Chronic Tendonitis Multiple Joints In Triathlete

by Chris Thornham
(Las Vegas, NV, USA)

Thank you for taking the time to answer questions. I've struggled with tendonitis for the last 4 years and was hoping you could help.

I know you get a lot of questions so I'll keep my question as short and to the point as possible.

I've been a triathlete for 4 years. Ever since I started the sport I've struggled with tendonitis. Since starting the sport I have had tendonitis in the following locations...

Left Shoulder
Left Foot
Left ITB
Right Posterior Tibialis
Right Medial Knee
Right Groin
Left/Right Patellar Region
Left VMO
Left Quadriceps Tendon

I've been very cautious with the build up of miles and always rested when I get injured. The problem is my injuries never seem to go away. I've done the following to cure my tendonitis...

Active Release Technique
Physical therapy for months at a time
Hot Yoga
Primal Diet (for over a year. supposed to be an inflammation limiting diet)
All organic diet (at least 80%)
Supplementation (fish oils, vitamins, cal/mag)
NSAIDs (ibuprofen, celebrex)
Cortisone shots
Full blood panel drawn by rheumatologist to look for autoimmune markers

Here is my current status...

In early December of 2010 an (ITB) illiotibial band issue from running and a shoulder issue from swimming has kept me from swimming, biking or running ever since. No training whatsoever for three months now. Even with walking I'm getting pain.

I've been with a sports minded physical therapist for 2 months and I am still in daily pain. I simply cannot get relief.

Some days seem worse than others. It almost feels like I have flare ups where all effected areas seem worse on certain days. Systemic? I'm not sure.

Here's an interesting point. I'm an identical twin. My brother, has the exact same problems and he is not a triathlete. Even trying to run for 10 minutes causes him to get flare ups.

Months without activity and he too is in daily pain even when seing a physical therapist and taking all of the steps I have taken above.

Here are some thoughts.

We both took Accutane 2 times about 10 years ago. Maybe that has no relation but a friend of mine who is also always injured also took Accutane as well.

Here are my personal stats.

Age: 29
Sex: Male
Height: 5'11"
Weight: 150-155lbs
I've always been very athletic and fit.

I guess I'm simply saddened by all of this. I'm 29 years old and I feel like I'm losing my quality of life. I've always been very active and lately getting groceries causes me pain. Any advice you could give me would be greatly appreciated.

Thank you very much for your time,

Chris Thornham


Joshua Answers:

Hi Chris.


So...if Accutane was an antibiotic I'd point you to information like Levaquin Tendonitis .

But it's not. It's a form of Vitamin A.

I'll get back to that.

My first thought after reading the above, was 'nutritional deficiency'.

You're doing all the right things, but clearly need some fine tuning. For instance, perhaps you're not taking -enough- foods/supplements.

But then you mentioned your twin. Which rather kicks out the factor of 'I'm a triathlete with high nutritional needs'. It's still a factor, of course, but.

So let's look at the similarities. 1. You both took Accutane. 2. Genetic similarities, as far as having particular nutritional issues/needs.

Some of the side effects of Accutane are stomach issues like Chron's disease, Irritable Bowel Syndrome, and ulcerative colitis.

Which again would make sense if it was an antibiotic, killing off the good bugs in your gut.

So even though it's not an antibiotic, it clearly messes with people's guts, all of which can cause Leaky Gut, which causes auto-immune issues and nutritional deficiency (which can result in muscle pain and tendonitis issues).

Moving on. Accutane is Retinol. Both are forms of Vitamin A. Vitamin A competes with Vitamin D for receptor sites. Potentially the Accutane jacked up your receptor sites....might have contributed to something we need to investigate/discover.

Accutane was a long time ago. Maybe that's just your particular family genetics. I don't know. Not particularly relevant at the moment.

So if, for -whatever- reason, you and your brother can't absorb Vitamin D very well, then you're vitamin D deficient (which most everyone is anyway, but potentially you have MUCH higher needs.

Guess what some of the side effects of Vitamin D deficienc are? Muscle pain. Pain that mimics tendonitis. Joint pain.

Having Symptoms of Tendonitis doesn't mean that you actually have Tendonitis. Or at least, it doesn't mean that you have any actual damage. You may or you may not, but even if you do, it's unlikely that that's the cause of your all over pain.

Theory aside, let's get to some questions.

1. What is your Vitamin D level? Don't know? Find out ASAP.

2. How much Magnesium do you take daily?

3. How much Calcium are you taking?

4. How much fish oil/Omega 3's?

5. How many calories do you eat in a day, approx?

6. How much of that is protein, fat, carbs?

7. Do you eat gluten/wheat? Probably not if on the Primal Diet, but let's take a look to see if you're Gluten Intolerant (which would produce all your symptoms).

8. Any other health issues? Digestive or otherwise?

Please reply using the comment link below. Do not submit a new submission to answer/reply, it's too hard for me to find where it's supposed to go.

And, comments have a 3,000 character limit so you may have to comment twice.

Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert

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Mar 14, 2011
Chronic Tendonitis Multiple Joints In Triathlete
by: Chris Thornham


Thank you very much for the work and time you have put into this so far. Let me answer some of your questions.

Theory aside, let's get to some questions.

1. What is your Vitamin D level? Don't know? Find out ASAP.

I don't know but I can find out.

2. How much Magnesium do you take daily?

250 mg per day (supplemental)

3. How much Calcium are you taking?

500 mg per day (supplemental)

4. How much fish oil/Omega 3's?

Fish Oil Concentrate 2400 mg
EPA 360 mg
DHA 240 mg
Other Omega 3 120 mg

5. How many calories do you eat in a day, approx?

My general rule of thumb is eat when I'm hungry stop when I'm full. I've always been a big eater. I currently eat 5 to 6 times per day and would say I always get at least 2500 calories per day.

6. How much of that is protein, fat, carbs?

I don't know exacts but my carbs are very low and my diet exists primarily of protein and fat.

7. Do you eat gluten/wheat? Probably not if on the Primal Diet, but let's take a look to see if you're Gluten Intolerant (which would produce all your symptoms).

I do not eat wheat. I would say for the most part I do not eat gluten. I don't make a conscious effort not to eat gluten but I think the nature of my diet eliminates most gluten if any.

8. Any other health issues? Digestive or otherwise?

No other health issues but... here is an interesting point. I had an MRI on my left knee (the knee with the ITB issue) a few weeks ago. Since I was still getting daily pain I wanted to make sure I hadn't injured my meniscus or something else. The MRI came back 100% healthy. Typically when you have tendonitis that shows on an MRI. You mentioned that having tendonitis symptoms doesn't necessarily mean you have tendonitis or any damage. 2 years ago I also had an MRI on another injury that had caused me pain for over 6 months. It too came back 100% healthy.

I've always been told I have tendonitis. Maybe you are onto something. Maybe it's not actually tendonitis.

Again, thanks for all of your help so far. Let me know if there is anything else I can do to help you.


Mar 15, 2011
Joshua Responds - Chronic Tendonitis Multiple Joints In Triathlete
by: The Tendonitis Expert

Joshua Comments:

Hey Chris.

1. Let me know when you get your D level.

2. Find your Magnesium tolerance level, as described on the Magnesium Dosage page. 250mg/day is likely not even close to enough for you right now.

Make sure it's not magnesium oxide.

3. The rest looks good.

4. I'll say it again. Just because you have pain, doesn't mean you have injury. That's an acculturated mindset passed down through time.

You step on a nail, you have pain and injury. Therefore, if you have pain in the knee, there must be injury, inflammation at the very least.

Nope. Nutritional deficiency, for instance, causes pain, with no injury (although you can get injury too).

When someone has pain all over, it's a huge clue that it's not injury.

At this point, I think you should focus on Vitamin D and Magnesium. Let's see what happens with that, as it's the cheap easy options.

If you get your Vit D levels up to 50-80, and a bunch of Magnesium in you, and -if- that doesn't help, then I'll send you to Kerri at for one or two specific tests to look at the function of some deeper systemic functions.

Mar 15, 2011
Blood Work
by: Anonymous


I'm going to get my blood drawn to check my Vitamin D level. While I'm at it, is there anything else I should have checked?




Joshua Comments:

Well, the more info, the better. Feel free to get a big workup if you want, depending on cost etc.

Personally, I'd just get the D level. Then supplement appropriately with D3 and Magnesium, and then if more testing is needed, get the 1-2 that Kerri works with, as you'll get more accurate, specific info.

But like I say, if you can get your doc to do a big blood panel, and it's not a hardship, go for it.

Mar 18, 2011
Vitamin D and Chelated Magnesium
by: Anonymous


I've had a hard time getting vitamin D levels this week. In my down time I've read a book titled "The Vitamin D Cure". In the book it asks you to do an assessment and rates your potential risk of being D deficient. I was rated a high risk candidate. I think I'm going to increase my D and see how I feel. It would probably be better to have my actual levels but I can't see any harm in upping my D and seeing how I feel if I keep the amount at a reasonable level.

I've also purchased some additional chelated magnesium to experiment with upping my magnesium.

Do you see any flaws in my logic? If not I'll report back on how I feel in 4 to 6 weeks.


Chris Thornham


Joshua Comments:

I see no flaws so far.

How much are you going to supplement with?

Jul 30, 2012
multiple tendonitis, not working out that hard.
by: Anonymous

I have read through the above post and have similar issues but most definitely I have tendonitis issues. I stumbled upon this article because I also took accutane 2 times about 12 years ago so I thought there might be a paralell. I am now 34, my first tendonitis issue was a ruptured left achilles when I was 29. Next was a right ruptured achilles tendon 2 months ago, age 34, and now I have a torn left distal bicep tendon. I need some help to determine what is causing theses weak tendon issues. I have always been very active. I have been doing weight training since I was 13, not heavy just to stay fit. I do weight training 3-4 times a week. For the last 6 years I do the same weight, never increase for added strength, I merely want to maintain. I also do yoga approximately 1-2 times a week. I am 5-11" tall, 190-195lbs. Please help me with some ideas on what may be causing my tendon issues.



Joshua Comments:

Hi Jim.

Assuming you've never done fluoroquinolone antibiotics, my first guess is 'nutrition'.

Describe for me a day in the life of how you eat/drink.

Dec 27, 2012
Another reader with chronic tendonitis in multiple joints
by: Anonymous

Hello Joshua,

I saw this post, and I decided to respond since I share many of the symptoms of the previous two authors.

I'm an active 29 years old, 145 lbs male. I've been running, hiking, biking, weight lifting, and canoeing, kayaking, and rock climbing since I was a teenager. In the last couple of years, I've been a graduate student and spending many hours on a computer.

I've dealt with tendonitis in multiple joints since I was in my early 20s. These joints include R & L wrists, R & L shoulders, and R & L IT band. For a couple of years, I've worn Carp-Mate wrist braces which have worked until recently, and foam-rolled my IT bands.

I bought and read your bicep tendonitis ebook approximately ten days ago. I immediately doing ice message, deep tissue self-message, and ice baths. However, after a week, I started getting disabling tendonitis in my elbows from the self-massage. Since then, I've had to stop the message and just ice.

I bought supplements online, and they took a while to arrive.

I've never thought about the possibility of having a gluten allergy.

Based on your responses, I'm wondering if I may have nutritional deficiencies that are causing my system-wide problems with chronic tendonitis. Do you agree with this hypothesis?

I have another stage in my life history that may or may not be a factor. In my late teens, I got quite sick and dropped from 150 lbs to 115 lbs in 6 months. When I recovered, I started body building and gained 70 lbs in about a year. I don't know if this sudden drop and gain in weight would make me more prone to inflammation. I didn't have any problems with it until a couple of years after this experience...

Also, I've been under quite a bit of stress the last few years as a graduate student. I'm quite sure this isn't helping my inflammation!

Thanks for your help!



Joshua Comments:

Hi Matt.

The weight gain/loss wouldn't necessarily set up an inflammation, but:
A> there is a certain amount of stress on the body from the ups and downs and efforts/factors that caused the body to change in either direction and
B> those stressors eat up nutrition and
C> the working out etc eats up nutrition and
D> it sounds like you were either short on nutrition and/or hand inflammatory issues before that.

What were you sick with?

Gluten intolerance (it's not really intolerance, it's that gluten is an inflammatory agent, like eating gasoline) can cause joint pain/problem in one, some, or all joints.

So if you were eating gluten and derivatives your whole life while being active, and not eating great as most of us don't, and got a sickness that caused a 50 pound weight loss in 6 months (and the metabolic waste product that that can/does release, and school stress, etc, then joint pain makes a lot of sense.

Apr 15, 2015
Pain in elbow when I extend arms, ruptured left elbow tendon
by: Michael D

Here's the history: I ruptured a tendon in my left elbow several years ago and had surgery to re-attach the ligament.

I injured it from hyper extension of my arm during karate. Things were good after that, I was only off work for a few months. Presently over the last year I have experienced pain in both elbows (yes, the one I had surgery on as well) on quick extensions and lifting over 100 lbs.

I was at the doctor and he prescribed me MSM supplements to help lubricate my joints. It was fine for a bit but the problem persists.

I sit at a computer for most of the day.

My Achilles tendons are usually easily inflamed and I have had physiotherapy to deal with that. I have injured inner ligaments in both of my knees.

I have been diagnosed with Achilles tendonosis but I cannot get a serious response from the doctor on what this is.

Nothing traumatic has been done to my arms and I really would like to know before I hurt myself again.

Any information is appreciated. Thank you!


Joshua Comments:

Hi Michael.

1. See: Tendonosis

2. See: What Is Tendonitis?

3. Something traumatic has been done to your arm(s). You jacked up your elbow, had surgery, etc. You don't go back to square one after that.

There's a Pain Causing Dynamic, and it's progressive.

4. Why exactly does your doctor think that you have achilles tendonosis?

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