Are You Prone to Ligament and Tendon Injuries and if so Why?


Tendons and Ligaments

You have ligaments and tendons around all the joints of your body.

Tendons are strong, tough bands of fibrous tissue that connect muscle to bone. Their function is to move bones.

Ligaments are tissues that link one bone to another bone to keep joints stable.

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Tendon and Ligament Injuries

Tendons can snap or rupture. The forces that a tendon has to withstand can amount to 5 times your body weight!

The most common areas of injury are the achilles tendon in your heel that joins the calf muscles to the heel bone; the rotator cuff which links four muscles of your shoulder to your upper arm; the biceps tendon in your upper arm and your quadriceps that links the four muscles in the front of your thigh to your lower leg.

Some people are more prone to tendon rupture – for example those with type O blood; those who have had injections of steroids into a tendon; those prone to gout or people with hyperparathyroidism.

You can see from the last sentence why most chiropractors will encourage you to try treatment for tendon injuries and stop you from immediately going for a corticosteroid injection. This injection may well reduce your pain but it will worsen the strength of the tendon and thus it may be more prone to injury.

The problem is that healing of tendons is a notoriously slow process and  patients want quick results!

Tendon and Ligament Repair

As both are composed of similar cells we can describe this process together.

They are both composed of bundles of filaments lying in parallel and along these threads are spread cells that ‘look after’ the tendon and ligament material and replace it when necessary.

There are a couple of theories:

  1. When a tendon or ligament is damaged, it bleeds, which releases platelets which those cells that protect the tendons and ligaments do not recognise so growth factors are released that trigger the cells to help repair.
  2. Molecules inside the cells that have been ruptured in the injury cause an inflammatory response which stimulates reconstruction of the damaged cells.

How long do they take to Repair?

This is very variable.

Healing can be inhibited by the very medication we are prescribed to help the pain!

Non Steroidal Anti inflammatory drugs (NSAID’S) such as ibuprofen and  diclofenac actually inhibit tendon healing. You might get away with taking them for a short period of time to help relieve the pain but you should stop taking them after only 5 days – otherwise you risk lengthening the time you have the injury. It is said that taking a normal dose of NSAID’s for 5 days is enough to reduce the strength of the tendon by one third after a week. Furthermore, recovery from this reduced strength takes a long time a even more and therefore prolongs the overall recovery period

Remember that inflammation is an important part of the tendon cell regeneration stimulus so it is a healthy reaction by the body.

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The only thing to be gained by taking NSAID’s for a short time is to allow us to weight bear or use the joint as quickly as possible because if we have less pain we will be more likely to do so, and encouraging weightbearing is important for those cells that organise the tendon repair. They need mechanical loading in order to decide how to orientate the repair cells along the tendon.

How long should we load the tendons for?

Just 5 minutes once a day should be enough for loading to produce benefits to the healing process. You should then build to a maximum of 15 minutes with resting in between while the inflammatory process is underway then you need to gradually increase what you do as the tendon heals according to instructions from the person treating you. However, you do need to be patient and recovery is always a slow build up of strengthening activities until recovery is complete.

What might be causing you to not heal quickly?

Recent research published in 2016 in the Proceedings of the National Academy of Sciences discusses why some people heal quickly and some just don’t seem to recover from tendon injuries.

Tendon injuries can affect all of us and even the best trained professionals such as Usain Bolt and Serena Williams.

The study investigated how tendons develop and stay healthy in the first place.

Genetics is playing an increasingly big role in health generally and it is here too that role of a gene called Mkx that has been discovered as vital to maintain and strengthen tendons in animal models.


Gene Mkx “ tells” cells to become tendon tissues. Small groups of cells that are needed for regeneration of a tendon to occur, are found in us all, spread over the bundles of collagen and elastin fibres which are responsible for making tendons both strong and flexible.

If there are, however, not enough of those cells spread along the tendon tissues, when we sustain an injury to a tendon, then the healing time will be slower.

It was found that Mkx is critical in the sensing of mechanical stresses in tendons all our lives. When our tendons are being used and therefore stretch, the Mkx factor forms more of the cells needed to maintain tendon fibres and thus Mkx keeps tendons strong.

This study may mean doctors will one day be able to use gene therapies to grow and repair tendons. Gene therapies could in future target Mkx to strengthen tendons.

Can Injuries Be Predicted?

For most of us, the answer is no! But for high level athletes or sportspeople then it is obviously something that players of high level sports or their managers  would love to know. If it could be predicted just how much of the gene Mkx a person has in their tendons and ligaments then they could predict who will be able to cover from injury most efficiently and who won’t.

Researchers from Stanford University’s department of developmental biology and genetics,  believe that genetic information can be valuable for amateur athletes, too—regardless of skill level, someone about to join a recreational basketball league or a tennis club would be well-served to know if they’re at risk of knee ligament damage or likely to tear an Achilles tendon.

One study published in the British Journal of Sports Medicine in 2009, South African researchers found that specific variations of a collagen gene named COL1A1 were under-represented in a group of recreational athletes who had suffered traumatic knee ligament injuries. Those who had torn their anterior cruciate ligaments were four times as likely as the uninjured study subjects to have a blood relative who had suffered the same injury, suggesting that genetics are at least partially responsible for the strength of the ligament.

The same COL1A1 gene has also been linked to other soft-tissue injuries, like Achilles-tendon ruptures and shoulder dislocations.

The human genome is so complex however, it is extremely unlikely that a single variant within a gene can determine a person’s genetic risk for a given soft-tissue injury. .

A growing number of companies offer genetic tests that can tell the average person  about their risk for sports injuries but genetic testing really is in its infancy.

The best way to deal with these injuries at the moment is to seek treatment by practitioners experienced in the treatment and rehabilitation of sports injuries and you will find Verity Moore at the Avenue Clinic has a wealth of knowledge in this area.