Overcoming Tendonitis – by Dr. Steven Low & Dr. Frank Skretch

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If you assumed tendonitis to be an inflammatory condition, you’re not alone. However, it’s not; the “-itis” nomenclature is a misnomer, and while one can rarely go wrong with reducing chronic/systemic inflammation, it’s not the cure for tendonitis.

What, then, is tendonitis and what does cure it? It’s a non-inflammatory proliferation disorder, meaning, something is growing (or in this case, simply being replaced) in a way it shouldn’t. As to fixing it, that’s more complex.

This book does cover 20 interventions (sorted into “major” and “minor”), ranging from exercise therapies to surgery, with many things between. It also examines popular myths that do not help, such as rest, ice, heat, and analgesics.

The style of this book is hard science, but don’t worry, it explains everything along the way. It does however mean that if you’re not very accustomed to wading through scientific material, you can’t just dip into the middle of the book and be guaranteed to understand what’s going on. Indeed, before even getting to discussing tendonitis/tendinopathy, the first chapter is very reassuringly dedicated to “understanding the levels and classification of evidence in studies”, along with the assorted scales and guidelines of the Center for Evidence-Based Medicine.

The rest, however, is about the etiology, diagnosis, and treatment of tendonitis and tendinopathy more generally. One interesting thing is that, according to the abundant high-quality evidence presented in this book, what works for one body part’s tendonitis does not necessarily work for another body part, so we get quite a part-by-part rundown.

Bottom line: this book has a wealth of useful, applicable information about management of tendonitis, making it indispensable if you or a loved one suffer from such—but settle in, because it’s not a light read.

Click here to check out Overcoming Tendonitis, and overcome tendonitis!

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  • A new government inquiry will examine women’s pain and treatment. How and why is it different?

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    The Victorian government has announced an inquiry into women’s pain. Given women are disproportionately affected by pain, such a thorough investigation is long overdue.

    The inquiry, the first of its kind in Australia and the first we’re aware of internationally, is expected to take a year. It aims to improve care and services for Victorian girls and women experiencing pain in the future.

    The gender pain gap

    Globally, more women report chronic pain than men do. A survey of over 1,750 Victorian women found 40% are living with chronic pain.

    Approximately half of chronic pain conditions have a higher prevalence in women compared to men, including low back pain and osteoarthritis. And female-specific pain conditions, such as endometriosis, are much more common than male-specific pain conditions such as chronic prostatitis/chronic pelvic pain syndrome.

    These statistics are seen across the lifespan, with higher rates of chronic pain being reported in females as young as two years old. This discrepancy increases with age, with 28% of Australian women aged over 85 experiencing chronic pain compared to 18% of men.

    It feels worse

    Women also experience pain differently to men. There is some evidence to suggest that when diagnosed with the same condition, women are more likely to report higher pain scores than men.

    Similarly, there is some evidence to suggest women are also more likely to report higher pain scores during experimental trials where the same painful pressure stimulus is applied to both women and men.

    Pain is also more burdensome for women. Depression is twice as prevalent in women with chronic pain than men with chronic pain. Women are also more likely to report more health care use and be hospitalised due to their pain than men.

    woman lies in bed in pain
    Women seem to feel pain more acutely and often feel ignored by doctors.
    Shutterstock

    Medical misogyny

    Women in pain are viewed and treated differently to men. Women are more likely to be told their pain is psychological and dismissed as not being real or “all in their head”.

    Hollywood actor Selma Blair recently shared her experience of having her symptoms repeatedly dismissed by doctors and put down to “menstrual issues”, before being diagnosed with multiple sclerosis in 2018.

    It’s an experience familiar to many women in Australia, where medical misogyny still runs deep. Our research has repeatedly shown Australian women with pelvic pain are similarly dismissed, leading to lengthy diagnostic delays and serious impacts on their quality of life.

    Misogyny exists in research too

    Historically, misogyny has also run deep in medical research, including pain research. Women have been viewed as smaller bodied men with different reproductive functions. As a result, most pre-clinical pain research has used male rodents as the default research subject. Some researchers say the menstrual cycle in female rodents adds additional variability and therefore uncertainty to experiments. And while variability due to the menstrual cycle may be true, it may be no greater than male-specific sources of variability (such as within-cage aggression and dominance) that can also influence research findings.

    The exclusion of female subjects in pre-clinical studies has hindered our understanding of sex differences in pain and of response to treatment. Only recently have we begun to understand various genetic, neurochemical, and neuroimmune factors contribute to sex differences in pain prevalence and sensitivity. And sex differences exist in pain processing itself. For instance, in the spinal cord, male and female rodents process potentially painful stimuli through entirely different immune cells.

    These differences have relevance for how pain should be treated in women, yet many of the existing pharmacological treatments for pain, including opioids, are largely or solely based upon research completed on male rodents.

    When women seek care, their pain is also treated differently. Studies show women receive less pain medication after surgery compared to men. In fact, one study found while men were prescribed opioids after joint surgery, women were more likely to be prescribed antidepressants. In another study, women were more likely to receive sedatives for pain relief following surgery, while men were more likely to receive pain medication.

    So, women are disproportionately affected by pain in terms of how common it is and sensitivity, but also in how their pain is viewed, treated, and even researched. Women continue to be excluded, dismissed, and receive sub-optimal care, and the recently announced inquiry aims to improve this.

    What will the inquiry involve?

    Consumers, health-care professionals and health-care organisations will be invited to share their experiences of treatment services for women’s pain in Victoria as part of the year-long inquiry. These experiences will be used to describe the current service delivery system available to Victorian women with pain, and to plan more appropriate services to be delivered in the future.

    Inquiry submissions are now open until March 12 2024. If you are a Victorian woman living with pain, or provide care to Victorian women with pain, we encourage you to submit.

    The state has an excellent track record of improving women’s health in many areas, including heart, sexual, and reproductive health, but clearly, we have a way to go with women’s pain. We wait with bated breath to see the results of this much-needed investigation, and encourage other states and territories to take note of the findings.The Conversation

    Jane Chalmers, Senior Lecturer in Pain Sciences, University of South Australia and Amelia Mardon, PhD Candidate, University of South Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Chair Stretch Workout Guide

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝The 3 most important exercises don’t work if you can’t get on the floor. I’m 78, and have knee replacements. What about 3 best chair yoga stretches? Love your articles!❞

    Here are six!

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  • Managing Jealousy

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    Jealousy is often thought of as a young people’s affliction, but it can affect us at any age—whether we are the one being jealous, or perhaps a partner.

    And, the “green-eyed monster” can really ruin a lot of things; relationships, friendships, general happiness, physical health even (per stress and anxiety and bad sleep), and more.

    The thing is, jealousy looks like one thing, but is actually mostly another.

    Jealousy is a Scooby-Doo villain

    That is to say: we can unmask it and see what much less threatening thing is underneath. Which is usually nothing more nor less than: insecurities

    • Insecurity about losing one’s partner
    • Insecurity about not being good enough
    • Insecurity about looking bad socially

    …etc. The latter, by the way, is usually the case when one’s partner is socially considered to be giving cause for jealousy, but the primary concern is not actually relational loss or any kind of infidelity, but rather, looking like one cannot keep one’s partner’s full attention romantically/sexually. This drives a lot of people to act on jealousy for the sake of appearances, in situations where they might otherwise, if they didn’t feel like they’d be adversely judged for it, be considerably more chill.

    Thus, while monogamy certainly has its fine merits, there can also be a kind of “toxic monogamy” at hand, where a relationship becomes unhealthy because one partner is just trying to live up to social expectations of keeping the other partner in check.

    This, by the way, is something that people in polyamorous and/or open relationships typically handle quite neatly, even if a lot of the following still applies. But today, we’re making the statistically safe assumption of a monogamous relationship, and talking about that!

    How to deal with the social aspect

    If you sit down with your partner and work out in advance the acceptable parameters of your relationship, you’ll be ahead of most people already. For example…

    • What counts as cheating? Is it all and any sex acts with all and any people? If not, where’s the line?
    • What about kissing? What about touching other body parts? If there are boundaries that are important to you, talk about them. Nothing is “too obvious” because it’s astonishing how many times it will happen that later someone says (in good faith or not), “but I thought…”
    • What about being seen in various states of undress? Or seeing other people in various states of undress?
    • Is meaningless flirting between friends ok, and if so, how do we draw the line with regard to what is meaningless? And how are we defining flirting, for that matter? Talk about it and ensure you are both on the same page.
    • If a third party is possibly making moves on one of us under the guise of “just being friendly”, where and how do we draw the line between friendliness and romantic/sexual advances? What’s the difference between a lunch date with a friend and a romantic meal out for two, and how can we define the difference in a way that doesn’t rely on subjective “well I didn’t think it was romantic”?

    If all this seems like a lot of work, please bear in mind, it’s a lot more fun to cover this cheerfully as a fun couple exercise in advance, than it is to argue about it after the fact!

    See also: Boundary-Setting Beyond “No”

    How to deal with the more intrinsic insecurities

    For example, when jealousy is a sign of a partner fearing not being good enough, not measuring up, or perhaps even losing their partner.

    The key here might not shock you: communication

    Specifically, reassurance. But critically, the correct reassurance!

    A partner who is jealous will often seek the wrong reassurance, for example wanting to read their partner’s messages on their phone, or things like that. And while a natural desire when experiencing jealousy, it’s not actually helpful. Because while incriminating messages could confirm infidelity, it’s impossible to prove a negative, and if nothing incriminating is found, the jealous partner can just go on fearing the worst regardless. After all, their partner could have a burner phone somewhere, or a hidden app for cheating, or something else like that. So, no reassurance can ever be given/gained by such requests (which can also become unpleasantly controlling, which hopefully nobody wants).

    A quick note on “if you have nothing to fear, you have nothing to hide”: rhetorically that works, but practically it doesn’t.

    Writer’s example: when my late partner and I formalized our relationship, we discussed boundaries, and I expressed “so far as I am concerned, I have no secrets from you, except secrets that are not mine to share. For example, if someone has confided in me and asked that I not share it, I won’t. Aside from that, you have access-all-areas in my life; me being yours has its privileges” and this policy itself would already pre-empt any desire to read my messages. Now indeed, I had nothing to hide. I am by character devoted to a fault. But my friends may well sometimes have things they don’t want me to share, which made that a necessary boundary to highlight (which my partner, an absolute angel by the way and not overly prone to jealousy in any case, understood completely).

    So, it is best if the partner of a jealous person can explain the above principles as necessary, and offer the correct reassurance instead. Which could be any number of things, but for example:

    • I am yours, and nobody else has a chance
    • I fully intend to stay with you for life
    • You are the best partner I have ever had
    • Being with you makes my life so much better

    …etc. Note that none of these are “you don’t have to worry about so-and-so”, or “I am not cheating on you”, etc, because it’s about yours and your partner’s relationship. If they ask for reassurances with regard to other people or activities, by all means state them as appropriate, but try to keep the focus on you two.

    And if your partner (or you, if it’s you who’s jealous) can express the insecurity in the format…

    “I’m afraid of _____ because _____”

    …then the “because” will allow for much more specific reassurance. We all have insecurities, we all have reasons we might fear not being good enough for our partner, or losing their affection, and the best thing we can do is choose to trust our partners at least enough to discuss those fears openly with each other.

    See also: Save Time With Better Communication ← this can avoid a lot of time-consuming arguments

    What about if the insecurity is based in something demonstrably correct?

    By this we mean, something like a prior history of cheating, or other reasons for trust issues. In such a case, the jealous partner may well have a reason for their jealousy that isn’t based on a personal insecurity.

    In our previous article about boundaries, we talked about relationships (romantic or otherwise) having a “price of entry”. In this case, you each have a “price of entry”:

    • The “price of entry” to being with the person who has previously cheated (or similar), is being able to accept that.
    • And for the person who cheated (or similar), very likely their partner will have the “price of entry” of “don’t do that again, and also meanwhile accept in good grace that I might be jittery about it”.

    And, if the betrayal of trust was something that happened between the current partners in the current relationship, most likely that was also traumatic for the person whose trust was betrayed. Many people in that situation find that trust can indeed be rebuilt, but slowly, and the pain itself may also need treatment (such as therapy and/or couples therapy specifically).

    See also: Relationships: When To Stick It Out & When To Call It Quits ← this covers both sides

    And finally, to finish on a happy note:

    Only One Kind Of Relationship Promotes Longevity This Much!

    Take care!

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  • Quit Drinking – by Rebecca Dolton
  • Eyes for Alzheimer’s Diagnosis: New?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Time!

    This is the bit whereby each week, we respond to subscriber questions/requests/etc

    Have something you’d like to ask us, or ask us to look into? Hit reply to any of our emails, or use the feedback widget at the bottom, and a Real Human™ will be glad to read it!

    Q: As I am a retired nurse, I am always interested in new medical technology and new ways of diagnosing. I have recently heard of using the eyes to diagnose Alzheimer’s. When I did some research I didn’t find too much. I am thinking the information may be too new or I wasn’t on the right sites.

    (this is in response to last week’s piece on lutein, eyes, and brain health)

    We’d readily bet that the diagnostic criteria has to do with recording low levels of lutein in the eye (discernible by a visual examination of macular pigment optical density), and relying on the correlation between this and incidence of Alzheimer’s, but we’ve not seen it as a hard diagnostic tool as yet either—we’ll do some digging and let you know what we find! In the meantime, we note that the Journal of Alzheimer’s Disease (which may be of interest to you, if you’re not already subscribed) is onto this:

    Read: Cognitive Function and Its Relationship with Macular Pigment Optical Density and Serum Concentrations of its Constituent Carotenoids

    See also:

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  • When Carbs, Proteins, & Fats Switch Metabolic Roles

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    Strange Things Happening In The Islets Of Langerhans

    It is generally known and widely accepted that carbs have the biggest effect on blood sugar levels (and thus insulin response), fats less so, and protein least of all.

    And yet, there was a groundbreaking study published yesterday which found:

    Glucose is the well-known driver of insulin, but we were surprised to see such high variability, with some individuals showing a strong response to proteins, and others to fats, which had never been characterized before.

    Insulin plays a major role in human health, in everything from diabetes, where it is too low*, to obesity, weight gain and even some forms of cancer, where it is too high.

    These findings lay the groundwork for personalized nutrition that could transform how we treat and manage a range of conditions.❞

    ~ Dr. James Johnson

    *saying ”too low” here is potentially misleading without clarification; yes, Type 1 Diabetics will have too little [endogenous] insulin (because the pancreas is at war with itself and thus isn’t producing useful quantities of insulin, if any). Type 2, however, is more a case of acquired insulin insensitivity, because of having too much at once too often, thus the body stops listening to it, “boy who cried wolf”-style, and the pancreas also starts to get fatigued from producing so much insulin that’s often getting ignored, and does eventually produce less and less while needing more and more insulin to get the same response, so it can be legitimately said “there’s not enough”, but that’s more of a subjective outcome than an objective cause.

    Back to the study itself, though…

    What they found, and how they found it

    Researchers took pancreatic islets from 140 heterogenous donors (varied in age and sex; ostensibly mostly non-diabetic donors, but they acknowledge type 2 diabetes could potentially have gone undiagnosed in some donors*) and tested cell cultures from each with various carbs, proteins, and fats.

    They found the expected results in most of the cases, but around 9% responded more strongly to the fats than the carbs (even more strongly than to glucose specifically), and even more surprisingly 8% responded more strongly to the proteins.

    *there were also some known type 2 diabetics amongst the donors; as expected, those had a poor insulin response to glucose, but their insulin response to proteins and fats were largely unaffected.

    What this means

    While this is, in essence, a pilot study (the researchers called for larger and more varied studies, as well as in vivo human studies), the implications so far are important:

    It appears that, for a minority of people, a lot of (generally considered very good) antidiabetic advice may not be working in the way previously understood. They’re going to (for example) put fat on their carbs to reduce the blood sugar spike, which will technically still work, but the insulin response is going to be briefly spiked anyway, because of the fats, which very insulin response is what will lower the blood sugars.

    In practical terms, there’s not a lot we can do about this at home just yet—even continuous glucose monitors won’t tell us precisely, because they’re monitoring glucose, not the insulin response. We could probably measure everything and do some math and work out what our insulin response has been like based on the pace of change in blood sugar levels (which won’t decrease without insulin to allow such), but even that is at best grounds for a hypothesis for now.

    Hopefully, more publicly-available tests will be developed soon, enabling us all to know our “insulin response type” per the proteome predictors discovered in this study, rather than having to just blindly bet on it being “normal”.

    Ironically, this very response may have hidden itself for a while—if taking fats raised insulin response without raising blood sugar levels, then if blood sugar levels are the only thing being measured, all we’ll see is “took fats at dinner; blood sugars returned to normal more quickly than when taking carbs without fats”.

    You can read the study in full here:

    Proteomic predictors of individualized nutrient-specific insulin secretion in health and disease

    Want to know more about blood sugar management?

    You might like to catch up on:

    Take care!

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  • The Biggest Cause Of Back Pain

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    Will Harlow, specialist over-50s physiotherapist, shares the most common cause (and its remedy) in this video:

    The seat of the problem

    The issue (for most people, anyway) is not in the back itself, nor the core in general, but rather, in the glutes. That is to say: the gluteus maximus, medius, and minimus. They assist in bending forwards (collaborating half-and-half with your back muscles), and help control pelvic alignment while walking.

    Sitting for long periods weakens the glutes, causing the back to overcompensate, leading to pain. So, obviously don’t do that, if you can help it. Weak glutes shift the work to your back muscles during bending and walking, increasing strain and—as a result—back pain.

    The solution (besides “sit less”) is to do specific exercises to strengthen the glutes. When you do, focus on good form and do not try to push through pain. If the exercises themselves all cause pain, then stop and consult a local physiotherapist to figure out your next step.

    With that in mind, the five exercises recommended in this video to strengthen glutes and reduce back pain are:

    1. Hip abduction (isometric): use a heavy resistance band or belt around legs above the knees, push outwards.
    2. The clam: lie on your side, bend your knees 90°, and lift your top knee while keeping your body forward. Focus on glute engagement.
    3. Clam with resistance band: use a light resistance band above your knees and perform the same clam exercise.
    4. Hip abduction (straight leg): lie on your side, keep legs straight, lift your top leg diagonally backward. Lead with your heel to target your glutes and avoid back strain.
    5. Hip abduction with resistance band: place a resistance band around your ankles, and lift leg as in the previous exercise.

    For more on all these, plus visual demonstrations, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

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    Take care!

    Don’t Forget…

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    Learn to Age Gracefully

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