Good nutrition for fascia and tendons

I got a client recently who has been suffering from fascia pain for over 20 years, to the point that he can’t wear dress shoes because it hurts too much.  Although he’s a little older (closing in on 50), there’s no reason that it should take decades to heal a fascia.  So I asked him some questions, and started to zero in on his diet.  Here’s the exchange:

Me:  How’s your diet?

Client:  I am definitely a slow healer, but my nutrition is good, to my knowledge. I stay trim and try to eat a balanced diet.

Me:  Okay, so for example.  What’s a typical day look like?

Client:  Breakfast: Quaker oatmeal squares or Wheat Chex.  Lunch: Variable, but balanced cafeteria lunch, with main course and two vegetables.  Dinner: Usually light, such as salad with chicken, or peanut butter sandwich, or fruit and nuts and yogurt.

Be honest now: how many of you out there think that the above is a good diet?  Admittedly, it’s basically not too bad, and certainly a lot better than eating at McDonald’s three times a day.  But there are two big problems here:

Problem number 1:  A lack of protein.

Assuming that the client had 8oz. of skim milk with his Wheat Chex, and the chicken salad (the highest protein choice of the ones listed), this client gets maybe, at the most, 80g of protein on a typical day.  For a normal-sized “trim” adult male, let’s say 190 lbs, he’s getting about half of what he needs for optimal recovery and healing.

Fascia and tendons are made of collagen.  Now, if you read some other sites, they will tell you that taking extra collagen as a supplement is beneficial.  This isn’t any more true than the cosmetics industry telling women that extra collagen is going to make their skin better.  Collagen is formed from protein.  If you’re protein-deficient, your body simply will not have the materials necessary to create new collagen to replace the old worn-out stuff.  And thinking that orally ingested collagen is going to make it through the digestive processes of the stomach, intestines and so on and somehow be “put in place” in your fascia and tendons… well, that’s about as medieval a notion as the belief that eating bull testicles will improve a man’s virility.

Problem number 2: Virtually no good fats.

While science is just starting to recognize the role that essential fats play in healing tendonopathies (see for example this abstract, which talks about the lack of evidence so far), there is no doubt in my mind, after a few decades of dealing with these issues, that they are very beneficial.  And most people don’t eat enough of them by any means.

Dr. Udo Erasmus, probably the world’s leading expert on good fats and what a lack of them can do to your body, has a long list of pervasive problems that can occur when there’s a deficiency in your diet.  (Here’s a link with the list.)  While there hasn’t been much formal experimentation done yet, in my experience you can add tendon and fascia pain to the list as well.  Any dietary deficiency that leads to joint pain, skin problems (skin is supported by collagen), organs falling apart and general inflammation is probably going to have an effect on your connective tissue as well.

In the sample diet above, the only foods listed that have a decent amount of good (ie, Omega-3 and Omega-6) fat were the peanut butter and nuts that my client sometimes has for dinner.  (Assuming they’re the right nuts; chestnuts aren’t much help.)

Omega-3 and Omega-6 profile for various nuts

Omega-3 and Omega-6 profile for various nuts

If he had whole milk with his cereal in the morning, he might also have gotten a little from that.  But overall, there is a clear lack here.

No wonder my client thinks he’s a slow healer.  He’s not getting enough in the way of building blocks to allow his body’s natural repair processes to do their job.  If you’ve had long-term fascia or tendon pain and can’t seem to get rid of it, one thing to look at is your diet.  If what you’re eating looks like the sample above, you may have found the culprit.

As you get older, it takes more to heal properly.  More time, more care, and more int he way of good nutrition.  It’s just a fact of life.

Author: Alex Nordach

Cortisone shots don’t work very well for plantar fasciitis

(I’m going to get a little technical with this post, but if you read past the boring part to get to the conclusion, I promise it’ll be worth your while.)

A recent study conducted in Melbourne, Australia and reported in BMJ (which used to stand for British Medical Journal, but now is just “BMJ”) shows that cortisone injections, while possibly good for a bit of plantar fasciitis pain relief in the short-term, just aren’t effective after about a month or so.

The study tracked 82 people who had plantar fascia inflammation, but not overall systemic inflammation.  These people were divided into two groups, with one group receiving a shot of dexamethasone sodium phosphate (a cortico-steroid, just like cortisone) and the other group getting a placebo shot.  The group that got the real shot reported a 10.9% percent decrease in pain at one month, but no statistically significant pain reduction at the two- or three-month markers.

The study concludes that cortisone injections are good for pain relief in the short-term, but not for the long term.  In other words, you can fool your body for a little while with these things, but not forever.

Okay, so here’s the good stuff.  First, the above has been reported pretty widely, but what I found most interesting wasn’t included in the study abstract.  If you get into the study itself, you’ll find that (1) about 75% of American physicians recommend using cortisone shots to treat plantar fasciitis, and (2) nowhere in the scientific literature has it really been established that these shots actually work.  (In fact, cortisone shots have been shown to be genuinely dangerous, but that’s another subject that you can read about in this post.)

Kind of strange, huh?  I mean, you would think that if all these doctors were recommending a particular kind of treatment, that treatment would at least have some pretty good science behind it…right?

Turns out that this isn’t the case.  I’m not going to go into all the reasons that your doctor might have for recommending something that doesn’t really work, but let’s face it: doctors are human and they can make mistakes just like anyone else.  A lot of times, they confuse plantar fasciitis with plantar fasciosis, which is a significant mistake when you’re trying to treat something.  Also, they’re really really busy, which doesn’t allow them to keep up with the latest research and studies.  (But if you’re reading this, and a doctor tells you to get one of these shots, now you can whip out the results of the best study done so far and see what s/he says.)

Sure, you might get a little pain relief for a short while…but let’s face it, even the people who reported an improvement only got about a ten percent reduction in pain with the shots.  And that was only for about a month.  After that the pain came back and they were just as badly off as they were without the shots.

Wouldn’t it make more sense to go with a treatment technique that actually has quite a bit of scientific evidence behind it?  And one that would actually get rid of the plantar fascia pain once and for all, rather than just temporarily “relieving symptoms”?  Fortunately there is such a treatment, and it’s available to anyone who has a little time to tend to their feet.  It doesn’t require any special equipment, and anyone can do it at home (or anywhere else, if you don’t mind showing your bare feet to strangers).  Furthermore, it comes with a money-back guarantee for 60 days, which is something that no doctor I know offers!

Of course, I’m talking about the ebook+video package that I sell on this site.  It’s called Target Plantar Fasciitis and Posterior Tibial Tendonitis, and I think that it’s the best thing going if you really want to take control of your foot pain.  But I don’t recommend it for everyone.  If you’re interested in buying it, please take the short (and totally free) one-minute test here before you do. It will show you what kind of PF pain you have, and whether or not the TPFPTT package will help you or not.

Author: Alex Nordach

Why is Ryan Mattheus going to get better before you do?

I ran across an interesting article recently.  It caught my eye because of two points, but I’ll let you read it before I tell you why I thought it was interesting:

Ryan Mattheus to visit specialist, will miss two weeks at worst

Washington Post (blog)

“By Adam Kilgore (Al Behrman – AP) Nationals reliever Ryan Mattheus will visit a specialist in Baltimore on Tuesday to determine the severity of plantar fasciitis in his left foot. Depending on the diagnosis, Mattheus could either return in time to …”


So what’s so intriguing here?  Well, one, the Nationals are confident that Mattheus is going to be cured of his plantar fasciitis within two weeks.  That’s not much time.  And two, it doesn’t matter how severe his condition is.  Two weeks is all it’s going to take.

Admittedly, Mattheus is a professional athlete, relatively young, and has access to some really good trainers.  But still, if you’ve been suffering from PF for weeks or months on end, you have to ask yourself why.  You’ve probably been to doctors and maybe done some internet research, but you still have the condition.  The answer is pretty simple: professional sports teams have access to better information than you do.  Or at least, they know which bits out of the overwhelming amount of conflicting data are really relevant and effective.

You could try getting in touch with a professional sports team trainer (very expensive, if you can even get to see one), or you could take a look around this blog and see that there’s very little hype and that everything is supported by science.  And then you could take a risk-free trail (everything is 100% guaranteed for 60 days) of the Target Plantar Fasciitis ebook + video package and see just how easy it is to get rid of long-term plantar fasciitis when you have the right information to work with.

Author: Alex Nordach

Ankle tendon pain

Let’s talk about ankles.

Lots of people complain about “ankle tendonitis”, but what does this really mean? If the pain is in the back of the ankle, just above the heel, then you have a problem with your achilles tendon. If it’s on the outside of the foot, running up the ankle, then you’re looking at some kind of peroneal tendon pain. And if it’s on the inside, running from the instep, under the ankle bone and up the leg a bit, then it’s probably a posterior tibial tendon problem.

Of course, calling any of these conditions “tendonitis” also might not be accurate. If you sprained your ankle and then developed some tendon pain, yes, you likely have short-term inflammation and need to do things like icing and taking aspirin to help combat it. But if you’ve had the pain for more than a couple of weeks, and it seems to be gradually getting worse without any kind of traumatic injury, then it’s much more likely that you have ankle tendonosis.

If you look at the top right of this blog, you’ll see a tendon/fascia test that you can take to determine which one you have. It’s free and will only take a minute – literally. There isn’t even an opt-in, so go ahead and do it now. The results may just change the way you think about your ankle tendon pain.

Author: Alex Nordach

Peroneus brevis and peroneus longus tendonitis

If you order Target Plantar Fasciitis and Posterior Tibial Tendonitis, you’ll see that it comes with a video. The exercises I cover in both are for the plantar fascia, the achilles tendon, and the posterior tibialis tendon (or post tibial tendon). One thing that wasn’t included was what to do for the peroneal tendons (which attach to the peroneus brevis and peroneus longus muscles), which are located on the outside of the foot, opposite from the post tibial tendon.

You don’t hear about it a lot, not like the Achilles tendon problems, but the fact is that quite a few people fall prey to peroneal tendon pain every year. And it can be really difficult to rehab, since the peroneal tendons are smaller and more delicate than the other major tendons in the ankle and foot. So not including the peroneus sisters was an oversight on my part, and I recently received an email from a somewhat dissatisfied customer who suffers from peroneal tendon pain. In order to make things right with him, I have just finished a video that will be available to anyone who purchases Target Plantar Fasciitis and Posterior Tibial Tendonitis (from this website; the videos are NOT included in the Kindle version of the book) starting today. And for anyone who has bought it in the past and wants to see the new exercise, just send me an email at the address listed in the book and I’ll hook you up.

Along the same lines, if there’s something else that you’d like to see in the book, make a comment here and let me know.


Author: Alex Nordach

Keeping it real – alkalinity and tendon/fascia pain

I’ve been involved in the health and fitness industry for something over 30 years now, and no one can say that I don’t appreciate the good that the industry has done over the last few decades. People are getting out and moving more, and that goes a long way toward combatting the ill effects of today’s sedentary lifestyle.  And a lot of folks have become much more aware of what they’re putting into their mouths.  But if there’s one thing that makes me roll my eyes, it’s the exaggerated, unfounded claims that come with trying to sell something that’s exercise- or nutrition-related.

I’m not just talking about bodybuilder protein shakes (“Put 7,423 calories of PURE ENERGY into your body! Supermaxidynamize it! Gain slabs of muscle in only five short minutes!!!”), although the supplement industry’s claims are as outlandish as any. And I’m not just talking about the claims that various exercise disciplines make either – although some of them would put Joe Weider to shame. (I read one book on Pilates that actually seemed to suggest the exercises helped to immunize people against the 1918 Spanish Flu epidemic.) No, the problem is everywhere. And remedies for tendon pain are no exception.

The specific point I want to talk about today has to do with one’s diet, and how alkaline it is. Recently I’ve seen some discussion–and even some articles–about how people have supposedly cured themselves of long-term tendon pain by changing up their diet to make it less acidic and more alkaline. The most generally recommended way to do this by eating more in the way of vegetables and less in the way of meat, especially red meat.

I fully agree that too much acidity in the body can make it easy for inflammation to occur, and as we all know, tendonitis/fasciitis are conditions of inflammation. But thinking that your diet alone is going to determine whether or not you get (or can cure) some sort of ~itis is sort of like thinking that replacing your tires is all you need to get you into the next town. Certainly, if your tires are old and worn it would be a good idea to get some new ones. But most people are going to need some other stuff as well…like some gas in the tank…and a battery under the hood.

Another point is that long-term tendon or fascia pain usually isn’t an ~itis at all, but an ~osis. Tendonosis/fasciosis means degeneration of the tissue itself, not inflammation, and you can eat all the vegetables you like but it won’t have any effect on the collagen fibers that make up both of these structures.

Nutrition experts tend to see everything in terms of diet, and exercise folks look at everything through the lens of movement. But this overloading of one or another facet of health obscures the truth. And the truth is this: a combined approach is the best, surest, and most complete way to eliminate persistent tendon or fascia pain.

Author: Alex Nordach

Cortisone shots and plantar fasciitis

Thinking about getting a cortisone shot for that plantar fascia pain? You might want to think again.

I was searching around in the PubMed archives (yes, I do this for fun) and came across the following abstract. I’ve been preaching against cortisone shots for a long time, but this study really made me shake my head. From the abstract:

From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection.

Wow. So of the people who actually had a rupture, over 85% were associated with some kind of corticosteroid injection. (There are a lot of different types of corticosteroids, so not all of these may have been cortisone. But since all of the options are chemically similar, they might as well have been.) This means that there’s a very good chance that if those patients hadn’t been injected, the overall rate of plantar fascia tearing might have dropped from 6.7% to slightly over 1%. In other words, going from an uncomfortable but treatable condition to a full-blown rupture (i.e., now you need surgery) was more than six times as likely to happen with a shot than without one.

If that right there isn’t enough to convince you, read on:

In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia.

Okay, so you get pain relief from your plantar fasciitis…but then you develop a whole host of other problems. And if you don’t know what all the medical conditions above are, let me just say that a lot of them are a lot worse than plantar fasciitis.

At an average 27-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve.

So your recovery chances are 50/50. And these academic researchers, who don’t have any particular ax to grind when it comes to one therapy or another (the study in question can be found here if you’re interested), end by saying that corticosteroid shots are basically a bad idea because they can cause worse conditions than the one they were intended to heal.

Yet, as we all know, doctors still like to prescribe them. It just doesn’t add up.

Before you try something that has been scientifically shown NOT to help, doesn’t it make sense to try something that’s been scientifically shown TO help? Especially if that something is cheaper? The techniques in my book have that scientific support (not to mention a whole host of real-world testimonials), but before you decide to order it I encourage you to take a free, one-minute test to see if they are right for your condition. No one therapy is right for everyone, and you want to make sure that something is a good fit for your particular condition before you spend any money.

Author: Alex Nordach

A short discussion about “pattern overload”

I’d like to talk a little bit about pattern overload today.

Fundamentally, pattern overload happens when too many repetitions of a given motion or exercise are performed. You don’t necessarily have to be using a lot of weight to incur pattern overload; your own bodyweight can be more than adequate…as can a one-pound dumbbell if the number of repetitions is high enough. Even typing can become a problem if you fail to alter your hand, wrist, chair and/or keyboard position on a regular basis.

Generally speaking, pattern overload isn’t too much of an issue because even with high-rep activities like running or swimming, each time your foot hits the ground or your hand slices through the water, your body is going to use a slightly changed “groove” when executing the movement. A highly trained athlete might be performing in more or less exactly the same groove for a time, but in the long run, as you begin to tire, your groove will begin to become looser and although this means that your efficiency of movement will degenerate, it’s one way that the body tries to stop itself from incurring an injury.

However, some types of exercise can be relatively worse for pattern overload than others. And this can create discomfort in your tendons and fascia. One example would be exercising on gym machines to an excessive degree. People who work out using free weights have a significantly lower rate of pattern overload than those who work only on machines. The reason? When you’re working with a barbell or dumbbell the weight moves in accordance with your body, but when you’re exercising on a machine your body moves along the machine’s predetermined and fixed weight-track. Even Smith machines, which incorporate a minor level of flexibility, are much more limiting and permit less natural “body adjustment” as you go through your sets than free-weight barbells and dumbbells.

Then, on the other end of the spectrum, there is Crossfit. It’s not that I disapprove of Crossfit in and of itself. I think that the essential idea of Crossfit – do something different each day, and keep good track of your rest times – has a lot of merit, and there’s no doubt that the training is stimulating and fun. But there are some drawbacks as well, particularly when you view Crossfit in relation to tendon injuries.

At base, a Crossfit workout involves choosing two or three exercises for distaff bodyparts, and then doing a lot of those exercises using a predetermined weight for a set time. The down time between sets is normally about ten seconds, and you rotate between exercises. As an example, one of the videos on the website shows three women doing bodyweight squats, then pull-ups/presses on gymnastic rings, then hang cleans with a barbell.

If you simply do too much of a movement, even if that movement is something totally “free”, like swimming, you can acquire tendon and fascia issues if you exercise so much that the amount exceeds your body’s capacity to recover. And this is where I have a problem with Crossfit. Yes, it’s true that on their site they pay a lot of lip service to not doing too much, but the reality is that they use technically complex movements (like cleans) and push to the point where correct form totally breaks down. It’s not the greatest idea for younger athletes, and for older ones it’s an almost sure-fire recipe for injury.

Naturally, you need to push yourself to some extent if you would like to make your body better. But there is a question of degree. Without getting into a long discussion about exercise theory, the bottom line is this: the idea is to provide enough stimulation to create an adaptation response, but not so much that it becomes too difficult to recover from the workout. As the great Lee Haney said, “Stimulate, don’t annihilate.” All too often, Crossfit crosses that boundary.

So if you’re suffering from fascia or tendon pain and have an exercise program (or doing some form of work) that incorporates too much pattern overload — either through limited and unnatural movement or by simply having too much volume — think about ways that will allow you to reduce or get around the problem. (You can take the free test on this page to see what sort of pain it really is.) You don’t have to stop exercising, but you will almost certainly be better off if you find ways to change up your routine a bit.

Author: Alex Nordach

Another great testimonial

This is a testimonial that I received on my other site, Target Tendonitis. Although Bobbi wasn’t suffering from foot or ankle tendon pain, the techniques that she used are completely transferable and effective for the plantar fascia, and Achilles and posterior tibial tendons.

Dear Alex,

Thanks for checking in. Since my last email we’ve been traveling. You’re entitled to some much deserved kudos!!

I feel I made tremendous progress, despite the “pep talk” (not!) the ortho gave me when I told him I was going to follow your protocol. I started with virtually no range of motion and tremendous pain in the elbow & shoulder to full range of motion and completely pain free for normal day to day activity in two weeks. I haven’t started working out yet. When we get home I’ll test it out on some light weights. Of course, I’m a bit nervous. I am a little confused to what my new regime will be. I do enjoy cross fit and wish my gym environment and trainer would be more supportive of what I need to do to modify.

Now, that I understand the idea of healing and maintaining tendon health, I’m excited to work on other areas (knees, back). Although, I am confused about how to target the back…

When we get home, there are many people I’m looking forward to recommending your book. I’ve seen a couple of msg boards out their full of people who could use your help. It’s quite sad to realize how many people have really been suffering for a long time. I won’t give away the secret but will definitely send them in your direction.

Thanks so much! Besides the healing, you’ve also provided me w/a tremendous amount of empowerment.

Bobbi Casellas

There really isn’t much to add here, except to point out how much more positive your outlook can be once you discover how to take control of your own tendon health. Bobbi is a 42-year-old weight trainer, crossfitter and generally very active. Congratulations to her for taking matters into her own hands and deciding to try something new–despite the advice of her orthopedist!

Author: Alex Nordach

A New Testimonial for Healing Achilles Tendonitis

I received the following testimonial the other day:

Dear Alex:

The book has been very beneficial… I have suffered from stubborn tendinosis three times. The first two ones were elbow tendinosis. I simply did too many pullups. These were not mere “tendinitis” . I aggravated the tendinitis because I didn`t rest enough. The point is I felt it in the morning only, but every morning was worse. So I had to quit pulling for months-well, more than a year-till I decided to perform [the recommended exercise].
I am currently curing from another one in my Achilles tendon. Now I´m better, but I had to stop running from last November to June. It was when I bought your book that I began doing [the recommended exercise], which improved my Achilles a lot.

To summarize : this stuff works and is very practical and easy to implement.

Thanks a lot, man. Tendinopathies really suck, and your book can help many people.

Santiago Ces Garcia

Kudos are due for Santiago, who decided to take control of his own recovery from both elbow and Achilles tendonosis. Congratulations!

The same techniques that helped him get back to working out and running can also help you if you might have plantar fasciitis or posterior tibial tendonitis. If you have either of these conditions, take a minute (really — less than ONE minute) to take the test that will tell you whether the techniques contained in my book will help or not. The test is free, there’s absolutely no opt-in or anything like that, and it might just change your life.

Author: Alex Nordach