Sunday, March 13, 2022

Train Your Tendons

If you are a runner and have had pain in your Achilles tendon, you know it takes a long time for it to get better. Compared to muscles, our tendons and ligaments have much poorer blood supply so they take a longer time to heal. Currently, most healthcare professionals recommend the Alfredson protocol (up to 180 eccentric heel drops a day) to get your Achilles tendon better.

Trained runners have been found to have a thicker Achilles tendon, stiffer and better structure compared to novice runners. A longer, stiffer tendon stores more energy and releases that energy when you push off with each step. It has also been speculated that the dominance of international running races by Kenyan runners are due to their long and springy Achilles tendon (Tawa and Louw, 2018).

Can you then train your tendons? Consider the following study. 40 pairs of identical twins were asked about their physical activity and sports habits to determine how active they were. Researchers then measured the stiffness of their Achilles tendons.

Results show that when one twin is active and the other inactive, the active twins have tendons 28 percent stiffer. Since identical twins start with identical genes, this shows that long term training can change the structure of the Achilles. It also fits in with previous studies that trained runners have thicker and stiffer tendons. These runners were not elite runners so you don't need excessive training levels to change your tendons. But these runners have been running for an average of 15 years, so there's plenty of time for change to occur.

Another point to note from the study. Those who did activities that involve an aerial phase with both feet off the ground (running, basketball or tennis etc) had a stiffer TA compared to those with no aerial phase (cycling, walking and swimming). This suggests that jumping and landing may hold clues to getting your Achilles tendon stiffer and stronger.

Tendons may be slow to heal and adapt to load, but for those of you who run, surely this is an incentive to keep on running. Those who play football, basketball or tennis, please carry on too.

Currently, when you visit your current healthcare provider for treatment, most will just recommend the Alfredson protocol (up to 180 eccentric heel drops a day) to get your Achilles tendon better. That you can do yourself (picture below).

In our clinics, after we assess you thoroughly, we mostly use our hands to treat what we find, no ultrasound, no orthotics, no shockwave (ESWT), no electrotherapy. And we get very good results. We DO NOT get you to do exercises DURING the time you have with us. We do treatment that you cannot do yourself.

Previously, I've written that there is some evidence that gelatin (or jell-o) can help tendons heal. Perhaps that is an area you may also want to explore? And do take note that some antibiotic medications can damage your tendons.


Sichting F, Kram NC and Legerlotz K (2022). An Identical Twin Study On Human Achilles Tendon Adaptation: Egular Recreatinal Exercise At Comparatively Low Intensities Can Increase Tendon Stiffness. Front. Physiol. DOI: 10.3389/fphys.2021.777403

Tawa N and Louw Q (2018). Biomechanical Factors Associated With Running Economy And The Performance Of Elite Kentyan Distance Runners: A Systematic Review. J Body Mvt Ther. DOI: 10.1106/j.bmt.2017.11.004

See how closely the Achilles and plantar fascia are related. In order to get the Achilles tendon better, you need to treat the plantar fascia as well.

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