Why do muscles – and especially tendons often take so long to heal?…
WHY don’t they fully recover from injury – even when you follow the “official” Tennis Elbow treatment advice to the letter?...
And why do they so often get re-injured in spite of your best efforts?
This article is basically a video transcript and contains references to visuals found only in the video, which subscribers can watch here – VIDEO: Healing Tennis Elbow
To begin with, there’s a myth about healing we need to dispel – The one that says… “IF I give my injury time and rest – it will heal on its own.”
Now this may be true when it comes to the mending of broken bones, once they’re set and cast – But it’s a perilous misconception when applied to the healing of most muscle and tendon injuries…
And Tennis Elbow is certainly a muscle and tendon injury.
Time and rest are NOT what’s most important – especially not in the mid to latter stages of the healing process.
So, let’s look at how the healing process is supposed to work – and discover where it gets stuck, so you’ll know what to do to treat your Tennis Elbow to help it heal instead of simply resting, hoping and waiting…
So you can break the vicious Tennis Elbow cycle once and for all – and get back that pain-free strength and confidence in your muscles and tendons as fast as possible.
Now, there are three very well-known stages in the healing process of muscles and tendons:
Step One In The Healing Process Is The 'Inflammation' Stage
In order to repair anything in the body that gets damaged or simply needs to be replaced, it takes extra oxygen, nutrition and other things that have to arrive through the blood stream…
…and inflammation speeds that process, among other things.
Of course, inflammation can get out of hand, for example, in the case of a sudden, major traumatic injury, like a bad ankle sprain, and it can cause a lot of swelling…
In which case, it makes sense to do some icing at first to reduce the swelling.
That’s almost never the problem with persistent, slow-healing tendon injuries though.
The problem is more likely the opposite – There isn’t enough circulation to the damaged tendon – And not enough inflammation!
And that’s why healing is going too slowly – or it’s not happening at all – and ice is only going to make that worse.
Step Two In The Healing Process: The 'Repair' Stage
And this is when Scar Tissue forms to repair the tear – To patch it back together, if you will…
And I hate to tell you this, but this is a necessary part of the healing process, too!
You see, any tearing that happens in muscle or tendon - whether it’s a larger tear or a smaller, microscopic tear – gets fixed with Scar Tissue.
And, I know this will probably sound crazy… But, there IS such a thing as “good” scar tissue – just as there’s “bad” scar tissue.
GOOD scar tissue is JUST enough to fix the tear…
And most importantly, good means that the scar tissue repair becomes both strong AND flexible…
And it’s Step Three the healing process, that’s supposed to make this happen.
It’s supposed to finish the job started by inflammation and scarring – and help make the repair stronger and more flexible, because it certainly doesn’t start out that way.
Now, in order to visualize this process, imagine we’re looking through a microscope, and this is the magnified view of some muscle fibers, which have torn.
If we didn’t know any better, we might assume this tear would just heal in a nice, clean, orderly fashion like this...
(And although I’m obviously simplifying here, the fact is that most muscle and tendon fibers do run in fairly straight, parallel lines like this, and that is important to their strength and flexibility.)
But, think about how your skin heals if you have a cut, or a bad scrape…
The scar that forms is a rough and lumpy mess, in the beginning – isn’t it?
Well, it’s not all that different in the damaged muscle or tendon underneath the skin…
It starts out in a MESSY and disorganized way, like this…
You don’t get an instant, perfect repair – What you get is more like a rough draft that’s going to take a lot of revising.
And that’s where the THIRD part of the healing process is supposed to come in…
Step Three In The Healing Process: The 'Remodeling' Stage
It’s called the Remodeling stage – And it’s all about making – or REmaking this rough, initial repair into something BETTER, stronger and more flexible.
This is a hugely important step, and one of the most valuable things I have to share with you, considering how neglected this step usually is.
The remodeling stage is one of the biggest challenges in the healing process – Because it’s a point at which healing very often stalls.
And let me tell you, the scar tissue can easily stay stuck like this, indefinitely, as is the rest of your life, unless you help the remodeling process.
Which means that, knowing how to help it is one of the most important keys to better, faster, stronger healing.
Don’t be surprised if you’ve never heard of remodeling, though, outside the context of fixing up some old house.
You could scroll through a thousand WebPages about Tendonitis and you might NEVER find any mention of it.
Why not – If it’s so important?
I can only suggest that it’s probably because there’s no magic bullet for it: There’s no pill, no shot and no other symptom-focused medical treatment that will help it.
Now, let’s look at how the entire healing process plays out differently in muscles and tendons.
They both have to go through much the same healing process – but their challenges and pitfalls are completely different.
And the reason why you need to know this, is because muscles and tendons need very different therapies to help them through those challenges and help them finish healing.
Let’s talk about muscles first. Muscles have the better blood supply and heal more easily.
The first two stages of the healing process: inflammation and scarring usually happen quite well by themselves…
The challenge with muscles ends up being mostly with this remodeling stage we’ve been talking about.
What we tend to get in muscles is plenty of inflammation and often too much scarring, and the risk is that it leaves the muscle bound up and restricted by a big mess of sticky scar tissue – like this – only worse…
And the key action we need to be thinking about here is releasing!
The remodeling of scar tissue in muscles is mostly about making sure it’s not all stuck and restricted – both to itself and to the surrounding area.
Most of all it needs to get more flexible, in other words…
Here I have some stretchy red stuff to represent a muscle, (which is red in color as you know) – and this white tape represents some scar tissue, which does happen to be whiteish colored.
As you can see, the scar tissue, which has formed here to fix this tear in the muscle, is a random sticky mess - and therefore it’s not as flexible as it should be if it had been remodeled.
But, the right kind of pressure and friction applied by hand to manipulate this can gradually break up and release this mess. It can encourage it to remodel…
And help transform it into a thinner and more flexible repair - like this …
Timing is really, really important of course – You wouldn’t start aggressively manipulating, the day after a significant injury happened any more than you would start stretching and exercising…
There is a right time to begin, and sometimes that’s as soon as three days, to a week after the injury – but there are too many variables for me to just give you a set time frame.
Of course with most cases of Tennis Elbow there is no single injury event – The damage has most likely been happening slowly over a long time – by the time the first symptoms even appear.
Yes, it’s possible to start too soon and be too aggressive – but most tendonitis sufferers do the opposite: They rest too much, and wait too long.
As I said in the beginning: Time and rest are NOT what’s most important – by the time we get to the remodeling stage of the healing process – rest becomes counterproductive!
And the more time that passes, the more critical it becomes to manipulate that muscle – work that scar tissue, and encourage remodeling.
It gets harder the longer we wait. And if there’s never any direct, hands-on manipulation of that scar tissue, to release and remodel it - it may never become the thinner, more flexible repair we want, and may stay a stuck, inflexible lump forever.
Muscles are much more forgiving than tendons, though, and it’s fortunately hardly ever too late to start releasing and remodeling.
Now, when it comes to tendon injuries, it’s not just the remodeling stage of healing we have to be concerned with…
The problem with tendons is often that all three steps in the healing process don’t happen fully. All too often they stop and start, or they fail altogether…
Coming back to our magnified view of a tear – Looking at the tendon this time – the risk is that there will be too little inflammation and repair – and very little if ANY remodeling…
Which would look more like this
…a weak, partial repair that’s so incomplete it can easily tear again – and again – until eventually it stagnates and degenerates…
So with tendons, the challenge, if there’s injury, is to keep the healing process going from start to finish, since it can stall on us at any stage – not just the last one, like with muscles.
The key action in this case isn’t so much “releasing” – as it is with muscles – although that’s still part of the process – when it comes to tendons we need to think stimulation.
To stimulate circulation and inflammation through heat, pressure and friction, so we get good tissue formation – which is what we need to repair the damage…
And then to keep stimulating the tendon throughout the remodeling stage, with more pressure and friction, to make sure remodeling happens, and that it gets completed, so that initial scar tissue is made better and stronger.
Now, there is more to the remodeling process than I can explain here, but the big thing I want you to takeaway from this – is that it just isn’t going to happen all by itself. Not completely anyway.
As I said in the beginning, this idea that we can just rest and wait for healing to happen is a dangerous myth…
Resting it too much, icing it, bracing it or taping it up – All of these things will slow down the circulation needed for the first two parts of the healing process – and delay the remodeling process.
The healing of muscles and tendons is an active, dynamic process – Rest plays a very small role in their healing – unless the injury is severe, and most tendon problems are not.
Sure, a little rest is important in the beginning – but less than most authorities would tell you, in my opinion.
OK, so what about stretching and strengthening exercises?
Yes, exercises and stretches can help release and remodel the scar tissue – And in a perfect world, that would be all you needed to do – But…
…If you look at how many people struggle through their program of exercises and stretches – and fail to make a full recovery in a reasonable amount of time – even under the supervision of PTs and trainers…
I think you’ll agree with me that exercise and stretching are not very effective – they’re not efficient
Now, I’m not saying they’re not important, you understand, they are important – I’m just saying they’re not enough – by themselves!
And there’s also the fact that it’s very easy to stretch the wrong way and re-injure yourself…
and I’m afraid I have to say that almost everyone IS doing it wrong, and taking a big risk.
It’s the same with strengthening exercises. As necessary as they are, you have the same risk of re-injury…
And let’s be honest, re-injuries are notoriously common among people trying to strengthen injured tendons.
The truth is, it’s very hard to stretch and exercise your way through the remodeling stage.
I’m not going to go into this in detail, but one of the biggest reasons is that your own nervous system’s over protectiveness, for lack of a better word, tends to fight you every step of the way.
It usually tries to guard the injury way too much, by resisting attempts to stretch and exercise – even when it’s desperately needed.
Fortunately, there’s a better way.
There’s a way to get around that guarding, and help the remodeling process that’s safer, faster AND more effective – And which helps prepare the muscle and tendon for stretching and strengthening…
That is, once again, to use hands-on therapies to manipulate the injured areas…
This is by far, the most powerful thing you can do to speed the healing of injured muscles and tendons, in my opinion.
IF you have just the right approach – The thing is, it needs to be very precise – because, as we covered, muscles and tendons need different things to help them heal.
Tendons need to be stimulated a certain way, with one technique – to keep them repairing and remodeling – and muscles need to be released of excessive scar tissue that’s restricting them, through a different technique.
The good news is that I can show you how to do just that, using the Tennis Elbow formula I’ve developed over the past five years of treating Tendon problems almost exclusively in my practice.
Learn Exactly How To Use These Principles To Help Your Tennis Elbow (Or Golfer's Elbow) Heal At Last
I call it the three times three program.
It centers around three powerful techniques for both releasing and stimulating all the muscles and tendons involved in Tennis Elbow, as the first step.
From there I show you the three essential stretches to do next, and most importantly, how to do them safely and correctly…
Followed – only then – by the three most important strengthening exercises – which will be so much easier and more effective – once you know how to release your muscles, and stimulate your tendons to get them ready for exercising.
All together, the program gives you the best tools to help you break the vicious cycle, and finally escape the Tennis Elbow Triple Trap.
And it’s ready and waiting for you in the private, members area of Tennis Elbow Classroom, in easy to follow video tutorials, just like this one.
Learn To Treat And Heal Your Own Tennis Or Golfer's Elbow Right Here:
You'll get instant access to a complete VIDEO program designed by a professional therapist to help you take charge and break your vicious cycle of elbow injury, pain and frustration!...
I'll be your personal tutor guiding you through easy-to-follow lessons, where you'll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home.
Just watch the videos, follow along and start putting an end to your elbow pain today.
Tennis Elbow sufferers, get started here: Tennis Elbow Classroom
Golfer's Elbow sufferers, get started here: Golfer's Elbow Classroom
Question: I have had tennis elbow for 9 years (got it from using a motorcycle clutch handle that was too large and stiff for my hand). Ironically, I played high school and college tennis and never had an issue! Ha, I wish that was actually funny. I have had 3 cortisone shots in the past, none within the last 3-4 years. I have several other issues along with tennis elbow: I have had patellar tendinitis (maybe -nosis?) for about 25 years, I have relatively freshly repaired meniscus with residual swelling (1 year ago) and a reconstructed acl in one knee from 25 years ago, degenerative arthritis in both knees and also degenerative arthritis in my cervical region. I have been taking nsaids of one type or another, nearly the entire time. (I also played college volleyball and years of flag football, so I’m a mess.)
My question: what do you recommend at this point in terms of pain management if I avoid the nsaids in order to allow the inflammation to do it’s job? I have kept up the nsiad drug regimen so that I can continue to function at work (high stress computer desk job) and work out to stay healthy and within a healthy weight. After reading your articles, I suspect that the nsaids are part of my problem, but I don’t know how to keep the arthritis from knocking me out of action and depressing me with pain without them.
I want to try your methods for the elbow and maybe the patellar tendons and want to buy your program for sure. Do you recommend getting the video plan for my complicated issue?
Maria McDavid says
I have a 50% tear of the elbow tendon. I had tenotomy with prp and a bone spur chipped off. Im in my 4th week doing PT taking Vitamin D3 and collagen. I am a competitive golfer .