Ask HN: How can I deal with chronic ligament and tendon injuries? | Hacker News Reader

Ask HN: How can I deal with chronic ligament and tendon injuries?

27 pointsdominotw56 comments

I love physical activities but I seem to get injured very easily.

I played tennis for a bit, now I have tennis elbow.

I did biking for a while, now I have IT band syndrome.

I tried swimming for while thinking it would be safe, now I have shoulder impingement.

I have had these injuries for decades and have gone to countless doctors, done countless hours of physical therapy. nothing helped. I just sit on my couch all day due to these injuries. I know people all over the world are suffering from much worse but this is making me depressed and resentful. What should I do? also, Has anyone tried stem cell therapy?

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I'm in a similar situation, and here are some thoughts:

How quickly do you increase your training volume? Do you have enough rest and recovery time?

When you first start feeling injured, do you stop, and rest a week or two, or do you continue through the initial pain?

For running, it's commonly known that you shouldn't increase your distance by more than 10% per week. For me, if I find that increasing 10% per week causes injury but if I increase only 6% per week, I'm ok.

Do you warm up and stretch? Do you do strength training or rehabilitation exercises? What about core strength?

I found a great massage therapist who points out issues with my body and recommends stretches to help fix some of them. (I can give you a recommendation if you are in SF)

Are you sure you have the correct form for the exercises? Maybe work with a personal trainer? I biked for years with a bike way too small for me. Only when I went to get my bike fit, and got a different one did pain go away.

Have you read up and gotten a good understanding of your injuries? I was better able to understand and manage some injuries when I read "Treat Your Own Rotator Cuff" and "Treat Your Own Back".

How carefully do you track your exercise? I tracked my exercise for a year and discovered that I was 3x more likely to be injured after any given workout if I had done X minutes of lower body exercise in the past Y days so I cut back and had less injuries.

If you find any good solutions, please respond to the thread and let us know!

Decide that you are going to fix your problems with weight training. Start ridiculously light, so there's no chance you will make it worse. Train every day at first, increase the weight by a tiny amount each workout. I would suggest one arm overhead press for your upper body, leg press or split squat for lower, preferably at home with your own weights. It's a pain to drive to a gym to do a 5 minute workout.

Buy 6 0.625 lb washers, 2 2.5 lb plates, 2 5 lb plates, 4 10 lb plates, 2 25 pound plates to start. You should be able to combine those to get any weight from 0.625 lbs up to 100 lbs in 0.625 lb increments. Keep a training log, I use google docs on my phone. Each workout add to the top of the file. Copy and paste the last workout and change the weights.

At first add weight to your working set in small increments. Gradually increase the increments up to 5 lbs for legs, 2.5 for arms. When it gets too heavy, reduce the jumps back down.

Do 3 sets of 15 for each exercise for your work sets. Divide the working weight by 4 and warmup by adding weight in those increments. For example 12 lbs / 4 = 3 lbs. Do an unweighted set, then 3 lbs, then 6, 9, 12. When the weight gets heavy, switch to 3 times per week.

You have to be in charge of fixing your problems. Not the doctor or physical therapist. It takes discipline and commitment. Training will not always feel good. You have to figure out when you're having acceptable rehab pain, and when you're damaging yourself. Obviously work through the former, and stop immediately with the latter. You will mess up and have to start over. Probably several times. But you can fix these problems. I'm available to help if you need it.

I agree with this overall. It is a long road to significant improvement, with the occasional setback (sometimes way back), but taking charge of this yourself is the only viable path for the long term.

One disagreement, though...I probably wouldn't do any overhead lifting with a shoulder impingement. But do research on exercises to strengthen the current injuries you have, and work into more general weight training over time. My two cents.

Do your injuries show up clearly on a CT/ultrasound/MRI? If the answer isn't a decisive Yes (decisive, because if you look hard enough you will always see something), you might be seeing psychosomatic symptoms: illnesses caused by your mind. The pattern you described sounds familiar. Especially muscle and tendon pain is suspect, but many back pain problems can be psychosomatic in nature, too.

At the very least read one of John Sarno's books, and see if your symptoms change. If they do, you are on the right track.

yeah, Dr Sarno's book(s) are worth a look if you suffer from back pain. Helped me to start running again after years of trouble.

This can be true even if there's something "obvious" on the MRI, since the importance really depends on the base rates of that abnormality in healthy individuals without symptoms[1]. For example, it's easy to find bulging discs when looking for the cause of back pain, but bulging discs are also very common in asymptomatic individuals[2].

1. https://arbital.com/p/bayes_rule/?l=1zq

2. http://www.ajnr.org/content/early/2014/11/27/ajnr.A4173.full...

Diet is important. The system needs food and the right nutrients to recover. Read up on this, as there's an extensive amount of information to read. If TLDR, then go high on the protein, go low on the carbs and cut out simple carbs and sugar. Make sure you get the micronutrients as well (electrolytes like magnesium, potassium, etc. etc.)

Rest properly. I sleep poorly, but I also only work out very heavily three times a week. The system need rest to recover.

It sounds like you're not differentiating different types of activities. So we don't know how often you do them, or anything else. Whether you took lessons or professional guidance or just jumped in the water and starting splashing hard around you, or what. Calisthenics / bodyweight training is very powerful, well-rounded as it will strengthen your ligaments and tendons as well as your muscles. In contrast to weight training (stay the hell away from machines unless you are in physical therapy), calisthenics strives for functional movements, which use several muscle groups in conjunction. You can find a lot of material on this online.

Tennis elbow I can't help with, but running pains are very normal. I have over-pronating feet so always suffered from knee issues and shin splint. But most runners I know have issues like this. Muscle imbalances mixed with individual mechanical quirks like flat feet (me). The muscle imbalance part is even more common, and fixed by educating yourself and doing complementary exercises. For example, exercises like squats and lunges help balance things out against the evils of running alone.

Doctors are a pain. As someone said, find a sports one. Otherwise you'll risk hearing 'Okay, stop exercising for 2 months and take aspirin every day.' I hate it when doctors do stuff like that (ignore the individual person's goals rather than work with them).

Do yoga. Get an MRI see WTF is going on with your tendons or CT scan. Older people typically get these types of injuries 60+. Its possible your straining yourself too fast. Your body has to get "used" to working out then up your workout. Your muscles need to support your activity level. You can't make your tendons "stronger" they have to be stretched out / warmed out. Im not a doctor. I don't know what i'm talking about BUT i been working out all my life. My 2 cents. Gud Lucky. ;-)

Yoga is a great idea for many — probably even most — people, and has certainly been good for me. Another comment suggested the possibility of Ehlers-Danlos Syndrome (among other things, a connective tissue disorder), however, for which yoga can be somewhat contraindicated. I'd want to that rule out before beginning a yoga practice beyond Yin or restorative.

A friend with EDS practiced and taught Ashtanga for years before her diagnosis. The ways the syndrome affects the joints meant that she was able to perform asanas from the later series within a couple years of beginning her practice.

Since she was doing stuff she was only capable of doing because of her condition, however, and not stuff she'd trained up to, she ended up doing significant damage to her joints; she's at the point now where her shoulders often dislocate just from carrying too many full grocery bags up the stairs.

You need to find a doctor that practices professional sports medicine. You know, the kind that treats professional athletes. Not the run of the mill storefront doctor or GP.

Have you ever been tested for Ehlers-Danlos Syndrome or similar connective tissue diseases? A lot of the time with rare diseases, you can go quite a while between doctors that have even heard of the disease, and come up with a course of treatment that actually would be useful. Chronic sprains and other tendon injuries are a pretty classic sign of the disease, and there are definite exercises you can do to help mitigate effects, but because a lot of the exercises are counterintuitive, developing a course of action that actually works is difficult.

Have you tried Pilates? I was getting aches and pains, had a bad shoulder from tennis for years, getting hip pain when I hiked and so on, just assumed I was getting old.

I've taken up reformer pilates and I'm the best I've been in years, maybe stronger than I've ever been (done about 30 sessions so far), shoulders better, pains are gone. It relies on strengthening your core muscles - and all the little muscles that don't get any work when you're sitting around. It may be a lack of strength in these that is causing your pains. My recovery time has increased to, yesterday I went for a 3 hour hike, thought I'd be sore today, but no! I've wound the clock back 20 years.

If you do decide to do some though, look around for someone who knows what they're doing - preferably a diploma and some years experience.

I go 2x1 hour sessions a week, and thats all you need, just whatever other exercise you want each day apart from that, eventually you'll be doing pilates 3 or 4 times a week on your own should you choose.

It has been magic for me, I recommend it to everyone.

Edit: oh and sitting on the couch is probably the worse thing you can do, all those little muscles will lose strength and aches and pains will not go away.

As disturbed as I am that you'd ask about this on hacker news... it sounds like a classic connective tissue disorder, i.e. joint hypermobility or Ehlers Danlos Syndrome. Your history of medical mismanagement is also typical of people with this problem: people will try to chase the problem around rather without identifying the underlying cause.

You deserve treatment for any psychological stuff caused by your physical illness.

Some people with long term pain benefit from cognitive behaviour therapy. You might want to see a pain clinic to get best quality advice about pain, and about rehabilitation.

If you want to know what treatment you could expect from the English NHS you could enter the condition in the search here: https://www.nice.org.uk/

They tell you the evidence they've used to come to their decision. They sometimes give "Do NOT" advice, telling people to avoid some treatments.

Or you can try NHS Choices to get some general information. http://www.nhs.uk/pages/home.aspx

In general, getting medical advice from the Internet is probably a bad idea.

>You deserve treatment for any psychological stuff caused by your physical illness.

Quite often the pain itself is caused by psychological factors. It's certainly worth addressing psychological issues either way.

Coming from a climbing background I can say that tendons, ligaments and pulleys are very common injuries because they take the longest(years!) to strengthen up to the demands that climbing puts on them. Take it slow, listen to your body, and rest enough.

What about walking, hiking and running?

About the tendons et al: are you able to voluntarily move your shoulder out of joint? Can you bend your fingers and thumbs backwards? Would you characterize yourself as "double-jointed"?

http://www.livescience.com/33186-double-jointed-people-hyper...

http://www.wisegeekhealth.com/what-does-it-mean-to-be-double...

Let me suggest No on the stem cell therapy:

http://www.nytimes.com/2016/06/23/health/a-cautionary-tale-o...

I improved my tendons by consuming gelatin as a supplement daily for like a year or two when they were so bad they were seriously interfering with, for example, my ability to get out of bed unassisted.

/anecdata

I have to live with a bunch of crap too (biceps, shoulder, back, knees). You might be at the point where injuries don't go away, you just manage them. My tips:

i) don't give up on exercise, I have had chronic injuries stay static or worsen with deliberate rest and only improve with focussed work. Very high rep pump exercises (30+ reps) getting a lot of blood into the muscle/tendon area really helps. Cable machines are great. You can usually find an exercise/angle/attachment combo that works the area without aggrevation. Something like walking for a few miles helps my back.

ii) avoid actions that aggravate the specific impingement e.g. using a mouse would cause acute pain in my shoulder but it was difficult to correlate activities because the pain can show up a few days after the activity.

iii) Work on flexibility and mobility. Causes of injuries are often non-local i.e. things are pulling other things out of place. Just work on complete flexibility especially where you are inflexible - like hip-flexors, shoulders and stuff. I have to do yoga exercises, stretching (90 second holds) and foam rolling everyday if I want to sit down for hours without significant pain.

I sympathize with your situation. It sounds very similar to chronic pain issues I've suffered for most of my life. I know how despondent it can make you feel, I've been there. Being able to enjoy physical activity is very important to one's mental and physical well being.

However, in recent years my condition improved dramatically. I believe I've an autoimmune disorder. Here's some suggestions that helped me figure it out and reverse it's progression:

Try high dose magnesium (Mg) for short while. 600-900mg of magnesium citrate daily is best I think. It's not to correct a deficiency. It's for the effect it has on the bowels. At a high does the bowels loosen and the microbiome quickly changes. This alters how new immune cells develop, hopefully positively as it did for me.

I wouldn't recommend taking Mg like this long term though. The best way to positively improve the balance of components of the microbiome is to consume a lot more fiber of various sorts and sources than is common in the western diet. The usual advice on diet is to be recommended. Cut down on highly processed simple carbohydrates. Some meat is ok but not a lot. Same for alcohol. If you want to eliminate meat that's ok as long as your diet is still varied and includes probiotic and fermented foods. And generally eat a lot more plants.

To sum up I believe the immune system is groomed in the gut and the microbiome is an essential part of that process. A malfunctioning and misdirected immune system is responsible for many illnesses from those well known like arthritis to ones we probably don't even have a name for yet.

Whether this helps you or not don't give up and keep looking with an open mind.

I agree with the others that suggest overuse injuries. Try resting more between workouts (yup, that means sitting on the couch even though you're not tired).

As for biking, a proper bike fit is crucial. Did you pay someone $200 to set up your position on the bike? If not, it's probably wrong. (Even if you did do a fitting, it could still be wrong. The fit changes as your develop or lose strength, flexibility, etc.)

Biking is a great exercise because you can collect so much data while you ride. Power is especially useful, so you can objectively judge how hard you worked out and how much recovery time you need.

Cycling generally makes your IT band tight. Foam roll it after your workout. I also spend a lot of time stretching out my hamstrings, because they are very tight from sitting at a desk all day and directly affect one's posture on the bike. (Standing desk is helpful for keeping your hamstrings long, if you can actually be productive while standing.)

With every sport if you have bad form it will lead to injury.

Let me address 2 of the non-impact sports you listed:

1. Swimming - if you have a bad stroke and immediately go on to do long yardage workouts you will hurt your shoulders. Working with a stroke coach and slowing down to focus on your form will do a lot to avoid shoulder issues. Alternate breathing mixed with some dry land work will help muscle imbalance issues too

2. Cycling is about fit and form. For i/t band issues if your position is incorrect and you do a lot of mileage you will have knee problems. Also doing some weight training can help. Get a proper fit from a bike shop that specializes in shoe/saddle fit as well. Adding some resistance training will also help

You must work up to being competitive. Going out and doing 60m or 3000 yards on the first day will definitely lead to injury. Investing in a good coach here can help.

I have been experiencing similar injuries myself. After talking to several trainers and physiotherapists, I found out that the problem is my sedentary life style.

If you spend your entire day sitting in front of a desk, the muscles in your body becomes less flexible and weaker. This effect is hard to reverse by exercising alone. (9 hours of sitting on a chair vs. 1 hour of exercise)

For a person who lives this kind of lifestyle , you need to have much longer warmups, do a lot of stretching (even on resting days and in the office), and most of all, try to change the sedentary lifestyle by working standing up / walking (walking desk) and stretch every few hours.

And a final comment, sitting on the couch all the is the worst thing you can do. Don't give up on exercise, even if it's just walking. (you'll be surprised how difficult a fast paced 10 mile walk can be!)

How much time have you invested into developing the proper form for these activities? Does your training regimen make sense? I'm a powerlifter so I can't speak to specific injuries in these sports, but most of the chronic injuries I see in my sport are form-related or volume-related (over training)

Fixing tennis elbow is trivial. They invented a foam bar and began clinical trials. The stupid thing was so effective they had to end the trials early.

Here is a link to the product. http://amzn.to/29Ni3Ex

I've tried this product. It exacerbated my tennis elbow.

I don't understand the "the our product was so successful we were forced to end trials" argument. How long is the trial? 4 weeks? How big is the control group? 8 people? Is it really unethical to have the control group wait a few weeks to start using the effective treatment? This sounds like the exact argument that a snake oil salesman would use.

I've been struggling with chronic issues like this for the past few years. The only consistent relief comes from yoga (I like vinyasa) and physical therapy.

I find there are some things that make it worse but overall feels pretty uncorrelated with anything obvious. Try keeping a detailed log of symptoms along with possible triggers as well as things that make you feel better.

Good luck

Continue with the medical route. If you're not satisfied with your docs, find better ones. Demand they address your specific concerns, and any failure of treatment or diagnosis to address root causes.

This is almost certainly not truly a physical problem. It is not normal to hurt yourself seriously and repeatedly doing normal physical activity. Do all of your tennis, biking, and swimming buddies end up with serious chronic pain?

You likely have a deeper physiological problem that the physical activity is bringing to the surface.

I can't help though, because I don't have mobility/physical issues and so I don't research it much. My friend who is very smart and has mobility/back issues says that this is the best book on the topic in the world, though: https://www.amazon.com/Becoming-Supple-Leopard-2nd-Performan...

Try crawl stroke or breast stroke of your shoulders hurt from swimming. I swam competitively for a long time and training backstroke always made my shoulder hurt

Are you overweight? Do you have a history of taking quinolone antibiotics? Is your diet terrible?

Just a few thoughts, could be related. Good luck, chronic health issues suck.

Second this, I had a terrifying reaction to Ciprofloxacin to the point where I could barely walk at one stage and have a range of progressive health issues that may be related. My advice - do not take these antibiotics unless you absolutely have no other option.

To my knowledge inflammation comes from lack of water, bad food (red meat) and bad posture.

If you drink sufficiently, have a clean diet and had some chiropractic consultations then you need to explore radical options.

Look at the Wim Hoff method, it's a crazy Dutch man that swims near icebergs and run naked in the snow. The method consist of breathing exercises, yoga postures and cold showers. Apparently it cures inflammation in the body (among other things).

I plan to give it a go this winter. If you can't afford it ($200) the backup torrent is not that hard to find ;-)

>To my knowledge inflammation comes from lack of water, bad food (red meat) and bad posture.

I've been researching this for a bit and seems like chronic tendon injuries show no sign of inflammation.

http://www.aafp.org/afp/2013/0401/p486.html

All chronic tendon injuries? Or yours? I guess what I'm asking is, have you had blood tests done to check your omega-3, omega-6, and c-reactive protein levels?

>have you had blood tests done to check your omega-3, omega-6, and c-reactive protein levels?

I've had blood tests done but i am not sure if these were tested. I am reasearching these now and will get this done if not already. Thanks for the pointer.

Have you looked into Trigger Point Therapy? It's worked for a friend of mine with RSI.

If you are female, have you had your progesterone levels checked post ovulation?

It sounds simple, but are you drinking enough water?

There are some studies about collagen

Hello,

I'm so sorry to hear about your frequent injuries! I'm chiming in here to agree with Sanddancer. Seven years ago, I suffered what I thought was my first tendon injury. One year ago I was diagnosed with Ehler's Danlos Syndrome, a disorder in producing one of the types of collagen the human body uses as a building block and sort of 'glue'.

Ligament and tendon injuries are the most common and most disabling part of this disorder due to their longer/hypermobile length, lack of tensile strength and poor healing abilities. We are prone to frequent dislocations and partial dislocations causing extreme pain. If this happens frequently enough, the tendons and ligaments in the joint can't pop all the way back into shape.

In normal people, these generally heal on their own and beyond anti-inflammatory meds, pain killers and steroid injections, orthopedic doctors don't have any ability to help. Every kind of surgery they've developed to physically shorten ligaments and tendons has failed- generally within 18 months of surgery.

I have severe right shoulder instability, instability in both hips and both SI joints, and patellar pain on both sides due to my knee caps not gliding properly. I've recently discovered something called Prolotherapy. These injections consist of a numbing agent, then an irritant followed by a pain killing dose of high concentration oxygen injected directly into the stretched and torn ligaments and tendons. The irritant causes new cellular proliferation, inflammation and healing and thusly, shortening of the damaged ligaments and tendons. If you are currently taking any anti-inflammatory medications- I'd stop now. They are blocking a natural healing response of the body. That pain is the feeling of healing. I made the mistake of taking them myself not knowing I was compounding the problem.

These treatments are rather controversial in the EDS community due to the rarer forms of EDS causing healing abilities so poor that they prevent the irritant from working. I have the most common form of EDS and the two treatments I've recently had in my hips and SI joint systems have taken me from thinking about a wheelchair to imagining hiking and dancing again. I too have always been a very active person and I look very forward to returning to my activities.

I'd look into visiting a geneticist to determine whether or not you have EDS. If so, and if it's Hypermobility Type III, I'd skip being told there is nothing available by an Ortho doc and go to the best Osteopathic Doctor you can find in your area.

After recieving my diagnosis, I realized I'd been suffering minor dislocations since childhood. Ten or so 'sprains' before 15 was probably not normal. Wishing you all the best and I hope Sanddancer and I are wrong. Without EDS or some other genetic connective tissue disorder though, the treatments I mentioned should be even more effective.

Perhaps you are just not made well enough for strenuous activities, sorry to say - this is the conclusion I have come to as I can't really run or cycle for more than a few miles before my knees get so sore I have to stop. I can walk around 15 miles tops and can lift weights if I'm very careful to not go too heavy. I have had a similar experience where I really want to exercise but keep getting injured. So these days I walk and lift weights gently. I've found that doctors are dangerous, prescribing poisonous combinations of drugs that is NSAIDs and quinolone antibiotics. Stay away from those and Aspirin unless you have absolutely no other choice. I seem to recall reading about stem cell treatments for people that had had bad reactions to quinolones but think its in its infancy. I am unusually flexible for a bloke so think this hypermobility probably goes hand in hand with injuries. Don't know if you find the same?

Why would the hacker news commentariat know more than actual doctors?

If you still trust doctors, you must be healthy ... once you start to have problems, especially the chronic kind, you will see that doctors don't know much and are just big pharma salesmen.

This has been totally true for me. 99% specialists I've seen are totally clueless. Some of them flat out said they have no clue and can't help me other than offering advice to rest.

I have found that physiotherapists have been far more helpful for me in coping with chronic injuries than any doctor. I only wish I had met him far earlier in my life

Find a sports physician. Ask around at a good powerlifting, strongman, olympic, or maybe even crossfit gym. (What is a good gym? They should have a lot of people squatting/dl over 500, and a handful 800+. There will be names on a leaderboard.) They'll know doctors that help you work through injuries.

And foam roller your it band. Every evening, and maybe every morning as well.

edit: with the it band, make sure it is your it band. Check with a good pt person that you don't have weak butt muscles (I forget which.) There's a simple test for this that involves lying on your side and raising a leg, but I don't think I can adequately explain it in text.

source: 10 months on crutches and a very tight it band.

"500"? Permit me to channel my secondary school chemistry teacher: 500 elephants? 500 biscuits? Units, lad! UNITS.

(Of course - I know you mean kg! But the point stands.)

pounds

500kg = 1102lbs; the list of people who can dl that is: Eddie Hall. AFAIK only 4-5 men have dl'd over 1k lbs ever (regulation height, no suit, not tire deadlifts or some bs) -- Benny, Eddie, Andy Bolton, Jerry Pritchett, Brian Shaw.

The list of 1000 pound squatters (no suit) is short too. Ed Coan, Malanichev, and a few others.

Anyone who can squat 500 lbs is strong. To depth, obviously -- lots of people can do 500 lbs knee bends.

Hash tag british humour.

Ordinarily I'd deploy hash tag that was the joke... but your reply in this instance was far too informative, and I'd run the risk (?) of looking (?) like (?) a twat.

whoosh

the sound of that joke going over my head =P

Yes, it seems to me doctors have cures for a bunch of standard stuff that have been diagnosed over the years. If you have something that they don't know then you're on you're own and that's probably why there's such a huge alternative medicine market.

If they want to operate get a second opinion (at least), if you or someone in your family have something that you think is a problem then keep going to doctors till you find a solution. Don't just take the first doctors answer if they don't know.

If you're in the chronic pain or odd problem area though then if doctors can't help go the diet / alternative medicine route - they may have an answer.

There's a lot modern medicine doesn't know, and most practitioners don't know it all anyway.

doctors have absolutely no idea how to treat any of this. Their standard NSAID/PT/Steroid shot combo is useless.

Just trying to see if anyone here has tried not anything unconventional.

Yes I had shoulder inflammation from tennis, doctors wanted to stick a needle in my shoulder regularly. Did some research and nope it doesn't work. I tried some weights and so on to get it fixed, it had some benefit but still there, so just thought I'd have to live with it. Some years later I took up some reformer pilates and it's gone! after only a few months exercise - it is truly a miracle. I recommend it to everyone who has aches and pains it's magic.

I also had tennis elbow some years ago, the doctor had no advice, Tai Chi helped me with that, same principle I suppose - gentle exercises for the small muscles. Though the results from Pilates have worked everywhere.

I know someone close with very similar shittery as you do. As her symptoms began to develop, we visited doctor (someone considered to be a great one with big knowledge). To my biggest surprise, she was never given any PT/Steroid, but: - checked for a variety of autoimmune diseases - tested for Helicobacter - searched for dental-, cervix- and tonsil problems - was given vitamin D. Since she shows symptoms at multiple locations, no responsible doctor dares to try hardcore goodies like steroid-like AI drugs, since in case of an autoimmune root cause that could make things much worse.

As medical professionals run out of ideas, they tend to identify mental background. Just ignore these notes and don't loose your trust. On one hand this is their natural response to their limits of knowledge; on the other hand many people stresses so much over their condition that they develop a mental root cause indeed.

Here is an example:

One of the best treatments for tennis elbow is heavy icing.

There is no financial incentive for anyone to tell you that.

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