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I was plagued by shoulder and bicep tendonitis as a slalom racer for over 15 years. I was always committed to training harder than anyone else with higher volume of training and accused of overtraining by just about everyone. The result was that I was pushing my body to and often past what it would tolerate without letting me know. The typical solution offered by doctors for fixing it is rest, ice, anti-inflammatory. The typical one from physical therapists is initial rest, then a variety of PNF and other rotator cuff exercises for your shoulder, and some sometimes some stretching, but usually quite a bit of rest, especially in the beginning.
While I am neither a doctor or a physical therapist by trade, I have learned how to deal with tendonitis in my body differently and successfully. Admittedly, I wasn’t sure about this time, as the case was more severe than I have had since 1991 when I didn’t paddle for 4 months the fall before the Olympics (I hadn’t learned my own tendonitis system yet and was following doctors orders).
A brief description of my situation this time.
I was excited to beef up a little before the season. I had two goals: be able to do 5 sets of 20 chin-ups slowly with full extension, and to bench 205 pounds 10 times, slowly. My chin-ups were improving rapidly as I started with sets of 10 and was already up to sets of 12 after 10 days. My bench was also improving as I went from doing 205 pounds only once to 6 times in only 10 days. (I could do this weight before, so it increased quickly) However, on the day I did it six times, I also tried to lift a lot more one time, and my shoulder really hurt the next day. The day after that I did it again, thinking my shoulder was just still sore from the first time, but not hurt. This time, I finished the workout, but by morning, I couldn’t lift my shoulder over my head, and just lifting it from my side hurt a lot. That was a week before coming to Costa Rica.
What I did during the next three and a half weeks.
1. I rested it for two days. It didn’t improve at all but just seemed to hurt more, and all of the time. I took anti-inflammatory (advil) but it didn’t do much.

2. After two days, I started paddling again at Rock Island and didn’t do much to keep off of that shoulder. I was taking Advil (4 three times/ day) but no improvement, and it didn’t get worse.

3. Left for Costa Rica- didn’t paddle for two days due to travel- Again my shoulder started to hurt worse and my neck started to tighten up too, and even if I warmed it up and tried to stretch my neck it pulled on my shoulder and made it worse.

4. Started paddling in Costa Rica- day 1 and 2 was a two day on the Paquare where I used my Hero, and did about 500 rock spins, some hikes and waterfalls, and normal EJ stuff that included using my shoulder. It really hurt when I started paddling but hurt less during the day, and then I couldn’t sleep at night, literally. I would fall asleep to pain, and then get woken up by the pain when it got worse and couldn’t find a position for my body that didn’t really hurt it. Started taking 6 Advil 3 times per day.

5. Bad Day- after my first day on the Reventazon, a 24 mile run where I had a total disregard for my shoulder (except that I wasn’t doing hard downstream moves where I might land on a rock, like the downstream airscrew, or kick flips in many rapids where an impact on my right arm was likely due to shallow rocks) I took my Advil in the morning, but didn’t put on the water until 12 pm, and then got off at 5pm, and didn’t get Advil again until 7pm at dinner. My shoulder hurt so bad that day that I was in a cold sweat with cold shakes, and went to bed wearing a sweatshirt with a hood on, pants and socks, and was shivering and sweating like I had Malaria. My tendons had swollen up due to the exercise, but no ice or Advil. I was short three doses (one at noon, and one at 5pm, and then one at 9pm before bed.

6. I managed to paddle the next day after 8 advil before bed the day before and then another 8 in the morning. The Advil is not for the pain, but for the swelling. (I’ll give you my theory about how I think you best heal tendons after the history). Literally, it was no worse this day after I had the Advil in me again.

7. The next week I paddled with little regard for my shoulder. I chose to train through it, and deal with sleepless nights, since I was in Costa Rica and couldn’t just go home, let it heal, and the come back. This was my kick start to my 2008 training and competing season. Every night was hard, as I had a hard time getting comfortable and couldn’t even had the sheets under my arm because it lifted them a little and seemed to make it hurt worse. If I had to get up or roll over I had to use my left arm because it hurt to use my left arm and I was trying to keep from irritating it.

8. The past two days, I finally did a better job with Advil, making sure to take it before I got on the water and then as soon as possible upon my getting off the river. I tried to eat with it, or at least take a tagamet to keep from irritating my stomach with so much Advil so often for so long.

9. Yesterday was the first day I got off the river and my arm didn’t hurt and on the ride back in Mario’s van with my right arm out the window, it didn’t start to swell up!

10. Last night I didn’t get woken up by the pain, and this morning it seems that it has healed past the danger zone and I now know that I am good to go! My only fear is that I am flying home today and not paddling. A day off from paddling is literally the most damaging to the tendonitis for me. This brings me to my theory.
What I know:

1. Tendonitis is simply when your tendon is injured or irritated. Often it starts when it is injured, but then after it “heals” it still gets irritated for a variety of reasons and when that happens it swells up. A swollen tendon doesn’t fit into its sleeve properly and when it is being used, it actually perpetuates the irritation. This is why people recommend rest. However, when you use it, during the time you use it you bring new blood into it and the swelling goes down during that time quickly, as long as the exercise you are doing isn’t high impact, and starts slowly.

2. When you rest an irritated tendon it heals, but often stays a little swollen in the process, and here is my big theory, the fibers in your tendon that were injured heal in a static state usually “shorter” than before. Those fibers, will, in my experience (everytime), tear again the first time you exercise again after rest, and the tendon WILL swell up again, putting you back where you started! Then you’ll think you didn’t wait long enough, and wait longer next
time, getting more and more out of shape and not helping the situation.
What theory I use when I want to get better:
1. Ice and Advil is the ticket for reducing swelling- once the swelling is down, you can use the tendon and not increase your irritation in it. Simply put, you can use the tendon and let it heal at the same time, but only if there is no real swelling. The more swelling while you use it the more you’ll perpetuate the issue. (I was without ice in costa rica both because of lack of available ice when I needed it, and being a little lazy about it, trusting the advil to do the job.

2. Quantities of Advil: consult with a doctor, of course (I am not a doctor and just telling you what I am doing and what doctors told me). Advil is a drug that you can increase the dosage without issues assuming you take care of your stomach and don’t get overly dehydrated. No drug is good for you, but neither is an appendage that doesn’t work. I start with 4 Advil (800 mg total) when it is a small issue and there are KEY times you MUST take it.

a. Before bed- NEVER go to bed without Advil or your tendon will swell up past the point of being able to use it the next day.

b. When you wake up- you’ll be past the time the Advil is working when you wake up and your tendons will be prime to swell up unless you get Advil back in the system right away. Don’t take with coffee or other stomach irritant, but with milk, and food.

c. At lunch time- keep things in check during the day

d. At Dinner time- your exercise day is about over- you have used your tendon and it is still getting irritated, keep the swelling down

e. Bed time- you know this one now.

3. Exercise no-nos:

a. Stretching- so you like to stretch before you exercise; well forget it! Stretching cold or semi-cold injured or irritated tendons tear the microfibers that are trying to heal all at once and you’ll swell up immediately and then your exercise will worsen the problem! Don’t do it.

b. Hard jerky, fully stretched out motions- try to keep your activities to smoother motions when possible that don’t push the range of motion of that particular tendon. For me, for example, a squirting stroke or rockspin on the right was a no-no. The tendon is at least slightly swollen at all times and that causes it to be shorter and to put more pressure on it with less stretch than normal. Instead of getting through your day of paddling without pushing past the limit, you’ll end up hurting it again and again.

4. In my case it took 4 weeks from injury, through irritation, to healing. Another week before I could likely do bench press again with totally healed tendon in my prognoses. This is not unusual. Giving up on, or forgetting your Advil or ice, is the key to prolonging the issue, or making it chronic.
Ice: Ice after workout for at least 20 minutes trying to get the tendon itself as cold as possible. I prefer a plastic bag to get it as cold as possible and not get too wet. Using a towel is too much insulation.
Summary: I believe healing your tendons during normal usage allows them to heal with a full range of motion, and at the same pace as rest. I believe healing them with rest sets you up for re-injury your first time out, and you’ll deal with this over and over again until you either get lucky or don’t actually heal it with activity. I believe that keeping the inflammation down while it is healing is the primary goal, along with not having any single large impact on it that would re-injure it. (like my rockspin yesterday that I fell off onto another rock on my right arm pulling it back into prime dislocation position (no harm done, lucky me on that one!)