Tendons are the tough, white, cords that connect muscles to bones, and are the least elastic of the Elastic, Collagen-Based Connective Tissues.  Are tendon problems common?  Governmental stats reveal that overuse injuries of muscle tendons are a leading reason people visit the doctor.  And although your doctor will almost certainly refer to your problems as “tendinitis”, in almost 100% of the cases, it is actually an incorrect and outdated term.

Over the past three decades, dozens of medical studies have conclusively shown that the major cause of “tendinitis” is not INFLAMMATION (aka “itis“), but something called “osis” (a derangement or degeneration of).  The truth is, even though doctors (self included) still use the term “tendinitis” with their patients because it is what they have heard their whole life, their AMA-mandated Diagnosis Codes almost always indicate that the problem is Tendinosis (HERE).

Is this differentiation between “tendinits” and “tendinosis” really that important, or am I simply splitting hairs and making a big deal out of nothing?  Instead of answering that question myself, I will let one of the world’s preeminent orthopedic surgeons and tendon researchers (Dr. GA Murrell) answer it for me, as quoted from the December 2002 issue of the British Journal of Sports Medicine

Tendinosis, sometimes called tendinitis, or tendinopathy, is damage to a tendon at a cellular level (the suffix “osis” implies a pathology of chronic degeneration without inflammation). It is thought to be caused by micro-tears in the connective tissue in and around the tendon, leading to an increased number of tendon repair cells. This may lead to reduced tensile strength, thus increasing the chance of repetitive injury or even tendon rupture. Tendinosis is often misdiagnosed as tendinitis due to the limited understanding of tendinopathies by the medical community.

Why doesn’t the medical community grasp this information and abandon their insistance on treating Tendinopathies with THE BIG FIVE (followed by surgery when those don’t work)?   We’ll get there in a moment, but for now, the real question we need to be asking is how this issue affects you, the Chronic Pain sufferer? 

It means that if you are dealing with a chronic tendinopathy, you are probably being treated using a model that is at least 25-30 years behind the times as far as the medical research is concerned!  Think not?  Read what Dr. Warren Hammer, board certified Chiropractic Orthopedist (in practice since the late 1950’s), had to say about the subject in a 1992 column from Dynamic Chiropractic:

The American Academy of Orthopedic Surgeons has provided a new classification of tendon injuries….  In the microtraumatic tendon injury the main histologic features represent a degenerative tendinopathy thought to be due to an hypoxic [diminished oxygen] degenerative process. The similarity to the histology [study of the cells] of an acute wound repair with inflammatory cell infiltration as in macrotrauma seems to be absent.  A new classification of tendon injury called “tendinosis” is now accepted.

“Tendinosis” is a term referring to tendinous degeneration due to atrophy (aging, microtrauma, vascular compromise). Histologically there is a non-inflammatory tendinous degeneration due to atrophy (aging, microtrauma, vascular compromise), as well as a non-inflammatory intratendinous collagen degeneration with fiber disorientation, hypocelluarity, scattered vascular ingrowth, and occasional local necrosis or calcification.

If your doctor is still treating you for Tendinitis and not Tendinosis, they are caught in a time warp. Plainly stated, Tendinosis is not an inflammatory condition (itis)!  It is a degenerative condition (osis)!  Not only is there debate over whether or not tendinitis actually exists, clicking on the previous link will show you that the drugs you are being prescribed are actually creating more degeneration — way more degeneration. 

What do I suggest?  TISSUE REMODELING of course!  The fantastic thing is that you will know quickly (one or two treatments) whether this approach is going to work for you.  The doubly cool thing about this method is that it’s NOT CRITICAL that we differentiate TENDINOSIS from FASCIAL ADHESIONS when treating as they are dealt with in like manner (links have numerous microscopic pictures).

IMPORTANT:  Please note that some muscles only cross one joint.  However, many muscles cross two joints.   muscles that act on more than one joint have a greater propensity for problems.  It also means that one muscle has the potential to give you problems (including tendinosis) at two different joints. 

  • SUPRASPINATUS TENDINOSISThe Supraspinatus Tendon is not only the most commonly injured of the Rotator Cuff Muscles, it is the most common to find tendinopathy in as well.
  • TRICEP TENDINOSIS: Tricep Tendinosis is rare.  About the only people I ever find it in is carpenters (hammering) and weightlifters.  However, here is the webpage.
  • BICEPS TENDINOSIS: Because both heads of the bicep muscle have attachment points in the front of the shoulder, Biceps Tendinosis is frequently mistaken for Bursitis or a Rotator Cuff problem.
  • THUMB TENDINOSIS: This extremely common problem can be debilitating.  You will frequently hear it referred to as DeQuervain’s Syndrome (in 15 years, I have never seen a case of DQS we could not solve).
  • PIRIFORMIS TENDINOSIS: This problem is related to Piriformis Syndrome, and causes pain in the butt (sometimes with sciatica as well).
  • SPINAL TENDINOSIS: Although most people never think of it, the potential for developing Spinal Tendinosis is greater than you ever imagined possible.
  • KNEE TENDINOSIS: Often referred to as “Patellar Tracking Syndrome,” this condition is arguably the single most common reason that people visit a Sports Physician.
  • ACHILLES TENDINOSIS: Achilles Tendinosis is found in the large tendon in the very back of the lower leg / ankle.
  • ANKLE TENDINOSIS: This common Tendinosis can typically be dealt with by following a few simple procedures.
  • POSTERIOR TIBIAL TENDINOSIS: This is related to the category above, and is typically found near the bony knob on the inside of the ankle.
  • APONEUROSIS / APONEUROTICA TENDINOSIS: Although you have probably never heard the word before, “Aponeurosis” are flattened out tendons.  They are almost always referred to as fascia, but technically this is incorrect.

This list is in no way considered “comprehensive”.  It is simply a list the most common areas that I treat.  The truth is that Tendinopathies can be found virtually anywhere that there is a tendon —- including the spine.  For VIDEO TESTIMONIALS, click the link.


138 responses to “TENDINITIS

  1. Teri

    I have been a licensed massage therapist, and natural healing practitioner for almost 18 years. I do have several of these issues and I am treating then quite successfully naturally with massage, pure essential oils and herbs, and acupuncture. Why is all the focus on the tendon? The muscle attached to the tendon is what is the cause of the issue, yet you rarely hear massage ever recommended to treat these conditions. Massage therapists are muscle specialists. All we deal with is muscles, fascia, tendons and ligaments. A well trained and experienced LMT probably understands the muscles better than most doctors, yet we are never thought of to treat these conditions. Much relief and healing can be found on the table of a good LMT people.

  2. Nikolay

    Dear Doctor,
    I have injured my shoulder last year, from sport I am very active and I participate in Martial art sports.
    I did MRI and my problem seems to be Supraspinatus Tendinosis and ever since I’ve tried a lot of stuff I even did a research on my own about band exercise and active rest, my problem is getting better with time, but still that triger point is there when I massage it! My range of motion is back, because I’ve been working on it a lot, but I still need help and I don’t want to do a surgery! I am 25 years old with a lot of things to accomplish in sports and not just sports, so if you guys have any advice I will be forever thankfull! I am based in Stuttgart, Germany so if you know any good doctors around that would help too.

  3. Margaret

    I’ve got Sarcoidosis I’m In horrible pain help.

  4. Michelle

    Can standing for 8 hours on hard marble floors cause quadriceps tendinitis and Tarzan syndrome?

  5. Dayanand

    Dear Doctor,
    I have injured my right ankle 1.5 years back where while playing football I suffered a ankle sprain(inwards). Due to no proper care, now the pain has become a chronic one. Recently with a orthopedic doctor’s suggestion I took a MRI scan of my right ankle and no issues have found in the scan report. Doctor told me that its ankle tendinitis and I need to strengthen and stretch my calf muscle. I’m doing some stretching exercises but still I dont have a confidence that this problem/pain will suffice. I can’t run and play football due to this issue. Please suggest me the best treatment or solution for this problem.

  6. Anne

    What kind of treatments are there during pregnancy? I am 21 weeks pregnant and am unsure myself what’s going on. I’m having a terrible flare up as that’s how I found this site. It is painful to type… I’ve searched the web and haven’t gotten much answers – my pain is on the palm side under my thumb, this has also spread to my wrist and forearm.

    • Hello Anne,

      Tough to say what this might be, but almost all treatments I use in my clinic on a day to day basis (not spinal decompression therapy of course) can be done during pregnancy.

      Dr. Russ

  7. Donna

    So what do you do for pain when your dr sends you for an x ray and tells you there’s nothing wrong? Is there some type of exercise for relief when you whole arm is in pain from the shoulder to your thumb?

  8. mladymocha

    I first felt the twinges of pain in my right elbow during basic military trying in 2008 when out weapons were introduced. For the following 7 weeks after receiving the weapon, I had to hold it in front of my body all day long because even though it was slung on my body, I am short and the weapon dragged on the ground, therefore I had my right arm bent in front of my body carrying/supporting the C-7 rifle. In those 7 weeks my elbow became invcreasingly weakened and painful. I finished basic, started my construction trade and ended up doing much concrete block masonry work which further damaged my right elbow, and started up the same symptoms in my left. I suffered everyday, and switched trades in 2013. Fast forward to this past Oct 2016, while doing some upper body light exercises in the pool, I once again am feeling the same familiar debilitating pain in my elbow. I had merely used the water for resistance for some light chest exercises…..And now I realize just how HEAVY water is, I have been suffering for the last 2 months in this pain, that wakes me up at night, it hurts to straighten my arm, gripping anything is almost impossible, and even enjoying a cup of tea is not possible because it hurts so much to just lift the mug….. This is a recurring problem, but now I am wondering if I have permanent damage to my elbow. I will be 50 next year and these problems started when I joined the military at 41. Prior to that I worked for purolator lifting boxes, pulling and pushing a cart for 8 hours a day, but never had any problems. What do you think?

    • Hello M,

      Isn’t that C-7 the Canadian version of the AR-15 / M-16? As far as your elbow, these are usually a quick and simple fix, as long as your tendinosis has not frayed the tendon too much. If that’s the case (they can fray to the point of rupture), they usually require surgery.

      Dr. Russ

  9. Jessica

    Hi Doctor,
    I’m at 29 y/o female, I had a accident 10 months ago my dominant arm was yanked and injured. I’ve seen two orthopedics diagnosed with De Quervains. After X-rays and MRI and cortisone, physical therapy, surgery and now occupational hand therapy with lots of cold laser. Even after all this the newest MRI shows the tendinitis past my wrist into forearm I still have all same symptoms and pain. With a more severe case with inflammation is it still curable? They keep telling me that it can be cured. I’m not sure if the tissue remodeling is something that could help with me but at this point I’m willing to look into all possibilities.

  10. Jocelyn

    Hi. I had a bad fall into a ravine almost 3 years ago and fractured 4 vertebrae one was burst and a bone graft was done so had a lot of metal in my back for a year. All has been removed now and I am doing well. However about a year and a half ago I got severe pain in my left thumb and fingers which was diagnosed as arthritis. The pain has moved around but is mainly still there and in my right elbow. If I stop the steroids it comes in my shoulders feet and fingers. I have been on methotrexate for a year and also predisonone. Every time I try to reduce the steroids the pain comes back. I can feel it all the time so am sure it is just being masked. Really want to stop the medication and the pain if possible.

    • Hello Jocelyn.

      First, long term steroids for something like this is extremely dangerous as to their side effect profile. For one, they cause serious joint deterioration. But even stranger is the methotrexate. This is the stuff they give people with major autoimmune diseases (it’s actually an old chemotherapy drug) — particularly hardcore RA. If you stop the meds, you need to look at my blog and see how to do an anti-inflammatory diet.

      Dr. Russ

  11. Angela

    I have bilateral patellar tendinopathy. I can’t bend my knees at all they swell up and it’s very painful it hurts to stand on them. I have had it for 4 weeks now and its not getting any better. I was wondering how long it will take to be able to walk again. Please help me as can’t seem to find any information on how long it will be.

  12. Jessica

    I’ve had repetitive tendinitis injuries the past four to five years, some ache without inflammation, others like both my wrists and fingers burn and I can’t eat or both wrist feel pain to lift and get inflamed. Only thing the doctor gave me was exercises to do with left ankle and knee that hurt as well, arch support and a hand splint which causes my wrists to ache. Icing which my doctor never mentioned to do helps me the most but still really hurts. I’m an avid lifter and now cannot do anything but lay in bed from pain. I have tendinitis in my wrists, fingers, both ankles and knees.

  13. Charlene

    I recently got this job where I’m constantly pulling a glue gun down and wiggling clips in a slit of carpet and I wake up 5 times a night with both my arms numb and in pain. When I eat I cant cut my food because it shoots pain up my arm. Like I don’t have the strength to do it. I can’t quit my job but I’m out of ideas to keep from hurting it’s my whole arm and wrist. Any ideas what it could be?

    Thank you

  14. Carli

    I’m new to running long distances, and recently came home from college which caused me to switch from running on the treadmill at college to running outside on pavement at home. I run about 5K everyday, but am working on increasing my distances to half marathon. However, about 2 weeks after being home and running everyday outside, I started noticing extreme pain in my right foot arch that became consistent, and occasionally the same pain in my left arch. After about 2 weeks of this consistent pain, stopping running, and barely being able to walk, I went for XRays assuming it was a stress fracture. However, it showed no stress fracture and I was diagnosed with tendonitis. It also showed that my Navicular bone sticks out quite far, but she said that was my natural anatomy (or could have been caused from my 14 years of professional ballet). I am currently 19 years old.
    My doctor recommended an MRI to further check for stress fractures, however, she gave me items to help relieve pain if it was just tendonitis. She showed me how to tape my arch to give it more support, told me to get arch support shoe insoles, and put my right foot in a Cam Walker removable walking cast. I felt almost instantaneous relief after a few days with these new things, now 2 weeks later I feel completely healed!
    My doctor never actually told me how soon it’d be okay to start running again, for she was waiting for the follow up appointment after the MRI, which I felt I didn’t need since the pain was cured instantaneously with the remedies she suggested, therefore myself concluding that a stress fracture wouldn’t lose pain that fast.
    However, last night was my first night back running. It’s been 2.5 weeks since I was diagnosed and have been using her suggested remedies. I got new supportive running sneakers, and put the insoles in. Towards the end of my run, my LEFT foot/ arch started hurting really bad. This is the opposite foot than that of which hurt before. What’s different about this time is that I have a bruise now right where the Navicular bone is. But the pain is the same I had when diagnosed with tendonitis in my right arch.
    What is the best route for pain relief here? I tried icing it last night after my run, but that didn’t do anything pain-relief wise. Icy Hot doesn’t help either. I made sure to warm up my feet well before running. Also, stopping running isn’t an option for me because I have a few races coming up the end of this month. I have tried taking it easy and will not be running everyday now because of this.
    Any suggestions would be greatly appreciated!!!

    Thank you,

    • Hello Carli,

      There are any number of factors that could be at play here, including foot biomechanics, and whether or not your orthotics and shoes are right for your foot typle. Firstly, this injury might take a very long time to heal to the point of you being able to run again. Secondly, I am not a huge fan of long distance running on a daily basis. I would suggest a training regimen based on strength, flexiblity, and sprints. Lots of stuff on my Doctor Schierling site on this topic. Trying to run through these sorts of injuries will often times leave people with deep regrets and potentially permanent problems.

      Dr. Russ

  15. Hannah

    I’ve been diagnosed with Quadratic Tendonitis.
    It can flare up at any point. For example….over use, being sat with it in the same position too long, basically anything angry everything.
    Background Story: I fell over about 2years ago and have been in constant pain since.

    Some months it will hurt 3 weeks out of 4 (the other week it will just twinge a little) and other months it’s 1 out of 4. But it never completely goes away. It will hurt at some point every day.

    I have had an MRI and the specialist said he could see some damage of the tendon and that has developed into the tendonitis.

    Physio doesn’t seem to be working, in fact it kind of makes it worse.

    Has my diagnosis been correct? And can you recommend a treatment as it is stopping me doing the things I love!

    • Hello Hannah,

      I am assuming here that you are talking about Quadriceps Tendinosis. As I mention in my article, I would suggest you try Tissue Remodeling.

      Dr. Russ

      • Yvonne

        I have a problem in my cervical c3 and 4,5,
        I been in a bad headache pain. Drs, are already giving given me the epidural injection, I am not to happy about it becomes lack of insurance my is HMO. I have to go with net.
        How can you help me?

      • Not sure I could help you Yvonne. Not very much info to go on.

        Dr. Russ

  16. Toby

    Hi doc

    I am a recreational weightlifter suffering from a bout of what seems to be long-head bicep tendinosis in my right shoulder. I have halted all horizontal pressing work, vertical pulling, and all bicep work as a result. I had PT, and although the stretches and rehab movements have helped my mobility, nothing has helped my pain. The major discomfort is when I reach my arm behind my back as if I was going to scratch my mid-upper back.

    I have tried various supplements, stretches, icing, heat, massage, slow eccentrics to promote inflammation, and nothing so far has really worked consistently. I am doing daily rotator cuff strengthening to ensure that this never happens again.

    Can you please give me some advice or help about what I can do to solve this problem? In particular I am struggling to ascertain how I can tell if anything is helping, given it has been 6+ weeks and the pinching/discomfort behind my back has not abated? Will this pain ever go away?


    • Hello Toby,

      Go on over to my Doctor Schierling dot com site and look at the picture page. Sometimes this is what it takes to break up the adhesions that form in muscles, tendons, and connective tissues. I feel that in many cases, it’s the missing link in treatment.

      Dr. Russ

  17. Jodi

    How common is it to have the same problem at the same time in two different parts of body.
    My right elbow and my left wrist(thumb) are both debilitating me. I try to do stretches. Stretches help for the moment but minutes later I have the pain again.
    I also have been diagnosed with Mormons neuroma in the last year. Is all this related.

    • Hello Jodi,

      The Morton’s Neuroma is not related. And yes, it is possible to have problems at multiple sites. Be aware that the more sites you have that both cross midline (right and left) as well as being both above and below the waist, the greater your chances of your Tendinosis being systemic. I have lots of articles on systemic tendinosis on my blog.

      Dr. Russ

      • Garry

        After more than two months of not being able to run, I think I have finally stumbled upon an answer to my problems. (I am 60 year old male. Been running (well) since I was 28).
        It started with what I thought was a pulled hamstring – pain and swelling in lower hamsting just above the back of my knee. Physio told me it was a minor strain and i would be running again within a week. Nope! Still hurts two months on. A scan revealed nothing last week so I started running (read hobbling) until last night..now back to square one.
        I had also been suffereing with on and off Planter Fascia pain (bottom of my heal) before that, but that too has gradually become worse.
        Now…to top it all, I have developed tennis elbow symptoms.
        Three different sites…all close to or involving tendons.
        Spent a fortune on treatments but nothing working..yet.
        I am going out of my skull.

      • Hello Garry,

        Usually the reason that doctors don’s solve these is because they are treating them like Tendinitis instead of Tendinosis.

        Dr. Russ

  18. JUDY

    Hi Doctor, I ran the Comrades marathon in 2012 and 2 months later I started to jog again. I experience pain in my front foot between the tendons where it goes up in you lower leg. Later the pain started on the inside of my ankle. Eventually I had surgery for a tarsal tunnel, which after 2 years was not the answer to my problem. Very much pain, swelling and stiffness. I was even diagnosed with OA. No problems could be detected on a sonar, nerve test, x-rays. The last option now in South Africa is a MRI.
    My gut feeling tell me this is something like chronic tendinitis. It is now 4 years later, I am not back on the road again, gaining weight and feeling miserable. Any suggestion please?

  19. Garth

    Help Please
    My wife is SUFFERING from what the doctors call fibromyalgia. Her pain feels like guitar strings being pulled too tight. It is mostly in her feet. She tried lyrica and the side effects were horrendous, and still ongoing almost a year after she stopped. We are desperate for any help and suggestions.
    Please help with any info

    • You could be correct about Fibro. Either way, she needs to treat this as a systemic problem. To see what I mean, go over to my blog and type the word “systemic” into the search bar and start scrolling. You will find several posts on systemic problems of this sort.


  20. John

    Dear Dr Russell, HELP. I’ve had pain in my left ankle for 8 years. Help.

    • Hello John,

      I actually have a page on ankle pain. The problem is, I am here, and you are there — wherever “there” is. Other than the tons of free self-help information I put out on my Blog, there’s not really much I can do.

      Dr. Russ

  21. Thomas

    Hi there. I’m one of those unfortunate people who was struck by these symptoms in my late twenties, and has spent a quarter of a century looking for an effective treatment. For the last five or six years, my hands and ankles. I have used every anti-inflammatory drug in existence. I have used steroids, and chemotherapy drugs. The only successful treatment was surgery that cleaned out inflamed bursa tissues in both shoulders. For this small victory I am most grateful since that pain was so severe I was (secretly) contemplating suicide. Currently, I am on a carefully controlled regimen of narcotic pain relievers. Even at dosages that were once used to treat cancer, I find that even moderate use of my hands (opening a jar say) produces moderate to severe pain.

    If this were simply my lot in life, I suppose I could deal with it. However, there have been sudden (overnight) complete remissions. I literally felt 20 years younger after the first one which was idiopathic and lasted a month. The second, and longest lasting (six months) came about as the result of a foolishly administered hydrogen peroxide enema (50/50 water and commercial peroxide 3%). Within minutes after applying it I felt as if the pain was draining out of me like sand from an hourglass. The next morning, I felt as if I had exchanged bodies with superman. Not only was the pain gone, but the significant hearing loss I had suffered from was gone, as was the ataxia I had developed over the last few years. Indeed, I seemed to have a level of neurological coordination greater than I had ever experienced in my life. Although my colon had sustained a chemical burn, and I was passing a small amount of blood in my stool, this cleared up within a week. For the next six months, I was symptom free.

    Sadly, after those six months, all of my symptoms began to slowly return. The pain in my hands returned, as did my hearing loss and ataxia. Fortunately, the strength which had returned to my arms and legs seems to have been, at least partially, retained. Naturally, I attempted to repeat the original treatment, but this time, it produced nothing save the bleeding and pain I had experienced the first time. Whatever happened the first time, seems to have been a one-off. If you think you might know what’s going on with me, and can suggest a treatment, I would welcome your input. I’m not very hopeful though.

    • Wow Thomas,

      I am guessing you already read the “Systemic Tendinosis” posts over at my Doctor Schierling dot com site? Great info there. Whether or not anyone figures this out, highly likely it’s an autoimmune attack against some aspect of your connective tissues. The thing that comes immediately to mind in your case is that it could be a Gut Issue — mainly because of the whole H2O2 thing (my mom healed herself of a 10 year chronic cough with food grade H2O2). Make sure to pay particular attention to the part on FMT (HERE). Please let me know if you find a solution to your problem.

      May God bless you in your endeavors,
      Dr. Russ

  22. Cristan

    Hi Dr. Russ,

    I have already been examined by ER staff and two separate orthopedists. I had an MRI and an x-Ray which both revealed nothing. I have been in debilitating pain in my left hand and wrist since December 29, 2015 (almost 3 weeks). The ER gave me pain killers (did nothing), first orthopedist gave me ibuprofen and a cortisone shot (did nothing), splinted for a week and began PT. Still no relief so I got a second opinion, said it’s probably DeQuervain’s, got another splint and now I’m on different steroids and still feeling no relief whatsoever. The new doctor told me to stop the PT. I’ve been icing and heating but nothing stops the pain. Even at rest, my hand, wrist, forearm, and elbow are in shooting/twisting pain. I am seeing a chiropractor on Monday and a neurologist later in the week. Any other ideas on what to do?

  23. lena

    after a direct injury on my knee causing patellar tendon issue that i am still battling with physiotherapy, I got issue with my arm tendon.. some people say it is biceps one some others supraspinatus.. without doing anything to push it more, i started having the same issue on my left arm.. It is very painful and makes me have absence from my job (i can barely even type here). I’ve read numerous articles and have still found no solution.. What can i do? and how come and this spread all over?
    thank you

  24. Eleanor

    Hi Dr. Russ,
    Wondering if you know of any likeminded doctors in Victoria, Australia?

    I have been suffering with what I thought was severe tendinitis in both wrists and elbows, with pain in upper and under sides of both forearms for almost 2 years.
    As both arms are affected my life has been dramatically affected, and both my osteopath and doctor are at a loss as to what to do.

    At the moment I am awaiting an appointment with a Rheumotologist (although bloods for rheumotoid factor have been clear) and my Osteo is treating my trigger points with massage.
    I am now wanting to perhaps find a naturopath or any other alternate therapy, but as I have been on this merry go round for so long now, I don’t want to waste any more time with people who don’t know exactly what they are doing.
    If you have any contacts in Australia you could recommend I would very much appreciate hearing from you.

    • Hello Elenor,

      Unfortunately, I don’t know anyone in your neck of the woods. Make sure to read my articles over on Doctor Schierling dot com concerning Systemic Fascial Adhesions and Systemic Tendinosis.

      Dr. Russ

  25. Deirdre

    I agree 100% with this article. I have been suffering for 2 years now – thumbs, ankles, hips, knees, back and heels. First I was treated for arthritis and now due for surgery for De Quarvains as my thumbs are the worst. My feet I have been given othotics that doesn’t help yet (after several cortisone injections). I am on a chronic anti inflammatory drug and still the pain continues. The medical professionals just doesn’t know anymore. Physio didn’t help either. Can you please help me?

  26. Julie

    I cannot believe i am finally reading something that describes my situation, thank you! I have had hip/thigh pain which moves and which developed after running for several years for five years. Been to too many docs to count and ultimate diagnosis was it is arthritis.
    But yin yoga which is all about strething these connective tissues and massage is the only thing that has helped with the pain.
    I would like to see a specialist who speaks your languag but I do not live near you. How do i find someone and is treatment ever covered by insurance?

    • Hello Julie,

      “Arthritis” is frequently a bucket diagnosis. Not sure what it is, throw it in the bucket labeled ‘arthritis’. Although Fibromyalgia is certainly real (I have about a dozen articles on it on my site), it is also a bucket diagnosis. As to finding someone, they are out there, not sure who.

      Dr. Russ

  27. Drew

    July 26, 2015

    Roughly between September – October my injury started. I remember doing an outdoor bar workout for around 2 hours and after it feeling really sore in the right elbow. I was doing handstand push ups, muscle ups, flag poles e.t.c.

    My training program at the time was 5 times a week at the gym for roughly an hour and a half. I was always changing my workout program but maintaining the days I went. I trained really hard, definitely above par and to failure. I was making exercises up which I think was a contribution to my injury.

    I started to wear an elbow wrap when I worked out and it kind of helped but I started to feel a popping/flicking sensation around my elbow when I did push exercises, especially tricep exercises.

    Around year 9-11 I had a lower back problem. My back is S shaped and I found it difficult to keep a good posture. I saw a physio and she gave me a hip exercise and it pretty much went away. At this stage I was doing a lot of training for martial arts, football, gym because I was representing at a national level. Around year 11 I also injured my shoulder doing a inclined shoulder press. The weights just dropped to the ground and it felt like my shoulder popped out. I took 2 weeks off from memory and just didn’t do shoulder exercises. I then started light weight high rep shoulder exercises. This got a lot better quickly!

    Around year 12 I remember wearing elbow wraps because my elbows hurt but once I wore them for a few days the pain went away. The elbow wraps are very thin and are just some stretchy fabric.

    I had a job after school in real estate for a while and most of time was at a computer desk which I think was a contribution to my problem.

    I remember throwing a ball at the beach (american football style) and then a sudden pain shot up through my arms and wouldn’t go away, I dropped down and caressed my elbow for a few minutes and then the pain went away.

    I saw a doctor and he prescribed anti inflammatories and rest because he thought I had tendonitis. I rested for, give or take 2 weeks (not enough time I know) and then continued to train avoiding exercises that aggravated the elbow.

    The problem didn’t go away and now was starting in my left elbow about 2 weeks after the injury. From there I think the doctor suggested cortisone injections which he did by feel (not under ultrasound) and it actually made things a lot more worse. After that I went to see a physio, who told me my tendons were degrading, that I felt pain over the common flexor insertion olecranon and triceps tendon of both elbows and that it could take up to 18 months to get better. He gave me some eccentric exercises for my forearms and triceps. Still nothing was getting significantly better, yes I was still training but being careful.

    Months later I went to see a specialist who said I had snapping medial triceps with ulnar nerve irritability. He said to continue what I was doing and that he didn’t want to operate.

    I then purchased Peptides (Thymosin (injections) but before I took them I went and saw another physio, who was absolutely useless so I decided to take them.

    6 weeks into the Peptides I got sick and went to hospital and they didn’t know what was wrong with me. The only foreign thing in my body from memory was the peptides. I was getting really sharp pains in my stomach for 3 days, I couldn’t eat and lost close to 10kgs.

    I got better reasonably quickly while taking time off from the gym. Since then I have continued to take time off, not training as hard and incorporate more stretching, swimming, running and Bikram yoga into my exercise regime.

    I had ultrasounds and X-rays done and the only thing in my doctors opinion that showed up was inflammation from the ultrasound. The ultrasound was done a month into the injury from memory.

    I also remember trying a Peptide cream well after the hospital incident. Called CJC-1295 / GHRP-6 Cream 20mg. It didn’t do anything and I started to feel the same symptoms that resulted in me going to hospital, so I stopped.

    I have been continuing to read up on the injury every day watching videos, reading articles but still not finding a solution. I then started a steroid cycle of Deca Durobolin and Testosterone Enanthate, taking 2mls a week, 1 injection twice a week, because I thought the deca would lubricate the joints and help speed up the recovery process.

    I continued to train lightly but not as much I started to find it more difficult I then took time off the gym while still on the cycle. I also started a ketogenic diet and I really started to bulk up, which I didn’t like. The steroids weren’t helping the problem in fact I was starting to get more problems in my neck, shoulders, back and knees. I had put on 6kgs in the first couple of weeks. My neck really started to hurt and was really tight along with my traps and back. My shoulders, elbows and wrists really hurt and my knees also. My whole body was acting like it was 80. So I decided to stop the steroids and start my post cycle treatment soon after.

    While I was on the steroids I also saw another physio who thought the problem was in my neck since it was bilateral in my elbows. He recommended a neck MRI, which I got and my doctor said nothing showed up. We also did a QUICK session of acupuncture. The physio gave me some neck exercises to do.

    To this day I have stopped doing eccentric exercises and am currently trying anti-inflammatories again. I wear elbow braces from time to time. I get massages regularly. I have purchased a new (medium) bed and am trying different sleeping positions (pillow between knees, side sleeping with pillow between arms) I have taken a month off from weighted exercises and am just doing swimming, running, bikrum yoga. I have found somedays bikrum helps and swimming helps and other days it doesn’t. It’s hard to find out what exactly works because anything can happen during the day to your arm which can leave you confused as to what is working.

    I am still doing neck and arm stretches but not as much as I should be. All of my joints crack all the time! My wrist and elbow hurt the most, then neck, then back/traps and knees and then shoulders.

    I have looked into crepitus but am unsure if I have it. My doctor did a blood check for everything and all the results came back fine.

    Whenever I am resting I am most restless and in pain. When I’m out walking around or doing things my arms don’t seem to hurt. When I sit down I’m in pain, when I sit at my computer I’m in pain and I am usually at my computer. Turning taps and doing push exercises or driving sometimes hurts also.

    My jobs that I do for a living require me to be in really good shape. This injury is having not only having an effect on me physically but mentally also. Also the more stressed I get the more pain I feel in my elbows.

    My Doctor has now recommended me to go see someone that does “blood plasma” and has also written that I have medial epicondylitis.

    My current daily medication is:

    · 4 Fish Oils

    · BCCA

    · Green Tea

    · Kava tablets (not daily)

    · 2 x Akamin 50 (minocycline) for pimples

    · Movalis 15 (mobic) (anti-inflammatories)

    · 3 x super joint and arthritis relief (1 = 750mg glucosamine hydroochloride, 250mg Chondroitin Sulfate Shark)

    · Post Cycle Treatment (Nolvadex, Clomid)

    · 1 x multi vitamin

    So in conclusion my elbows aren’t getting better and i haven’t found anything that can significantly fix this problem. I am having whole body aces, pains, cracks, tightness e.t.c. I need to be physically active for my mental side and for my career. Surgery is something I am NOT leaning towards because of the risks, recovery time e.t.c.

  28. z

    Hey. I was wondering if spinal tendinitis could cause slight misalignment in the spine. Ever since a pinched nerve in my back 8 months I’ve had all kinds of discomfort and slightly out of place bones (including a vertebrae in my lumber region, my neck and a bone in my lower shoulder). An MRI shows the problem is so slight it should not even be causing discomfort and the funny thing is, with frequent massage and physical therapy these bones go right back into place….only to go out of place again after a month of no massage. I happen to be in China and I’ve preferred Chinese traditional treatment (at least when I can find reliable, authentic ones, which are not always easy to find), the western doctors seem to think this problem isn’t serious and keep focusing on the bones. They missed two huge lumps in my back between my spine and shoulder blades. This makes sense because I had a habit of carry a heavy bag with my computer and textbooks everywhere, even on strolls around the city….for about 10 years! Stupid, I know now! The traditional doctors say this lump is on a tendon (or a word that seems to translate to tendon, 筋) and so I have had weekly massages to try and massage this lump out. I tried acupressure and found it extremely relieving though the problem always seems to come back. Acupressure doesn’t focus on muscles but pressure points or “qi points” which relax the muscles. So recently I’ve found another traditional doctor who is trying to massage the lumps out. Is this what you are talking about?

    The problem always seems to be aggravated when I sit down and try to keep good posture for over 20 minutes. The best thing, besides massage, seems to be a hot shower which I take once in the morning and once at night.

    And does my problem fit the definition of tendinitis or does it sound like something else? Is it normal for the bones to move slightly out of place from tendinitis and could they easily move back into place after proper treatment?

  29. David

    Hi Dr Schierling,

    I’ve had chronic hamstring tendon pain in both legs for 8 years after a strain when performing leg curls in the gym. I injured the tendons on the inside of my leg, behind the knee. It was a minor strain, but I kept trying to get back to gym exercises too soon and aggravated it and maybe that is why it became chronic.

    The injury site is still sore to the touch and is aggravated by anything that stretches or puts weight on the tendon. I used to see it as a sort of CRPS-like condition, but when I asked a pain specialist about this, he said, “If it is, it’s very mild.”

    The injury caused problems in other areas of my body, like my back and my knees. I found that the only way to fix this was to stretch through pain. Now that I’ve gotten most of my mobility back, I want to see if I can treat the hamstring pain.

    Also, I’ve learned that, sometimes, working through pain is the answer. So I was going to try doing Leg curls again, to see if my hamstrings would heal by getting used to the stimulus of having increased load (they did get used to stretching, mostly). Do you think this could work, or is it a bad idea?



    • In order for tissue healing to take place, you have to put mechanical loads on the tissue and cause “deformation,” which promotes FIBROBLASTIC ACTIVITY. This is a big part of the purpose of my Tissue Remodeling treatments. However, loading it up and doing leg curls again might be a very bad idea. The truth is, there are any number of biomechanists and kinesiologists that recommend you not do hamstring curls. As far as Tissue Remodeling for this, it should not be a problem as long as it is not Complex Regional Pain Syndrome (Sympathetic Dystrophy) — your doctor should be able to tell the difference.

      Dr. Russ

  30. Elvis

    Is there a Dr. who specializes in intermittent flares of tendon pain and restriction. I’ve been trying to narrow down to possibly a food allergen but only thing I can verify is physical work definitely flares up my tendons. I have been better and less flare ups since I’ve been eating healthy and drinking water and no more sodas.

    • Hello Elvis,

      Sounds to me like you have diagnosed the solution to your problem yourself. The first step is to cut any inflammation out of your life. My doctorschierling dot com site is loaded with huge amounts of free information about how best to go about doing this.

      Dr. Russ

  31. gochoosy

    Dear Doc…
    I have been in pain for 2 years. It is debilitating. I have a locked up gluteus medius..and I have pain where my appendix area is… I’m guessing its actually obturator or iliacus pain. CT scan shows enthesophyte at the lesser trochanter and bone spurs at the sacroiliac Joint. I have been to chiropractor..PT.. Taken a ton of Advil..prednisone only once.. I have had NO injections of any kind nor dry needling. Im in my 40s.. This pain affects nerves as well. It all started when a PT tried to do an internal fingertip trigger point therapy on my obturator internus… for POP….which hurt like hell and then had me follow up with hip rotations and cobra exercises… within 3 weeks I went from very little pain to being excruciatingly bedridden. 2 yrs later and I can walk and sit and get around but after an hour or two I must lie down and rest for several hours due to pain before doing anything once again.. I also use heat pad mostly instead of ice. Is this harmful? I dont know what to do anymore.. I cry every week.. I went from working a job and swimming..sledding.. hiking..dancing..etc to living in chronic limiting pain. I need help and I dont know where to go or what to do. Any advice would be appreciated.
    Thank you..
    at my wits end

    • Hello,

      This kind of thing is almost impossible to diagnose or help you with long-distance. Have you seen anyone who will absolutely get in there deep and tear up adhesions and scar tissue? There almost certainly is some in there because of the bone spurs. These bone spurs are probably not causing you any pain, but are indicative of restriction and screwed up biomechanics — probably for quite some time. The other thing I always suggest is to go to my doctor schierling site and figure out what to do with the inflammation.

      Dr. Russ

  32. Melissa

    Hi, I am a professional musician, pianist and organist and have been suffering with tendinosis for four months. Before this injury I was playing a lot, every day, sometimes up to 8 hours a day. After the injury, I was unable to use my hands at all for three months, they were fixed like a claw and I only had thumb to first finger movement. My doctor said it is an overuse injury, rsi. I have been prescribed anti-inflammatories, muscle relaxers, prednisone, pain medicine, I have gone to physical therapy, a neurologist, an orthopedic surgeon, as well as two primary care visits per month. I have had labwork and tested negative for RA and autoimmune disease. I have changed my diet to an anti-inflammation diet, high in protein, eliminated sugar, alcohol, most carbohydrates. I am taking vitamins, and fish oil, cod liver oil, milk thistle, turmeric, and other herbs. Nothing has helped. I am still in pain and unable to play the piano or do most ordinary tasks. Where can I get this treatment? Please help me.

    • Hello Melissa,

      I truly feel for you. This problem is so common in musicians that I wrote a post about it (HERE). You can also check out our Testimonials as I think one of the last ones I put up is from a professional piano player from Cleveland (by way of CA).

      Dr. Russ

  33. Flavia

    Hi Dr. Russ,

    Two months ago I twisted my ankle while walking and since then I have been feeling a growing (but tolerable) pain in my right ankle. When I twisted it, I was still able to walk and I immediately went to the doctor (a couple days later), because I am a trail runner and wanted to make sure I was able to continue running without compromising my ankle. I started trail running one year prior to this, by the way. One month later, I did an MRI, since the condition wasn’t improving, which revealed “mild (peroneal) tendenosis”. At the time (one month in) I hadn’t worn any walking boot, I just stopped running, but was walking normally in my daily routine. I did cycling for that month, which the doctor asked me to stop. I changed doctors (the first one wanted me to give me a corticoid injection), and the second one asked me to go on a boot and start to do EPAT, which I’ve done 3 times (and no anti-inflammatory or ice).

    Is this the same as connective tissue breaking? I feel it’s not improving, on the contrary. The pain is mild and tolerable, but constant, and the pain locations are hot. I feel like when I use my foot, it takes days to go back to where it was before (IF it does..). The pain goes from the side of the basis of the foot to the side of the lower leg near the knee, started to go up to the side of the leg and sometimes I feel it’s connected to my butt muscle. And one week ago, the worst happened. Because I was compensating on the left leg, the left ankle started with the same symptoms (going up on the leg as well), and my arms (which I believe is where the tennis players have pain), started with a mild (very tolerable) burning feeling coming from the elbow and sometimes also on the upper arm. I do not know what to do anymore, as I decided not to step with the right leg, but I have to step with my left one! And my life has been at home using a knee walker and crutches, trying to spare both feet, but not being able to. I’m miserable, as I need to go about my daily activities. I’m currently not working, but in final interview processes this week, and I wonder how I will be able to work like this if I get a job (soon). I feel it is never going to improve, because I have to use my feet and cannot rest both!!! I read your systemic tendinosis page and I have to say I already eat very healthy (following what you say), the only thing (sometimes) is I eat gluten, sugar and do not take enzymes. I felt at first this was due to running (both ankles), but with the arms now, I don’t know anymore. I need help, as this has the potential of not allowing me to accept (very needed) a job and it is ruining my daily life, because it just gets worse!
    Please help!!!!!!!!!!!!!!! I’m desperate!

    • EPAT is not the same as Tissue Remodeling. With this spreading to multiple sites on both sides of the body, and above and below the waist, there almost has to be some sort of Systemic issue at play — possibly an autoimmune reaction against your connective tissues (an ANA test, while certainly not definitive, is not a bad test to start with). There are any number of factors that can drive Autoimmunity (make sure to take a look at my doctorschierling dot com site). However, one of the biggest is Gluten. Although tendinosis itself is not considered “inflammatory”, autoimmunity certainly is. Figure out what might be driving inflammation in your body. I have tons of information on this topic on the site mentioned above.

      Dr. Russ

  34. Damien smith

    Don’t know wat problem is for sure seen doctor 1 year ago and got told pulled muscle got anti inflammatorys fortes since then I have had ultrasound 3 MRI’s 3 injections found biceps tendinosis with small effusion Supraspinatus tendinosis with associated Bursistis am now going to physio but think it might be getting worse wat do I do ?

  35. Kassa

    Hello I have flexor tendon myf fifth finger,Dr.gave me MELOXICAM 7.5 MG.I am still taking scenes10 days ago,i’m working with my pain my doctor told me rest but if I quit my job I have no income and work with pain The most difficult situation in my life I don’t know what to do.please help.
    My name is Kassa

    • Hello Kassa,

      The very first thing you need to do is understand that Tendinosis is not inflammatory. Go over to my Doctor Schierling dot com site and type “NSAIDS” into the search bar, as I wrote an article on this just a few days ago.

      Dr. Russ

  36. Susan

    I started to have severe pain in the middle portion of my right thigh one day after my yoga exercise. I called my friend in India and she suggested another yoga exercise coupled with resting the right feet above the heart. I am now back into yoga and conquered the problem. My suggestion never ever use any of he pain tablets such as Advil, Aleve, Tylenol, etc as they are in way the cause of tendonities in our body where ever that may be.

    • Hello Susan,

      I might also suggest to beware of the Fluoroquinilone Antibiotics (levaquin, cipro, etc) as I get numerous emails about them. I have written several articles on this topic on my blog.

      Dr. Russ

  37. Chad

    wondering where your office is or if there is anyone in Kentucky that uses this procedure .been three years dealing with golfers and tennis elbow along with elbow pain .tried everything that u mentioned with little to no improvement.

  38. Roger


    Ive had golfers elbow from improper technique in tennis starting from last july. Being young and unaware of the consequences i took nsaids and continued playing everyday through january this year. I took a month and a half off starting february when i stopped taking nsaids and stopped training. At the start the pain was so severe that lifting a finger brought pain, mid march the pain was minimal and nearly gone but would get severe if i was playing without nsaids(only tried once for ten min during the break). I started taking nsaids again and played for a month and a half until may 22 when i stopped playing and stopped taking nsaids until now. The pain is no where near as severe as the beginning of the first break but is clearly still evident. Theres stiffness if i leave it in any position (bent or straight) for too long and theres pain when bending the elbow and when turning the elbow face up when the elbow is bent. Its also been swollen throughout the entire time since the beginning of pain last year with or without nsaids. Not sure if that signifies inflammation.Obviously playing is out of the question and i wont until its healed. What would you advise to someone like me? Im very desperate

    Much thanks in advance

    • Hello Roger,

      Best guess is that you are systemically inflamed (see my Doctor Schierling site) with local tendon derangement (tendinosis). Because NSAIDS contribute to Leaky Gut Syndrome (Increased Intestinal Permeability) they contribute to systemic inflammation at the same time they are being used to squelch it. If you go back and read about tendinosis again, you’ll begin to realize that rest or drugs is probably not enough to heal it. Find someone in your area breaking adhesed tissue.

      Dr. Russ

  39. Trent

    Hey mate. I’ve had pain in my lower hamstring for six months now. About 2 inches above knee, Inside hamstring but not quite abductor. The pain is about 3 inches long. I play professional sport and ive had many injuries and muscles strains and muscle fatiguing but nothing like this. Many scans later on the affected area, back, hips and knee; nothing has shown up out of the ordinary. I’ve seen many different sports physicists and doctors and a few have said my pelvis is unstable and glut isn’t firing. I’ve worked hard to correct this and have had no improvements in the feeling/pain. It’s not muscle pain because of what I’ve experienced before and there is no spot that I or anyone else can feel or touch. I’ve been able to train and also play some games but after one game I’m usually sidlined for the next week.

    • Hello Trent,

      Severe enough Tendinosis “may” show up on a good MRI. Fascia will not. Your problem is probably Fascia, although it could certainly be some sort of funky neurological thing. You need someone to get nasty with that area and break up any adhesion and Fibrosis that may be present.

      Dr. Russ

  40. John anderson

    I have had constant pain in my shoulder over a year then I felt a pop and extreme burn now the pain is gone what could have happened

  41. Pascal

    I am a 43 year old male with a BSN and well versed with different massage therapies, long history of fitness and weight lifting. I have been massaging my own tendons,ligaments and muslces for years with great result and satisfaction (From my neck down to my ankles). I spent 2 years in mexico at a mission and other then a few hikes was not able to be as active as I wanted to. I came back to the States last October and started right away with lifting (low weight and high reps) got into feeling great after six months and was able to keep up with the young bucks (biking, running etc.) About 3 weeks ago I did two ab-workouts in one day (one by myself and another one with the residents from calfarley’s boys ranch here in Texas) and played a high powered basketball game for about 90 minutes (haven’t done that one in a while). After a long and busy day I felt some unusual muscle soreness in my groins and lower abdomen/pelvis but it felt like the good kind of pain and I fully ignored it. I kind of “cringed” through 2 more workouts for a couple days until I could not do any major exercises anymore. I layed of from lifting for the past three weeks but the pain is still quite substantial now even with rest, tried some kayaking yesterday and the pain today in my groin but even more so my pelvic area is very much present. From leg raises to jogging to horse back riding it all pretty much hurts. I can compensate some with controlled body positioning but the performance is definitely stifled. I am thinking very munch aponeurosis tendonosis but it is a tough one to treat with the origin being under the symphysis pubis. Part of my job is being active with teenagers and itis getting harder And harder

  42. Celina

    Hi I have has an ultrasound and been told they think I have Bilateral Gluteus Medius Tendonosis, (my hips and thighs were scanned) my Dr is now saying he will try and get further scans done especially if my hip and pelvis I said I want my buttocks done to as a lot if pain in buttocks and back and thighs sometimes behind knees, had this for five years only just getting the Dr to do tests now, pain is worsening not sleeping well and painkillers not working I’m having to beg them for sleeping pills so I can get enough sleep to go work in the morning, feeling very stressed really want to find out more about the scar tissue remodelling, do they do this in the UK? Do you know where au can contact? Any advice would be much appreciated (I’m 32 and an administrator) worry about time off sick as I don’t get sick pay in my job

    Many thanks

  43. Nancy

    I have had issues with tendonitis & bursitis(less often) since I was a kid. I have had major tendon issues within the last 10 years. Both medial & epicondal surgery on my left elbow, & now it has moved into the wrist as well. I am waiting to see if this leading to both wrist surgeries as well. I’ve been wondering for a very long time (since last elbow surgery 2009) if there is some underlying cause I was born with. Anti inflammatory meds reduce swelling but never eliminate the pain, my tendons start to deteriorate and truthfully I am too young to feel this darn old and live in this debilitating pain. The elbow was blamed on repetitive motion, but haven’t done anything repetitive long term since the elbow, for my wrist to now be affected. I am not even using that arm or hand at all in the typing of this.

    • Hello Nancy,

      Even though Tendinosis is not considered “Inflammatory” because there are no Inflammatory cells found in it, I still believe that Chronic Inflammation can lead to Chronic Tendinosis. This occurs either directly or more often, indirectly via autoimmunity. If you want to understand what I’m talking about read THIS, THIS, and THIS. Hopefully these will be of help.

      Dr. Russ

  44. Molly

    What do you do to induce tissue remodeling? Are there other practitioners around the country using your techniques? I had an SI joint injury many years ago which caused intermittent pain, but this has been mostly ameliorated over the last year with intensive PT rehab exercises including weight lifting. However, over the last several years I have developed hip flexor pain on the same side as the SI injury which hasn’t improved at all with the rehab. Hip pain gets better briefly with massage/trigger point work but often returns in a few hours to days and keeps me from walking more than 1/4 mile without discomfort. I am interested in your ideas but live in the upper Midwest and would like to work with someone local. Do you conduct trainings so other professionals can use these techniques?

  45. Peggy

    I have been diagnosed with shoulder impingement syndrome/ tendinitis and I’m taking an anti-inflammatory. I have been through 3 months of PT, still doing exercises and I’m still having pain plus now my hands keep going numb. Any advice would be helpful

    • How were you diagnosed. With problems like this I would always hope that the person had tried some chiropractic adjustments, as the problem could be coming from nerve interference in the lower C-spine / upper T-spine. Sometimes these dx are made without much thought.

      Dr. Russ

  46. Kelly

    I was diagnosed years ago with”tendinitis” and now have “chronic tendinitis” in my elbows, shoulders, hips, feet, and (after reading your article) I am now assuming in my buttocks (sciatica) as well. I cannot recall all these so called injuries happening to me per se. Are there other factors or things that could cause this “chronic tendinitis”? I have already been treated with NSAIDs and muscle relaxers, but currently, the only thing that even remotely helps is tramadol and baclofen; however, i have found that deep massage does give give a little immediate relief. Unfortunately, however, my insurance does not cover massage therapy,at least to my knowledge. My grandmother had rheumatoid arthritis and my sister has MS. There has also been some suggestion of possible Ehlers-Danlos syndrome in our family, so i am wondering if this could factor in somewhere.

  47. tiffanylo

    I would love to hear more about flexor hallucis tendinosis/tendonitis… I believe that is what I am suffering from (well, one of the chronic issues!) after a tibial sesamoidectomy/bunionectomy/hammertoe fusion in April of 2013. My last MRI (in August) showed “thickening” of the flexor hallucis tendon near the lateral sesamoid (the one that remains), as did the MRI I had done in April… I have a host of other issues, but I believe this is the one that continues to “flare”, and cause me a great deal of pain in the ball of my foot. I would imagine that part of this “syndrome” is related to scar tissue from the sesamoid removal, but I also think biomechanical changes and “chronic stress injury/post-surgical changes” (as my MRI report says) are contributing factors… Any thoughts or recommendations on how to manage this? I have been dealing with chronic foot pain for over 2 years now, due to a “midfoot sprain” that evolved into a plantar plate tear and fractured medial sesamoid, then the three surgical procedures (oh, and removal of hardware this year!). That’s the quick explanation, anyway. 😉

  48. Gigi Vazquez

    I have been a cook for 32+ years. Since 2012 I have had trouble with carpal tunnel syndrome in both wrists. I had surgery in October 2012. By May 2013 my right thumb started triggering. I had surgery in August for tendon release in my thumb. Now my middle finger of my left hand is stuck bent, and I can feel my fingers on my right hand starting to trigger also. I have been on anti-inflamitories since 2004 when I had arthritis surgery in my right knee. A month after going back to work I ruptured my tendon in my right knee. I can no longer work because I can’t hold my tools, knifes, hot pans. I have become a danger to myself and others at work. Do you have any words of wisdom on how I can talk to my doctors? They say to stop doing the things that are making it worse. The only thing I have been doing is working.
    Thank You

  49. wes

    Amazed to come across the site! I have a great ART guy who is treating me with breaking up these “adhesions”…however I don[t see on here a name for my problem(first diagonised 5 years ago as “adductor tendonitis”) by a specialist in Toronto…lumpy , ropey adductors and pain like an icepick being driven into my inside upper thigh area and into the crotch/crease where legs meet trunk of the body. Most massage therapists don’t want to get that “close” to you to do a working of the pain and binding in that area.; I am on disability because of this , and other pain areas, like rotator and back, hips etc…so what is pain in the upper adductor called as a “term” for treatment?
    I was even given Nitrol Cream to put on the adductor and adductor entry point out of the pelvis…it worked but HUGH painful headaches, almost unbareable tradeoff! It now remains on shelf and heat bags a couple of times a day are used, but I feel like an old man at 51…:( also have venous insufficiency and valvular incompetence too, but trying to name the condition is my question…thanks!

  50. Danny

    Great web page and thanks for offering your advice for those of us in pain.

    Around five years ago I used to train very hard using kettlebells and body weight exercises. Unfortunately both elbows and both hands have become excessively sore even after months of rest. Even daily chores or holding a phone leave them aching and numb the next day. My hands often gets pins and needles easily and especially in the morning, they feel week and easily strained. My elbows are so sore I have roll out of bed on my side. The right elbow clicks loudly and the left makes a crunching sound. This has persisted for five years now. I have tried many different treatments, supplements, oils, massages etc but to no avail.

    The problem doesn’t seem joint related. I am no expert so please forgive my self-diagnosis but the problem seems to be very tense and tightened forearm muscles, tendons and ligaments and where the tricep meets the elbow too. Excessive gripping of heavy kettlebell’s and chin-ups, the jerking action of clapping push-ups, and the excessive pressure of handstands I believe caused this. Although I stopped these movements soon after the injury arose why O why are they still lingering after all this time?

    If you have any advice on how to remedy this I would be more than grateful. Could this be to do with diet or structural flaw? Is it tendonitis or tendonosis? Lastly, I am based in London, England, is there a good specialist you could recommend? The hospital just passes me off with “pills and rest” but that doesn’t solve anything.

    Thanks in advance,


  51. foodartlife

    Hi, so pleased to stumble on your site. Fantastic! I am a 55 year old active female, Certified Nutritional Practitioner. Roller blading accident 5 years ago may have been factor in my issues, although fell on right thigh. I have a left side tear in gluteus minimus, tendonosis in hip flexor area (MRI) and also some pain in hamstrings with hip flexion (stretch of back of leg) and quadriceps/lower inner thigh tender when doing foam rolling. I suspect SI joint issues as well as those mentioned previously, as I felt a crunch in that area when I hit the ground. Have been to naturopaths, physiotherapists (including laser treatment), chiropractors (including Active Release) for several years with no improvement – finally got the MRI recently and found there was a tear/tendonosis. I am continuing weight training for osteopenia, but lots of pain when moving positions, external rotation impossible due to severe restriction and pain, flexion/extension also hurts. Used to do Bikram yoga – the extreme tree pose with foot on front of opposite leg was my first indication (probably about 3 years ago) of pain with external rotation and it has progressed to being unable to sit in a cross legged position. I had adrenal exhaustion, but have changed my diet and lifestyle drastically over the past 10 years, so better than I was at one time. I am also hypothyroid (all the symptoms) but subclinical TSH. Probably related to the adrenals. Not overweight, but some hormonal fat gain around middle. Do you know of anyone in Oakville/Mississuga/Toronto Ontario Canada area that does scar remodeling? I have had Active Release but it didn’t work. MANY THANKS!!

    • This is a tough one Laurel. You could have kinetic chain issues contributing to various mechanical dysfunctions. Sounds like you are dealing with many of the underlying metabolic (potential) causes. You have done the things that I would have personally done, and recommend. Sometimes these tears take an incredibly long time to heal, and sometimes, depending on how bad the tear really is, they won’t completely heal on their own.

      Dr. Russ

  52. Sandi

    Dr. Russ is your treatment similar to Rolfing?

  53. Noel

    Hi, The index finger of my left hand will not close fully at the proximal interphalangeal joint. It has been this way for several months with no pain present when I attempt to close it (except if I try to force it closed with the other hand, and this is usually only a dull ache rather than a sharp pain). i have had an x-ray and an ultrasound performed on the finger from which my doctor has indicated no apparent damage, only inflammation. She has recommended I see a hand specialist to have steroid injections. As the specialist is booked until next year, My questions from reading your article are – should I even go ahead with steroid injections, are there other methods I can use to regain function (I haven’t directly attempted to exercise the finger) such as stretching and strengthening work, should i stop doing weight-lifting activities. Thanks for any suggestions and information you can provide.

  54. jean troy

    Dear Dr Russ

    I have had recurring tendonosis of my Achilles for about 10 years.I have visited 2 different general doctors who have both told me take NAISDs for a month. I did for a bit , then got scared taking them. i’m so glad i didn’t. Your website, is so informative , just what I was looking for. I feel much more able to cope now I understand the problem. I realize from your website that I need spend more time on the eccentric exercises. . I go to a podiatrist and have orthotics for the condition and am now going to a Physio who does ultra sound and something with an electric current . Most times it’s healed up and I’ve been able to go on hikes but this time it’s been painful for about 5 months. The leg with the achilles problem, sometimes feels heavy and a bit numb, or achy and bruises take ages to heal. I’m 61 and live in the UK.


  55. Peta

    Hi Doc Russell, I have chronic plantar fasciitis (which I’ve had for 10 years) in both feet which is getting worse. I can stand on ye feet for about an hour a day with a pain level of about 8 – 10. I have previously tried scenar to no avail and was wondering if the cold laser would be better. I would need to buy one outright which starts about $2000 because of where I live. How many people have you treated successfully with PF that have had a good outcome with this new treatment? Also how is scenar different to the cold laser therapy?

    • Hello Peta,

      I saw two people with PF yesterday. Both were better immediately. Bear in mind though that with PF there are any number of variables that can throw a wrench in the machine. I dealt with PF for years before meeting Shawn Eno of Xtreme Footwerks in Idaho Springs, Colorado. Shawn built me orthotics that dealt with my old injuries, anatomical anomalies, a short leg, and my crazy high arches. I literally owe him my life. Cold Laser is incredible, but it will not overcome poor biomechanics — particularly if you spend significant time on concrete.

      Dr. Russ

  56. gavin

    Hey Dr. Russ. 21 year old male. diagnosed with tendinosis in both wrists on the ulnar side via mri (bad weightlifting technique+guitar+computer). took it easy for awhile and iced vigorously but a year later and i have not been able to fix it. have recently been having similar “tendinitis” pain in my elbows and Achilles despite doing no physical activity that could have caused these . It is strange to me that these injuries have effected both sides equally. Im beginning to wonder if i have a food allergy causing these effects or some nutrient deficiency. Any ideas?

  57. Judith

    I was diagnosed with addhesive capsulitis of the hip. Where do I go from here. I live in Vancouver Canada. Which doctor or treatment you recomend me. Your recomendation is really much appreciated.



  58. Dianne Korber

    I have a sudden onset after starting a new job of wrist pain which started first only on palm side of wrists and then had a trigger thumb and pain in hands. This has been since the end of March and OT is not helping. I have been told I have flexor tendonitis and possibly CTS. Never prior to this new job which had horrible ergonomics have I had wrist or hand pain. Both wrists on the top and bottom and all fingers hurt, burn and tingle which is a wandering type pain… moves around. I am desperate to get relief… any ideas. Pain also changes in severity throughout day. Heat and compression feel good on hands. Ice no longer does but haven’t done that in a while.

  59. Vee

    Hello, I am a pianist, although I have not played much in the past 2 years except for a little demonstration in lessons with my students. I don’t type a lot but do answer email everyday. Two years ago, I worked in a carwash squeeging the floor for 3 weeks straight. Needless to say, I could barely move my hands after and suffered a lot of pain in both palms and forearms. I’ve been to several physiotherapists who all believe I have nerve entrapment because I have burning pain in my palms – no tingling or numbness though. I either have a lot of pain or burning, sometimes the burning becomes so strong I can’t move my hands. I’ve had a lot of physio (treating nerve entrapment) and chiro for soft tissue manipulation in my forearms – which I think did help as my forearms don’t usually get sore any more. Saw a neurologist and hand specialist who said I do not have nerve entrapment or carpal tunnel – that the burning I now feel should go away if I let myself rest and stop massaging my hands as I’m reinforcing a memory of my injury. My forearms certainly aren’t as tight as they use to be. But I still suffer from burning in the palm, my thumb muscles do cramp a little and I can’t really play the piano or type for very long. Could I have tendinosis in the palm of my hands?

  60. Jannice

    I’ve been reading your articles online and they have been very fascinating. I am a runner (I have to admit I am one of the worst offenders out there) and am 35 years old of age. I’ve have never had tendonitis and didn’t know realize how serious this injury was until seeing how long it is taking me to heal.

    It started in the beginning of November 2013 when I was just walking and I felt a slight tinge (kind of like something popped out of place) on my left ankle and kept walking no problem. The next morning, it bothered me a bit but I didn’t think anything of it so I went for a 5 mile run. Needless to say I was limping afterwards and couldn’t bear any weight on my left foot so I made an appointment with an Orthopaedic thinking I maybe broke something. He ruled out fracture and said that I had “insertional tendonitis” He recommended an ankle brace, which I thought I can just tough through this. I continued running for a few weeks and the problem got worse to the point where it was really really painful for me to walk. I went back and he recommended an air cast that goes up to the knee which I wore for about 3 days (which by the way put my back completely out of wack) so I compensated by wearing wedge heels on the other foot.

    Well….needless to say my other foot started bothering me and it was the same kind of pain, so I banned my aircast and stopped wearing it and went to 2 sessions of acupuncture, which kind of helped. Later I found out that I had “posterial tibial tendonitis.” My left foot is about 95 %of the way healed but my right foot is still bothering me! I have been battling this off and on for quite some time. There is some inflammation/puffiness on the inside of my ankle right under my ankle bone and some on the inside of my foot along with some tingling sensations from time to time and a dull ache. In the meantime, I’ve been to a foot and ankle doctor and got custom orthotics made (which are superhard) but I’ve noticed that has helped in the healing process ( I can stand longer w/o pain). My foot and ankle doc told me that I’m bowlegged so I pronate. I’ve also been seeing a chiropractor and physical therapist. It is just a stubborn injury that is taking forever to go away. I have not been exercising at all other than the exercises my PT gives me since I’ve been seeing him for the past month which are mostly core and ankle strengthening exercises.

    I definitely think it maybe muscular in nature as I get muscle spasms and tightness in my calves and I think about the pain all the time. How can I make this injury heal faster? I’m so scared that this is going to be permanent since it has been going on so long. If this is permanent I think I’m going to shoot myself. (not really) Everyone tells me that this will heal and it just takes time but I think 5 months is too long. Do you think rest at this point given that I didn’t rest initially will help? And if that is the case, what kind of rest. Should I stay completely off the foot and maybe go back to wearing the aircast? My fear is that this will bother my left foot. I was even thinking about a wheelchair at one point, which is going to not work unfortunately. Any help/advice/recommendations would be really really appreciated. I’m desperate at this point!!

    • Hello Janice,

      There are a couple of things that catch my eye here. Firstly, while I have occasionally seen bowlegged folks who are pronators, this is rarely the case. Bowed legs are almost always indicative of supination — a problem that has the potential to be every bit as severe as pronation, but must be dealt with in a totally different fashion (don’t ask me how I know). As always, when it comes to feet, Shawn Eno of Xtreme Footwerks is the man to see. He is a biomechanical genius who literally saved my life and career a number of years ago. You almost certainly need some Tissue Remodeling done in this area as well (this is a large part of the thrust of this site). COLD LASER is a wonderful modality for helping any healing process, including Tendinosis. I would also recommend that in the future, you back way off the cardio, take up sprinting (when you are able), and begin engaging in some strength training. Numerous articles on this on my http://www.DoctorSchierling.com website.

      Dr. Russ

  61. stuart wemyss

    Very interesting indeed! I have had a knee injury for over 3 years now and it has been ultrasound scanned on many occasions. Every time my right knee shows a patellar tendon that is much thicker then my left and there is always a lot of blood vessels showing up. I feel strong pain where the patellar tendon joins the knee cap, when on stairs hills or ladders and discomfort when walking normally. I had an MRI scan and it didn’t show any sign of tendinosis but did have prepatellar bursitis showing up. I have been telling the dooctor that isn’t where the pain is. So now they seem intent on treating bursitis rather than where my pain is just because the tendinosis isn’t on the MRI!

  62. Jessi

    I have what Im being told is acute tendonitis. I have severe pain and swelling. Sometimes in the shoulder, sometimes my elbow and even my wrists. I take Celebrex daily. It is no help to me. The pain is so severe that for a few days I cant even move those joints. Do I have any other options?

  63. Roark

    Obviously not ideal, but it sounds like one way to recover from tendinosis is to eventually tear the tendon and allow it to heal back together with new collagen? I was told by my ortho that a lot of times the tear is a result of slowly progressing tendinopathy anyways. But I hope after it is healed up with newly arranged fibers and cells, that will fix the original tendinopathy.

    • Hello Roark,

      That is one way. Just be aware that tendons heal extremely slow. Tissue Remodeling is like a controlled form of trauma that breaks down old and tangled tissue, causing fibroblastic activity to create new tissue. When aligned by the proper stretching and then strengthened by exercises, it can work quite nicely.

      Dr. Russ

  64. Anita Yenigalla

    I have been diagnosed with a high grade torn supraspinatus torn tendon in my right shoulder, pl help. Thanks . Anita

  65. Professor / Dr Brian A Rothbart

    Excellent blog on the differences between tendinosis and tendonitis. Very salient if you are a researcher in the area of chronic pain. Less important (or of no importance) if you are a chronic pain sufferer looking for a solution to end your chronic muscle and joint pain.

    Both tendinosis and tendonitis are symptoms (just like pain is a symptom). In order to eliminate the symptom you must first determine the cause and then treat that cause directly.

    Professor/Dr Brian A Rothbart

  66. Hi I have just been diagnosed with patella tendonosis in my right knee, unfortunately it was not diagnosed for three years. Its in the proximal pattelar tendon and also the distal quadrangle tendon and, “proximal and patellar tendonosis is quite extensive over full thickness of tendon” it’s bloody painful. I have been declined surgery and have now fallen through the gaps of my countries health system. I don’t know what to do to go about fixing my knee other than stop working as a mechanic. I broke my left tibia 7 years ago and it turned into after having a rod inserted turned in a complete disaster. Bone infection and 4 oeratipns to save it. It took around a 14 months to be able to walk properly again. All the while favoring my good leg, which unfortunately now, and has done for at least three years developed tendonosis. The only way I can receive funding for correct medical treatment is to prove the tendonosis is a direct result of my accident seven years ago. Or as you pointed out tendonosis can be sustained in an accident. It’s possible I didn’t notice tendonosis in my right leg when my left leg continued to sustain trauma after trauma. I would love for you to comment on this and possibly point me in some kind of direction. Thanks heaps

  67. Wayne Bauer

    Hi, I have been a PT for 25 years and have been a tendinosis sufferer for about 20 years. Recently I have begun deep tissue and transverse friction massage to my subscapularis tendon with promising results. I have seen so much “Anti-inflammatory ” treatments fail it is silly anyone would still try them. I really found your website informative and believe everything you state. Keep up the good work!

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