Tendon Health

A potential answer to those nagging pains

Apr 22, 2025

Unless you’re superhuman, aches and pains often come along for the ride with two things that we should all be doing — exercising and aging.

And if you aren’t doing the latter, congratulations. Netflix will be calling soon with a mini-series contract waiting to be signed.

Looking at you, Bryan Johnson.

In reality though, a number of us walk around daily with a little twinge of pain here or there whether that be in the low back, knees, feet, shoulders, you name it.

These minor nuisances are quite normal… although annoying.

That being said, this is a slight tangent to the crux of our conversation today — tendon ailments and the best way to manage them with exercise and diet.

It’s worthy of a discussion as tendon disorders make up a good portion of these nagging aches and pains affecting nearly 17 million people per year in the U.S. according to one analysis.

Golfer’s elbow, tennis elbow, Achilles tendinopathy, patellar tendinopathy (jumper’s knee), rotator cuff (shoulder) tendinopathy, the list goes on.

Many of you have or currently struggle with one of these whether you’ve had the medical diagnostic label put on it or not.

Quickly stepping back, let’s build the foundation.

Overview

A tendon is simply a type of connective tissue that attaches a muscle to a bone. For instance, our lower bicep tendon connects our bicep muscle to one of our forearm bones so we can bend our elbow. The purpose of a tendon is to transmit the force generated by our muscle to our bone for movement while also being responsible for force absorption and injury mitigation.

The primary component of a tendon is a protein many of you have heard of — collagen. Specifically, neatly organized collagen that is particularly adept at absorbing and transmitting force occurring in a distinctive direction.

To make this more tangible, think about your Achilles tendon. The collagen fibers within this tendon are predominantly organized in an up/down parallel fashion which makes it tolerable of force that stretches and puts tension on the tendon.

Achilles Tendon (Calcaneal Tendon): Function & Anatomy

Understanding the above isn’t terribly important to today’s overall message, yet it readies us for what’s to come.

Tendon Disruption

Previously, experts pointed to inflammation as the driving factor of pain and irritation which led to the all-famous “tendinitis” term — meaning inflammation within the tendon.

But that paradigm has shifted and now it’s well-known that most tendon issues are the result of disorganization and breakdown of the collagen structure… not inflammation.¹

Which is why from here on out I’ll be referring to these ailments as tendinopathies; broadly, a disordered tendon.

Recognizing this is imperative to piece together why the old ways of treatment have been abandoned.

You’ve likely heard of the RICE method – Rest, Ice, Compression, and Elevation. Often, this is accompanied with anti-inflammatory medications such as Ibuprofen.

And while today isn’t a slap on the wrist for the RICE method (although some believe it would be warranted), it doesn’t make sense for most tendinopathies as, again, inflammation is rarely the culprit.

Counterintuitively, complete rest can do more harm than good when you consider our next big takeaway.

Tendon Loading

You might be wondering what can possibly be done to help these nagging tendinous injuries if the ol’ tried and true RICE method is off the table.

And that’s where the SAID principle comes into play.

My apologies for all the acronyms in this one… I promise I’ll put them to rest here.

SAID = Specific Adaptation to Imposed Demand.

Our bodies adapt/change according to the stresses placed on them.

More or less, what doesn’t kill you makes you stronger.

Or on the other hand, doing nothing will make you much weaker.

The concept holds true for tendons.

Like muscles, tendons undergo frequent remodeling because of the load placed on them.

When is a load placed on a tendon? Muscular contraction.

Remember, tendons connect muscles to bones and therefore every single time a muscle contracts, the tendon is being “worked”.

While any muscular contraction works, there’s a specific type that has shown exceptional promise for these nagging tendinopathies.

Briefly, when the muscle contracts and shortens, this is considered the concentric phase and when the muscle contracts and lengthens, it’s the eccentric phase.

Think about the bicep curl — arm coming up, concentric… arm going down, eccentric.

However, there is a third that is center stage today, isometric muscular contractions — one where the muscle doesn’t change length at all.

Envision the wall squat or forearm plank as two prime examples.

And while any type of muscle contraction allows for tendon remodeling, loading up on concentric/eccentric movements can often be too irritating — especially for acute injuries and tendons that are already leveraged in a regular exercise schedule (i.e., high level athletes, regular exercisers).

This makes isometric exercise a perfect stand-in.

In fact, research in the last several years has overwhelmingly supported isometric exercise in the treatment of tendinopathies.

So, what’s the protocol?

Anywhere from 5-60 second (or longer) isometric holds for a cumulative daily time of 5-10 minutes multiple times weekly has been shown to benefit the tendon structure, offering immediate and long-term relief to disrupted tendons.

Of course, it depends on your area of ailment for what exercises to choose.

Here’s just one incredibly juvenile example for someone with patellar tendinopathy — often referred to as “jumper’s knee”.

Wall Squat: 5 sets of :30 second holds with an equal or longer rest between each repetition.

Repeat this 2x/day and you’ve hit your daily 5 minutes.

To overload once you start to adapt, you can play around with increasing the time of each set, number of sets, and even the type of challenge such as moving to a single-leg version.

This protocol is even valuable as a warmup to your typical exercise routine!

Understand these don’t have to be at a high intensity. A recent study demonstrated that even ~40% effort isometric exercise yielded positive benefits!²

If you’re struggling to find an isometric exercise that suits you, search YouTube with the body part of interest followed by “isometric exercise” and I promise you’ll have an abundance of options.

Key Point

Slight pain with isometric exercise is NORMAL and even WELCOMED.

With that being said, we don’t want to overdo it and cause further setbacks which is why the 5–10-minute protocol is so effective.

Many physical therapists like to give patients a subjective 0-10 pain upper limit, typically between 2-5/10.

But really, choose a difficulty level that is manageable for you and you’re in the green.

Nutrition

I’d remiss if I didn’t leave you with a final piece of advice regarding ways you can leverage your dietary intake to promote tendon health as well.

As mentioned before, the primary component of tendons is collagen.

So, I imagine you can guess what I’m about to say.

Yes, consume collagen… but the timing, dose, and what to take with it is also critical.

To avoid being too long-winded, here’s what the research has demonstrated…

Consuming 15g of collagen (animal-based) with ~225mg of Vitamin C roughly 1hr prior to targeted exercise provides the amino acids necessary to foster tendon health.³

Remember, the protein turnover rate is high in tendons so inducing a substrate environment that is rich in the amino acids needed to rebuild tendons only makes sense!

Sure, these studies still need some repeating to give an A+ recommendation but if you have a few extra dollars to spare, there’s no downside.

Your skin, hair, and nails will thank you nonetheless!