New Year, New Pain? Let's dive into tendon-related pains that we experience
The New Year is always a perfect time to hit the reset button and recalibrate new goals for the next year. Goals or resolutions are usually centered around the simple idea of improving mental and physical happiness. The most common New Year’s resolutions are usually to work out more and eat better. Such simple things, yet so difficult to comply with. We as people love that instant dopamine hit. We want things now and we want to be able to appreciate true physical change. As a result, when we start these new aspirations for the New Year, we go all in. We strive to achieve a caloric deficit that we truly don’t even know if it is the right fit for us, or we follow a workout plan we found online or from a friend because it worked for them so why wouldn’t it work for us? While I am a movement specialist, and there is nothing more that I love than seeing people improve their health, this can sometimes come with danger.
I have been lucky to have been surrounded by a handful of intelligent and driven individuals in my career and personal life. It doesn’t take long to know when someone is just “different.” And I mean “different” in a really good way. Whether it’s spending time observing them, listening to them, or breaking down their daily routine, it becomes very apparent they take a different path to achieve mental and physical happiness. Common trends I’ll see in these individuals are that they do the simplest things such as reading books about improving their lifestyle, meditating daily, breathing daily, doing routine exercise, and avoiding unhealthy foods. The reason I bring this up is these same people usually share one more common trend. Since they already prioritize their health in so many different avenues, they also act much differently when they begin to experience musculoskeletal pain. They don’t want to be in pain, because if they are in pain it acts as a speed bump for their personal and professional goals. I see it all the time in my profession and my everyday life. There are three approaches people take when experiencing pain: (1) You do something about it, and you commit to it (2) You do nothing about it (3) You do something about it, but don’t fully commit. Yes, I understand that sometimes pain does go away on its own, and in a sense that can condition even the best of us to have a bias to take the path of “doing nothing about it.” Let the rest of this blog serve as an understanding of when it is time to act on the pain if you are ready to commit.
The reason this is all specifically relevant to this time of year is most of us will begin to experience “pain” once we get into the gym after the holiday hiatus. When speaking specifically to muscle/tendon, there are four types of discomfort we likely experience: Muscle strain, Delayed onset muscle soreness, tendinitis, and tendinopathy. All four are very different. For sake of length, I will save the discussion of muscle strains for another time. Next, let’s get the obvious one out of the way: Delayed onset muscle soreness, or “DOMS” for short. While to some it may seem obvious, it is not always as obvious to others who have not exerted their body or specific body region over an extended period of time. Take me for example, yesterday I was back in the gym and decided to work my biceps. Sadly, it has been well over a couple of months since I have done a biceps workout. Yesterday after the workout I felt great. Even before bed, I still felt great. However, this morning it feels like a train ran over my arms. It is uncomfortable to stretch my arms straight and even when picking up my daughter this morning my arms felt wobbly. The good news about this, how I felt this morning is the worst it will feel. What we know about muscle soreness after a workout is that sometimes it can take up to 24 hours to begin to experience the “soreness” feeling, thus the term “delayed onset.” Once the soreness has set in, within the next 3-5 days it should be fully resolved, with each day beginning to feel better. DOMS is something that shouldn’t concern us. Yes, maybe it means I did a few too many pounds, or one set too much, but our musculoskeletal system is resilient and will heal. How do I know what I am feeling is DOMS? My discomfort began an entire day later, I am already feeling 50% better after being awake and stretching for 6 hours, and I feel the soreness right in the muscle I targeted during my workout.
The next two soft tissue pathologies get a little trickier so before we get into those, let’s first define what a tendon is, it will all make more sense then. A tendon is a soft tissue structure that attaches the muscle to the bone. We rarely injure the true muscle belly, instead, the injury generally occurs at the spot where the muscle begins to turn into a tendon. If you visualize your bicep, the bulk of the muscle belly is right in the middle of the upper arm (picture Popeye’s arm). If we injure the bicep, it rarely happens at this spot. Instead, if the bicep is injured, we will experience pain near its attachment to the bone at the elbow or up at the shoulder, thus the musculotendinous junction.
Okay, now let’s break down the two: Tendinitis and Tendinopathy. Medical words are fun, the word itself tells you exactly what is going on. The prefix “Tendin-“ obviously means tendon. The suffix “-itis” means inflammation and the suffix “-pathy” means disease. Simply put, we have tendon inflammation and tendon disease.
Tendinitis is the diagnosis we have most often heard of or have been diagnosed with by a doctor. The truth is, if that was the diagnosis you were given, there’s a strong chance it was incorrect. What we know about any inflammatory process in our body is that it is quick to generally heal. Take a cut for example. Cut your knee today, visualize the scar being laid down tomorrow, and by next week you will forget it was even there. That is a prime example of the body’s ability to heal itself through an inflammatory process. Tendinitis generally occurs if acute overload occurs at the tendon. Meaning, there is generally a recent traceable instance when this could have occurred, and it was the result of too much weight or activity to the tendon in that instance. Tendinitis can heal on its own and will usually resolve in the next 2-4 weeks. Modalities such as ice/heat among many others, as well as an appropriate amount of rest, can serve as an excellent adjunct to improve recovery time. I say “appropriate” amount of rest because that’s where the main danger from tendinitis can occur. If you overload your biceps today, and in 2 weeks you are feeling better, it is safe to be back in the gym exercising that muscle. Yes, something needs to be modified, whether it’s the load, form, intensity, etc., but that’s a story for another time. The worst thing we can do is become avoidant. Again, circling back to individuals that are “different.” If you feel you are in a situation where you had pain for a couple of weeks and it is better now and you don’t want this to be an excuse to stop you from achieving your goals, please reach out. A simple phone call and we will be able to achieve a lot in terms of determining what’s safe, what’s not safe, and whether this is something where further evaluation would be helpful.
Now for the monster: Tendinopathy. Do you know that tennis player with “tennis elbow,” that runner with achilles pain, or that carpenter with constant pain when tightening a screw overhead? They most likely aren’t experiencing tendinitis. What they are most likely dealing with is tendinopathy to the wrist extensors, the achilles tendon, and the rotator cuff. Now there’s certainly a handful of other pathologies these individuals could be experiencing, and the last thing I want to do is put every single musculoskeletal pain in the bucket of it being tendinopathy, but what I rather want to do is draw awareness that this type of pain is significantly more likely a tendinopathy rather than a tendinitis. Why is this important? Tendinopathy doesn’t heal on its own like tendinitis. Without getting too scientific, under a microscope, we can see that the tendon has begun to go through a disease process where the collagen fibers being laid down are thicker and weaker. There are many ways in which a tendon can begin to undergo this disease process and the reasons you may be dealing with tendinopathy are not always fully understood. Some characteristics we can generally attribute include one or multiple of the following: intrinsic factors (metabolic health, age, gender, BMI, etc.), extrinsic factors (repetitive overuse), and genetics.
What we know about tendinopathies is that injections and surgeries are not always the answer. While a cortisone injection can help with the pain in the short-term, we cannot expect long-term results without ever addressing the root of the issue. Most surgeons will not administer more than one injection due to research indicating that injections can sometimes be more harmful in the long-term to tendon health. Surgery is sometimes a solution, but there are a lot less invasive and inexpensive interventions that can yield similar, if not better, results. Perhaps, the most important piece to improving pain generated from tendinopathy is education. The education of something as simple as this is a hurt, and not a harm. You are safe to move. If you move, yes it may hurt, but you are not going to harm yourself anymore. Movement may be the solution. Now again, every situation is different, so it’s never fair to generalize, but this is something that with a thorough assessment, the right education, and correct interventions, we can begin to already see dramatic changes in physical therapy after only 2-3 sessions. One last important piece, while the pain can be better after 2-3 sessions, that doesn’t mean the root cause has been addressed. Sometimes these types of pain can take 2-3+ months to make a full recovery. The quicker you act on it, the odds of improvement increase significantly. This is not a “wait and hope it gets better” type of pain.
Again, I write this for many different reasons, specifically for its current relevance. Many of us will look to improve our fitness levels at the start of the year. A handful of those people will begin to experience pain that is not their “normal.” From here, you have options. You can quit your fitness goals and hope that this gets better with time, you can continue to keep pursuing your fitness goals independently and push through the pain, or you can do what most “different” people will do. That is to understand some professionals can help with this and whether it’s a simple or complex issue, being informed and educated will always prevail!
Happy New Year to everyone. Please, if you find yourself in a situation where the pain is hindering you from achieving your goals, let’s find time to chat. I would love nothing more than to hear what it is you are trying to achieve in 2023 and I will always give you an honest response if I feel I am the right person to help you accomplish your aspirations.
Stay tuned because in February I plan on sharing more about another passion of mine I love to educate on: Osteoarthritis.
Hope you enjoyed!
Dr. Ryan Holewinski, PT