How to treat tendonitis and repetitive strain injury ~ A recovery formula

I’m a tendinitis expert, but not by choice. In 1997, I started an online business and by 2002 my hands were so sore from typing I knew my company and career were in danger. Then, I got bad advice from a doctor and the sh*t really hit the fan. After wearing a brace for three weeks, my muscles atrophied and my condition worsened so much I was unable to serve my food, drive a car or even dress myself. I’m going to teach you how to treat tendonitis (and tendinosis) so you can avoid the agony I experienced.

Repetitive strain injury (RSI) goes by a lot of names – it can also be called tenosynovitis or chronic tendinopathy by doctors. Don’t let their fancy jargon scare you! It’s kind of simple – tendinitis happens when you repeat a motion frequently on tight tissues and when the rate of damage exceeds your body’s natural rate of repair. MDs like to give your pain fancy names when you’ve had the problem for a long time. They sound smarter that way but they’re not.

I’m going to show you what I’ve learned about how to treat tendonitis and RSI by loosening tissue and accelerating my body’s repair efforts. If you like technical terms, the primary technique I use now that I’m in maintenance mode is called self-myofascial release and sometimes trigger point therapy.

My primary injury was to my hands so this guide will focus on the hands, but I’ve also used the same principles on my feet, elbows and glutes (for plantar fasciitis, lateral epicondylitis / tennis elbow and upper hamstring tendinopathy). These techniques work for treating tendinitis or RSI no matter what body part is affected.

How to treat tendonitis – The formula

• Faith
• Rest
• Stretching
• Massage therapy
• Rolling and myofascial release
• Strengthening
• Icing
• Warming up
• Treating root causes
• Avoid
• Resources

Faith

The first thing you need on your journey of healing is to know that you will heal. Your miracle will happen once you learn what your body needs because it has a remarkable will and capacity to heal itself. Know too that you aren’t alone – there is a large community of people who have suffered similar injuries and therapists who can help you heal.

Fifteen years ago when my injury reached crisis stage, I was frightened when I read that some people never recovered from RSI if it was allowed to progress too far. With research and experimentation, however, I discovered an effective therapy. Now, 15 years later, I still have the same underlying disease which makes me ultrasensitive to repetitive stress, but I’ve refined my therapy protocol and I can get a lot done with my hands as a result (those are mine in the picture).

Here’s how I’ve learned to treat tendonitis and repetitive stress injury (with the help of many books, therapists and much trial and error):

Rest

Stop or slow down whatever you’re doing that’s causing you pain. I know as well as anyone how difficult that is — I didn’t drive a car for three months and bought new pants that were easier to get on and off. I didn’t pick up my newborn daughter for months. I relearned typing on the Data Hand keyboard and eventually I switched to speech recognition software Dragon Naturally Speaking (a tremendous nuisance but it works). Whether you like this advice or not doesn’t really matter because your body will eventually force you to do what’s necessary – still, sooner is better than later. Take my word for it.

One of the ways I rested my hands is by using my knees to click the mouse. Notice in the photo at the right, I used hot melt glue to position an optical mouse upside down under my desk on each side of the keyboard. I use the right knee for right clicking and the left knee for left clicking.

Today I work standing up (see pic on left) and move the cursor with a wacom tablet and use my left thumb to click the mouse buttons on the same old trackball.

“A recovery for every effort.” When you’re healthy, you can do whatever you like. But, with a chronic illness, the metaphor of the bank account should guide you. Imagine your injury as an overdrawn bank account – when you rest or do therapy, it’s like making a small deposit. When you do physical activity that stresses your injury, you’re making a withdrawal. Healing happens when you make more deposits than withdrawals.

Stretching

I’m going to talk about stretching before massage because it’s where most people start and where I started. Today massage or more accurately myofascial release is my preferred starting point because I find it requires less skill, works faster and is safer. Nevertheless, stretching when done right is important to have in your bag of tricks for beating tendinitis and keeping it away.

Erase everything from your mind you know about stretching so we can start from scratch. Injured tissue is very delicate and therapeutic stretching is a science. I learned how to do it from Sharon Butler’s superlative book Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program. There’s also a very helpful collection of emails she wrote on sorehand. I broke down in tears reading those emails when it gave me hope I could recover the use of my hands. Thank you Sharon!

I still do about 45 minutes of stretching every evening to improve flexibility in my hands. At the end of my session, my hands feel worn out and crappy, but the next morning, this extra layer of distress is gone and from experience I know this is a good protocol for me. About a third to one half of my stretching targets the upper body and the remainder is focused on my fingers and hands themselves.

Understanding the Stretch Point is the first key to healing your injuries. The Stretch Point is just a very small stretch, but we’ll need to measure how small it is to make sure we’re doing it right and doing it the same way each time. The stretch point is the amount of stretch that subsides when held for 15 seconds.

Let’s try it – put both hands together in front of your face as if you were going to pray. But, these are very subtle sensations, so do this in a quiet place, when your mind is quiet and where you will have no interruptions. Next, raise your elbows slowly out and upwards keeping your hands in the same position. When you feel a very small stretch, stop and hold that position. Start counting – you should start to feel the stretch fade. If it fades substantially within 15 seconds, you just found the Stretch Point, congratulations. If it takes 45 seconds, your stretch was too strong, try again.

Why is this important?

Your body will heal when you perform the right stretches – always using the stretch point as a guide to avoiding further injury. Anyone who has experienced the recovery process knows that it’s not easy to avoid taking two steps forward and one back. With a little forward progress, everyone gets excited and pushes a little too far, too fast and inevitably falls backwards. The Stretch Point is a critical yardstick that will protect you from overstretching. It will help you to have a deeper understanding of how stretching works too.

First, let’s talk about fascia, a form of connective tissue that supports and gives form to muscles. If you want to learn how to treat tendonitis, you’ve really got understand this. Inside a muscle, the smallest muscle fiber is wrapped with fascia. Then, bundles of those fibers are wrapped together with fascia. Then, bundles of bundles are wrapped with fascia, then the whole muscle is wrapped with it. If you follow that muscle along, at some point, the muscle fibers end. But, the fascia doesn’t – it continues until it joins other strands of fascia to become a tendon. Finally, if you follow the tendons along, they attach attache to and blend into the bone.

You can feel this too — how fascia that was spread in many layers, running lengthwise through the muscle, joins together becoming tendon — in your lower calf where the belly of your calf muscle is very thick up near your knee, but narrows and becomes the Achilles tendon down at your ankle.

The same structure is present in every muscle in your body. That means that fascia connects everything in your body to everything else. So what, you ask?

Well, fascia is unique in its ability to chemically change in order to protect the body. When stressed, the collagen fibers that make up the fascia bunch together, forming a thickened and denser bunch of fascia. This can happen instantly as in the unfortunate case where you get rear-ended at a traffic light. At the moment of impact, your fascia instantaneously thicken to create a natural neck brace that protects your spinal cord. Or, if you fall backward on the ice as I did last year and stick your hand out to break your fall, you find that your wrist sustains an enormous impact and bends backward much farther than you like, but doesn’t snap.

Fascia also thickens to protect your body in non-emergency situations, for example when you are typing. The body’s ability to adapt slowly or instantaneously to our activities and accidents is miraculous – what’s not so hot is that the fascia lacks the ability to reverse the thickening and tightening on its own. So, the consequences of stress and trauma in your body are cumulative – your fascia thickens and causes some muscles to work harder than others which causes more thickening in another muscle and the restrictions accumulate. Eventually, it becomes painful especially when tight fascia tugs and pulls on a nerve.

What bodyworkers like Dr. Ida discovered, is that stretching restricted fascia is the most effective way to restore its normal, loose fluidity. By applying pressure, we can manually stretch our fascia back into its natural shape.

Understanding how it all works is helpful, because now you can start to understand what you are doing and feeling as you stretch and massage. You’ll understand what’s happening when you feel a stretch point resolve. You should see too that massage pressure creates a stretch of your fascia the same way that performing a split or bending your wrist back does.

Now, you can understand how rolling with the Deep Recovery or other roller releases restrictions in your fascia that are inaccessible any other way. Finally, you’ll understand how restrictions causing pain at one point, can result from restrictions in your fascia located in different parts of your body and sometimes in different layers of the same muscle.

Massage

Massage has been used for thousands of years to heal injuries, but your doctor won’t mention it, because until recently, scientific evidence has been lacking. Last year, however, researchers from Ontario and California found clear molecular evidence that overworked muscle cells respond to massage with decreases in inflammatory compounds and increases in cell metabolism and healing factors.

Twelve years ago, my first experience with massage was a disaster. I received a strong massage on my hands and they swelled up right afterwards. It was 7 days before the swelling went down and they returned to ‘normal’. So, go slow if you’ve never had a massage before.

If you have sore hands, for example, get an upper body massage that excludes your hands and do your own very gentle massage on your hands before letting someone else touch them. I do my own 30 minute massage on my hands and forearms when they get overworked and it’s transforming. Here’s how I do it:

When my injury was acute, I also used a tool called the Armaid which was very helpful. It has a significant drawback, though, which prevents me from using it any longer. It requires too much physical strength in the hands to operate, so while I’m doing therapy with it, I’m also stressing the same tissues I’m trying to heal. For this reason, I had family members assist me to do massage on my forearms using Armaid. Now, I prefer my own invention, the Body Track™, because I can use my body weight to apply pressure to avoid further stressing the injury.

What I’ve learned about how to treat tendonitis with massage:

• Pressure heals.
• Strong, slow deep tissue massage makes a difference, anything else is just relaxation.
• Deep tissue massage is a type of internal stretching for tissues that are inaccessible through yoga or standard stretching.
• Rolfing/bodywork and myofascial release can create long-lasting changes in your body.
• Pain is just tightness leaving your body.
• A great bodyworker or massage therapist is worth higher rates.
• Great massage therapists can work miracles but having the right massage tool at home can also prevent a serious problem from occurring in the first place.
• If you can’t get by without regular massage, there’s a reason you have tendonitis — think of it as the canary in the coalmine. See treating root causes below.

Rolling

Before I developed Deep Recovery™, the tools that I used most were rollers – the black foam roller and the calf and thigh rollers are good tools for healing tendinitis in the lower half of the body. The black foam roller is also good for working the lats which connect to the arms and hands but not as good as 4″ PVC pipe! Now, I rarely use a roller.

I find massage balls are better at isolating problem areas and penetrating the muscle belly to release trigger points and create flexibility where you need it. The right massage ball is the closest you can get to the hands or elbows of a massage therapist. When used right, they have the power to create lasting changes in your tissues, so please check out my massage ball guide next.

Strengthening

I initially started strengthening exercises because my muscles atrophied after using a brace. However, I continue to exercise my fingers using rubber bands. Here’s why – look at your arm, for a moment. When you bend your elbow, your biceps (flexors) shorten while the triceps (extensors) on the other side of the arm must lengthen an equal amount.

That makes them protagonist and antagonist and there must be an easy balance between them. If there is imbalance due to scarring or thickening of the fascia, one muscle will have to work harder, making it feel fatigued.

When my hands are at rest, my fingers are curled from tightness in my flexor muscles. So, I do rubber band exercises to strengthen the extensor muscles hoping to restore balance between the two. I just use rubber bands but there are special gloves and devices like the Thera-Band Hand Xtrainer or Digi-Extend shown on the right.

Wherever your pain is, consider strengthening your extensors because that’s frequently a source of imbalance and pain. You can find devices to help you strengthen the toe extensors and shin muscles, for example, which may help you beat foot pain if you’ve got it.

Ice

I have used a lot of ice and always find it helpful to help treat tendonitis. Grab a large kitchen bowl and fill it with 4 or 5 cups of ice and about the same amount of water so that you can submerge both hands in ice cold water. I leave them in as long as I can tolerate the pain, usually for bursts of 10 to 20 seconds.

After 4 or 5 minutes of this, when my hands are so cold that they start numbing, I’m finished. It temporarily decreases inflammation and greatly improves circulation. A pain in the a** to be sure, but when you need to make an immediate deposit in your therapy account, this works!

Warming Up

Tendinitis is always more painful when your body is cold (because your tissues are tighter) and I find it helpful to keep my hands warm. So, in the winter, I use the hand warmers you see in the picture on the right to help treat tendonitis. There are tighter fitting fingerless gloves available which I wear occasionally. Mostly though I find these loose-fitting ones in the picture most comfortable.

Causes of RSI & Chronic Tendonitis

If you’ve got tendinitis or repetitive strain injury, it means your body is not healing fast enough to keep up with the strain it’s under.  If you’ve got a garden-variety case of RSI,  you probably need to fix your posture or technique and maybe your diet. After some rest and therapy, you’ll be back in business in no time.  However, if you have a case of RSI that won’t go away after you’ve done all the right things,  you’ll want to take a deeper look at your health picture.

Here’s how to treat tendonitis when it’s chronic and you’ve already tried the basics outlined above:

• Is your vitamin D too low or too high?  vitamin D is actually a hormone and tightly linked to sleep. Your body does its repair during the night while you’re in deep sleep. So if you’re not getting deep sleep every night, that’s a very important signpost. Dr. Stasha Gominak has been treating sleep problems for decades and says you want your 25 hydroxy vitamin D to fall in the 60 to 80 ng/ml range. Consider a home sleep study using an oximeter to determine whether you are suffering from sleep apnea. If you’re not sleeping deeply, you’re not healing. I did a formal sleep study and threw away $1500.  My  $100 oximeter worked much better. Now you can get a $35 iPhone attachment too.

• Get a Manganese RBC blood test – manganese deficiency (which I have) is know to cause TMJ, Repetitive Motion Syndrome, and Carpal Tunnel Syndrome. it’s also a sign that you may have Lyme disease as I do (the Borrelia bacteria feed on manganese).
• Do a series of colon cleanses and liver flushes.
• Look into copper toxicity – Some mineral balancing experts contend that 60% of the US population has toxic levels of copper. Sources of exposure include copper water pipes and IUD birth control. You can be born with a copper overload as it is passed from mother to child. This will show up on a toxic and essential elements hair test by Trace Elements or ARL. Get a consultant to analyze your results.
• Low potassium can be caused by low magnesium which makes it another one of those widespread issues. Severe deficiency results in muscle cramping which is quickly resolved with a few hundred milligrams of potassium (which you can get from a banana).
• Do you have mercury in your mouth?  Amalgam fillings can be highly toxic to some sensitive individuals disrupting their natural healing capabilities. It takes time, but you can fix this.
• Go see a naturopath, nutritional balancing specialist, osteopath, chiropractor, rolfer and or nutritionist.
• Are you suffering from Electron Deficiency? Consider grounding your body while you work and sleep.

What Not to Do

Repetitive Stress Injury is a chronic disease putting it into a category where the traditional medical establishment in the US fails tragically. My personal experience leads me to believe that you put yourself at great risk of physical harm if you take your RSI to a traditional MD.

If you want to let my experience guide you, pay close attention here! This is how to treat tendonitis without inflicting any major setbacks on yourself:

• avoid medication (anti-inflammatories/painkillers)
• avoid cortisone injections (but look into prolozone)
• avoid surgery
• avoid splints and braces
• avoid thinking your average MD will help you (unless it’s an ozone therapy MD like Dr. Rowan)

How to treat tendonitis – more resources

Books

• Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program
• It’s Not Carpal Tunnel Syndrome!
• Repetitive Strain Injury – A Computer User’s Guide

Info & discussion

• Clay Scott’s RSI page at University of Michigan
• Paul  Marxhausen’s  RSI page at University of Nebraska-Lincoln

Mouse alternatives

• DIY footmouse

Related Articles

• Forearm pain
• Neck pain

Therapists

• Guild for Structural Integration
• Hellerwork Structural Integration
• Rolf Institute of Structural Integration

Tools

• Armaid
• Foam rollers
• Deep Recovery