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Tendons! What are they and how do we prevent injury!

Updated: Dec 13, 2023



You may have heard of or have been unfortunate enough to have suffered from a tendon injury. Achilles Tendinopathy, Rotator Cuff Tendinosis, and Patella Tendinitis, are all terms often used to describe various tendon injuries and pathologies.


So firstly what is a tendon?

Tendons are the structures that join our muscles to our bones. They are white in color and are made up of a mixture of collagen fibers and proteoglycans. The collagen provides the tensile strength and the proteoglycans provide the elastic properties. Tendons vary in size and shape, depending on the function of the muscle it attaches to. Muscles that control fine movements such as those of your hand tend to have long and thin tendons, whereas muscles that produce lots of power tend to have shorter and thicker tendons. Tendons play a very important role in transmitting the force from the muscles to the bone and are often referred to as the springs of our musculoskeletal system. This is because of their elastic properties, they can absorb a very high level of force and then re-exert that force much the same as a spring being compressed and then released.


How are tendons injured?

To know how to maintain tendon health, it is first a good idea to understand how tendon injuries occur. Tendon injuries usually occur in one of two ways.

Firstly during a traumatic or an acute event such as a ruptured rotator cuff tendon due to a fall where the load on the tendon is too high and it fails.

Secondly is a degenerated tendon, this is one of the most common presentations we see in our clinic. Often our clients will not describe any memorable event or mechanism that led to their pain. The client will present with very severe levels of reported pain within a few days of onset. Unfortunately, tendons are not highly innervated, meaning they do not have a high level of nerve receptors within the tissue. What this means is that a tendon can degenerate (think of a rope fraying) over time. And as this is occurring, there is no pain reported to the brain. This process then continues unnoticed until the point of the tendon becomes a very degenerated (frayed) and unhealthy tendon. This then causes swelling and triggers the pain response. Unfortunately, tendons also have a limited blood supply compared to other tissues such as muscles, meaning that when we do see a client with a degenerated tendon in the clinic it can be a very long recovery (months to years). In very severe cases, the tendon can be so severely degenerated (rope frayed so much) that the only solution is to surgically reattach or cut the injured tendon to improve function and reduce pain. 


Maintaining Healthy Tendons

But this article is about how we prevent these long-term injuries and maintain healthy tendons. So how do we do this?

Well, tendons love exercise, in particular resistance exercise. Resistance exercises, strength exercises, or exercises that add additional load ensure that tendons remain strong. Think of increasing the tensile strength or the breaking point of that rope. That's what the correct types of exercises will do. Now that thicker and stronger rope will be resistant to fraying.


But due to their low levels of blood supply and healing ability, Tendons don’t like too much exercise too quickly. It's important that when you are adding additional load to a tendon this is gradually progressed. This can be a tricky balancing act when adding in new exercises.


The Tale of Peter

Let me provide you with an example. Peter’s very trustworthy Physio advises him that running and jumping is a great way of maintaining healthy lower limb tendons. So Peter decides to start running again on the advice of his expert physio. On day one he is very sensible and he runs for 500m, he feels ok after the run and there is no significant increased pain the next day, great start Peter. So, two days later he goes again but he runs for 600m, and the same response is had, great job again Peter! On his third run, Peter is a bit overconfident and runs for 2km, now apart from being a bit out of breath he doesn’t feel too bad during the run. But after Peter cools down, especially the next day he starts walking like a duck due to the pain in his Achilles tendons. See, what Peter didn’t consider was that his tendons were not used to this level of load and they responded by swelling up. This was just his body’s way of telling him it was too much load too soon. After seeing his physio again, he is assured that his tendons will be fine and he returns to his running a week later. Some people might read or experience this and think "‘I told you exercise is bad for your health". I hope you can see that this is not the case and if Peter sticks to his progressive loading strategy, he will be running his half marathon goal with healthy tendons in the not-too-distant future.


A healthy diet will also help to ensure tendons remain healthy but that's a topic for a later time. 


If you need help with setting up a great exercise regime to maintain healthy tendons or want to work towards a longer-term goal, Our team is sure to help.


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