"Litmus Test for Intelligence" - Tendinopathies

[Jordan Feigenbaum]

You are an interesting man Jordan.

Candid discussions cannot be had without thick skin.

You may close my account and delete its posts as you see fit. You are the boss here.

I wish you and Barbell Medicine the best!

Likewise- if you can't take the heat right back at you then you should reconsider posting like an asshole on the internet. You are posting anonymously and being inflammatory with your comments re medical school, Barbell Medicine's "uniqueness", and even your initial comment suggesting my remarks were outrageous.

I'm not sure what candid discussion you'd like to have, given your admitted (and demonstrated) lack of understanding of these issues in addition to no formal training in these manners either. This is coupled with a lack of experience training as well, which tends to be problematic in understanding complex issues pertaining to training (like tendinopathy).

You're welcome to stay here, or leave. Choice is yours.

[Jordan Feigenbaum]

The "quick scan" comment was not reflective of my knowledge level in this area. Rather, it was rhetoric demonstrating the ease of finding some level of medically accepted evidence.

I'm not sure that you have any knowledge in this area, as evidenced by your reply.

This will really get into the weeds and will become specific to which tendons we are talking about and if we are including ligaments in the analysis in addition to patient age, background and injury source if we go much further. It will also depend on the specific definitions we use for tendinopathies and what we consider to be medically actionable.

Fortunately, by doing that you demonstrate a lack of understanding of both tendinopathy management and pain science in general.

I would see no reason to give second thoughts for example to suggesting Ibuprofen to an 80 year old male with calcific rotator cuff tendonitis.

I would however recommend against a strong course of NSAIDs for a 16 year old athlete with persistent or highly irritable patellar tendinosis.

Again, demonstrating a lack of knowledge on the topic- there would be potential risks and benefits in both scenarios, but none of the risks would be due to decreased healing rates.

I believe I understand your position on the matter. I consider it to be a valid position and the current orthodoxy, but unnecessarily unyielding and myopic. I do not agree with much of it.

I would disagree, as many do not share our view of tendinopathy management. That said, we are all fortunate that you are not responsible for giving anyone recommendations and given your (admittedly) untrained position- your opinion is meaningless in this context

[曹操到达了]

You are an interesting man Jordan.

Candid discussions cannot be had without thick skin.

You may close my account and delete its posts as you see fit. You are the boss here.

I wish you and Barbell Medicine the best!

[Jordan Feigenbaum]

I have been doing SS for just over a year, but I was unaware BM had become a separate entity until a few days ago. I was just listening to some of your the podcasts in the background as I did some work. I didn't see the refs or know about the newsletter. i will take a look at it.

Yea, I would check those out. As an aside, I would consider changing your programming, as it is not possible to do SS for 1 year productively.

It would be an interesting and potentially useful to provide a bulk compilation from a citation manager to a central Resources section of the website though. I would certainly take a look from time to time.

Eh, I don't think this is something I'm interested in doing, answering questions about, and maintaining publicly.

You or Austin would post once a week or so a link to a current review or research article you found particularly interesting without providing any analysis.

We already do this and provide analysis in our research reviews and reading lists.

I am impressed with the amount of content you generate. Especially when considering the work and performance it takes to jump from a mid tier med school to UCLA for residency. (What are you specializing in?)

A mid tier medical school??? LOL. Cool man.

The word "unique" implies an extremely high level of differentiation from your competitors in the same space. It implies you stand unparalleled.

Correct. There are exactly zero other people doing what we are doing.

My frank assessment is you produce excellent work, but there is not much other than The Bridge that is unique to BM. (take it with a grain of salt, as I did not know this site existed 3 days ago. Feel free to edit my post if you do not feel all of it belongs on you boards.)

You are unfamiliar with what we do then. I would advise you to stop commenting and consume more of our information before passing judgement, in addition to changing your tone when posting here. Alternatively, we can show you the door if you like.

[曹操到达了]

Quite often, especially recently- I cite the literature in the description section of the YouTube video or our blogs, newsletters, etc. so I'm not sure what you're asking.

I do have my articles organized privately.



We already have a monthly newsletter that goes out as a review of the current science.

I think nearly all of the things we do are unique, but we have to pick and choose where our efforts go.

I have been doing SS for just over a year, but I was unaware BM had become a separate entity until a few days ago. I was just listening to some of your the podcasts in the background as I did some work. I didn't see the refs or know about the newsletter. i will take a look at it.


It would be an interesting and potentially useful to provide a bulk compilation from a citation manager to a central Resources section of the website though. I would certainly take a look from time to time.


I was referring to a situation that could look something like this:


You or Austin would post once a week or so a link to a current review or research article you found particularly interesting without providing any analysis.

Then the users of the forum (I am under the supposition there are quite a few engineers, scientists and medical professionals here capable of critical analysis) could discuss and analyze the article.

Your input could be included in terse verse if at all or when needed to save time for yourself.

Just an idea.


I am impressed with the amount of content you generate. Especially when considering the work and performance it takes to jump from a mid tier med school to UCLA for residency. (What are you specializing in?)


The word "unique" implies an extremely high level of differentiation from your competitors in the same space. It implies you stand unparalleled. My frank assessment is you produce excellent work, but there is not much other than The Bridge that is unique to BM. (take it with a grain of salt, as I did not know this site existed 3 days ago. Feel free to edit my post if you do not feel all of it belongs on you boards.)

[曹操到达了]

I don't think you can do one of these "quick scans" and have an interpretation of the literature for these types of topics. At present, there are less than a handful of studies showing the potential mechanism for decreased proliferation for some elements of tendons in vitro (not in live patients), yet this result has not been seen in humans. Furthermore, while we cannot ignore biological components to pain- we cannot rely on the mechanical damage (and thus a need for "healing") as underlying mechanism of tendinopathies.

At best, one could say that long term data on NSAIDs suggests no real improvement over placebo, though to suggest harm would be another thing that has yet to be demonstrated. As a corollary, much of the data on collagen (and other nutraceutical targets) suggest an improvement in certain elements of tendon remodeling, the same things potentially inhibited by NSAIDs- though neither have been shown in vivo and clinically meaningful improvements (or harms) have not been shown to date.

So, I stand by my statement. The litmus test reference suggests an incomplete understanding of tendinopathy and pain in general.

The "quick scan" comment was not reflective of my knowledge level in this area. Rather, it was rhetoric demonstrating the ease of finding some level of medically accepted evidence.


This will really get into the weeds and will become specific to which tendons we are talking about and if we are including ligaments in the analysis in addition to patient age, background and injury source if we go much further. It will also depend on the specific definitions we use for tendinopathies and what we consider to be medically actionable.


I would see no reason to give second thoughts for example to suggesting Ibuprofen to an 80 year old male with calcific rotator cuff tendonitis.

I would however recommend against a strong course of NSAIDs for a 16 year old athlete with persistent or highly irritable patellar tendinosis.


I believe I understand your position on the matter. I consider it to be a valid position and the current orthodoxy, but unnecessarily unyielding and myopic. I do not agree with much of it.

[Jordan Feigenbaum]

One more request/suggestion: Jordan often cites literature in podcasts, etc. Does he have these articles organized in Mendeley or somewhere? It would be interesting to see the references or at least bulk/somewhat organized sources.

Quite often, especially recently- I cite the literature in the description section of the YouTube video or our blogs, newsletters, etc. so I'm not sure what you're asking.

I do have my articles organized privately.

Have you considered adding a "Journal Club" or "Literature Review" section to the forum? High level discussion of the more technical aspects of physiology as related to Barbell Medicine could be interesting and unique to this organization.

We already have a monthly newsletter that goes out as a review of the current science.

I think nearly all of the things we do are unique, but we have to pick and choose where our efforts go.

[Jordan Feigenbaum]

Feigenbaum seems adamant that no evidence exists to contradict NSAID use for tendonitis. Curious why you are so convinced? (Enough to jocularly claim differing opinion is a litmus test for intelligence)

A quick scan of the literature generates no conclusive evidence (difficult thing to come by in biosciences), but does produce data and logically developed hypothesis to suggest NSAIDS may inhibit or attenuate the healing process especially when the condition is present for longer than 16 weeks.

ex. Schwartz A, Watson JN, Hutchinson MR. Patellar Tendinopathy. Sports Health. 2015;7(5):415-20.

I don't think you can do one of these "quick scans" and have an interpretation of the literature for these types of topics. At present, there are less than a handful of studies showing the potential mechanism for decreased proliferation for some elements of tendons in vitro (not in live patients), yet this result has not been seen in humans. Furthermore, while we cannot ignore biological components to pain- we cannot rely on the mechanical damage (and thus a need for "healing") as underlying mechanism of tendinopathies.

At best, one could say that long term data on NSAIDs suggests no real improvement over placebo, though to suggest harm would be another thing that has yet to be demonstrated. As a corollary, much of the data on collagen (and other nutraceutical targets) suggest an improvement in certain elements of tendon remodeling, the same things potentially inhibited by NSAIDs- though neither have been shown in vivo and clinically meaningful improvements (or harms) have not been shown to date.

So, I stand by my statement. The litmus test reference suggests an incomplete understanding of tendinopathy and pain in general.

[曹操到达了]

https://www.youtube.com/watch?v=9vWfWjePiNc

about 8:25 - 9:00


Specifically, he claimed there was no evidence to suggest NSAIDs could result in slower healing of tendonitis or "Things that alter inflammatory signalling [in reference to NSAIDs for treatment of tendonitis].... [do not] slow down tendon healing... It has been studied very well and is not the case at all [No contraindications for NSAID use from a tendon healing or remodeling perspective]

I am sure he has come to a logical conclusion based on the evidence, although it differs from my current interpretation of the data.




One more request/suggestion: Jordan often cites literature in podcasts, etc. Does he have these articles organized in Mendeley or somewhere? It would be interesting to see the references or at least bulk/somewhat organized sources.


Have you considered adding a "Journal Club" or "Literature Review" section to the forum? High level discussion of the more technical aspects of physiology as related to Barbell Medicine could be interesting and unique to this organization.

[Austin Baraki]

Can you clarify what you think Jordan's position is on this matter, and cite where you are getting this from?

[曹操到达了]

Feigenbaum seems adamant that no evidence exists to contradict NSAID use for tendonitis. Curious why you are so convinced? (Enough to jocularly claim differing opinion is a litmus test for intelligence)


A quick scan of the literature generates no conclusive evidence (difficult thing to come by in biosciences), but does produce data and logically developed hypothesis to suggest NSAIDS may inhibit or attenuate the healing process especially when the condition is present for longer than 16 weeks.

ex. Schwartz A, Watson JN, Hutchinson MR. Patellar Tendinopathy. Sports Health. 2015;7(5):415-20.