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Weight-Bearing, Or, Saturday Morning at 10:26am

Diagnosed with my fifth type of tendinitis in nine years, I suspected something other than oops was in play. Meaning, nobody serially injures their biceps tendon, Achilles, outer elbow, thumb and both knee tendons unless they are a high-powered athlete. I am not. Sure, I’m getting older, but it felt suspiciously as though my body were ticking in distress around something, like the hands of a clock. I have a useful nugget, if you can bear with me through a few hundred words.

I began to ask for help. Such a brilliant strategy. So many of us neglect to do this, seduced by our own competence. Just me?

I saw two orthopedists; they like to operate and one told me so outright at 7:30 one morning, saying he was a hand surgeon who spent his days tending to patients who’d done stupid things and persisted in doing stupid things that he could not fix in the operating room. OK then.

I went to PT, but they specialize in specific body areas, and my issues have been systemic. This last time, when my left thumb freaked out and began to “pop” with pain when bent, and my knees started to burn on the treadmill, I went to a physical medicine doctor, got another referral to PT, and insisted on telling her my whole sorry saga. She listened.

But she specialized in the lower body. While it’s nice to be back to squats and leg lifts, and I can feel myself regaining strength, it wasn’t enough.

So I told my friend who used to do PT, and she listened too. She thought it wasn’t my thumb only, or my elbow, but more to do with how I used my rotator cuff. Insight, in bits and pieces. Aha.

Finally, my daughter referred me to a Pilates instructor/kinesiologist. She told me the following, and I’m still reeling,

  • Small motor muscles use a completely different part of the brain than gross motor
  • If you’re typing or doing other small motor things, take a minute to transition before moving to gross motor
  • We tend to prioritize our thoughts over our movements, and we will rely on muscle memory to do repetitive tasks so our brains can keep nattering away. If you’ve been engaged in small motor activities and you don’t pay attention, the small motor muscles may carry a disproportionate degree of your subsequent efforts. Aha. I often pick up a teakettle without even processing the action
  • Our nervous system doesn’t mean just neuron to neuron, i.e. thought to muscle, we have “proprioceptors,” described in Wikipedia as: “Proprioceptors can form reflex circuit.s with motor neurons to provide rapid feedback about body and limb position.” These are often known as the sixth sense, i.e. they tell us where our body is, not just what’s around it reflecting light or making noise or whatever.
  • Essentially, for me, before picking something up, stepping into a yoga position, or shrugging on a motorcycle jacket (that’s how I injured my biceps tendon, if you can believe it) this means, take a second or two to feel what you’re doing before you do it. Feel your feet on the floor, feel the teapot in your fingers, feel where your arms are.

Then, once you’ve let your senses, including your proprioceptors, tell you what is needed, you can call on your big muscles to pull their weight. Literally.

This is life-altering. I’ve always relied on a) my brain’s ability to build conceptual models quickly and  b) my physical capacity to explode, hurry and endure. Thinking about one thing while doing another, as quickly as possible. Conceptual model to brute strength, and back again. Highly rational to strong emotion. And back. Little to nothing in between.

It’s natural to use what we’re good at, but our strengths may fray. It’s time in later life, and a luxury, to give the rest of our being a place in the meadow. In the sun even.

Have a beautiful weekend, peaceful or thrilling, you decide. If you have hints, I’m always listening.

33 Responses

    1. Nancy, thank you. I should have mentioned this. My friend suggest I talk to a rheumatologist, but when I saw my internist she said I didn’t have the symptoms. Good for everyone here to know, though.

  1. Lisa – Are you actually doing Pilates now? It’s wonderful – at least if you do it intentionally, or more accurately, attentionally (which is not a word). I mean, actually paying attention to what your body is doing and feeling at each stage, and being aware of how your body (with a little help from your brain) plans each move beforehand.

    I’ve never heard of the micro-to-macro considerations you mention – so I am going to think about that …

    Good luck with your own micro to macro moves! And get better soon. xoxo

    1. Victoire, I’d say I’m working with a Pilates practitioner, remotely, maybe edging towards full on sessions:) Thank you!

  2. As I was reading this blog, I also wondered if you should see a rheumatologist for a diagnosis, My niece has ehlers-danlos.

    1. Marilyn, thanks. I should add this to the post. In fact I will. My internist ruled it out, but it’s a real concern.

  3. So very interesting, I will try to be very conscious of every movement in the future. I’m always a step ahead of myself.
    Hope you see real improvement .

  4. Lisa,
    There is a lot to be said for being more aware of your body before you engage it. I have had chronic pain since my thirties with small increases in pain every year that can leave me debilitated.
    This is from severe scoliosis. I have a spinal rod from T3 to L2. Whether or not surgery was a mistake is complicated.
    I wish you the very best with managing your pain. It is a process of small steps with many items in your “basket” to cope. I would say aging has taken its toll. Keep Moving!


    1. Oh, gosh, Luci, I’m so sorry! That must take so much of your capacity. And yes, absolutely keep moving. Which is easier said than done as we age.

  5. Lisa, I’m sorry you are dealing with this medical condition, which appears to be a mystery at this time.
    I’ve read some of the comments, thus far. I did a bit of research on EDS, as it was mentioned twice. EDS seems to be a genetic condition. A geneticist would be on your team, if that’s the diagnosis….whether it’s that or another condition…

    Based on your symptoms/injuries, it seems like it’d be a good idea to start with a rheumatologist.
    A neurologist may also help with diagnosis.

    For a condition that’s complicated to dx, it’s helpful to work with a team of excellent docs who communicate well together. You’re fortunate to have two excellent hospitals (you’d look for the specialists who work within each) in your area: 1. Stanford Health Care-Standford Hospital (ranked #3 in CA) 2. UCSF Health-UCSF Medical Center (ranked #4) in CA. Cedars-Sinai in LA is ranked #1. Could be a good option for dx.

    Diagnosis is the most complicated area of medicine. (My dad was a medical malpractice attorney. I learned a lot over the years. He always refer friends to the best medical centers in the country for dx and/or treatment.) I’ve had personal experience in this area — grateful for Vanderbilt in Nashville for myself – they saved my life. And grateful for UNC-Chapel Hill and Duke for my son. A correct dx is everything.

    I care about you. I hope you get a proper dx soon and relief and healing. xx Elizabeth

    1. Elizabeth, thank you. My primary care doctor says I don’t have the right symptoms for the immune system disorder. So right now I’m focused on positional issues, and strengthening myself to try and put everything back where it’s supposed to go, along with changing my movements so I don’t do this again. But, if I get nowhere, I may explore another diagnosis. The PT person did say I am qualify as hyper-mobile, so it’s still possible.

  6. Seems like a trip to Mayo ( for a complete workup) might be something to seriously consider. You are too young to be experiencing this kind of discomfort.

    1. Joyce, I’ve heard about the Mayo complete workup program, and have been curious. I am very hopeful right now that this can be addressed with the approach I’m trying, but I agree, if no progress, Mayo might be a great next step. I have also been wondering whether UCSF might offer something similar.

  7. We have to be our own advocate. Search for the best provider.
    Be very mindful of your body, Lisa…if you’re pushing through and it hurts, rest a bit.

  8. I’m glad you are pursuing this. Being an active vital woman you need to get to the bottom of this. UCSF or Mayo sound like excellent places for a good evaluation.

    1. Susan, thanks. I agree. I want to understand this and get as much pain-free function back as is possible.

  9. Lisa,
    Our muscular skeletal systems cannot work efficiently and injury free with out a larger understanding of fascia, it’s integrated and essential function for the human movement system. As we age we start to notice pain which is generally related to under and overactive muscles which translate into compensation and finally muscle dysfunction then pain.

    Most of our generation ( exception those who danced or did gymnastic, yoga in their youth) have performed activities over the years producing wear and tear on their musculoskeletal system disproportionally . Think tennis, gardening, sitting etc. I don’t recall being told to stretch or roll on a foam roller before I played tennis or hiked ….. etc

    Even sedate activities working on computer, driving bowling, house work etc produce unwanted effects that proprioceptors send messages to the CNS and BAM years later all my clients think they have a specific incident that created their now unwanted pain and discomfort. They think they are injured and isolate the problem.

    Without going into great detail a majority of this can be reversed even at our age! A daily dose of balance and core exercises, stretch and light weight training can be tools to mitigate further dysfunction and less discomfort as we age – and STRETCHING including foam rolling is a MUST. Massage even better if you can afford it!

    I have clients who have now avoided surgery, have pain free mobility and generally feel ten times better with simple understanding of what movement and activity will be beneficial for the future longevity amd good health.

    ( give me a call! I have an idea for you!! I have a ZOOM class three times a week- why don’t you jump in to get an idea of what I’m talking about –

    Victoria Frost

    1. Victoria, this sounds wholly on point! I’ll give you call, or message you this week. I know your fitness is profound.

  10. Just a note that you can check yourself for hypermobility:

    There have been some changes in how EDS is defined over the past decade and a half or so, which might be after your internist’s training in EDS. (I was “benign joint hypermobility syndrome” before the classification changes, now I’m EDS something or other else, I don’t remember.)

    Anyway. If you’re more flexy than average, that is very much worth keeping in mind in daily activities, in exercise, but *especially* in PT. Any time we are something other than average/normal, there are things that aren’t problems for most people that are problems for us (and vice versa), so it’s really helpful to know all the ways we’re a bit weird, so we can assess and apply appropriately rather than being harmed by a one-size-fits-most solution.

  11. That is *fascinating* re: gross motor and fine motor control, and now I’m wondering if that’s one of the ways I keep injuring myself…

  12. Agree completely with Victoria Frost. I’m not finding it unusual that you’ve had 5 tendonitis episodes in 9 years, although I realize I’m in the minority. I’m a couple of years older than you, but at least half of my friends, and my spouse have had joint replacements in the last 10 years or so.
    David is very disciplined about stretching and doing the foam roller (which I find excruciating) but I know I should do a la Victoria Frost. Also massage, which is pricey if you hire someone, but even using something like a theragun can be helpful. Definitely you should give up all housework….very hazardous.

  13. Lisa, thank you for this post. I tore a meniscus in March and nothing has been the same since, all lower body, and odd things such as ankle pain in the other leg. Your story to keep asking and trying gives me hope. This is my first serious injury and managing the pain has been at times depressing but I will keep at it.
    Wishing you health.

  14. Note to KSL from Victoire:

    GIVE UP ALL HOUSEWORK FOR MY HEALTH?!? What a fabulous idea – or excuse, as the case may be. Doing so would certainly improve my mental health – although when those piles of old New Yorker mags collapse on top of me, causing immediate physical extinction, the question of mental vs physical health would be fairly moot…

  15. Hi there

    I ended up seeing a muscular skeletal specialist after a car accident. Found out I had an alignment problem due to my hip and lower back injuries. I was referred to a physio who specialized in alignment.
    What I have found over the years is pain is often referred from one area
    to another. Often my pain in my knees is caused by being out of alignment – so do lower back stretches. Pain is relieved. Found too foot pain again was not a foot problem but again being out of alignment.
    Finally found out after one year that the pain/odd sensation in my elbow had to do with my neck! Pressure on a nerve. Chiro did a neck adjustment- viola – no more elbow symptoms. (the neurologists had not clued in that there could be an issue in the next!)
    the body is very complex so we must see if the symptoms we have are originating elsewhere.

  16. Ah, proprioception. A word I learned just a few weeks ago. In my case it was sciatica, hip pain, balance issues, and noticing on our ring cameras that I walk funny–as if left leg and right leg were on different bodies. I thought I was in good shape because I walk up and down the hills in our area frequently.

    During 3 months of PT, I learned that some of my quads are fairly strong, but the inner and outer ones are weak, especially in my right leg. Right leg is much weaker overall than left. The first few weeks were painful, but I’m keeping at it although PT has ended. I’ve added my old PF exercises from 20 years ago. I could brag about all that I can do now that I couldn’t do before, but I’ve learned a lesson about hubris . . .

    Good luck to you–keep at it. By the way, I’m just beginning my 9th decade.

    And a bonus! My feet don’t hurt so much these days.

  17. This yr I discovered Rolfing. I did the 10 series bc I so loved how good I felt after the first session. Rolfing and Hellerwork are supposed to be kinds the same .

  18. Bodies are such interesting things. The right side of mine is hyper mobile and the left is not. Ten years ago after experiencing a series of injuries on my right side I was sent to a number of doctors to figure out why — finally one did after I walked up and down a hall about 20 times. It is really tricky to exercise, and I have to move carefully and thoughtfully. No more classes because I can’t keep up. Regular PT assessments also help.

  19. Having read the post and comments I wanted to offer a related resource for those who might find it worth engaging. It’s a book “The Inside Story: The Surprising Pleasures of Living in an Aging Body” by Susan Sand, PhD. Related to proprioception, she writes about “interoceptive awarenesses.” I’ve found it a thought-provoking read and it’s got me thinking about/engaging with my body in some new ways. Lisa, wishing you healing and restoration!

  20. Hello Lisa. This is a very interesting perspective- I am sorry that it s pain that has caused you to come to this awareness.
    I don’t know if Alexander Technique is a thing over in the States. I participated in a series of groups session a few years ago, though I think it is more commonly taught one to one with a practitioner. I think it could help, or be of interest.
    Best regards, as ever

  21. First time commenter.

    I was diagnosed with EDS in my 50’s. I would recommend seeing a geneticist.

    Thanks to reclassification of EDS around 2017, there is even conflict among experts. The geneticist said I had Hypermobility Spectrum disorder, but did not take into account age and injury as far as my Breighton score. A EDS doctor at a teaching hospital and my own PCP agree I have EDS type 3, which is Hypermobile EDS. I also have hyper-POTS and MCAS, which goes along with the condition.

    My doctor actually has an instagram account called “hypermobility answers” that you may find interesting.

    If you are hypermobile you could have hypermobile spectrum disorder.

    The EDS doctor told me, hypermobility is fun when you are young, but is not so fun as you age. There is physical therapy you can do for EDS. It’s called the Muldowny Method.

    Good luck in your quest for answers!

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