Dear Mark: Tendon Edition

Dear Mark Tendon Edition in lineLast week, I told you how to strengthen your tendons and improve their resilience to strain and injury. You had a lot of questions in the comment section. For today’s edition of Dear Mark, I’m answering some of them. First, can Dan John’s “Easy Strength” program work for bodyweight training? Probably, and I give my suggestions on doing so. Next, what’s the deal with meniscus tears—mild ones? Can you heal them yourself? Are there any exercises that help the process? And finally, can the tendon exercises I discussed in the original post help folks with carpal tunnel syndrome?

There were some other questions about nutrition for tendon health, which I’ll cover in a future post. Don’t think I’m ignoring them.

Let’s go:

How would you apply the principles of the Easy Strength program to body weight exercises? Just reduce the reps? This is coming from a sedentary 46 year old beginner who is thinking about getting started.



As I understand it, the Easy Strength program was meant for long time lifters who were sick of getting bogged down in the details, the type of people who’d jumped from program to program in search of the optimal way to train and in the process of stressing out over it actually stopped training. Easy Strength just boils things down and makes training a lot easier (both physically and mentally). It removes the guesswork.

For an untrained sedentary middle aged guy, bodyweight “Easy Strength” is great.

Pick five movements to do every day:

A knee flexion exercise (squat, lunge, single leg squat, etc).

A hip hinge (deadlift, kettlebell swing, etc; this generally requires a weight so bodyweight may not work exclusively).

A press (overhead, pushup, dip, handstand pushup).

A pull (pullup, row).

A loaded carry (again, you need an external weight for this, but it doesn’t have to be a dedicated piece of exercise equipment; a heavy bag of books or a sack of sand work).

For each movement, assess your max reps. Go to failure on each, note how many reps you managed, and cut them in half for your work sets. So if you can only do 30 pushups in a row max, do 4-5 sets of 15 each day. If this rep scheme is still too hard to do every day, reduce by a third (15 reps becomes 10). Remember, it should be “easy,” not difficult. Your reps should “pop.”

As you progress, you can add weight by wearing a weighted vest or using weighted implements around the house. Load up a backpack with heavy books. Carry your kid or spouse.

Can you advise about slight lateral tears in meniscus? I’m 62, just started weight lifting this year and seem to have injured my right knee – but not badly enough for surgery. Any suggestions for strengthening?


Movement, movement, movement. Wait, let me amend that: pain-free movement, pain-free movement, pain-free movement.

Just keep moving, exercising, and training. Do everything that doesn’t hurt.

Low-or-no-resistance cycling. It’s boring but it works. Motion is lotion. Get a good book or podcast going and hit the bike.

Knee circles (see this great post by my buddy Angelo Delacruz).

Dick Hartzell’s knee rehab exercises. You’ll need some bands.

Focus on strengthening the hamstrings, glute medius, and glute maximus.

Basically, the entire posterior chain tends to be weaker in people with knee issues.

  • Hamstrings: Romanian deadlifts are great for this, and much simpler than they look.
  • Glute medius: Lie on your side and lift your leg up to 45 degrees. Stay fully extended at the hip. Don’t go into flexion (don’t bend). Aim for 3 sets of 20 reps on each side.
  • Glute max: Try glute bridges. Both weighted and unweighted, single leg and double leg. Hip thrusts (eventually with a weight across your hips) are also great for the glute max.

Squatting with different stances. A fun drill is to scatter a handful of coins across the floor. Then, using the position of the coins as a guide (a la Twister), squat down in various stances (wide, narrow, stagger, lunge, etc) to pick them up. Again, avoid pain.

Standing up from a cross-legged sitting position without using hands (and going back down). See this link. Make sure you can do this without pain. It’s a great way to condition the connective tissues of the knee.

Walking on various parts of your feet. Sounds weird but it hits your tissues at different angles. Walk on the outside of your feet. Walk on the inside. Walk on your heels. Walk on the balls of your feet. Walk with your feet turned out and in. Do this on sand. Do it barefoot as much as possible.

If you hurt yourself lifting weights, consider finding a good trainer for a few sessions until you get the hang of it.

The good news is that tears on the outer edges of the meniscus do receive blood flow and can heal themselves. Check everything out with your doc/PT before trying them, but I think you can make very good progress. Good luck!

I wonder if/how some of these exercises could help prevent certain other repetitive use injuries, like carpel tunnel. If the surrounding tendons are stronger/more supportive, maybe it’d have some protective benefit. Just thinking out loud


The carpal tunnel is a big causeway in the wrist for the median nerve and tendons to pass through on their way to the fingers. In healthy wrists, there’s a lot of movement through the tunnel. Every time you flex a finger or bend your wrist, that nerve and those tendons slide through. They should slide through smoothly. In carpal tunnel syndrome, they don’t. The median nerve doesn’t glide in carpal tunnel; it gets stuck and stretches. This is painful and can even restrict the function of your hand.

The physical therapy treatment for carpal tunnel with the most evidence behind it are probably nerve glides.

Here’s a good basic description and video of them. Or try the following a few times a day:

  • Sweep your arm out to the side until it is slightly behind you, palm facing forward, elbow gently straight
  • Pull your wrist back until you feel a gently tension somewhere in the arm
  • Relax the wrist forward until tension is relieved
  • Repeat 10 times
  • Ease the tension on the wrist to about half
  • Holding this position, gently raise your arm until you feel tension (stay below shoulder height)
  • Lower the arm until tension is relieved
  • Repeat 10 times
  • Ease the tension on the arm to about half
  • Tilt your head (bring opposite ear towards opposite shoulder) until you feel tension
  • Straighten the neck until tension is relieved
  • Repeat 10 times

As a major cause of carpal tunnel syndrome is repetitive motion, or keeping your wrist stuck in that “poised over keyboard” position, wrist mobility training can really help. Try Mobility WOD or wrist yoga.

Play around with some self hand-massage, too. Really dig into any tender spots to break up adhesions that could be inhibiting proper nerve movement.

That’s about it, folks. Thanks for reading, thanks for asking questions, and thanks for assisting with your own input down below in the comment section.

Take care!

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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30 thoughts on “Dear Mark: Tendon Edition”

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  1. Great article. Thanks for the tips (including the one about nerve glides).

  2. I think there should be a tutorial of wrist yoga where you put on gloves made by Lululemon and go through a Vinyasa flow. I’d watch it

  3. Love that coin toss squatting tip! I’m in an upper unit apartment with hardwood floors, so I imagine my downstairs neighbors might be a little alarmed if I was throwing loose change on the floor all the time. But I see no harm if it’s done once a day during a reasonable hour. 😉

  4. I wish I’d asked about MCL strains on that article so it could be addressed here. I’ve been in physical therapy since April and while I am improving, it wasn’t a very extreme strain and i’m still STILL working on healing it up. As of last week I started lifting weights (bar only) with Stronglifts 5×5 and I am focusing on getting the form perfect consistently before I add weight, as its still mildly flaring up my knee (along with the increase in golf and hiking and swimming I’ve added to my life).

    Anyone have insight on whether weight lifting will actually help strengthen the knee and help me heal more quickly, or if it’ll tear down all the good work I’ve been doing?

    1. Lenora IMHO weight training (squats) will definitely strengthen the quads and should help with your knee pain. What the rehab folks had me do was steps ups (you can do them on stairs on the bottom step, do a search for proper form, you’ll be bringing the other knee up and timing your arm movement as you alternate feet) and squats against the wall pressing your back against an ab ball. Those really seemed to help my knee rehab. Do NOT do machine leg extensions BTW in case you ever go to a gym. Also work on your hamstrings and calves. Golf might put a lot of torque on your knee, but of course you have to be the judge of that. When you hike you have to be careful of your footing not to twist the knee. Also, before you do your leg workout start with Angelo’s knees rotation exercise per one of the links above. Good luck!

      1. Thanks that’s super helpful! I’ll review all of your advice and try to incorporate it.

  5. I think inflammation due to a high carb diet is a major factor in carpal tunnel. The nerves swell thanks to sugar and other simple carbs. I had a horrible case for years that was finally resolved with a low carb primal diet. Even though I changed nothing else and spend hours on the keyboard.

    But if I start eating carbs again in large amounts (PMS) it comes back. I think large amount of nuts does the same to me.

    People have always done repetitive movements for jobs (digging, sewing, etc) yet carpal tunnel is something we saw more of now. Try eating ketonic for a few weeks and see if you feel better. It cured me!

    1. All of the people I’ve heard complaining about carpal tunnel have extremely poor keyboard posture with their hands. Mostly, they rest their wrists on the keyboard as they type, which is painful, inefficient, and bound to lead to repetitive motion injuries. As a child when I was taking piano lessons, one of my teachers made me perform my piano exercises with a quarter sitting on top of each hand. The quarter only fell off if my hands were in the wrong position, i.e., my wrists dropped. The best way that I can describe the best position is this:

      Relax your arms at your sides with relaxed hands. Without moving your hands, bend your elbows until your hands are at keyboard height.Turn from the elbow so that the fingers are resting gently on the keyboard. As you type, move only your fingers. There should be no bend at the wrist.

      Keep in mind that classical pianists practice about 8 hours per day for decades, and these days probably type on a computer keyboard as well. It is highly unusual to see a classical pianist with carpal tunnel. Using the method described above, even with a my conventional wisdom “healthy” diet for decades, I have never had any wrist pain that did not involve leaning on my computer mouse (bad habit, but pain is a quick reminder) in spite of having jobs involving typing a good part of the day and also playing the piano for fun an hour or two several times a week.

    2. Thanks Rita! I know so many people that struggle with carpal tunnel. Exciting to hear that you controlled your.

  6. Thank you for the advice on body weight “Easy Strength” training. This would be great for older patients or people looking to get into shape after being sedentary. Also, for the question regarding the meniscus tear: most people over the age of 40 probably some sort of “tear(s)” in their meniscus. This could be viewed as merely normal joint wear-and-tear and ALMOST considered to be normal for someone who is active. Strengthening the posterior chain and working in a pain-free ROM is PERFECT for anyone who is experiencing knee pain in that age-range. For Carpal Tunnel, the “poised over the keyboard” position is a killer. Optimal workplace set up and ergonomics will also help to mitigate Carpal Tunnel Syndrome.

  7. Thanks for the “tendon” loving care you pour into MDA and the great advice you give us daily Mark! 🙂

  8. P.S. Just tried Angelo’s knees rotation exercise, great explanation of the biomechanics involved. I have not using using optimal form when I’ve been doing them, awesome to have that corrected and much appreciated.

  9. Wow, I tried these exercises and will incorporate them in my routine! Thank you Mark.

  10. What about tendon exercises for damaged rotator cuffs? Any guidelines to help rehabilitate rotator cuffs, which get hurt easily in later years of life?

  11. For Peg, I can highly recommend the book “Treat Your Own Knees” by Jim Johnson. It’s a slim little paperback with great at-home exercises. I had a small meniscus tear and doing the exercises in this book solved all my problems.

  12. Wow, interesting questions and answers. And helpful comments! None of the questions really apply to me, but I was interested in the carpal tunnel since I know so many people that have really suffered with that. Looking forward to the follow up on nutrition for tendon health! This is clearly a hot topic.

  13. The only body weight hip hinge exercise I can think of is the single leg hip thrust done between benches. It’s a great one, though.

  14. Just on carpal tunnel – a lot of the times it can be actually causes by impongement in the shoulder causes by trigger points in the back and shoulder. This explains why all the therapies focused on the wrist tend to fail -they don’t address the actual cause.

    Try trigger point therapy on the shouldet and back muscles in particular to free up impingements.

  15. The carpal tunnel info is interesting. What do you know about the equivalent at the elbow?

  16. Thanks for the tips!
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    I bought one with bear footprint. I choose it because it’s hypoalergenic and non-toxic. Now the manufacturer runs a 48% discount promo on Amazon. As I like it a lot I decided to recommend. Check here:

  17. Thanks for the tendon love, it’s very interesting!

    The carpal tunnel question reminds me of my ganglion cyst I have in one of my wrists. The only advise I can find for cysts are “hit it with a Bible” or “get surgery”. As a massage therapist both of these options scare me (one might damage the wrist, the other puts me out of income for a while).

    I’m going to try doing the nerve glides, but does any one have any other suggestions?