Andy (00:01.516)
All right, so today we're gonna talk about tendinopathy, which is really a big deal. It's one of those kinds of injuries that takes a long time to heal, is painful, and actually does not seem to respond to most of the stuff people try to do for it. So it's yeah, super, super frustrating. So, Jarlo, you've...

Jarlo Ilano (00:23.921)
Yeah, it's very frustrating. Yeah, very frustrating.

Andy (00:30.958)
seen a lot of our clients through the last decade and a half plus, you're working in clinic full time now, what are some of the main tendinopathies you see?

Jarlo Ilano (00:44.003)
so what do I have in the last couple of weeks? Got a couple of elbow tennis elbows. That's the lateral part outside of your elbow. Have one inside what's called golfer's or little league elbow. And that's with like throwing around the inside of your elbow. Achilles, right? That's another thing. And let's say I'm going to be part of a trial on that. It's like seeing what interventions might help speed that along. there are all kinds of shoulder.

these right? mean that's one other thing is like I have so many shoulders on my schedule now it's ridiculous. But those are the main things like elbow. Elbow is a huge one where it's very very frustrating like it can take months or even up to a year is not uncommon. And one of the things too and we're talking about this earlier offline is that even when you're doing all the right stuff that you're supposed to be doing it can take months and months.

in even years. That's why there's so much stuff out there or people are just desperate to find an answer. So you got this cream, right? You got this gadget, you got all of this stuff. And it's billion dollar business because if you can get somebody out of pain, right, that they've been dealing with for months. But unfortunately.

Andy (01:56.323)
Right.

Andy (02:00.386)
Well, mean, the first like major like the first like injury that I knew a name of that I can think of would have been like tennis elbow or golfers elbow, which is really funny because I heard these words thrown around when I was a kid. you know, what is it really that common? Like to people that play tennis or golf like always have this. And I think that one of the things is that people that play tennis or golf, especially it's like their main hobby and social activity. And so if they can't do that thing.

Jarlo Ilano (02:10.258)
Yeah.

Jarlo Ilano (02:28.463)
Exactly.

Andy (02:30.22)
Like they're gonna pay a ton of money for this, right?

Jarlo Ilano (02:32.687)
Exactly, exactly. And that's also the thing too, is you can't just assume that because you play tennis a lot, or that you play golf a lot, or you play softball a lot, that you're gonna get one of these things. If 100 % of people that played a sport got this injury, then maybe people would be playing, right? With that kind of thing. But it's also...

Andy (02:53.528)
Yeah

Jarlo Ilano (02:57.243)
It makes sense to one of the let's just kind of go back to first principles of this. So like what is a tendon ops? The what is a tendonitis? And it's fundamentally it's like an overload of forces on your tissues. Like we should be our body adapts. It absolutely adapts. But when it doesn't adapt is when there is too much on the on the balance scale of forces and repetition. Right. The

The literal overuse injury is right in the name. He just overused it. Now,

Andy (03:31.18)
You're doing something at a rate or intensity that it cannot adapt to quickly enough to prevent irritation.

Jarlo Ilano (03:38.097)
And that's a huge thing to say is because it is adaptation.

That's massive because it's not just it's not wear and tear. It's not like you're eventually gonna kill your elbow if you play tennis because your body does adapt. Exactly. There is no set quantity of tennis swings or pitches. Well, that's a controversy with baseball. probably is. There probably is a number of, you know.

Andy (03:52.716)
Right, right, right. There's no quantity. Yeah.

Andy (04:07.34)
Well, yeah.

Jarlo Ilano (04:12.259)
above 80 mile an hour pitches before your elbow finally busts, but that's physics, right? That's just what it is. But really, that's the thing. It's like...

Andy (04:18.198)
Yeah, yeah. I think at the extreme ranges of pro athletics, it's a completely different thing. you're pitching 100 pitches a night, 100 days in a row, how many years in a row, right? It's a whole different thing than somebody that's, yeah, yeah.

Jarlo Ilano (04:30.973)
Yeah, that's real wear and tear. Yeah, that's a real wear and tear. You can't beat physics, right? Physics is gonna get you. But what we mean is occasionally playing tennis here and there, or badminton. It's interesting, I've had more people say they're playing badminton in my clinic. And even yesterday I had a guy, his daughter, there's high school badminton teams now. I had no idea. Yeah, super cool.

Andy (04:58.2)
Really, not pickleball.

Jarlo Ilano (05:01.009)
Nope, badminton. Super cool. Yeah, I actually like that because it's super fast. It's probably less stressful because it's the weight of the racket, right?

Andy (05:12.334)
The reaction speed and hand-eye coordination for badminton is actually off the charts. It's so quick. Yeah.

Jarlo Ilano (05:16.851)
Yeah, it's huge, massive. Yeah, it's super fun to watch. But anyway, we're not talking about like, you know, just kind of doing it for fun. You were not saying that you're going to do that and then you're eventually going to get a tendonitis. It is that for whatever reason, your body wasn't adapting fast enough. And every time I say for whatever reason, there are so many reasons. You didn't sleep well, your diet's not good, you have a pre-dispos- genetic predisposition to it. All of these things.

all of these things.

Andy (05:46.808)
Right, because people are gonna say, well then how could I prevent it? Or on the flip side, they'll say, well, it's just genetics because everyone in my family has this. And like, maybe that's true or part of it, or maybe you're just wrong, but it kind of doesn't matter at a certain point.

Jarlo Ilano (06:01.363)
It just, think, let's, my thing is always avoid the extremes or avoid these causal factors, right? Avoid this A always gonna leading to B, always gonna lead to C. And think more in terms of propensity and percentages, right? And that just goes with body types. Like some people are skinny and others, some people have longer limbs and others.

Andy (06:12.984)
Mm.

Jarlo Ilano (06:29.971)
You know, sometimes the forces that go into the elbow are going to be a little bit higher. Yes, but again, it shouldn't limit you from doing anything. It just means that either you have to either limit the amount of time you're doing it or you have to get a little bit stronger or maybe a lot stronger, you know, to handle it. Or you got to be really good about your diet or you got to be like, if I didn't sleep well these last three, four nights, then maybe I shouldn't go and try and swing the hell out of that ball.

I think those are very reasonable things to say to people.

Andy (06:59.18)
Right. So, yeah, and it's also when you are in a situation where you have a higher propensity towards a certain type of injury, then it's probably pretty simple to say, then in that case, you should probably just be a little gradual and cognizant of that and monitoring. So, are there, like, from a clinical perspective, are there any sort of, like, high percentage things where someone

should probably be just being aware that they have a higher incidence of a tendinopathy or injury and should be careful.

Jarlo Ilano (07:37.234)
sure.

Yeah, and I was actually talking to one of my mentors this morning about it. And here's some stuff. If you have systemic conditions like diabetes, high cholesterol, if you are of a certain age, this is unfortunate, but a lot of tendonitis, isis, inflammatory things happen when you are a perimenopausal woman.

Hormones are massive, massive thing. So you're looking at, if you're looking at general medical history, you are looking at that. What is your overall health? And again, not saying you shouldn't exercise. You should exercise. You should be doing stuff, especially if you have these metabolic syndromes. But be aware that you probably have to be very careful and limit.

Andy (08:24.3)
You should exercise.

Jarlo Ilano (08:36.817)
the forces limit the amount of time. mean, these are not unreasonable things to say. Again, these are not unreasonable things to say that you gotta be careful.

Andy (08:42.094)
Right, it kind of stands to reason, yeah, like it kind of stands to reason that if you have a lot of inflammatory things going on, your body can only respond to a certain amount of inflammation in the metabolic cycle, you know? So, you know, like you can't fight, yeah, like just...

Jarlo Ilano (08:58.449)
I think that's it. Yeah. I think that's something you could say.

But it's also, there's a lot, you know, I'm just kind of interject here. There's also a lot we don't know. It could be that, and I probably would say that's a good bet. I would say that's probably a really good bet, but there's also, there's other factors where you don't know.

Andy (09:11.256)
Sure, sure. It could be.

Andy (09:18.79)
It's right. So yeah, what I just said falls into the plausible explanation without any kind of

Jarlo Ilano (09:23.281)
Yeah, and I think more than plausible too, but we just kind of don't know. Like that's another thing we got to avoid is these big pronouncements, which unfortunately other people are going to make. Unfortunately, other people don't have the qualm to go. They will just say the thing. I think, but also I think people that listen to us know that we're not just going to say the thing just because it's coming up, pull that out of our ass.

Andy (09:28.819)
True, true. Right,

Andy (09:35.608)
Mm, yeah.

Andy (09:41.612)
Yeah, this sounds very nice.

Andy (09:49.955)
Mm-hmm.

Jarlo Ilano (09:52.593)
There's that and there's also, you know, past medical, past history. There's also, it's a truism where like, what is the most common reason to have say, say knee pain or back pain or neck pain prior history of knee back, right? Right. And so that seems like a tautology, it's actually true because it also, if you look at a broader view of it, it just kind of showed you, yeah, there's probably something in your

Andy (09:52.632)
Sure.

Andy (10:09.646)
Prior history.

Jarlo Ilano (10:22.737)
and your makeup for whatever reason that just makes you little bit more vulnerable. Other things too. Exactly.

Andy (10:27.296)
or something in your movement habits and any kind of number of things that if you're not addressing that very subtle cause somewhere in the chain, you're going to have the same outputs.

Jarlo Ilano (10:37.945)
That's what it is. And this is interesting. don't think it's too off track, but there are what they call modifiable factors and non-modifiable factors. So a non-modifiable factor is your age, right? A non-modifiable factor is this particular gene expression, right? But a modifiable factor, right? A modifiable factor is actually weight, is diet, is your attitude, is how much you can sleep, right?

Andy (10:56.224)
limb length.

Jarlo Ilano (11:07.635)
and all of those things. So if we're going to talk about propensity, there's also this thing, and this kind of comes close because I just had a patient a few months ago. What's happening in girls and younger women is this thing called relative energy deficiency. So that's just a fancy term for not eating enough for everything that you're doing. And it just happens, Women in sports and that's

the women listening to this know this. A lot of times you're doing your work and you're practicing, you're doing everything through there. And this is a time where that adage, you can't outrun a bad diet, right? Well, you can outrun not eating enough, right? You can overwork yourself because you're just simply not eating enough. So those are the types of things. So I think the major through line for what

predisposes you are these very big things. And you mentioned movement idiosyncrasies and asymmetries. You could say that's part of it, but I think it's also that they're very minor. They're very minor and they are modifiable. If you really wanted to work on something, yeah, if you really wanted to work on something, you know, and

Andy (12:27.234)
They are modifiable. I think that's, yeah. The thing with those is that they're mostly not known and so then you won't modify it because you're not aware that you, you know, do this thing.

Jarlo Ilano (12:40.303)
Exactly. And it's also a kind of, you know, the term is opportunity cost. It's like, if you focus too much on these things that aren't very well known, but like, you know, somebody told you, you gotta do this thing, right? And you spend your time and energy on that, you won't take care of the other bigger rocks, which is, probably have to work on your diet. You gotta probably work on sleeping a little bit sooner.

Andy (12:47.587)
Mm.

Jarlo Ilano (13:07.519)
You've to work on your stress levels. Those are the things that are going to be way more important than, your angle of this pull on this exercise is not optimal. Yeah, no. That's just not going to move the needle.

Andy (13:20.226)
Perhaps, very, very perhaps, optimizing your walking gait is going to fix all of your health problems. It's very, very minor. But maybe you should spend six months doing specific walking exercises and optimizing your gait. Maybe it'll fix everything. Give it a shot.

Jarlo Ilano (13:32.509)
Yeah.

Jarlo Ilano (13:38.195)
Yeah, that's what we in the profession call a bad bet. Right? That's a bad bet. This goes back to, you know, we're talking about this too, because a lot of times on our private forum, private community forum for our company, people ask these things. They're like, oh, man, I'm dealing with this. I've heard that isometrics are the best thing for tenonopathy. Oh, I've heard that heavy, slow

Andy (13:44.566)
Yeah.

Andy (13:58.467)
Mm-hmm.

Jarlo Ilano (14:06.865)
know, lifting is the best thing for tendinopathy. I heard that doing lengthened partials, you know, to failure is the best thing. And to that we say yes. The answer is actually yes. Everything is the best thing. And I'm being facetious. Right. I am being facetious about it, but it actually is born out because here's the thing that is super in vogue. Every, every...

Andy (14:22.392)
for some person somewhere out there. Right?

Jarlo Ilano (14:33.669)
In rehab, I've been a PT now 28 years. I've seen so many things come and go. And the trends that happen in social media have also happened in every part of healthcare. I think it's human nature to hop on trends. It's not just since the beginning of Instagram or Facebook or whatever. Hopping on trends.

Andy (14:39.907)
Mm-hmm.

Andy (14:53.992)
yeah, we're memetically driven social animals. Like this is the thing.

Jarlo Ilano (14:57.731)
Exactly, Isometrics was one of those things. I don't even know when it started, probably in the early 2000s. And it was this, here it is. This is it. Everyone just has to do five sets of 45 seconds of isometrics and you got it. And it did work. It worked for a lot of people. I'm not saying it doesn't work. What I am saying is that later on, and actually through experience too,

other things work too. Right? It's not, this is the best thing actually. It's the best thing to know that several things can work. Isn't that awesome? Isn't that freeing? Isn't that empowering? It's amazing, wonderful, positive news. And the reasons if that is because some people don't like isometrics. Some people don't like heavy slow loading. You know, some people don't want to lift weights, right?

Andy (15:29.442)
Mm-hmm.

Andy (15:36.876)
Right. That's actually, it's amazing news.

Jarlo Ilano (15:57.011)
And that's the whole thing. like, bone health. If you're an older woman, you got to lift heavy weights. Well, it turns out if you lift moderately or lighter weights, same thing happens. You get better. You get stronger. Your bone density improves. It's nice to have several things work for you. It's awesome to have options. It's a wonderful thing. So all that to say is that you have lots of different options.

Andy (16:11.265)
Mm-hmm.

It's a wonderful, wonderful thing, yes.

Jarlo Ilano (16:23.539)
for treating your tendonopsis. The main thing is working on loading your tendon, your area appropriately and figuring out the progression, right? And there's gonna be lots of ups and downs, but there's also lots of protocols. There's lots of techniques and you have to find what's best for you. That's the hard part. That's the art and science of it.

Andy (16:45.87)
Okay, so let's talk about, yeah. So let's talk about like some of the main ones and sort of how you might be able to figure that out for yourself because some of it might be preference, I just don't like weights or I don't want to go to a gym or something like that. I mean, for a lot of people that are training and going to be listening to this, like they probably don't really have an aversion to any of this stuff. how do you go about finding, you know, is it isometrics? Is it, you know, is it.

You know, medium range loading. it heavy stuff? Is it something else like?

Jarlo Ilano (17:19.603)
One of the really good things, and just out of personal experience, isomestries work really well for me because they are analgesic. Analgesic meaning pain reduction. That's variable. There's lots of people that swear by it and like, yeah, if I just do a little bit of this, and I've had patients tell me that too, like I just gave them these things and they're like, yeah, it's funny. I was a little bit sore, I was sore and then I did these exercises and I felt better for a few hours.

So that's, and it feels good. that's one of the things where isometrics were really touted. It's like, oh look, it's proven, it's analgesic. It actually helps people's pain almost immediately, temporarily. So it wouldn't be like you just do one session of isometrics. What it does is like these isometrics dampen down the pain so you can get on with your day, do more stuff, right? It comes back a little bit, then you do it again, right?

Andy (17:49.454)
And it feels good. That's positive sign, right?

Jarlo Ilano (18:17.235)
And before we go on further, the timeline for dealing with these tendinopsies, depending on how bad it is or where you're along, where you are in the process, can take months. It's not uncommon for to take months to even a year or more. And that doesn't mean that you're doing the wrong things either. You could be doing all the right kind of stuff and it's taking that long. It doesn't mean that you're going to be in eight out of 10 pain for a year and a half.

It means if you're doing the right things, you will be able to do more, but the pain is still there. You'll have all these ups and downs, but you'll have a sense of progress within that months or year. But that's really important to say right now. It's like, don't give up on your exercises and on your treatment and doing things. As long as you have a little, if you feel a sense of progress, you can keep going because it's there.

you know, if it's like, it didn't work at all. So that's how, that's probably my long way of saying, well, you which one, which one should you, should you do? You can.

Andy (19:24.428)
Yeah, and it's like there's two dimensions to this with knowing sort of about some of the different protocols is one is you want to pick something that you are going to feel comfortable sticking with for a long time.

Jarlo Ilano (19:36.857)
Exactly. That's it. And also the analges, the pain reduction can happen with heavy slow loading. It can happen with just, you know, a little bit higher repetition count. And we talked with isometrics. It can happen with stretching, know, not like overstretching with stretching in a particular angle. So that's one of the things you can do right away is like you try the protocol, whatever it is, you Googled it.

you know, someone gave it to you, it's like, oh, you gotta do this. Try it, try it. And you should actually, this is why I tell my patients all the time, within three or four times, you should feel a benefit, not saying 100 % better, but enough that if two weeks from now, I say, asked you how you're doing, you wouldn't have to go, uh, right? You would go, oh, yes, I know. That's probably the best, the best way I could say it. It's like, you wouldn't have to reach in the back of your head and go, yes, you know,

Andy (20:07.502)
Mm-hmm.

Jarlo Ilano (20:34.579)
do all these mental gymnastics to say this thing is helpful. You just know in your head, you're like, oh yeah, it is better. So there's that. I mean, it's kind of a glib answer, but it's true because a lot of this you have to try on there. You have to do it a few times, right? So if you're very lucky, the first time is good and you're like, okay, here it is, right? You know, just keep doing this and I'll feel better for a bit. And a lot of this is activity modification too.

Andy (20:54.542)
Yeah, I'll just keep doing this. Great.

Jarlo Ilano (21:04.467)
in another podcast we talked about active rest and should you just totally rest or should you keep going? Well, say in the case of tennis and all of that, if you're able to play and then you can still have a baseline of about three or four out of 10 and you're playing, I think that's great. You just keep going. Or if you're a runner and you got some Achilles tendonitis stuff, but you change your shoes a bit or you change a little bit about your gait pattern and

you know, you're doing your exercises and then you're able to go and do a good run for 30 minutes and you're still at that three to four out of 10 pain. You should be doing that. You should be doing that. So I think what we really want out of this discussion here is you got a lot of options. You don't got to stop doing what you're doing, you know, within reason. It does take a long time, unfortunately. I know it's very frustrating, but there's also

You can deal with this and it's not like you've to be in 100 % pain for a year. There's ways out of this and again, there's less options.

Andy (22:14.936)
Yeah, and I think that that's great too, is like, you side of, you know, knowing that there's multiple things is that, you know, after a few weeks or a couple of months doing something, if you don't feel like you're happy with it, or if you get bored of it, then there's other protocols that are probably just as effective.

Jarlo Ilano (22:34.387)
Yep, absolutely. There's a lot of nuance here too though, is because you have to actually give something a bit of a chance, right? You have to give something a bit of a chance, but also that doesn't mean like six months. A bit of a chance to me is again, what we said earlier, it's like three or four times, a couple of weeks. That was for me that was saying like coming to PT, right? Going to PT and working with me. It's like, know, give me three or four sessions, you know.

Andy (22:43.992)
Sure, yeah.

Andy (22:48.856)
Right.

Andy (22:54.157)
Yeah.

Jarlo Ilano (23:01.807)
but that's a couple weeks or a month, depending on how far you're going into. So say you're just trying this on your own, it probably would be like a couple weeks of, is that affecting my daily life? Am I feeling a little bit better? Can I tell without just kind of convincing myself it's better? So yeah.

Andy (23:20.674)
Right. And tendons, you know, we're talking about something, this is clearly, this is a slow thing. the damage, lot of times, so obviously there's acute damage, there's injury, but a lot of this damage that we're talking about is over time, these overuse things, right? And so the healing is also happening over a lot of time. And so you can't really judge a specific protocol on how it feels, you know, within an hour of doing it or within a day.

Jarlo Ilano (23:49.584)
Exactly.

Andy (23:50.356)
It needs to kind of stack up to sort of see how that feels compared to doing your regular activities. Yeah.

Jarlo Ilano (23:56.697)
Exactly, And yeah, again, sometimes you get lucky and you hit something where it does decrease your pain right away. You know, for some people it's isometrics and some people it's, you know, heavy loading and whatnot. I got an example for me is over the, this past year and a half has been good, but for like four years before that, I had knee pain in my right knee for like a year and a half. And then in my left knee for like a year and a half.

And it was some tendonitis of the pesantorine, in the middle, the medial knee, like everyone can look it up. But it's just because I just kept going. When I probably shouldn't have kept going with running, with lifting. And one of the things I did is I chose that. I chose that for myself. It was a level pain that I was like, it's okay. Right?

And that's, it was just a personal choice. And sometimes it wasn't, I was like, that's not okay. And then I had to figure out what it was. Like, for example, this is when I was doing, I was running a lot and also doing a lot of my martial arts. You know, was training a lot, right? I was just training three, four hours a day. And I figured out one flare-up happened because I was doing my martial arts forms after my jog. And so I would,

Andy (25:01.848)
Right.

Andy (25:23.886)
Mm-hmm.

Jarlo Ilano (25:25.171)
my level of tolerance drop because I was tired from the thing. Like I was fine during jobs, fine. And then like 20 minutes, I'm like, why is my knee hurting? doesn't make any sense. This is like not even hard, right? So.

Andy (25:37.774)
Why would my knee be hurting after?

Jarlo Ilano (25:40.755)
Yeah, right. But this also I bring that up because you can also change. This is what I mean by activity modification is you it does it also means activity, but also can mean like the order of the way you're doing things, because lots of lots of people listening, they like to do a variety of things or, you know, even just a single sport, there's different training within the thing. Also, too, I remember, you know, I doing a little bit of apply work because I was trying out a new program and I wanted to be able to help people.

Andy (25:54.839)
Right.

Jarlo Ilano (26:10.333)
kind of evaluate it. And the same thing too. I figured out I had to do that first. I had to do that first before I did all this other stuff. Because at a certain point, I was doing all the other stuff and then I did that at the end and it was fine until it wasn't. So don't be afraid to switch things around. Very seldom, and I'll say this with again,

Andy (26:28.172)
Right, right, right. Yep.

Jarlo Ilano (26:37.299)
take it with a grain of salt, but very seldom do you have to remove something totally. Right? And again, this is nuance. I'm not saying you can do everything at once, but very seldom do you have to just say, I can't do that at all. Right?

Andy (26:41.922)
Mm, great.

Andy (26:50.254)
Yeah, well, I mean, this is one reason why we kind of created our protocol to where we have, you we move from prep to practice to play to push and ponder is because, you know, we looked at all these different kinds of training and all of the things that we might want to include in a program someday or like, man, that's a lot of stuff to fit in this kitchen drawer. Like we need one of those little drawer organizers where you put the spoons and the knives and the stuff and everything, right? So we kind of divided it up. And if you do things in the right order,

Jarlo Ilano (26:58.835)
Absolutely.

Jarlo Ilano (27:15.387)
Absolutely.

Andy (27:20.366)
It actually, generally, and I say right, mean this is like an 85 to 90 % confidence rate of what that is. There may be things where you might change it up, right? But yeah, it usually can make a really big difference in how well your body responds to things. And plyometrics are a really classic one because in the, I can never, I can't pronounce the name of the guy, the father of plyometrics, right? But, you

they did all of these experiments with stuff, but they were doing experiments with people that were basically runners and jumpers. And then when they tried to do the same ones on people that were not from those backgrounds, they had all these trouble because the people weren't prepared for this kind of stuff, right? And so yeah, like high impact plyometric type stuff tends to do really well towards the beginning when you're fresher and your nervous system can respond to things and your tissues have more elasticity. But then

like you mentioned jogging or something that's high impact but it also like it's really tiring. you know, yeah.

Jarlo Ilano (28:21.555)
Yeah, yeah, and again, I think just making sure there's a through line for all this is that there are so many options and how to adjust your training and to keep training, right? And don't be so, number one, don't be so enamored of your perfect program, because that doesn't exist, because it always changes. But also don't be so beholden to like, this guy that I trust really, maybe you trust, says I gotta do this thing.

Andy (28:32.078)
Great.

Jarlo Ilano (28:50.427)
If I don't do this thing, I'm not going to get any better. That is just not true. It's just not true. There's so many different ways to get better.

Andy (28:58.126)
Right. And even more than that, would just say is that I think due to the prolonged nature of the tendinopathy kind of thing, it is one of those things that really, really grinds people down over time. And I think it's probably, it's one of the biggest reasons for people giving up on programs and giving up on training and because

Jarlo Ilano (29:10.897)
It's tough.

Andy (29:19.008)
It's demoralizing when you don't get better at something and when you're hurting. And I think it's really important for people to know that you do have options and there are ways to adjust and that you can continue to do stuff you enjoy and get better while you manage that. But you do need to be aware of it though.

Jarlo Ilano (29:23.957)
yeah man.

Jarlo Ilano (29:37.809)
Yeah, absolutely. And that's why we all have examples from ourselves of dealing with it. I was kind of kidding about my knee pain, but there was a lot of time during those months when like, it was like, why is it still here? But I don't want to get, you know, I just kind of, again, but it was a choice, right? I could have actually gotten zero knee pain and I had that, or if I didn't do anything for a while, right? But also I knew my personality is like, if I'm going to do something, I'm going to.

Andy (29:42.797)
Right.

Andy (29:55.15)
Mm-hmm.

Andy (30:01.422)
Mm-hmm.

Jarlo Ilano (30:06.259)
do a little bit more, you know. So I kind of accepted it. I'm not saying these things like you should just accept your pain. I'm just saying that you have to know yourself. I get the frustration, but there's also, you know, there are modifications that you can do and it's better in the long run. I just had stuff that I wanted to do. I just had stuff I wanted to do. And that's a choice. That's a choice I made for myself that maybe was probably, actually, I don't want say maybe, it was the bad thing. I shouldn't have done that. I should have just taken care of it.

saw somebody and not dealt with it. But that's the ups and downs of tendinopathy. Some days you're, oh, that's fine. Yeah, not even, it's not even that bad. But then it flares up again and you're like, holy shit. What? Why? Right? And then it goes down again and then you have, I have a short memory. Right. And then I have a short memory and then it gets better again. I'm like, oh, it's fine. And then it comes back. Right. But again, like a year, like, do I need to deal with it for a year and half? Like that badly? Probably not.

Andy (30:52.216)
Yeah, what did I do to make this happen? Yeah.

Jarlo Ilano (31:06.129)
would it have lasted a year, but probably a little less? Maybe. Maybe. So I think all of these stories are just to kind of help people kind of.

Andy (31:11.107)
Mm.

Jarlo Ilano (31:17.683)
help them find maybe a little bit of patience or actually a little bit of hope. It does take a long time. It does take a long time, but it also doesn't mean you gotta be in high levels of pain for a long time. It doesn't mean that you gotta stop everything you're doing for like a year and a half. I really don't believe that at all.

Andy (31:40.386)
Right, and I think that's exactly it. Know that it's gonna take time, but also know that it doesn't mean you really have to give up on anything or that you have to accept an unbearable amount of pain long term either. Just because it doesn't feel like it's getting better in the short term doesn't mean you're stuck this way.

Jarlo Ilano (32:01.523)
And I get it from the other side too. Like I don't want my patients to Like have months and months of pain. I don't want them to have that so we're gonna do all you know That's why there is can be helpful to go and have different, you know therapists do their different techniques, you know, whether it's needling or shockwave, know shock waves and not man shockwave is so popular now, you know why because that machine is so expensive like these vendors are gonna sell you a $30,000 machine, right?

Andy (32:08.694)
No, of course not.

Andy (32:27.758)
Right?

And if you are a clinic that just spent $30,000 on a machine, you are gonna tell every single patient how amazing it is.

Jarlo Ilano (32:35.707)
You're going to use, that's right. That's exactly right. And not to say that doesn't work, because there's actually some benefit for it. It's the same thing with like PRP and injections and all this stuff. It's not to say it doesn't work, but probably it maybe lessens the time. Maybe, hopefully lessens the amount of time that you're dealing with it. Could you say that maybe if you did some activity amount of

Andy (32:47.598)
Mm.

Jarlo Ilano (33:03.219)
and good exercises kind of been part of it that you would be also better? I don't know. I don't know if I could say those things, but probably. But probably. Do you really need to get dry needles? And I love dry needles, right? I don't know. I don't know. But there's options. You should do the option. If you want to go try it, you should. As long as it's not going to hurt you, right? As long as it's not going to, you know.

Andy (33:11.342)
Right? I can't say it won't, but.

Jarlo Ilano (33:32.371)
or cost you like, know, somebody's gonna take a grand, a thousand bucks off of you. I promise you the world. Yeah, please don't do that either.

Andy (33:41.88)
Right. Cool. All right. So yeah, basically, tenetopathy, sorry, still going to suck a long time.

Jarlo Ilano (33:50.765)
gonna suck a long time but it'll have varying degrees of suckiness. If we do things well and you figure it out for yourself it will be it will be manageable.