Tendinitis vs Tendinosis? Long Time Athlete Who Can't Train Anymore

by Susan
(BC)



I am a 45 year old female, very active for most of my adult life, a dance and fitness instructor, runner and triathlete, but am now at the point where I have so many injuries that won't heal, that I can really only swim with a pull buoy and water run.

I am desperately looking for some information that will help me so that I can once again enjoy my active lifestyle pain free.

I have had back and hip pain for about 5 years now and was diagnosed with iliopsoas tendinosis.

It bothers me most on the bike and yes I have had a professional bike fit, even got a new bike and had a fit done on that one as my old bike was a tad too big. I use balls and a foam roller for self-massage 3-4 times a week and that helps to keep things from getting any tighter, but I'm in essentially the same level of pain since the initial injury.

I have seen so many chiropractors, massage therapists, physiotherapists, sports therapists etc and none have been able to help me.

Last year I also started having knee pain under the knee cap after a long bike ride. Running doesn't bother it though. I finally had to give up riding some months back as it now starts to bother me only a few minutes into a ride. I was again told it was tendinosis.

I have tried to get some straight answers on what the difference is between tendinitis and tendinosis, but I haven't found an explanation I can understand, when I can get one.

Most people tell me that tendinosis is just chronic tendinitis. If so, would the ice treatments that you recommend help me? And what would be the best way to approach icing my lower back and hip? Is there anything I should be doing differently for tendinosis than for tendinitis?

I have tendinitis in my wrist for 1.5 years too, and am finding your info very interesting. I am definitely going to try the ice treatment with my wrist and also my foot where I still have a lingering case of plantar fasciitis (I know, I sound like a train wreck!)

I like the way you explained these conditions as it makes so much sense as to why I'm still in pain after so much time and treatment, and also why my muscles still feel tight no matter how much I stretch (I'm very flexible so you'd think I could easily stretch out these tight spots, but not so).

One more thing, last February I pulled a groin muscle and it still has not healed so that I'm not able to run without pain. I stopped running in March while getting some therapy and was given exercises for the injury which I did religiously.

Eventually they made my knee worse and worse so that now I can't even do them. I was just told to avoid core exercises too, so as not to aggravate the groin injury.

Can icing help with that, given that the muscle is fairly deep? I'm still not running, except in the pool, and it seems odd that a muscle injury should take so long to heal. Could this be a tendon issue also?

Thank you for any advice you can offer.



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Joshua Answers:

Hi Susan.

Wow, yes, it does sound like you're falling apart.

Where to start......

I assume that you have already read the What Is Tendonitis? and Tendonosis pages.

http://www.tendonitisexpert.com/tendonitis.html">Tendonitis can show up anywhere. So can Tendonosis. They show up together.

Essentially, Tendonosis is cell degradation due to lack of circulation and the resulting lack of vital nutrition, and Tendonitis is pain, Process of Inflammation, and potentially tissue damage and resulting scar tissue build up.

You certainly have a long term Pain Causing Dynamic in place.

You certainly are at the dry, crunchy sponge end of the spectrum.


But here's my real suspicion.

You are hurting nutritionally. Decades of high level physical activity and not enough nutritional intake to support your body to survive it and thrive amidst it.

It's awesome that you pushed yourself that hard. Triathlete, instructor, etc.

And the scenario you describe, to me, points to that you are severely nutritionally deficient.

Meaning, not enough protein, not enough good fat, not enough connective tissue support components, burning through lots of vital vitamin and mineral stores in your body, and as you are in pain and certainly have lots of inflammation process in your body, Inflammation Causes Vitamin B6 Deficiency.

Sure, I could be wrong. You may respond with 'But I eat well and take supplements, etc'.

And I'm going to play the 'the proof is in the 'card.

You are hurt all over. You are 'falling apart'. You are not healing.

We can talk about the phyical aspects of injury and reducing inflammation, and we will, but I submit to you that we first need to look at the level below that, which is nutrition.

This includes:

1. Increasing your protein intake. By a lot more than you might like.

2. Eating this every day. Bone Broth as the best Tendon Supplements.

3. Increasing your good fat intake, meaning Omega 3's, and coconut oil and/or coconut butter.

Omega 3's are also anti-inflammatory.


4. Making sure you are taking loading doses of Vitamin D, Magnesium, B6 and B12, and whatever else we may think of.

The good news is, the above are cheap and easy.


We need to deal with this first, essentially because if we don't, no amount of physical work is going to heal you.

For instance, skilled massage will help, but if you don't have enough protein building blocks to repair damage, damage will not be repaired.


(Answers to you questions continued in the next comment.)




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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
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Nov 08, 2009
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PART 2 - Tendinitis vs Tendinosis? Long Time Athlete Who Can't Train Anymore
by: The Tendonitis Expert

(Continued from original post)


Answers to your questions:


1. Icing isn't likely to be effective for the Psoas thing, as it's deeper than ice is really going to get to unless you work really ahrd at it.

Unless you are ice massaging the insertin in the upper thing, that you can get.

2. The treatment for tendonitis and tendonosis are essentially the same, but the intention for tendonosis is more focused on getting ciruculation to the site of degradation so the tendon will have necessary nutrients and oxygen and such to start to heal.

It gets confusing because everybody uses the terms differently. And it gets confusing because it's REALLY tough to tell the difference between the tow, and tendonosis may be present with most all of the chronic tendonitis issues, but doesn't have to be.

Ultimately, it's good to know the difference between the two as I categorize them, but it doesn't really matter. Tendonosis is degradation from lack of circulation. Tendonitis is tendon damage and scar tissue build up.

Either way, or both, the treatment is almost exactly the same. Close enough to the same to call it the same, just to keep it simple.


3. I am so not suprised that you have iliopsoas issues. Which likely are playing a huge role in your low back pain.


4. Remind me again later to say more about the flexibility/tight muscles thing. That's an interesting topic but let's save it for a while.


First things first.


So, that was kind of a big shotgun approach answer.


The good news is, I'm happy to help.

The bad news, you have A LOT going on. There's a whole world of depth and complexity to talk about as to why you hurt and how to reverse it. But if you're patient, interested, and motivated, we'll have fun:)

Or we won't have fun, but we'll get you feeling better if you're willing to work at it some.




Nov 08, 2009
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PART 3 More On My Nutrition - Tendinitis vs Tendinosis? Long Time Athlete Who Can't Train Anymore
by: Anonymous

Thanks for your very detailed comments Joshua. You are right, my first reaction is to say no way, my nutrition is great! But here is a little more objective response so you can better judge where I'm at.

I've been active at this level for about 5-6 years now. Prior to that I taught dance and fitness off and on (between raising kids) and did more gentle forms of exercise like walking. So my body has really only been under this kind of nutritional stress for about 5 years, which I suppose is good news.

I do agree with your assessment of the protein situation. Being mostly vegetarian (I do eat some non-farmed fish on occasion, maybe once a week or so) I started to wonder if I might need more protein when I got into some heavy training years. I started supplementing with a good quality whey protein and also ensured I ate protein with every meal or snack (nuts, eggs, cheese, yogurt, beans, tofu, cottage cheese, etc).

I did notice a big difference in muscle recovery and general fatigue, so I kept up the extra protein while I was training. Now that my activity level is much lower, I only occasionally use the protein supplement as a convenience. Would you suggest that I continue to consume higher levels of protein even now to facilitate recovery, or is this necessary only when in heavy training?

I eat loads of fresh fruits and veggies, and in the summer grow an organic garden which supplies with me with all my fruit and a good portion of my veggies (I aim for 8-10 servings a day). I'm not super fanatical as I do indulge in occasional treats and sweets, but my daily routine is to eat only whole grains and avoid white sugar and processed foods. In other words, I do eat a pretty clean diet most of the time. I even make my own yogurt and, on good weeks when I have time, bake my own bread from wheat that I grind myself.

My daily supplements include a morning greens drink, pharmaceutical grade fish oil, a good multi (though I realize the levels of some nutrients in this may be less than I need), iron (I'm prone to anemia if I don't take this), and recently I've added maca for adrenal support as I'm under a fair bit of stress. I also use flax and/or hemp oil liberally on my food (in salads and on cooked veggies, rice, pasta, etc.) and I cook exclusively with coconut oil.

What kinds of doses would you recommend for D, B6, B12 and magnesium for someone like me?

(continued in next comment)

Nov 08, 2009
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PART 4 - More On My Nutrition Cont'd - Tendinitis vs Tendinosis? Long Time Athlete Who Can't Train Anymore
by: Anonymous

(continued from last comment)

Also I have a question about the bone broth...as I'm mainly vegetarian I wonder if there are any non-animal supplements that are as effective? If it comes down to it, I may be willing to try this using organically sourced bone, but if there is an alternative that you feel is as effective I'd be interested to hear of it.

I am definitely open to any and all suggestions, and I take direction well. I am so motivated to get better, and I always do my assigned homework, but so far nothing seems to have helped. I also hate sounding like a whiner!

It was recently suggested that I look into laser therapy as well...can you say anything about this? I have done a bit of research and it seems effective, but as it's fairly costly I don't want to waste money on yet another treatment that isn't going to address the root of the problem.

Thanks again for your detailed suggestions. I look forward to hearing more!




Nov 09, 2009
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PART 5 - Tendinitis vs Tendinosis? Long Time Athlete Who Can't Train Anymore
by: The Tendonitis Expert

Joshua Comments:

Thanks for all that detail.

That all confirms my belief that you first need to deal with systemic/nutritional issues before we even begin to touch on the physical issues.

Here's why.

* Vegetarians are highly prone to B12 deficiency. B12 deficiency can essentially mimic/result in anemia.

(Some vegetarians get all defensive in the face of a statement that a vegetarian diet may not supply everything a body needs. I don't know where you fit in there, but every body is different, every vegetarian eats differently, and having said that, vegetarians end up with a lot of Vit B12 deficiency.)


* High level athletes are prone to adrenal exhaustion. The adrenal fuction is responisble for realing/recovery.


* Having kids and resulting stress can take a lot out of your body, nutritionally.


The body will keep chugging along as best it can, but as you illustrate, it can only go so far.

The bad news your body is played out. The good news is, you can fill it back up and it can recover.

It will take some effort and some work and a little bit of at least temporary lifestyle change.


Moving on.

re: bone broth. Valid ethical/moral beliefs aside, I believe that it will be very worth it for you for the near future to go the bone broth route. I don't know of any non-animal substitute that compares.

re: laser therapy. I am 100% certain that it would be a waste of time and money. You don't have a tendon/connective tissue problem. I mean, you might, but really your 'problem' is the systemic level underneath all that that is keeping you from healing and keeping your body from working properly.

I'm going to have my Kerri from www.Easy-Immune-Health.com add her thoughts here.

She's sitting next to me and we've been talking aobut this. She deals with this kind of issue all the time, and is THE PERSON to talk to about getting your adrenals/cortisol balance/vital nutrition/health.


More quick questions:

1. Any twitch or spasm going on?

2. How are your overall energy levels? How is your muscle strength/energy? Meaning, do they tire/fail quickly?

3. How is your digestion?






Nov 10, 2009
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Hi, It's Kerri!
by: Kerri Knox, RN- The Immune Queen!

Hi Susan,

Joshua asked me to take a look at what is going on with you and put in my 2 cents.

My first thought about all of this is that your adrenals are probably SEVERELY fatigued. Every single time that you train for longer than 45 minutes, your body sees that as stress.

There is a fairly well-known trainer by the name of Paul Chek who, I believe, coined the term "Chunky Aerobic Instructor Syndrome" because so many aerobics instructors get belly fat and/or can't lose weight because all of their 'good' exercise is raising their cortisol and contributes to belly fat.

You may not have belly fat, but I use this to illustrate the point of a lot of exercise DOES increase cortisol levels and if that is kept up continuously, at some point it becomes difficult to make cortisol AT ALL any more and your cortisol levels stay low all of the time.

This is one of the underlying causes of the all-over body pain of fibromyalgia. And it can begin to make you feel like 'you are falling apart' all over. Take a look at the Adrenal Function Test that I offer.


Next, I would DEFINITELY recommend looking into getting the nutritional test that I have called The Organix Profile which tests virtually all of your nutrient levels and could really help to pinpoint what, if anything, your nutrient levels have to do with it.

Both these tests are just sent to you by mail and done in your home, but since you are in Canada you'd have to contact me as the shipping costs are different.


I would also suggest that you take a look at my Magnesium Dosage page and try to get as much magnesium as possible into you- that can also help with your adrenal glands. It would be great if you would ALSO get the magnesium oil and use that directly on any of the painful areas.


You might be surprised!


Also, are you getting to SLEEP before 11:00 pm. Your body also sees staying up late as stress and that, alone, can cause physical problems in extremely healthy people.

OK. Enough for now. Feel free to let me know if you have any questions.



Kerri Knox RN Immune Health Queen

Kerri Knox, RN- The Immune Health Queen
Functional Medicine Practitioner
Easy Immune Health.com



Nov 10, 2009
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Oh, I forgot...
by: Kerri Knox, RN- The Immune Queen!

DEFINITELY check with your doctor and try to get a Vitamin D Level. This is EXTREMELY important and could very well be contributing to some of your all over body pain. And you are at increased risk of Vitamin D deficiency living up there in Canada.


Kerri Knox RN Immune Health Queen

Kerri Knox, RN- The Immune Health Queen
Functional Medicine Practitioner
Easy Immune Health.com

Jul 27, 2010
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27 w/ similar injury
by: Anonymous

I'm a 27 year old former athlete and I have nearly identical problems. I have lower back pain, hip pain and weakness in my knee on one side of my body. My doctor says it's a tendon issue, that my body is not supporting my muscles. At first I had a traumatic injury while playing baseball, after a few weeks it seemed to heal. However, over the next two years my body has been slowly breaking down. First my lower back, then my hip, now my knee (swelling and loss of mobility + numbness in my leg). I am getting a treatment called prolotherapy. It really helped get the swelling in the knee under control but seems to have little effect on my back. I was just wondering what you have done to deal with your issues Susan; have you found anything that works?



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Joshua Comments:

Hopefully Susan will comment, but I'll put my 2cents in.

Sounds nutritional to me. You're a hard core athlete. That takes a toll on your body.
Sure there's biomechanical issues like muscle imbalance and repetitive use issues, but still.

Vitamin D, get your level checked, then get your level up between 50-80.

Absolutely get some Magnesium in you. Find your tolerance level as described on the Magnesium Dosage link at the bottom of that page.

Protein, protein, protein!

You may want to get something like this ebook about hip tightness and muscle balance.


Also, you said "My doctor says it's a tendon issue, that my body is not supporting my muscles."

What the hell does that even mean? Makes no sense to me. I believe your doctor said that, but it gives you no access to doing anything beneficial.

You're either 'breaking down' because you've been too tight for too long and your body just can't compensate for it anymore. Meaning, you're loosing the battle, and need to loosen your muscles and connective tissue or it will continue it's Downward Spiral into increasing pain and tightness.

And/or, you're nutrient deficient (again, see the Magnesium page) and that causes the body to literally be unable to keep itself going strong.

Jun 02, 2011
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I'm back!
by: Susan

Sorry to be absent from this thread for so long, I guess I had my notification preferences turned off.

First I want to thank you for your generous advice and the time you've taken to provide detailed information.

In answer to the athlete with similar injuries, here's what I've done. Last summer (2010) I again saw my sports medicine doctor who again told me it was tendinosis in my hip. I said fine, now what can I DO about it?

He said not much. Eccentric exercises are showing some promise, but it's very difficult to do that for the hip. He didn't seem to think there was any kind of nutritional connection, but I don't think that's atypical of medical doctors. The advice was that basically I should just find something else to do that doesn't aggravate my hip. Or my back. Or my knees, wrist, foot, etc.

And that would be.....???? Oh I know, channel surfing LOL!

Now at this point I had closed my dance studio and sold the building because I was not able to teach without constant pain and it just wasn't worth it anymore. Also the stress of managing people was really getting to me. I've learned that I work much better as a one woman show!

Anyway, I told the sports doc that I'm not some couch potato wanting to milk a disability claim - I'm self-employed, have no disability or extended medical, no reason to drag this out, and I really, really, really want and need to get better because now I can't do what I love to do and I need to find another way to pay the bills and put food on the table.

Unfortunately, finances have also been an issue in my treatment. I've spent thousands of dollars on massage, chiropractic, etc etc and at one point just before I got out of my business I was totally tapped out. My credit was totally maxed and I had to plan car trips so I used as little gas as possible.

Even buying supplements at that point was something that just wasn't in my budget, which is a major reason I wasn't able to take Kerri up on the testing she offers through her site. Unfortunately, the medical route was my only option as we have full coverage here in Canada (though we often wait months or years for treatment).

Jun 02, 2011
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I'm back part 2
by: Susan

Anyway, the sports doc referred me to a colleague of his, a radiologist who does prolotherapy. I had 6 injections, each 6 weeks apart, so it took a while. This did improve one specific pain I was having in the front of my hip. Previously, after running I couldn't bend over and lift my foot (to take off my sock for example) as I would have very bad pain in that hip. After the treatment I didn't have this anymore, but the other pains in my hip and back continued.

At this point Dr. says it's still tendinosis but I'm starting to suspect it's something in my hip joint because of the character of the pain. I've always suspected there was more than one thing going on, though I suppose it could all be referred nerve pain. Chiropractor who's been treating me with ART (and knows my soft tissues very well by now!) suggested a contrast MRI to check for labral tear. As I said, I'm in Canada so I'm still waiting for this, scheduled for December 2011.

However, I'm now revisiting the nutritional side of things, and also looking at the research around tendinosis and therapies that show promise. My body is just not happy, and every time I try to do something just a little extra (like run/walk 5/1 x 5 instead of x 4) I seem to get another little injury.

I've had chronic plantar fasciitis for 7 years, hip and back pain for 6 years, knee for 3 years, plus an assortment of muscle strains that seem to take forever to heal, and this tells me that something is just not right. Other athletes my age are able to train and compete without debilitating injuries, and I refuse to buy into the argument that I'm just getting old and this breakdown is natural.

So, I have an appt with a naturopath this afternoon and plan to get myself screened for nutritional deficiencies so I can address those. I will also start taking the bone broth and I'm thinking of starting off with a detox cleanse just to be sure I'm starting with as clean a body as I can.

As far as my research, I now feel like I know more about degenerative conditions than most doctors! The research I've seen (actual research, with cited studies, not just opinions from lay people who've overcome an injury) points to ART and laser as the two treatments that show the most promise.

More and more research docs seem to be concluding that a lot of tendinitis is actually tendinosis, and that in many cases the medical community has been treating a degenerative condition as though it were an inflammatory condition, when in fact they're two different conditions requiring two different treatments. With -itis we need to reduce inflammation, whereas with -osis we need to provide the body with support to rebuild tissue that is degenerating.


Jun 02, 2011
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I'm back part 3
by: Susan

It was particularly eye-opening to read one doctor's opinion that chronic fascial pain could be viewed as being similar to tendinosis, in that both are indicative of degenerative conditions. In other words, this lingering plantar fasciities of mine is not likely an inflammatory condition. It probably was initially, but after repeated re-injury and lack of nutritional support available for healing, the tissues have started to degenerate, resulting in an inability to do their job, with pain being the result when I ask my foot to support my weight while on my toes for example.

I'd be interested to read your thoughts on this Joshua, as it seems to be a fairly recent shift in thinking that -osis requires a different plan of attack than -itis. Though it appears that with your focus on nutrition that you're ahead of the crowd here.

Anyway, back to the topic at hand!

I've been getting ART for some of my more recent injuries, and have to say that it's definitely helping. Last fall I reached a point where I was unable to swim at all due to very bad shoulder pain, and after a few treatments and diligent homework exercises, I was able to get back in the water. Starting in January I rejoined my competitive swim club and I'm now swimming strong again.

Any new niggles that come up, I go back for another session and it always helps, so I'm hopeful that means I'm starting to build up my reserves again, but the older injuries are being stubborn.

I was planning to give the laser a go, but have been sitting on the fence about that for a while. Some people claim it's a miracle, others are more skeptical.

And after reading what you had to say Joshua, I do agree with you that it's not likely to do any good unless my body has the raw materials available to rebuild. That seems to be key as to why some people have success with it and others don't.

Jun 02, 2011
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I'm back part 4 - Tendinitis vs Tendinosis? Long Time Athlete Who Can't Train Anymore
by: Susan

(Wow, I'm talkative!)


So my plan now is to do a cleanse, get my current nutritional status evaluated and supplement where necessary, then give the laser a go to hopefully speed healing. I'll also continue with ART as it has been helpful, but again, the research is saying these tools need to be backed by nutritional support that makes the raw materials available, otherwise the therapy is wasted.

And of course I am still doing my best to rest my body and not disturb the healing process. I do get a good 7-8 hours of sleep, and am definitely not a night owl, so that sounds like a good thing. I'm generally in bed by 10:00, especially on swim mornings when I know I have to get up at 5:00.

I know it took years for my body to get into this state, so I'll need to continue to be patient while it goes through a process of healing and regeneration. My plan now is just to try to do more good than harm so that the equation works out in my favor.

I can't just stop moving altogether as that would drive me batty, but I'm trying to do things that don't aggravate specific injuries, and to balance the activity with lots of rest and of course good nutritional support.

I'm also starting to do EFT. I'm a big believer in our body's tendency to hold onto trauma, stress, and other negative associations in our tissues. Funny though, how it hadn't occurred to me before...always easier to be objective with someone else than see this in ourselves!

So that's my update. I'll try to remember to come back and share how my nutritional evaluation goes, and what the outcome is of supplementation and the laser therapy.


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Joshua Comments:

Yes, do keep us updated!

Movement is good. Definitely keep moving.

And yes, nutrition is vital. As you said, without the proper building blocks.....




Mar 28, 2012
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Massage therapist with TendinOSIS
by: Anonymous

So, i am 24 and have been practicing massage for a little under 6 years now, i focus 95% of the time doing very deep intensive work and stretching which has caused me to develop tendinosis in both wrists(dominating in the left)

My passion (and ego)about helping and changing people's lives through my work made me forget the most important rule: "you cant help anyone unless you first help yourself".

And i forgot that because i focus so much on my clients that i push my body to the point of tears and pain to apply the pressure and stretching to ease their pains. I am very petite and have weaker bones in the women in my family. Im going to get a second opinion today but this thread has been the most help ive come across so far! i do live a VERY active lifestyle but have completley backed off of my weight traing and am currently studiying and (obsessed) with nutrition.

I am just at a crossroad now about treatment.. if it is tendinOSIS then the splints and icing the first dr. recommended wont do much good right? and i normally do trigger point work up into my forearms and can get a some relief but it doesnt help the face that when i flex my hands backwards (kind of like how it is in a pushup position) its such a sharp shooting burning pain, and its gotten to the point where i CANT do pushups,most yoga moves, even opening things gets to the point of intense pain.

I currently have 10 days off.. im on day 5 and besides my hands having some relief just from not doing my everyday deep tissue work, that movement or anything like it, the pain is still just as intense.

I've kind of hit a wall and know i will probably have to get out of deep tissue work and most massage, but its ok because i have a passion for nutrition and healing with food as well and will not let this get me down!!

I just wanted a few other opinions and where to turn next.. Thanks for anything and everything!


Jessika


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Continued in next section




Mar 29, 2012
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Joshua Responds - Jessika - Tendinitis vs Tendinosis? Long Time Athlete Who Can't Train Anymore
by: The Tendonitis Expert

Joshua Comments:

Hi Jessika.

Why exactly do you think it's Tendonosis? As opposed to anything else?

1. Elbows and forearm. Learn to use them. It's amazing that you have passion and a desire for help. Great. And, stop using your hands/fingers so much. The tip of your elbow is just a big thumb. Use it.

2. I'm all for healing with food. I'm also a pragmatist and it's my humble opinion that you can't get enough, for instance, Magnesium for Tendonitis from food.

3. Ice dip LIKE CRAZY for the next week. Keep a 5 gallon bucket handy. How To Reduce Inflammation

3. Trigger point work is great. But. You need to focus on lengthening the connective tissue that is now constrictively shrinkwrappying everything.

4. The primary cause of your pain is the chronic, constant, overtension the TOO TIGHT (constantly firing) muscles are tugging on your tendons constantly.

5. Too tight = less blood flow/cirulation = less nutrition to the tendons = Tendonosis.


The moral of the story is...focus less on the tendons and more on everything that's connected to the tendons.



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