Tendinitis & RSI
(Repetitive Strain Injury)
INTRODUCTION:
I’ll now get right to the Major Points about what we will cover in this small book.
Of great importance, I will do my best to give you all the information necessary to understand and evaluate my point of view on the matter of tendinitis. It is your body, and you might be one of those people who have a lot at stake, like some of the teenage musicians I have worked with who are in danger of having to give up their career in music because of their pain. Or a lifelong butcher that can’t work anymore because of the pain. Or a secretary that cannot type any more for the same reason.
So you might need to make some decisions, like drugs or no drugs, surgery or not, or are you willing to spend the time and energy necessary to do the self-healing techniques, or try and find a therapist who will work with you along the lines presented in this book. Quite often it comes down to a choice between investing time versus money. Either way it is going to take time, but paying someone to help can be quite a bit more efficient and effective.
Although I find this whole issue to be relatively simple, it is definitely not easy.
SUMMARY of the Issues
Okay, let’s get to the Heart Of The Issue with a summary of the Main Points in this book:
The word TENDINITIS, according to medical dictionaries and other resources, means inflammation of a tendon.
There are many problems with this word and its definition.
FIRST: The phenomena called tendinitis is usually a misnomer from the start because many or most cases of tendinitis (inflammation of the tendon) usually (according to recent research) has NO true inflammatory cells present in the area of pain.
Therefore treating it as an inflammatory condition is misleading at best, even though doing so sometimes causes short-term relief. This is because most drugs are not truly curative agents. They merely distract the nervous system from the mechanisms of pain, while doing little, if anything, to affect any true healing influence.
At worst, the problem exacerbates to the point of debilitation because the client is deprived of proper treatment focused on the proper tissues and causes. There’s an assumption among many people, including physicians, that pain always indicates inflammation. This is not true across the board, and maybe even rarely.
There are many instances where someone has pain but no inflammation. Or, immediately after a trauma or severe strain, there is inflammation, but the inflammatory cells quickly dissipate, even though pain is still present. The inflammatory cells only persist for a few days to a few weeks after the initial trauma.
A partial exception to all this is, of course, if there has truly been a direct, tissue damaging impact, laceration, or tear at the tendon. This is in contrast to the very prevalent incidence of tendon problems from repetitive action and misuse of musculotendinous units versus tissue damage.
I do not like the commonly heard term “overuse” because it implies you only have so many actions available before breakdown occurs. I believe it has far more to do with HO you use it, and whether you use proper maintenance or not.
In such cases of actual tissue damage, the tendon will initially need more direct care to heal. But it still cannot usually be treated in isolation because if the trauma was enough to truly harm the tendon, it was most likely also enough to affect the respective muscle(s) and other connective and surrounding tissues.
SECOND: The word tendinitis itself causes people to focus on the tendon as the source of the problem. Then most, if not all, of treatment is focused on the tendon. But tendons are essentially passive as far as their ability to cause or do anything. They are transmitters of force, not creators of force. Therefore, they do not do anything that contributes to the problems of pain or dysfunction. They are the “victims” of certain stresses or injuries, but usually not the cause.
THIRD: Even though the pain is felt in the area of the tendon, the pain is often actually in the periosteum, which is the connecting tissue between the tendon and the bone, or in the skin over the area. According to the leading medical texts, a large percentage of the most pain sensitive nerves in the body are in the surface of the skin and in the periosteum, deep in the tissues, encasing the bone.
There are other pain and motion sensitive nerves in the general area of the tendon possibly affected as well. It even seems the nerves themselves can be painful if irritated. The point is, to focus exclusively on the tendon is not very useful.
Compounding the matter, there are comparatively few pain sensitive nerves in the muscle bellies. So the real source or cause of pain or dysfunction can be very misleading. It is very possible for the PRIMARY cause to be in the muscle tissue, but FELT in the tendon connecting muscle to bone.
FOURTH: It is very difficult for most people to make clear, sensory distinctions between the various tissues (muscles, tendons, periosteum, skin, or the nerve itself), as they are so close together and they share a common nerve trunk, which makes it difficult to distinguish sensation emanating from one tissue versus that of another nearby. Therefore, being clear about the source of a pain is not always easy, even for a doctor, and is even more difficult for a patient to communicate their subjective experience to a treating physician or therapist.
FIFTH: Much of the literature about tendinitis says the tendon is subject to “mechanical forces not well understood.” Then they usually immediately stop talking about these mysterious “mechanical forces” and just focus on the tendon itself. The lack of internal logic here should be obvious, but is all but ignored in the orthodox, and much of the alternative, healing community. We are told the tendon is the victim, and then it is treated as the cause, completely ignoring, most of the time, those strange “mechanical forces.”
SIXTH: It is the premise of this book that these “mechanical forces” that are “not well understood” are the muscles that deliver mechanical forces through the tendons to the periosteum (attachment point of tendons to bones) then to the bones. ALL muscles have a built-in tendency to become chronically contracted, shortened and hardened, which results in a constant input of stress to and through their respective tendons and on through to the periosteum, as well as pressure directly on the nearby nerves.
If the musculo-tendinous units are not regularly and systematically stretched from childhood on, then this built-in tendency will result in what I call C.E.M.&.N.T. or Chronic, Excess Muscle & Nerve Tension & Stress.
SEVENTH: The constant chronic stress placed on the tendon and periosteum by the Chronic, Excess Muscle Tension leads to stimulation of the pain sensitive nerves and eventual wearing down and breakdown of the various tissues involved in the whole process. On the other hand, even if the tissues cannot fully heal, they can be brought back to sufficient functionality and health to achieve your needs and goals.
EIGHTH: There are specialized nerves within these structures that, with proper stimulation — meaning slow and gentle with no pain — will engage the central nervous system to create a relaxation response in the chronically contracted muscles which will, in turn, take the stress off the tendons and periosteum, relieving the irritation of the pain sensitive nerves and allowing the metabolic system to heal the involved tissues.
NINTH: The necessary stimulation of the muscles and nerves to effect tension release can be achieved by proper manual pressure (hands-on, therapeutic Massage or Bodywork) or Conscious Stretching (Yoga), and can very often be achieved by one’s self, working on or with one’s self.
Come to think of it, even un-conscious stretching will achieve quite a lot. Some people will only do the stretching while watching TV. Although not ideal, it is far better than not doing it at all.
TENTH: In the event there’s too much trauma or desensitization of an area, or you’re too weak or exhausted, and self-help techniques are insufficient or too difficult, outside help might be necessary. However, you, the Client, assuming that what you read here makes sense, should find a therapist that is amenable to the principles in this book, and you should maintain a significant amount of control and direction as to how the treatment process proceeds. Be cooperative, but not subordinate, to your therapist.
BOTTOM LINE: From the very beginning, naming the problem tendinitis, we are distracted both by the pain and the name of the diagnosis to focus on the tendons, while not focusing much, if at all, on the root cause of the problem, which, in a large number of cases, is the Chronic, Excess Muscle & Nerve Tension (C.E.M.&.N.T.)
I will do my best to show you why there is a high likelihood that C.E.M.&.N.T. is what’s really bothering you, and how to reverse and resolve it.
PLEASE NOTE: Again, the “tension” we’re talking about is not IN the tendon. It is transmitted through the tendon from the contractile muscle tissue to the periosteum and bone.
Now, it is true … There’s no way of knowing exactly, or even approximately, what percentage of people all the above is true for, nor to what degree. But if you are not responding adequately to other forms of or approaches to treatment, it is a good likelihood that chronic muscle tension & nerve is your real problem.
Because of certain time and size limitations, and because most people seem to respond better to shorter books, I am going to focus on principles and overall techniques, and leave the more specific treatment section to up-coming supplements.
CHAPTER ONE: Tendinitis
What Is Tendonitis? — The OFFICIAL Definition
The Orthodox Medical Establishment calls certain painful problems Tendinitis. It is also sometimes spelled Tendonitis (with an “o” instead of an “i”).
A Tendon is a dense bundle of tough, whitish tissue called connective tissue or fascia that connects the end of a muscle to a particular bone.
The suffix “–itis,” in medicine, literally means inflammation.
The word tendinitis means then, literally, inflammation of a tendon. It usually refers to pains or unusual sensations experienced in certain locations of the body, primarily at the wrist, the elbow, the rotator cuff in the shoulder, the hip or knee, or the Achilles area near the heel of the foot.
Fascia, it should be noted, is a kind of connective tissue taking a range of various forms and found in large quantities throughout the body. The word fascia gets thrown around a lot now-a-days, because of it’s new found relevance to many health issues.
But the 38th and earlier editions of Gray’s Anatomy (the big huge one from England that costs almost $200, not the one you find at many bookstores) says the word fascia has almost become meaningless, because it refers to so many kinds of somewhat related but very different tissues.
For our purposes, we are focused on the fascia serving as the above mentioned compartments surrounding muscle fibers, and also becomes the tendons, ligaments and periosteum. Periosteum serves as the attachment points to the bones, and will be described more later. Ligaments attach bones to bones to keep them from moving too far past a certain range of motion.
What Are The Symptoms of Tendinitis?
According to the University of Maryland Medical Center web site, the symptoms for tendonitis are:
- pain and tenderness around a joint
- pain is worse with activity and aggravated by movement
- night pain
(They do not go into what night pain is with more specificity.)
It should also be noted that one website, the The Arthritis Foundation suggests tendinitis is a subset of arthritis. This makes sense from one point of view. If “arthro-” means a joint, and “-itis” means inflammation, then it would follow that most tendinitis would be considered to be an inflammatory condition of the region of the joint. But this is a bit of a leap, once we get more clear on what is really going on.
Earlier I wrote that tendinitis ” … usually refers to pains or unusual sensations experienced in certain locations of the body, primarily at the wrist, the elbow, the rotator cuff in the shoulder, the hip or knee.”
The reason I say that tendonitis usually refers to pain is that unless the patient is actually experiencing pain, or some sort of dysfunction, there’s little indicator of anything going wrong in the area. Without a patient’s report of pain, there are seldom indicators of trouble. Yet, except in sudden severe trauma, it is seldom the case that the problem starts when the pain starts.
The root problem very often begins LONG before the pain or dysfunction shows up.
Further compounding the issue, people often cycle back and forth between pain and no pain, symptoms and no symptoms, but is highly unlikely the underlying causes of pain or other symptoms go away just because the pain has faded. There are many conditions of the body going unnoticed for a long time before the pain or symptoms start.
The human body is very forgiving and resilient, up to a point. But that allows problems to develop unnoticed for long periods of time before they’re noticed or interfere with one’s life.
Unless there was a specific, sudden injury, strain, or sprain involving the tendon, the problem causing pain usually starts long before the pain does. So technically, the actual source of the problem can start long before the pain does, but it’s only the pain that’s recognized as a problem. When the pain stops, the problem is usually considered to be solved, and therefore ignored from that point on.
One of the first things to consider is the question: Was there a specific injury directly to the tendon that’s causing the pain? Or has this been a long developing problem just “sneaking up” over time?
Here, by “injury,” we’re referring to actual tissue damage — lacerations, tears, sprains, and other actual trauma to the tissue. This is in contrast to the main topic of this book, that being stresses and strains in, and resulting from tensions transmitted to, the tendon fibers.
If it was a direct injury to the tendon tissues, direct attention to the tendon is of course the best course of action. Yet sudden, acute injuries are secondary to what we’ll be discussing in this book, but still important.
If, on the other hand, the problem was from internal tensions imposed on the tendon, than we need to go to the source of the tension, which is usually the muscle tissue.
We will be looking more at longer-term, chronic development, of this thing called tendinitis. If this is your situation, then the approach in this book should take priority over methods of treatment aimed at acute injuries.
So this can be a bit ambiguous. People are not always clear on what has happened to them, or it happened so far in the past that they have forgotten. Or it developed so slowly and gradually, they did not notice the developing tissue issue.
Especially when you consider that pain is, for the most part, a reaction to, or a warning signal about, a problem, rather than the problem itself. When it comes to chronic problems, pain often shows up late in the game, and often disappears long before the core problem is fully resolved.
Alternatively, there might have been a direct, acute injury to the tendon that, for the most part, healed a long time ago, but there was a residual protective action left in the neuro-musculo-fascial system that has slowly, over a long time, been adding stresses and strains in the background.
Many people have these things developing in the background, and take many years before they hit a Straw that Broke the Camel’s Back moment. At that moment, tensions and stresses accumulating in the background, sometimes for years or decades, hit a critical mass, sometimes making a critical mess!
At that point, the body cannot take it any more and starts a pain message asking for help.
As well as pain, or instead of pain, people also experience what they think is weakness, as in not being able to hold something, even a light object, with full strength, or not at all. They may also get tingling, buzzing, aches, burning sensations, and so on. And theses symptoms often seem to come along with the pain at the joint. But not all of these are always classified as tendinitis.
From my experience, the diagnosis of tendinitis is often used as a quite vague diagnosis, only an approximation of what might be happening.
This is like the word “arthritis.” Many of us believe the term is really kind of a “throw away” word that’s not used very precisely. It’s often used more like a slang term, and in such cases loosely means “pain or trouble in or near the joint.”
And because too few physicians know much about how chronic, excess nerve & muscle tension can cause so many problems, the diagnosis actually tends to distract from the real source of the problem. What About Tendon Weakness?
This adds an interesting dimension to the problem.
We are often told that in tendinitis, tendons are supposedly getting “weak.” So we’re then told we must do exercises, like squishing the little ball, to strengthen the tendons. But as we squish the little ball, what we are also doing is exercising & strengthening the muscle connecting tendon to the bone.
So yes, this can build up a certain level of cellular integrity and resistance to strain (strength) in the tendon. But at the same time we’re most likely also building up increased, habitual tensions in the muscle. Those increased muscular tensions increase the strain on the tendon. We are then, as I will show you, in turn, potentially breaking down the cellular integrity of the tendon.
Hmmmm … We are compounding the problem as we think we are solving it?
Please do not get me wrong. I am NOT saying we should never strengthen the tendon, nor the muscle. What I am saying is we need to get our priorities straight. We should get the debilitating, muscle generated tensions off of the tendon first, which will allow the tendon to heal more effectively and efficiently.
Then, once the neuro-musculo-fascial is all normalized, or at least more so, we can focus on building general strength.
But strength of the tendon and strength of the muscle are two different things.
Squishing the little ball can “build strength” of the muscle and simultaneously break down the tendon, the exact opposite of what you are trying to achieve. It does not matter how strong you make a tendon, if the muscle is constantly placing too much stress on it, the tendon can never get “strong” enough to avoid symptoms and breakdown.
When receiving treatment from a physician or therapist, make sure they know, and can explain, the difference between the two different kinds of strength. If they cannot do so, then consider finding someone who can, or is willing to learn. I explain my perspective on this very important question in Chapter 4.
Confusing Terminology & Philosophies
Unfortunately, I’ve worked with many people who’ve been given very different diagnoses for quite similar problems, or similar diagnoses for very different problems, and although there might — somewhere — be an accepted medical standard of terminology, not all physicians seem to stick with these. Or, they don’t really know or remember what the standards are, so they just utilize whatever terminology is handy, or the they remember.
There is also the problem that if you go to a medical doctor, or an osteopath, or a chiropractor, or a naturopath, or if you go to a yoga teacher, a massage therapist, or other practitioner, their quite different philosophies could give very different interpretations about what is going on, and why its happening, even though their terminology might be similar on the surface.
Within each health care profession, and between them, the use of terminology is often not as precise as you would think. Based on the complexity of the words they use, you might think two groups are saying the same thing, while in reality, they’re saying very different things.
If you are into various forms of Oriental Medicine, be it Indian or Chinese, the language is completely different, as are their concepts of what is going on inside the body. The classic text The Web That Has No Weaver, written by a Westerner, Ted Kaptchuk, shows how in Oriental medicine, there are SIX different conditions that would be called an ulcer, several of which require very different treatments, and all different than how Western medicine would treat them.
So, if you ever feel confused about what people are telling you, IT’S NOT YOUR FAULT!!!
There can be a lot of ambiguity. For instance, Carpal Tunnel Syndrome of the wrist has pain, burning etc., but is not, in and of itself, in strict terms considered to be tendinitis, although tendinitis might be involved. But, according to medical thinking, tendinitis can cause Carpal Tunnel Syndrome.
In Carpal Tunnel Syndrome, the allegedly “inflamed” tendon, which supposedly causes the tendon and local tissues to expand (and probably do), takes up too much room in the tunnel through the bones of the wrist, causing the nerve to press up against the bony side of the tunnel, irritating it, and leading to pain.
(When nerve press up against a bone, or vice versa, that usually, or very often, causes pain.)
You can, of course, get different practitioners of the same medical or chiropractic discipline to argue endlessly about the nature of the same problems in the same person.
Bottom Line: NEVER assume that there’s a definitive, purely scientific understanding or explanation of what’s going on with you.
While it makes sense to make sharp distinctions between, for example, tendinitis and carpal tunnel syndrome, these distinctions often serve to confuse those who are suffering from the problem. For instance, severe physical and emotional, not to mention financial, damage has been done to many people with severe, continual muscle aches and pains all over their body, but are told they do NOT have fibromyalgia.
Fibromyalgia has been medically defined in a very specific way, mainly to satisfy hospitals and insurance companies needing to control payments and claims and to minimize claims in a courtroom setting.
So in order to qualify as having fibromyalgia, you must have pain in 11 out of 18 very specific points in your body. But what if you only have 9 out of 18, but you are on the floor with agony every few days? The whole thing breaks down into nonsense after you’ve been around it for a while. Paradoxically, sometimes the attempt to be too precise leads to higher levels of ambiguity.
Just because there is some minor technical variation in findings during examination and diagnosis, many doctors say “NOPE, you don’t have fibromyalgia, its all in your head.”
Now, after a while, and enough doctors and therapists saying the same thing, many start to think “Well, maybe it IS all in my head.” … “Maybe they’re right. Maybe I AM crazy?” … “Maybe I need a psychiatrist?”
Others get angry and start to retaliate and go against the system, looking for alternatives and going to non-standard practitioners of various systems of natural healing. This usually eliminates their ability to collect any insurance because they did not fully cooperate with The Medical System. So unless you fit into a very narrow and, for the most part, unrealistic, category, and cooperate as if you do, you lose. And everything spirals downward from there.
I am using fibromyalgia as an example because it is one of the most controversial illnesses, and feels much like having (so-called) “tendinitis” throughout your whole body! I also believe that someday, when the truth comes out, that (supposed tendinitis) will be much closer to the truth than is acknowledged anyway.
But of course, if you read the introduction to this book, it’s not really tendinitis anyway, but we’ll get to that soon!
Much of the cause of so-called “tendinitis” is, in my opinion, C.E.M.&.N.T. — Chronic, Excess Muscle & Nerve Tension & Stress. That’s habitually hyper-contacted muscles putting too much stress and tension into the tendon.
C.E.M.&.N.T. is also the cause of much of fibromyalgia and many other problems being poorly treated or ignored by the medical establishment because of this single error, which you will be reading more about here in this very book.
Hopefully, we can clear up much of these confusions by coming at the problem from a completely different angle than is commonly discussed. In the process, I hope to help you get to the bottom of your (or your family member or friends) problems, or prevent them from ever happening to you if that’s your interest.
But first, we must look at a Very Big Blind Spot around tendinitis existing in the medical field right now. A blind spot causing large numbers of people to receive totally inappropriate treatments for their problems. Meaning strength exercises; drugs, especially anti-inflammatory; and surgery.
It turns out that, according to a number of medical researchers, the term and diagnosis “tendinitis” and its alleged treatment is totally off the mark for the vast majority of people.
What’s Wrong with the Focus on Tendin-Itis (Inflammation of the Tendon)?
Technically, inflammation refers to the production of specialized cells delivered to an area to facilitate repair & healing of tissues damaged in some way. When inflammation is present in tissues of the body, the assumption is there’s a healing response going on. That is what inflammation is supposed to be. It is a healing activity for specific damaged tissues.
So naturally, if there is indeed a metabolic healing response, there was some damage to the tissue requiring healing. So far, so good. But …
Many doctors assume that pain is a good indicator of inflammation.
Well, sometimes, but not always, and maybe not even usually. There are other causes of pain not entailing inflammation. Sometimes, there’s an event causing pain, and the healing response (inflammation) sets in a short time later. So pain and inflammation are not the same thing.
They might sometimes arrive at the same time, but are not always correlated. And pain is NOT necessarily caused by inflammation, nor vice versa.
Inflammation also implies swelling of the local tissues, as more inflammatory cells and accompanying fluids accumulate in an area. Yet, in many cases, there is no real overt evidence that the tissue has actually swelled as in inflammatory swelling. Sometimes, a muscle that’s been stressed contracts, flexes, and expands or bulges, giving the appearance of swelling. Bodily fluids can get trapped in an area from excess muscle tension.
As soon as the muscle relaxes, the bulging, the appearance of swelling goes away. The fluid retention, which is not always the same as inflammation, reduces as well.
But, as in so many other cases in other kinds of diagnoses, such as back and neck pain, inflammation is almost immediately pointed to as the problem. It has come to the point that when a person has pain, they automatically think that the area is inflamed.
But as Dr. John Sarno, (create footnote) in his books on back pain states, there’s never really been any substantive proof that most of what many physicians call inflammation is, in truth, really inflammation.
In a more definitive vein, research over the last couple of decades have repeatedly shown that, except, possibly, in the first few days or weeks after a painful event that is labeled tendinitis, there are NO inflammatory cells in that area.
Let me repeat that. They have discovered that in most situations, there are no inflammatory cells in the neighborhood.
They found this out first by doing biopsies (where they surgically open up and explore an area) in animals such as rats. (Sorry, animal lovers, I’m not advocating it, I’m just telling you what happened.) Later, they examined the local tissues in human beings who were undergoing surgery for tendon related problems. They seldom found inflammatory cells in the area.
They did find discoloration and breakdown (fraying) of the tissues of the tendon, but usually did not find inflammatory cells. This can be confirmed, if you would like, by going to the web sites of various entities such as the British Medical Journal. Check out the article: Time to abandon the “tendinitis” myth in BMJ, Mar 2002; 324: 626 – 627.
http://bmj.bmjjournals.com/ (DSL-Do a search for <tendinosis>.)
The most well known researcher on this topic seems to be Dr. Karim Kahn, who has published quite a bit on the issue.
What Dr. Kahn and others are saying is there’s very little evidence that most people are suffering from true inflammation of the tendons. But there IS, in advanced cases, a breakdown — a fraying and visible discoloration — of the sheath of the tendon, and in advanced cases the fibers of the whole tendon is in degeneration and breakdown.
These physicians and researchers prefer to call the problem tendinosis or tendinopathy.
-osis means a pathological state
-pathy means disease process
Since the very word tendinitis explicitly states that the problem is inflammation, we cannot honestly use the term except in the case of a particular individual with a particular condition who has been clearly diagnosed as having a truly inflammatory condition. A situation that is quite rare, according to modern, up-to-date research.
Plus, clearly accurate diagnosis is a tall order. It was not until they actually looked inside and tested the local fluids during surgeries to see if there were indeed inflammatory cells, which there usually were not. Remember, pain by itself is not an inherently inflammatory sign. And the fact that there are people who got pain relief from taking anti-inflammatories does not mean they had inflammation. (See previous chapter.)
How many physicians do biopsies of a tissue area to determine whether there are actual inflammatory cells in an area? … Not many, if any.
Which means that one should NOT probably prescribe anti-inflammatory drugs, which are, like any drug, toxic to the system.
At this point, we need to move from using the word tendinitis to other, more appropriate terms.
In the medical field, the terms tendinopathy and tendinosis are sometimes used, and are technically more accurate, given what has been, and is being, discovered about the lack of inflammation in these problems.
Tendinosis — pathological state of the tendon
Tendinopathy — disease process of the tendon
However, we still have the problem that the focus is on the tendon, rather than those pesky “mechanical forces” that are “not well understood.” Not that we should not consider the tendon, but to recognize that unless there is evidence of direct damage or trauma to it, it is difficult to find a way to blame the tendon for its problems.
Since the main focus of this book is on the “mechanical forces” from the muscle, the name of the problem should include the muscle.
The prefix myo- literally means muscle. So we can use a term like myotendinopathy or disease process of the muscle & tendon.
That is a less specific diagnosis, but it is more honest.
More On Toxicity Of ASAIDS
Yes, some people seem to achieve relief from taking anti-inflammatory drugs. But there are many cases of people taking drugs meant for one kind of illness, but seem to work for some people in other illnesses.
Doctors and researchers often cannot explain why a drug works for a particular symptom. This opens up a whole area of conversation we cannot get into here. But please be aware of this reality when consulting with physicians about drugs for your problems.
The Bottom Line for this chapter is the very naming of a problem as tendinitis can be the real start of your problems because most of the time, you do NOT have actual inflammation, nor true weakness, of your tendons!!!
BUT, the very first thing doctors do when they’ve got the tendinitis idea in their head is to prescribe — you guessed it — anti-inflammatories!!! These are drugs you very probably do not need, can be toxic to your system, and the research shows there’s little evidence anti-inflammatories help anything at all in these cases.
There is the added issue the in science, if you do not know the mechanism of how a drug works, it is not advisable to take prescribe the drug. So if an anti-inflammatory works, yet there are no inflammatory cells, then they do NOT know why or how it’s working.
So, when a doctor tells you you have tendinitis and prescribes anti-inflammatories, you have every reason to run as fast as you can in the opposite direction. Unless they can give you very conclusive proof to the contrary, it is highly unlikely that this is your problem.
So what, then … IS your problem? Well, let’s continue …
The “Over-Use” Concept
We are often told that the many problems in this overall category such as tendinitis, carpal tunnel syndrome, tennis elbow, golfer’s elbow, and so on are a result of “over-use.”
When you are told you are over-using something, it makes you think about it in ways that are not very productive. In fact, as I am going to show you, it is outright counter-productive to think in this way.
The over-use concept shows up in ways that make us think we must stop doing the movements related to that part of the body. We think we have only so many actions of a muscle, then we can’t do that action anymore. That we must stop typing at the computer, that we must stop playing tennis, that we must stop exercising, or stop playing our musical instrument. Whatever it is you do that makes the pain start. This often gives people a crummy attitude about things they like to do, work they need to do, or about life in general.
Sometimes, they start to feel crummy about themselves!
Some people, understandably, get really upset if the activity causing the pain is how they make their living. Their very survival seems to be at stake. Especially if it’s also something they love to do.
Imagine you’re 17 or 21 years old and have been playing an instrument, be it cello, violin, piano, harp, or any of the other instruments, for 15 or more years with the ambition to make your living at it … maybe even become a star. And you’re good enough to be in one of the top schools in the country. Now, you have not even graduated from college yet, and you cannot play your instrument without pain.
And sometimes, the pain is so bad you cannot play at all.
It has been suggested that you need to get drugs injected into your body, drugs that others have told you gave them bad side-effects. Or maybe you’ve been told you need surgery, which has a significant failure rate, and possibly worse complications. You’re also told you need to reduce your playing dramatically, which means you cannot practice your music, which means you might not get as good an evaluation at your recitals, which can make or break a career in a day.
You start to worry that your career in music is over. That makes you feel even worse. And the stress of thinking about that makes you even tighter in the … Muscles!
Because … The Muscles … are where we dump many forms of our stresses — physical, emotional and mental — in the form of neuro-musculo-fascial tension.
The tension & stress makes you feel even worse, including making the pain in your arm even worse.
So we need to ask a few questions here.
For instance, if something is being “over-used,” how come some musicians play till they are in the seventies or eighties or even later, but there are a bunch who are breaking down in their teens? Certainly a sixty year old musician has been playing at least three times as long as a twenty year old. He or she has been “using” the muscles three times as long. Plus many of them have the stresses of traveling and lugging things around the country or world on and off airplanes, whereas students have not had to do as much of this … yet. Surely the long-time pros are “using” their muscles far more than the twenty year old.
The actual movements of playing are nearly identical, regardless of how good you are. Yes, there are subtle technical differences, higher levels of skill and precision of movement, but the overall motions are for the most part very similar. The seasoned professional plays more smoothly and probably even more powerfully, but the distance the bow travels back and forth over the strings can’t be very much different.
Masters learn to play with much higher levels of relaxation, and attempt to teach this to their students. Of course, some of the Masters didn’t actually learn to relax, they “just kind of knew,” somehow, how to do it. They just stumbled into it “by accident.”
So it’s difficult for them to teach it to their students.
But is relaxation a function of how much you use a muscle? Or is it a function of how you use it?
And, if you’re calling it tendinitis, and over-use of the tendon, but it’s really all about relaxation, then, can a tendon, in and of itself, relax?
As we will see, in this context, NO, a tendon cannot relax in the way a muscle can. Only the muscle fibers can truly relax in the sense we are speaking of it here, which in turn causes the tendon to soften, reducing its stress.
There are Two Kinds of Relaxation: the first is neuromuscular relaxation in which we turn off the nerve impulse to the muscle fibers that causes the fibers to actually disengage and lengthen in a mechanical way.
The second is much different. If you are pulling on the ends of a rope, it develops a kind of internal “tension” even though there is no action generated by the rope itself. When you stop pulling on the ends of the rope, the level of strain is reduced, and the rope “relaxes.”
Obviously, these two kinds of “tension” are very different. In the human body, only the muscle fibers have the ability to generate the forces of contraction or relaxation as we are speaking of them here.
And why do some musicians get pain in one arm and not in the other? Why in one person does the right arm moving the bow get painful yet the left arm that presses on the strings does not, while in another it is the reverse? What would be the “over-use” factor here?
Does a butcher with carpal tunnel syndrome have to butcher twice as many animals to get carpal tunnel? If so, why are there a lot of younger butchers with pain and a lot of much older butchers without it?
The short answer is that it is not about OVER-use. It is about INCORRECT-use. Or, it is because there is a pre-existing trauma from some accident, often in the distant past, that has the … muscles … and tendons in a stressed or injured state preventing the muscle-tendon unit from being used correctly.
Tendons cannot take action. They cannot DO anything. Tendons cannot create tension, they only transmit the tension generating power of the muscle to the bone, or the weight of the load on the bone to the muscle. Only muscles can DO anything. Only muscles have the power to contract and generate any force.
I will go into this in more depth in a later chapter. But first, lets look at the various treatments commonly offered for tendinitis, and then the concept of tendinitis in and of itself. Sometimes, defining ones terms solves lots of problems.
Here’s an interesting quote from the website of a research oriented chiropractor, Dr. Russ Schierling:
“Now, take a look at something that comes from an Italian Medical Textbook that was published thee decades ago. Researchers knew back then that most overuse tendon problems were not inflammatory (itis), but instead degenerative (osis).”
| “[There is a] remarkable discrepancy between the terminology generally adopted for these conditions (which are obviously inflammatory since the ending ‘itis’ is used) and their histopathologic substratum, which is largely degenerative.” From an Italian medical text called, “The Tendons: Biology, Pathology, Clinical Aspects” (1986).
http://www.doctorschierling.com/tendinosis.html |
Check accepted etiology
So we must remember the point made by the late Dr. Robert Mendelsohn in confessions of a Medical Heretic: