How Can You Get Stronger Tendons?

If you are a NFL fan, you probably remember the first week of the season last year when Super Bowl MVP quarterback Aaron Rodgers made his debut playing for the New York Jets. What made it so memorable wasn’t his performance that night. Rather it was the injury he sustained on the first drive of the game. Dropping back to pass, with nobody around him, he suddenly hobbled on one foot and had to be carried off with what turned out to be a season-ending Achilles tendon rupture. 

Usually an achilles rupture means the end of a football career, especially someone like Rodgers who was 39 years old at the time. But his rehab went so well as the season progressed that there was talk of Rodgers actually playing again by the end of the season in January. That didn’t happen, but Rodgers insists he could have played if needed. This shows how far we have come in understanding the proper way to rehab tendon injuries. 

This may bring up some questions: 

How are tendons different from muscles? 

What can you do when you have tendon pain? 

Is it possible to actually get stronger tendons, and if so how do you do it? 

Well read on for the answers!

First of all, let’s define what a tendon is, and how it is different from a muscle. 

Think of a tendon like a springy rope that connects a muscle to the bone (whereas ligaments connect 2 bones together). The muscle generates the force, the tendon transmits it, and uses the force to move the bone where it needs to go. This energy transmission and springiness is what allows us to run, jump, lift and throw things with power. This system works great until something overloads the tissue more than it can handle. In the case of repetitive motions, the muscle ends up transmitting more force over time than the tendon can absorb.

Muscle tissue has much greater blood flow and vascularity than tendons do, which means faster recovery. That means when you start a strengthening program, you can see gains in muscle strength within a week. Tendons, however, take much longer to build up tolerance to higher loads, even up to 8 weeks. This is why when starting a strength program it’s important to build your resistances and repetitions slowly and steadily, to allow your tendons to catch up with the progress your muscles are quickly making. 

It is common to see people who take steroids get tendon injuries, or even tears/ruptures, because their artificial progress in muscle strength happens way too fast for their tendons to catch up. Extra force= extra stress and eventual breakdown. Small microtears from repetitive stress (commonly known as tendonitis) can heal with time, but it requires proper guidance for full recovery. A full rupture would likely require surgical repair and a whole protocol to follow for rehab. 

So let’s say you’ve been feeling some tendon-related pain around your joints, usually in the elbow, shoulder, knee, or ankle.  What can you do?

First, determine what it came from. Is it overwork/overuse? If so, your first step is activity modification: reduce the activity that caused the inflammation, at least for a short time. The inflammation is your body’s attempt at healing the damage, so let it happen. Help it along with some easy massage, range of motion, or some ice/heat contrast. Tendons themselves don’t stretch very well, but stretching the muscle they attach to can help reduce tension passing through the “rope”. A brace might help take tension off the tendon, but use only for a short time. You don’t want to be dependent on a brace for the rest of your life, right? 

Once you are out of the inflammation phase, we want to start strengthening the tendons. Yes, you can make them stronger and more resilient! The process lies in treating it with progressively more load, but slowly enough that the less vascularized collagen tissues can adapt over weeks. 

One method is taking a light to moderate weight and applying tension to it for a longer period of time. Think slow and controlled heel raises off a step for lots of reps, or modified pushups for higher reps for pec tendon strengthening. 

Another method is work focusing on the eccentric, or lowering portion of the movement. Using a load slightly higher than what you normally would use, but trying to slowly lower it down rather than lift it. The extra stimulus puts more force into the tendon and encourages thickening of the collagen fibers. 

The next phase involves rebuilding the speedy rebound effects of the tissue, building back the ability to run, jump, throw, etc.  If guided properly those tendons can be stronger than they ever were and more resilient, ready to take whatever you throw at it. 

These techniques should be followed with professional supervision, especially if you are dealing with an injury, so please reach out to us if you are dealing with any of these tendon issues yourself. We would love to help guide you through the confusing minefield of what to do or not do, and get you back to doing the things you love to do painfree for life!