How to Workout with Pain; 4 Steps to overcoming Tendonitis

It’s your 97th ON day at the gym. You are the epitome of a professional bodybuilder / cross-fitter (or whatever program you follow), but you chose not to compete because of some reason you made up to justify your fear of failure.

You don’t take rest days because neither did Ronnie Coleman and that dude was swole house thunder jacked.

Adrian Peterson Looking jacked! #whodat

Adrian Peterson Looking jacked! #whodat

Now all of a sudden, yeah, it kinda hurts to squat, or bench or put the box of Reese's cereal back into the hiding place above the fridge. That range of motion is annoyingly painful. Just enough so that you’ve unconsciously asserted your hurt shoulder into every conversation you have citing your last session of half rep shoulder presses you did with the 95s. Or even worse, you begin to tell me about every single WOD you did last week and go into excruciating detail about the weight, rep scheme and time frame of your workout.

::RANT:: Research shows this is true specifically for people that come from Crossfit Gyms

Let’s go down this rabbit hole briefly while we’re on the topic. If I'm at Chipotle eating a double everything bowl with two forks per hand by myself with headphones in, take that as a cue that I don’t want to sit with you and talk about this entire week of programming you just did. Bro, we don’t train together, and we don’t even go to the same gym. What makes you think I care about your training? You’re talking at me to hear yourself talk about the workout you just did as if putting it on Instagram and Facebook wasn’t a good enough reminder.

For real tho

For real tho

I promise the only reason people act interested in hearing about your last workout is those who are impatiently waiting to tell you about THEIR last workout as a pissing contest of work capacity.

Here’s how to know if you should share your workout with anyone: Was it a record? Did someone gets seriously injured? Are you asking my opinion? Are you giving good, actionable advice in the form of an anecdote? If not, relax and let’s talk about the Saints upcoming season.  

::End Rant::

Tendonitis or Tendonosis

Guess what. Because you don’t take the 10 minutes after your workout to stretch and instead run to the nearest mirror to snag a flex sesh, snap a few dozen photos and spend the next 30 minutes posting to Instagram, you’ve developed TENDONITIS. Or tendinosis.

It’s pretty much impossible to discern which one you have, but I've called in the scientists and dug up fossils of our bro ancestors to help you figure out what you got and how you’re going to fix it so you can get back to benching way more than that other guy that comes into your gym disrespecting your bench with his fuckboy headphones and flashy new Nike Romaelos though you’ve never seen him actually attempt an Olympic Lift in his life. Yes, this paragraph is only one sentence. Suck it, English.

Tendonitis - you probably don’t have this. The “itis” refers to inflammation. It comes from overloading the tendon with excessive force. Now I know what you’re thinking. “Bro, ehem, Beaux, I excessively overload my tendons every second of every workout ever, this is it.” Calm down turbo. No it's not. 

TendonITIS = inflammation. Usually caused by small micro tears from forces too heavy or too sudden.

  • Time to recover: days to weeks

TendonOSIS = Non Inflammatory. You’re degenerating the collagen without giving it enough time to recover; you can think of it as a repetitive strain injury.

  • Time to recover: weeks to months -> it takes about 100 days to make new collagen.

How do you know which one you have? If something sudden and dramatic happens and you experience pain, it might be Tendonitis. More often though, almost 90% of the time, it’s from repetitive stress. So, if your program is getting much harder and you’re not compensating with recovery tools like stretching, massage, stem, food, sleep, and meditation -- you might have developed Tendonosis. It’s ok Brosideon; it’s treatable without drugs.

Case Study

I began developing Tendonosis in my knees when I increase my squat program from 2 to 3x per week. This increased repetitive stress improves strength but also damages the body far past it’s ability to repair itself. Strength is a slow process (which I'm being forced to partake in) without the use of drugs (steroids). I also began neglecting stretching, which I currently regret.

right knee collapses, putting inefficient and damaging tension on the knee. Over time, this will lead to tendonosis or meniscus damage. 

right knee collapses, putting inefficient and damaging tension on the knee. Over time, this will lead to tendonosis or meniscus damage. 

If it were tendonitis, my first course of action is to

  • Control and reduce inflammation
  • Stop doing the shit that makes it hurt.
  • Use NSAIDS (not steroidal anti inflammatory drugs)
  • Ice and Rest (as much as possible) - I’d do lots of muscle cleans, power cleans and deadlifting instead of heavy, deep squats.
  • Lots of massages, perhaps Gua Sha or other scraping modalities to break up muscle and tendon adhesions.
  • Improve mechanics. If you get to this stage, you’ve been doing something wrong. Small tweaks in movement over the course of a long training cycle lead to injury. Plus, you look like an idiot when you’re working out the wrong way. Get a coach to help identify faulty movement patterns.

Since I have tendinosis, I will do something similar, but drastically different in a few fundamental ways.

The big differences are:

  • Heat and Stimulation NOT Ice and Rest
  • No NSAIDS, they reduce the repairability of collagen

Specifically, for Tendonosis, I have a plan that will last for not less than two months. Anything less and the problem will still exist, though it may be significantly reduced. 

Actionable Stuff Below!

FIRST: I identified the problem that caused the damage. Personally, I had a few muscles that deactivated (yes that happens quite frequently) causing my hips to shift and knee to collapsed during heavy lifting. Now, this won’t hurt me if I do it a few times, but chronically, repetitively and under heavy loads will become a big issue.

I saw my Chiropractor, Dr. Ben at Allied in Metairie to address the muscles that were giving me a problem. I’d suggest you do the same. He helped straighten me our and identify which muscles were in need of special attention. 

SECOND: Friction Massage. Get yourself massages! Self-massage works too if you’re on a budget. Voodoo flossing works, and I'm currently experimenting with Gua Sha techniques. Stem and heat can also fall into this “repair category” as well.

THIRD: Corrective Exercises. This includes muscle activation therapy to improve your biomechanics, as well as joint strengthening. Exercise that strengthens the area without putting too much strain on the tendon is good. Don’t do anything that hurts the tendon.

In the first six weeks, everything should be very slow and controlled. Consider making mostly “negative” or eccentric motions. This stimulates collagen production, alignment and cross-linkage formation improving tensile strength. Also, reduce the load. Stop worrying about the weight, just get better and fix that poor form that got you tendinosis in the first place.

As you start to see the progress, you can introduce the movements which caused pain initially back into your workout, but very carefully with light weight, lots of control and have a coach there to make sure you’re on a better movement track.

FOURTH: Stretching. For real this time. Make this a part of your program. Like write it down and do it. Before and after you train. Stretching will improve recovery by aiding in blood flow as well as lengthen the tendon which reduces the amount of tension placed on it during lifts.

Don't let pain keep you from the gym. Of course it's a great excuse of why you "can't workout" but if you're looking for reasons why NOT to workout then this article probably isn't for you. I'd suggest reading this. 

If you need help with any of this - please reach out! We have dealt with issues of our own and preexisting issues with many of our members. 

Common places to have Tendonosis; lower back, shoulders, elbows, knees, wrists, fingers, ankles and achilles. If something hurts in a very specific motion, but doesn't hurt outside of that motion, you probably have some sort of tendinopathy. 

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/

http://www.sportsmd.com/sports-injuries/knee-injuries/how-to-treat-tendonitis/

http://elitesportstherapy.com/tendinosis-vs-tendonitis/

http://www.doctorschierling.com/tendinosis.html