Tendons have been on my brain a lot this year since I've suffered 3 tendinopathies that have left me feeling a little unprepared. Rehabbing them has been different than other injuries I've faced!
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I've been reading, seeking, and trying new techniques to help them heal, and I feel like somewhat of an in-the-trenches expert at this point 10 months into the journey. I've helped many others with tendinopathies before, so why has it been so hard for me to follow my own advice? I wish I knew...
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So today's tool in your Physiology Toolkit is HOW TO SCREW UP TENDON HEALING.
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​The TLDR (too long didn't read) is highlighted below.

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​Here's the cheat code to screwing up tendon healing:

1. DO TOO MUCH
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   ​Adding in "a little soccer game" or "a little too much hiking" can be enough to flare up your tendon when you have a tendinopathy (a problem with the tendon). Doing a little too much restarts inflammation (short term/days) that slows down the proliferation phase (that takes weeks) and the healing/remodelling phase (which takes months).​
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   How do you know you've done too much? The tendon will tell you, with pain (typically the next morning, not always day of).
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   For me, the tendons would talk to me with a little ache/tightness post-run. Not even anything alarming, but something that felt like I needed to *stretch* though stretching felt more stiff than normal muscle stretching. As I continued to ignore these little aches, they built up into a full blown tendonitis (acutely inflamed tendon). The weird thing was that my volume didn't experience big jumps in volume as I have been getting coaching from one of Vital's endurance coaches Rick, but truth be told, the symptoms prior to the full flare up WERE there.
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2. DO TOO LITTLE
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   When someone tells you to rest for a tendinopathy, run! Not literally if you have tendinopathy, but figuratively run away from them.
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   ​Doing too little decreases collagen synthesis and you need that to rebuild the tendon!​
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   ​Tendons love load!!! But they don't love dynamic load when they are inflamed or hurt. Start with ISOs. I wrote a little more about isometric loading for the achilles tendon HERE if you want to read a little more about the progression of loading up a tendon.
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   ​The piece of advice in #1 is contrary to the advice in #2 so this is why tendons can be SO finnicky.​
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3. HAVE AWFUL METABOLIC HEALTH
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   ​Leading an unhealthy lifestyle leads to bad metabolic health. Bad metabolic health means poor glucose control in the blood, and it's this very glucose in the blood that creates cross links in tendon. Cross links in tendon make it more stiff, but tendons are supposed to have elastic properties like an elastic band. Their stiffness (the good kind - the kind that comes from a strong muscle and healthy elastic tendon) should come from strength training that helps thicken the whole unit but keep the tendon's elasticity.

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Something that could help tendon healing could be COLLAGEN supplementation (linked a great brand there that is made from bovine skin. Getting your supplement from bovine skin sources is better than using collagen from bone broth, or ground bones for example, because large mammals store their heavy metals in their bones, and you could get a super dose of heavy metals like lead when you consume them. I recently learned this from renown tendon researcher Dr. Keith Baar).

Here's what else you need to know about collagen supplementation:

Though there is definitely MIXED evidence about the consumption of collagen helping with tendon recovery, there are some new studies that do show a positive benefit of collagen supplementation on rate of force development increase in football players (study HERE), in osteoarthritis gen pop (study HERE), and the like. There's also some research by Dr. Keith Baar that show a beneficial tendon response to consuming collagen or vitamin C enriched-gelatin with vitamin C (the building blocks for collagen) as shown in THIS paper.

On a recent podcast linked HERE, Dr. Keith Baar postulates that endurance athletes and those with high training volumes could potentially see more benefit from collagen supplementation than the average person, since the training increases the dietary needs of amino acids (and collagen is made of 2 main amino acids: glycine and proline).
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Here's how you might dose your collagen or gelatin/vit C combo if you integrate this method into your own tendon healing:

1. How much?​
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   Research on recreationally active people suggests 15g is beneficial for helping to re-synthesize collagen in the body.
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   I personally usually ramp my dose up to 20g because I'm more than recreationally active, there are no downsides to taking collagen if you're getting it from a good source, and because there's some evidence that more training volume could require more collagen turnover and more building blocks for collagen in the diet.
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2. What time?​
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   You should take it 30-60 minutes BEFORE you stress the tendon. Tendons potentially also need more time to chill out between bouts of stress than muscle, so if you have 2 training sessions planned in one day, try to space the stress out by 6 hours or more, and you could supplement a second time that day if you're recovering from a bone, ligament, or tendon injury, and if your overall training volume is high.
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3. Not with?
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   You shouldn't take it with your coffee because it interacts with caffeine which might cancel out it's healing effects. This is something I learned relatively recently; support for that evidence HERE.
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In your physiology toolkit, make sure that if you've been diagnosed with tendon pain, or suspect your client has a tendinopathy (pain near the attachments of muscles to bone), that you start down the simple path to figuring out more by checking in with a physiotherapist or health professional.

We wrote more on tendons HERE and HERE if you're interested in doing a deeper dive. If you're new to our newsletter (which is about 20% of you... this thing has been blowing up lately!) then I just want you to know that you can reply to these ANY time and I will reply back 100% of the time. Or, forward this to a friend if you found the info helpful - that always helps me out.

Lastly - if you have a shoulder tendinopathy, we created Shoulder Foundations to help with that! I've updated the discount code NOBADTENDONS for 20% off for the next 24 hours if you want to check it out!

Yours in physiology,

Carla