New Evidence That Collagen May Help Your Tendons

Collagen liquid used in the study

I recently had quite a bit of pain in my right Achilles tendon. Besides getting Aized to treat me and wearing my Strassburg sock to sleep, I had to do some rehab as well. Running didn't hurt much, going down stairs was more painful.

Naturally my curiousity was piqued when a newly published study (Lee et al, 2023) on a group of elite female football players found a big improvement in tendon stiffness after taking collagen supplements 3 times a week. The study measured the properties of the patella tendon which connects the patella (kneecap) to the shin bone as this is a common injury site for female soccer players. Ultrasound and strength tests were measured before and after training.

Training consisted of on-field soccer practice, leg strengthening exercises and plyometrics.

The participants took 30 grams of hydrolyzed collagen (pictured above) 3 times a week immediately after training while the control group took a calorie- matched placebo drink. Both groups also took 500 milligrams of Vitamin C as it is thought to be necessary for the body to be able to use the collagen.

Results showed an increase in tendon stiffness. The stiffer tendons become, the more they stretch and the more energy they store. Stiffer tendons have shown to be associated with better running economy since they can recycle more energy from each stride.

The group taking the collagen had a significant 18 percent increase in tendon stiffness compared to the placebo's 8 percent gain. There were no differences in size or cross sectional area of the tendon, suggesting that the extra collagen ingested improved the microscopic structure of the tendon. There was also no differences in leg strength.

Remember Professor Keith Barr? I wrote about his gelatin collagen research in 2019. His research group from UC Davis published evidence suggesting that taking collagen plus Vitamin C enhances jump and squat performance but without significant change in leg stiffness (Lis et al, 2022).

Another published research (Jerger et al, 2022) found that taking collagen supplements daily boosted tendon cross sectional area, but did not improve tendon stiffness more than the placebo group.

Confused? Especially with each study mentioned above producing different results. Study protocols were different and this is actually good since it means that you do not have to follow one specific 'magic' protocol to get the benefits.

More research and details need to be worked out, as more studies are done, it will hopefully prove that tendons and ligaments can heal better than we think. So other than training your tendons and wearing your Strassburg sock when you sleep, collagen supplements may be something you want to try.

References

Jerger S, Centner C, Lauber B et al (2022). Effects Of Collagen Peptide Supplementation Combined With Resistance Training On Achilles Tendon Properties. Scan J Med Sci Sports. 32(7): 1131-1141. DOI: 10.1111.sms.14164

Lee J, Bridge JE, Clark DR et al (2023). Collagen Supplementation Augments Changes In Patella Tendon Properties In Female Soccer Players. Frontiers in Physiol. Vol 14. DOI: 10.3389/fphys.2023.108977

Lis DM, Jordan M, Lipuma T et al (2022). Collagen And Vitamin C Supplementation Increases Lower Limb Rate Force Development. Int J Sp Nutr Ex Metab. 32)2): 65-73. DOI: 10.1123/ijsnem.2020-0313

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.

References

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.

How Gelatin (Jell-O) May Help Healing

Home made soursop flavoured

I came across Professor Keith Barr's work on ligaments, tendons and how they heal etc and was amazed that gelatin may hold the secret to recovering from many ligament and tendon injuries.

Professor Baar and his colleagues at UC Davis have been growing "engineered ligaments" in the university lab, subjecting them to all sorts of loads/ abuse) to understand what factors affect injury risk and healing. They may also have found how to train and feed (yes, you read correctly) connective tissue like ligaments, tendons, bones and cartilage.

We've always thought that connective tissue does not heal well. But Professor Baar's "engineered ligaments" grown from remnants of ruptured ACL's collected during reconstructive surgeries showed that it may not be totally true.

When ligaments are "exercised" by movement/ stretching, they respond by forming new collagen fibers (these are the building blocks for new ligaments and tendons). However, this process peaks in about ten minutes and begins to switch off if exercise is continued. Exercising for three hours may be good for your heart and muscles, but not great at all for your tendons, ligaments and other connective tissue.

The "engineered" ligaments also respond to proline, an amino acid. Professor Baar found that best way to ingest proline was taking gelatin. Their study showed that blood test of participants in a skipping rope test for six minutes, three times a day doubled the rate of collagen growth. When the participants consumed 15 grams of gelatin with Vitamin C an hour before each skipping rope session, collagen growth doubled again.

Now, I'm not asking all of you to run out and buy all the gelatin you can get, cook and eat it an hour before doing the specific exercises you need. Skeptics among you readers (myself included) will probably scoff at the idea of eating gelatin and hoping that it will specifically go to strengthen the injured ligaments and tendons in your body.

Professor Baar himself has said that as word of his research spreads, some athletes may develop unrealistic expectations. Eating gelatin without doing the specific strengthening exercises to help new collagen fibers grow in the stressed areas is one. The optimal exercises will depend on what type of connective tissue you're trying to strengthen.

For the injured and non injured athletes that are reading this, I've read that hydrolyzed collagen powder is easier to use compared to gelatin as it does not require boiling and cooling down. It also seems to be equally effective for tendons based on preliminary research in Professor Baar's lab.

For those of you who torn your ACL fully, no amount of gelatin plus specific exercises would help. This is more for patients who have strained (not totally torn) ligaments and tendons.


References

Lis DS and Barr K (2018). Effects Of Different Vitamin C-enriched Collagen Derivatives On Collagen Synthesis. Int J Sp Nutr Ex. DOI: 10.1123/ijsnem.2018-0385

Shaw G, Lee-Barthel A et al (2017). Vitamin C-enriched Gelatin Supplementation Before Intermittent Activity Augments Collagen Synthesis. Am J Clin Nutrition. 105(1): 136-143. DOI: 10.3945/ajcn.116.138594.

*picture by Smabs Sputzer (1956-2017) from Flickr