Tendon Health in Training and Sport: Balancing Nutrition and Knowledge

by Dr. Sam Schwartz, PT, DPT

Let’s talk about a topic that is rarely discussed in the fitness world – tendon health! Yes tendons, you know those sinewy bands of tissue that connect your muscles to your bones? It turns out they serve a vital function in our biomechanical ability to do, well, anything involving movement. Most people that exercise, train, play a sport, perform manual labor, etc. probably don’t think twice about the health of their tendons until they get injured or feel pain. Tendons just take care of themselves, right? Sometimes. As long as gains are made and my muscles become bigger and stronger and I’m performing at a high level, who cares? Until injury happens. But what if you could do something about it? This article will show you what to do about it and how to do it.

Anyone reading this may have the right to be ambivalent about keeping their tendons healthy until they are struck by injury or chronic pain. More than likely, if you’re an athlete or are just someone who works out, you’ve experienced some sort of ache, twinge, or activity-reducing injury during your lifetime. It’s estimated that ‘50% of all injuries in sports can be classified as sprains, strains, ruptures, or breaks of musculoskeletal tissues’ (2). This may seem like an obvious statistic, but it highlights the importance of maintenance strategies that ensure active individuals are pain and injury free. This may not be the sexiest topic, but neither is a torn Achilles tendon that turns you into a rag doll when you try to jump off the ground.

 

Understanding Collagen’s Role

To frame the subject of tendon health appropriately, we should first discuss the general (and I mean general) composition of tendons. You may have heard of something called collagen. We’re going to keep it simple here. Collagen is a protein, and in mammals it’s a very important protein that makes up about 30% of all protein in humans (3). Now, there are four types of Collagen: Type I, Type II, Type III, and Type IV. Collagen type I makes up about 90-95% of your body’s total collagen so we’ll crown it as the real hero for now. The structure of tendons varies greatly depending on the loads they are exposed to and what specific muscle they are attached to. The one uniform trait they all have is that closer to the bone attachment areas tendons are stiffer, and closer to the muscle attachment areas they are more elastic. In order to have those traits, different areas of tendons have varying amounts of collagen type I and type III and as such, possess different biomechanical properties. Type II collagen is important too because it is found in elastic cartilage, which helps to cushion your joints. In terms of collagen and its importance in tendons, this is as rudimentary and simplified of an explanation we can give.

Okay, so now that we understand how important collagen is when it comes to tendons, what are some practical ways that we can ensure our tendons are safe, healthy, and happy? With all things in the nutritional supplement/fitness industry there is a lot of B.S. pooling around throughout every tube of the internet. And admittedly, researchers tend to agree that not only do we not know a lot about the complexities of tendon structure and function, but the healing process from injury is also not very well understood (1). That being said, there are a number of reputable sources that show how specific nutritional supplements combined with exercise training regiments can be effective in maintaining and potentially improving tendon health and function. Most importantly, these methods are simple and not even time consuming! And no, we’re not just trying to channel some early 2000s infomercial buzz words here. They really are quite simple.

 

Collagen and Tendon Health

Let’s talk a bit about the nutrition side of things first. After all, that’s likely what brought you to this article. Nonetheless, it’s no mystery that what we choose to fuel our bodies with directly affects its health and function. This is also complimented by a balance of quantity and quality of the things we choose to ingest. In a reputable study by well-known nutrition scientist Keith Baar, PhD, he noted that supplementation of vitamin-C enriched gelatin in combination with specific tendon-focused training increased collagen type I synthesis in subjects (2)(4). This study is compelling because they compared the amount of collagen in the blood of human subjects, and that of ‘engineered’ tissues that were lab-grown from stem cells. The findings showed that the engineered tissues demonstrated improved mechanical properties, and collagen concentration. Within blood samples collected from the subjects, the researchers found that the amounts of an important amino acid called glycine also increased (2)(4). This study in particular lays the groundwork for further investigation into the positive effects of supplementing these proteins and vitamins along with training.

While Baar’s research focuses primarily on the combination of collagen/gelatin and vitamin C, there is a significant amount of research that looks at Type 2 Collagen (UC-II®) supplementation and its benefits on joint and tendon health. In this 2013 study by Lugo et al, the researchers found that“after 120 days of supplementation, subjects in the UC-II group exhibited a statistically significant improvement in average knee extension compared to placebo (81.0 ± 1.3º vs 74.0 ± 2.2º; p = 0.011) and to baseline (81.0 ± 1.3º vs 73.2 ± 1.9º; p = 0.002). The UC-II cohort also demonstrated a statistically significant change in average knee extension at day 90 (78.8 ± 1.9º vs 73.2 ± 1.9º; p = 0.045) versus baseline. No significant change in knee extension was observed in the placebo group at any time.” (7)

In 2016, James Lugo and his group of researchers again studied the benefits of Type 2 Collagen on knee osteoarthritis pain, concluding “This study found that UC-II, a nutritional ingredient containing undenatured type II collagen, significantly improved knee function in OA subjects by day 180, compared to placebo and to GC, and was well-tolerated.(8)

This is why we at Upper Echelon Nutrition created a tendon and joint support formula which contains 100 mg of Vitamin C, 15 grams of Collagen Peptides, and 40 mg of Undenatured Type 2 Collagen known as UC-II® in line with the research of Baar and others. (1, 6, 7) Based on the research, we feel that this combination of Type 1, 2, and 3 Collagen along with Vitamin C can be highly beneficial when combined with an appropriate training regimen. The inclusion of Vitamin C is important for a few reasons, mainly because “preclinical studies demonstrated that vitamin C has the potential to accelerate bone healing after a fracture, increase type I collagen synthesis, and reduce oxidative stress parameters (9) or in other words, Vitamin C is essential for the synthesis of collagen and has an essential role in connective tissue healing.

For the full white-paper on UC-II®, click here.

 

Tendon Health – Putting It All Together

With a general overview of the right way to nourish your tendons let’s go over a few principles to keep in mind to maintain tendon health with specific exercises. As I mentioned before, frequency and intensity of the training itself is a lot lower and easier than you’d expect. First off, it’s best to focus on areas that are specific to your activities. For example, basketball players generally could focus on some patellar and Achilles tendon focused work. Research like Baar’s has shown that tendons respond quickly to a load stimulus and don’t need to be hammered with long periods of high intensity exercise to adapt (2)(4). Optimal dosage for tendon-focused activity was determined to be less than 10 minutes, with 6 hours in between, 3 times per day. That seems like nothing, right? Well in this case, less is measurably more. The “magic” lies in creating just enough of a stimulus, then providing the body with the proper nutrients to be able to recover and rebuild. These exercises should be focused on active lengthening or eccentrically loaded movements (5). Think for the Achilles of a negative calf raise. For the patellar tendon, it could be a weighted single leg squat with a slow eccentric or even an isometric hold. Variations on these could be endless. It’s important to do the right exercises with the right sets and reps, so make sure to consult a professional when attempting any modifications to your training program.

Hopefully this brief resource can provide you with some tools to tackle your tendons with some additional armor against the smoke and mirrors clouding the fitness and nutrition space. Being informed is always the best defense when it comes to your health, nutrition, and training. In order to help you maximize your benefits from nutrition, we have developed a comprehensive collagen-based tendon support supplement with ingredients backed by science at clinically effective dosages, that have been proven to help maintain or improve connective tissue health. That, in combination with surprisingly brief and focused supplemental training methods, will help give you more of an edge and supercharge your recovery during your training.

 

References 

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4650849/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5183725/
  3. Di Lullo, Gloria A.; Sweeney, Shawn M.; Körkkö, Jarmo; Ala-Kokko, Leena & San Antonio, James D. (2002). "Mapping the Ligand-binding Sites and Disease-associated Mutations on the Most Abundant Protein in the Human, Type I Collagen"
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371618/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527202/
  1. Trč, T., Bohmová, J. Efficacy and tolerance of enzymatic hydrolysed collagen (EHC) vs. glucosamine sulphate (GS) in the treatment of knee osteoarthritis (KOA). International Orthopaedics (SICOT)35, 341–348 (2011). https://doi.org/10.1007/s00264-010-1010-z
  2. Lugo JP, Saiyed ZM, Lau FC, et al. Undenatured type II collagen (UC-II®) for joint support: a randomized, double-blind, placebo-controlled study in healthy volunteers. J Int Soc Sports Nutr. 2013;10(1):48. Published 2013 Oct 24. doi:10.1186/1550-2783-10-48
  3. Lugo JP, Saiyed ZM, Lane NE. Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: a multicenter randomized, double-blind, placebo-controlled study. Nutr J. 2016 Jan 29;15:14. doi: 10.1186/s12937-016-0130-8. PMID: 26822714; PMCID: PMC4731911.
  4. DePhillipo NN, Aman ZS, Kennedy MI, Begley JP, Moatshe G, LaPrade RF. Efficacy of Vitamin C Supplementation on Collagen Synthesis and Oxidative Stress After Musculoskeletal Injuries: A Systematic Review. Orthop J Sports Med. 2018;6(10):2325967118804544. Published 2018 Oct 25. doi:10.1177/2325967118804544
  5. Bagchi D, Misner B, Bagchi M, et al. Effects of orally administered undenatured type II collagen against arthritic inflammatory diseases: a mechanistic exploration. Int J Clin Pharmacol Res. 2002;22(3-4):101- 10. PMID: 12837047.
  6. Crowley DC, Lau FC, Sharma P, et al. Safety and efficacy of undenatured type II collagen in the treatment of osteoarthritis of the knee: a clinical trial. Int J Med Sci. 2009;6(6):312-21. PMID: 19847319.