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Tendons: Part 1

Updated: May 8, 2023

An overview


In the land of physio/sports medicine, few body tissues can be as perplexing and frustrating as a tendon. Tendons are the strong collagen rich connective tissue that attach muscles to bone. Muscles generate force, tendons transfer it, and the bone gets moved or supported depending on the situation.

It is fair to say that huge progress has been made regarding how we manage tendon injuries. A better understanding of the physiology and morphology of the actual tissue, better grasp of the specific roles of tendons, and vastly improved acknowledgement of the neurophysiology and psychological factors involved.

The Achilles and patellar tendons are arguably the most common tendons requiring treatment in the athletic population; with shoulder tendon injuries there or thereabouts.

Most people have heard of the Achilles, a famous tendon if ever there were one. Strong beyond compare, and dramatic in its demise. The Achilles routinely deals with a force of 6-8 times bodyweight with each stride while running, so for 80kg person we are talking 560kg per step!


When we look at these numbers it becomes clear that we ask a lot of this collagenous band. It then makes sense that we look after them.

The truth is tendons love load!

They require regular loading to keep them “fit and strong!” They also take a long time to change significantly. Their poor blood supply is a major limiting factor. Instead, they keep things pretty in house and produce various types of collagen and associated fibres in response to stress.

Problems arise when we introduce stress in a way the tendon can’t keep up. Some examples include:

  • Starting a new activity that introduces force in a way the tendon isn’t used to e.g starting daily running in lockdown. Press up challenges etc.

  • Changing technique/equipment too rapidly in a familiar activity e.g. low support shoes, heavier hammer at work, changing grip in tennis/golf

  • Not providing the appropriate environment for recovery e.g. poor diet, poor sleep, overtraining etc.

The outcome of this overload is often referred to as a cascade.

Which will be covered in the next blog.

- James Sincock

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