OpenHealth Q&A

From Athletic to Disabled: My Struggle with Widespread Tendon Pain

### Introduction I'm a 24-year-old who led an active lifestyle until May 2020. My past includes breakdancing and tennis, and I maintained my fitness without gym workouts. However, the lockdown caused me to spiral into depression, leading to an 18kg weight gain and suicidal thoughts. I ended up relying on antidepressants and sleeping pills for a period of inactivity that lasted two years. I managed to regain my mental health by 2023 and stopped taking medication. ### The Trigger of My Pain In August 2023, while participating in an advanced hip-hop class, I suffered a torn ACL and medial meniscus. I underwent ACL reconstruction surgery in November 2023, understandable given my significant weight gain and lack of consistent activity during the lockdown. Initially, my recovery seemed smooth, and aside from normal post-surgery stiffness, I did not experience any pain for the first three to six months post-operation. I focused on upper body workouts and felt fine. However, around the seventh month into my recovery, I began to experience severe pain in my right knee, as well as on the medial side of my left knee. An MRI revealed inflammation in the cartilage, leading to a diagnosis of Chondromalacia Patella grade 1. Additionally, the MRI of my left knee indicated a meniscus tear, a symptom I had prior to the surgery. Consequently, I began to experience discomfort from my IT band and lateral knee pain. My left knee's condition worsened due to the weakness of my right leg, and by July 2024, I developed bilateral triceps tendinopathy without any clear cause. The pain intensified over time, to the extent that I was unable to perform even a single push-up, an activity I had previously done with ease. My progress in the ACL rehabilitation program stalled, and any slight increase in exertion exacerbated my pain. To complicate matters, I started noticing discomfort in my lateral ankle, particularly on the left side, as well as pain in my wrist, thumbs, and lateral deltoids. One fateful day, while attempting assisted cossack squats, I experienced sharp pain in my hip flexors that soon transformed into a burning sensation in my hip and groin. This discomfort later extended to mild abdominal pain on my right side and lower back pain that migrated from the right to the left. Although the abdominal pain has since subsided, sleep has been a challenge; whether on my back or sides, I've often found myself using pillows for support to ease discomfort. Despite some temporary relief from muscle relaxants, my ACL rehab took a backseat when these issues emerged. Re-initiating my rehab in December 2024 resulted in the development of bilateral Achilles tendinopathy after a simple calf stretch off a step. By the end of that month, I began feeling pain in my left upper back when breathing, which subsequently spread to involve my entire upper back, mid-back, and neck. At this point, my activities were limited to basic stretches for ACL rehab, and yet the pain persisted. I even began to suffer jaw pain when chewing moderately hard foods or when applying pressure to my jaw. I then experienced toe pain following the use of the leg press machine and discomfort in my fingers after lengthy typing sessions. Occasionally, I would feel sharp pain in my ribs and chest, though those episodes eventually dissipated. ### Current State of Affairs Now, even mundane tasks such as brushing my hair, washing my teeth, or writing can trigger tendon pain. My joints have become remarkably noisy, with persistent snapping sensations in my shoulder tendons during basic arm movement. I'm subjected to constant pain in my back and neck, and walking for more than ten minutes results in discomfort in my ankles and lower back. Sitting for extended periods brings distress around my tailbone, while sleeping on my side is an ordeal due to shoulder and upper back pain. Once a fit individual capable of performing handstands and engaging in sports, I now find simple existence painful. ### Medical Evaluations and Findings I underwent various tests: - **Blood Tests:** Showed normal inflammatory markers, negative ANA, and HLA-B27; Vitamin D and B12 levels were initially low but have been corrected. - **Spine MRI:** Indicated a bulging disc at L4-5 compressing a nerve. - **Shoulder MRI:** Revealed mild brachial plexus issues and subcoracoid bursitis. - **Hypermobility Assessment:** Scored 1 out of 9, indicating limited hypermobility. ### Diagnoses from Specialists - **Rheumatologist 1:** Suggested hypermobility and fibromyalgia. - **Rheumatologist 2 & Orthopedic Specialist 1:** Diagnosed seronegative arthritis. - **Neurologist 1:** Stated fibromyalgia may be present and noted an abnormal pain tolerance, indicating heightened pain perception. - **Neurosurgeon:** Dismissed fibromyalgia or autoimmune disorders, suspecting instead nerve chemical imbalances due to muscle spasms causing tissue degeneration. I have reservations about the fibromyalgia diagnosis because: - My pain is exclusively in connective tissues, bilateral, and there is no accompanying muscle soreness or fatigue. My muscles feel strong; it’s primarily tendon pain that is problematic. - Physical activities, even basic ones, seem to trigger my symptoms rather than mere stress. - I can sense tangible changes in my body—intensifying joint noises, which, although common, have escalated alarmingly fast at my young age. ### Medications and Queries Currently, I’m taking Duloxetine (40mg) and Amitriptyline (25mg). While these have helped with sleep, they do little for controlling pain. **Questions I Am Facing:** 1. Is the pain solely attributable to fibromyalgia, or could there be another underlying issue? 2. How can I further explore my diagnosis to gain confidence in its accuracy? 3. Is there a solution through improved diet, exercise, and pain management, or should I consider alternative approaches? 4. Could the widespread tendon pain be linked to the antidepressant and anxiety treatments I underwent previously?

Answers (1)

4/23/2025, 2:21:10 PM

OpenHealth AI

Key Points

You're facing widespread tendon pain following a history of physical activity, recovery from an ACL injury, and a complex medical background including mental health challenges. Your concerns about whether the pain is solely related to fibromyalgia or if there's an underlying issue merit careful exploration. Addressing your pain, while also focusing on mental and physical well-being, is crucial.

Explanation

Widespread tendon pain can have multiple contributors. While fibromyalgia is one possibility characterized by heightened sensitivity to pain, your symptoms—including joint noise, specific areas of discomfort, and a significant history of injuries—might suggest a more complex interplay of issues such as connective tissue disorders, inflammatory conditions, or even repercussions from previous injuries and surgeries. Given your experience, narrowing down the exact cause of your pain can help in managing it effectively.

Next Steps

1. Pain Management Strategies:

   • Use a combination of pain relief techniques like hot/cold therapy, which may alleviate some discomfort in your joints and tendons.
   • Gentle stretching and low-impact exercises (like swimming or stationary cycling) can help maintain mobility without exacerbating your pain.
   • Consider consulting a physical therapist specializing in pain management and rehabilitation. They can tailor a program focused on strength and flexibility that respects your pain levels.

2. Dietary Considerations:

   • Incorporate anti-inflammatory foods into your diet, such as:
     • Fatty fish (rich in omega-3 fatty acids)
     • Fresh fruits and vegetables (especially berries and leafy greens)
     • Nuts and seeds
   • Stay hydrated and limit processed foods and sugars, as they can contribute to inflammation.

3. Explore Alternative Therapies:

   • Engage in practices such as yoga or mindfulness meditation, which can help manage pain perception and improve overall mental health.
   • Acupuncture might also be beneficial in reducing pain and improving well-being.

4. Evaluation of Current Medications:

   • While medications like Duloxetine and Amitriptyline can help with pain or mood, if they are not effectively managing your pain, revisiting this with your healthcare professional may be necessary. Explore other options like non-steroidal anti-inflammatory drugs (NSAIDs) or topical analgesics that could be more effective for tendon pain.

5. Further Diagnostic Exploration:

   • Continue discussing your symptoms and consider getting a second opinion from a rheumatologist or pain specialist. It's also beneficial to keep a pain diary to record your symptoms, triggers, and any responses to treatments. This detailed account can guide healthcare professionals in making a more accurate diagnosis.

Taking these steps can help you manage pain more effectively while also supporting your recovery and overall health. You're not alone in this journey, and focusing on a multifaceted approach can build your resilience and improve your quality of life. Let me know if you need more information or support.