confident that you know what to do to get yourself off the DL and back into the game of life? Or are you slowly starting to feel overwhelmed, and getting to be afraid that this tendon problem you have is going to permanently affect your life?

If it’s the latter, it doesn’t have to be that way. There is good scientific evidence, supported by over a hundred human (not animal or “in vitrio”) studies across the entire globe, that certain types of exercise and nutritional supplements can completely reverse tendon pain in most cases. It’s what I write about in my ebook. Chronic tendon pain, usually called “tendonitis” but more accurately referred to as “tendonosis”, doesn’t have to affect you forever…as the Yankees well know.

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.

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.

Bye-bye, Food Pyramid

In a long overdue move, the United States Department of Agriculture (USDA) has gotten rid of the famous Food Pyramid that for close to two decades was supposed to tell you how to eat. The new symbol is a plate-and-cup that will hopefully be easier to understand.

Michelle Obama, Agriculture Secretary Tom Vilsack and Surgeon General Regina Benjamin got together to announce the new paradigm, but the message seemed to be a little contradictory. According to Ms. Obama, parents “don’t have time” to measure out portions of food…yet, according to Dr. Robert Post, Deputy Director of the USDA Center for Nutrition Policy, “We know that with proper planning, you can get enough protein” from a vegan diet.

Hmmm. I can tell you from personal experience that, once you have the scale, it takes about ten seconds to measure out a portion of anything. On the other hand, I know very few vegans who actually (a) combine plant proteins properly on a regular basis and (b) get enough overall protein into their bodies (which is probably why so many of them start looking gaunt and eventually go back to eating animal sources). I have nothing against any particular diet plan, so long as it’s healthy, but let’s be clear about the realities of eating. Weighing food takes almost no time at all, and there is no better way of coming to grips with the reality of what you’re putting into your mouth–it’s just that it’s a bit of a hassle.

Anyway, time will tell if this new plate-and-cup idea takes hold. Meanwhile, if you have long-term tendon problems, here are some food-based issues to consider:

If you are overweight, the first thing to look at is losing the excess poundage.
If you are underweight, are you getting enough good fats in your diet?
For any American male, do you eat a preponderance of red meat versus fish and nuts?

Any or all of these can be (and probably are) contributing factors to your tendon pain. Fixing them is one step toward having healthy tendons and preventing recurrences of tendonitis/tendonosis. For more information about nutrition and supplementation as they relate to having healthy tendons, check out my book Target Tendonitis.

Another testimonial (from a tennis player)

Just received another nice testimonial from a woman named Cindy Sekelick. She was suffering from lateral epicondylitis (otherwise known as tennis elbow) and wrote in to say:

Hi Alex,

Implementing your ideas really did help me. I was injured last June and in the last few weeks I can say my arm is almost healed. I play tennis so that was a strong motivation for getting my arm back to normal.

I am so glad your information was available. Thank you so much.


CIndy had suffered from tendon pain for over half a year, and bought Target Tendonitis in January. Less than three months later, she’s almost back to normal.

If you’ve been suffering from a tendon condition for more than a couple of weeks, do you really want to wait any longer? You can try the techniques and nutritional recommendations in Target Tendonitis absolutely risk-free for 60 days – more than enough time to see whether they work as advertised. So what have you got to lose…other than your tendon pain, of course. 😉

How to tell the difference between arthritis and tendonitis

The initial symptoms of arthritis and tendonitis can feel very similar, so here’s an easy home-diagnosis way to tell the difference: try taking glucosamine for two weeks. If it helps, you likely have osteoarthritis. If not, it’s more likely a tendon problem.

What’s the reasoning here? Glucosamine (often packaged with MSM and/or chondroitin) has been shown in quite a few scientific studies to help with cartilage formation. Cartilage is what your joints are made of, and what arthritis attacks, so upping the rate of production in turn helps your joints. End result: you feel better…if you have arthritis.

On the other hand, glucosamine will not help with collagen formation, and tendons are made of collagen. So it stands to reason that if you feel like you have “joint pain”, take glucosamine, and don’t experience any relief, one very likely culprit could be your tendons. (Tendon insertion points are often very close to joints and it can be difficult to tell exactly where the pain is coming from.)

Taking NSAIDs, using ice and so on can provide temporary relief for either condition, but since both arthritis and tendonitis are both the result of inflammation, using these treatments won’t help you distinguish between the two. And knowing which one you have is of course very important if you intend to treat the condition yourself.

If you do decide that you have a tendon problem, however, and you’ve had your pain for more than a couple of weeks, I caution you against assuming that the issue is tendonitis. More likely it’s tendonosis, which is an actual degeneration of the tendon. (This is especially true if you take NSAIDs and they don’t help.) If you think that this might be your problem, have a look at my tendon test. It’ll only take a minute, is completely free, will tell you whether you have tendonitis or tendonosis, and give you some options about what to do about it.

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.