Training with Small Frame? Tendinitis?
Got a weird case that could be scientifically interesting discussion, hence I'll post here because the folks here are knowledgeable. I have been trying to get strong for a long time and would appreciate some guidance on how to actually do it. I promise I won't take anything as medical advice.
I know from the responses to similar threads on other forums, the first two questions of my post is generally a taboo line of questioning. But, I'd really appreciate some clarity on this matter because my case is an unusual one.
I (male, 24) had a long-term eating disorder for 10 years from childhood through adolescence, had stunted growth and osteoporosis from it, and my wrists are only 5-5.2 inches in circumference, my ankles only 7 inches in circumference.
- Can this be pathological for tendon capacity to tolerate load?
- Could tendon capacity be nonlinear with respect to size, so that perhaps minor deviations in size of 1-2 standard deviations are not significant (hence the common answer to not worry about things like frame size and muscular potential, common answer where someone with small but on-the-charts wrists like 6 inches shares their progress), but larger deviations of 3-4 or 5 standard deviations may in fact be pathological?
- Are there other considerations for why eating disorders cause tendinitis after recovery, long-term? (See another example case: https://www.reddit.com/r/EatingDisorders/comments/1q7iih/request_questions_re_muscular_skeletal_strength/)
- If you had unlimited resources, say a billion dollars, could you fix such a problem with the right drug cocktails or injections of HGH + other substances to drive local increase in bone and tendon diameters?
MY CASE:
My complaint is that I get tendinitis easily. When I first went to the gym at age 15 the limiting factor was tendinitis, it still is. I never had any issues and did typical crazy kid stuff growing up before my eating disorder at age 10, so I don't think it's a genetic problem. Being underweight was horrible for my tendons, and still to this day everytime I actually injure myself its in a calorie deficit. But basically, at age 20 I recovered 100%, I gained weight, got normal BMI and my tendons got a LOT better, but still way worse recovery than any of my peers and it's been 4 years now that I've been weight recovered. My osteoporosis is improving, but my tendons aren't.
I also only sleep 5-6 hours a night and haven't slept more than 7 hours since 2017. I wake up frequently and cannot seem to do more than this, but maybe I need to try some kind of strict schedule or something. I end up lying in bed for 9 hours, because the rest of just not moving is still worth something, enough so that I'm never sleepy. Unless I'm just genetically bolstered against sleep deprivation's effects in all aspects EXCEPT for tendon/connective tissue, I seem to be getting enough? Or is it really just that important if you want to be stronger than just sedentary? I dont know how to get more if that is the case... Are tendons really that much more susceptible to sleep deprivation than your mood, subjective energy level, and muscle/bone tissue? Is there some genetic interplay going on, where my genes are such that sleep is the main factor in tendon recovery? I see some other powerlifters out there with severe insomnia, but perhaps they have a frame size and non-eating disorder history advantage?
I got up to doing about 200 lb bench, 200 lb squat, and 50 lb weighted pullup at my best in 2024, before getting pec tendinitis and achilles tendinitis and bicep and infraspinatus tendinitis. Are those numbers the max I can ever expect to get with my frame size? I imagine better training could have somehow kept my tendons healthier...but idk I thought I was doing a good job of managing the load back then, but I was trying to progressively overload still even if I wasn't feeling great subjectively. Maybe I should have been in a bigger surplus. Or maybe I still have too little fat, I'm at a BMI of 20-21 even, but my lower body MRIs say "paucity of subcutaneous fat of unknown significance". I have scoliosis so my torso doesn't look lean at all because it's compressed so I assume I'm at a healthy amount of fat, but maybe I still need to put on more fat? My height would be 3 inches taller if I got scoliosis corrected so maybe I'm still underweight somehow?
Can lack of subcutaneous fat mechanically increase the risk of tendon damage during movement?
Thanks to anyone who read through all this, really appreciate it!