Tendon health and treatment of injury by Ray Sahelian, M.D.
March 12 2016


A tendon is the fibrous tissue that attaches muscle to bone in the human body. The forces applied to a tendon may be more than 5 times your body weight. In some rare instances, tendons can snap or rupture. Conditions that make a rupture more likely include the injection of steroids into a tendon, certain diseases such as gout or hyperparathyroidism, and having type O blood.
   Being physically active outside of work protects against work-related repetitive strain injury. Leisure-time physical activity improves balance and nutrition to the musculoskeletal system which counters the repetitive or sedentary effects of many jobs. For more information on soft tissue.


Reduce inflammation
High cholesterol levels and high levels of inflammation in the body may increase your risk of tendon problems and pain, . Tendons are the tough fibers connecting the body's muscles and bones. High cholesterol buildup in immune cells can lead to chronic low-level inflammation, prompting tendon abnormalities and pain.


Natural supplements for tendonitis
Curcumin prevents interleukins from promoting inflammation. Tendons, the tough cords of fibrous connective tissue that join muscles to bones, are essential for movement because they transfer the force of muscle contraction to bones. However, they are prone to injury, particularly in athletes who overstretch themselves and overuse their joints. Tendinitis is a form of tendon inflammation that causes pain and tenderness close to the joints, and it is particularly common in the shoulders, elbows, knees, hips, heels, and wrists. Examples of common tendon disease include tennis elbow, golfer's elbow, and Achilles tendon injury.


Breast J. 2014. Hypovitaminosis D is a Predictor of Aromatase Inhibitor Musculoskeletal Symptoms. The aromatase inhibitor (AI)-associated musculoskeletal pain symptoms are often debilitating and limit compliance with this important hormonal breast cancer therapy. The cause of this syndrome is unknown. Our findings suggest low vitamin D levels in the body may be contributing to the AI-associated musculoskeletal pain syndrome and in particular to the development of tendonitis.


Heat treatment for tendon Injury
Deep heat treatment can help relieve shoulder pain due to inflammation or tearing of rotator cuff tendon. There is currently no agreed-upon treatment for patients with inflammation or tears in the tendons that make up the rotator cuff of the shoulder. Hyperthermia, in which the surface of the skin is kept cool while tissues deep in the affected area are heated with microwaves to about 110 degrees F, has recently been introduced as a physical therapy and rehabilitation technique. After having success with hyperthermia for treatment of tendon and muscle injuries in athletes, researchers tested the approach in a pilot study of patients with a type of rotator cuff injury known as supraspinatus tendinopathy. The supraspinatus muscle is located on the top of the shoulder blade and is joined to the humerus bone at the top of the arm by a tendon. Hyperthermia was found to be effective in the short-term for treating supraspinatus tendinopathy. The American Journal of Sports Medicine, 2006.


Achilles tendon inflammation
The Achilles tendon, named after the legendary warrior and hero of Homer's Iliad, extends from the back of the heel into the calf and is the thickest and strongest tendon in the human body.
   Achilles tendinopathy is caused by chronic use may arise after a particularly arduous training session or competition. Pain is the most common first symptom, especially among distance runners. People can stay active while undergoing rehabilitation for Achilles tendinopathy, as long as they keep an eye on their pain, Swedish researchers report. Karin Gravare Silbernagel of Goteborg University had 38 patients with achilles tendon injury undergo physical therapy to strengthen their Achilles tendon for 12 weeks to 6 months. Half were instructed to continue with their normal workout routine, but to monitor their pain and reduce their activity if they rated their pain above "5" on a scale from 0 to 10, with 0 being no pain at all and 10 being excruciating pain. The other half were told to avoid tendon-loading activities such as running and fast walking for the first six weeks of rehab. One year after the rehab program began, there was no significant difference between levels of pain and functional ability between the two groups. People with Achilles tendon injuries have previously been instructed to rest and avoid all activity, Karin Gravare Silbernagel has said, while within the past 5 to 10 years exercise to strengthen the tendon has become standard therapy. American Journal of Sports Medicine, May 2007.


If you rupture your Achilles you need to consider nonoperative treatment, because it's safer than surgical treatment, as long as you do functional rehabilitation you will have an outcome just as good as surgery and you almost eliminate the absolute risk for surgical complications.



Q. I'd like to know if are aware of any particular foods or nutrients or supplements that are effective in aiding healing and repair/rebuilding of ligaments and tendons. I ask this as a Physical Therapist (intern) who's particularly interested in Sports medicine and sports injuries. I'm aware of glucosamine and chondroitn and the nutrient MSM for healing of cartilage in joint structures, but are there nutrients that enhance healing of tendons and ligaments? Would glucosamine, chondroitin and MSM also play a role in healing of these structures?

   A. We have not seen any specific studies addressing the issue of tendons and ligaments in terms of nutritional supplements, but this is a good question and we will keep this in mind.


Fluoroquinolones are antibiotics than can cause tendonitis or tendon rupture and peripheral neuropathy.I took it a month ago. I am in a lot of pain not just in my ankles but in different parts of my body all over (calves, crease of legs, inside of upper arm, elbows, neck, lower back, spine, feet, it seems to have effected my ligaments as well . If you do get tendonitis and pain from fluoroquinolones would Collagen 1 help? I did some research and fluoroquinolones bind to protein and can effect the cellular matrix and the enzymes that lead to collagen development. Studies show an increase in metelloproteinases in the cellular matrix and a decrease in type 1 collagen elastin fibro nectin. It binds to the gopoisomerase enzyme to prevent DNA replication in the bacteria it is suppose to kill. I am currently taking Vitamin D3, CoQ 10, liver cleanse with milk thistle, B complex (with methylcobalamine), Omega 3 EPA / DHA, magnesium malate, and serrapeptase. The serrapeptase is the only thing that has seemed to help some.

I was wondering if you could explain why patients experience a burning sensation when their tendons are in the process of healing. I asked my DPM, but he didn't really explain why this occurs and I really want to understand it.[2 weeks post op on a re-connection of a severed extensor hallucis longus EHL tendon. The burning sensation is so bad at times, that I look down and totally expect to see my foot afire] Anyway, I found your articles on tendons and collagen most informative.
   I have not studied this topic in enough detail to know. Perhaps regenerating nerves may cause certain sensations but I am not sure.