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All you need to know about Tendons

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Some facts about our tendons

  1. They come in varying shapes and sizes within the body
  2. They allow smooth movement around corners and are efficient pulleys for the action of our muscles.  Good example of this is our the tendons in our fingers and hands which allow the fine and precise movements we have but within the restricted space of our slim fingers and hands.
  3. Tendons attach muscles to bones. This allows the muscles a firm surface to pull against and it allows our muscles to move our bones for us and produce movement efficiently.
  4. Tendons also work as a unit with muscles to store energy when lengthened and release it when needed to propel us forwards. A good example of this is the Achilles tendon (below) in the ankle which stores energy when lengthened with running to propel us forwards, allowing us to run long distances whilst using the least amount of energy possible.

Achilles tendinopathy

What are tendons made of?

  • Tendons are made of incredibly tough collagen fibres formed into tight bands with several other components.
  • They do not have a large blood supply
  • They do contain active working cells called Tenocytes which turn over and repair tendon constantly but very slowly.

Why is repair in tendons slow? Recent research backs why

The speed of repair and renewal of itself within tendon tissue is much slower than that of other tissues within the body such as bone or muscle. This is partly due to the poor blood supply it has. Studies have looked at the tissues of people affected by the Chernobyl disaster (catastrophic nuclear accident that happened April 1986) to determine whether there are still signs of the carbon 14 from the fall out and if so, how much is now left after years of natural tissue repair and renewal. As we are living beings, our tissues renew and repair constantly throughout our lives and so the tissues we have now will not be the same as the tissues we have in ten years time but some will renew quicker than others. We know from these studies that tendon tissue renews itself incredibly slowly as carbon 14 data from tendon samples were still very high in the tendons tested.

So what does the above mean for us in day to day life?

 It means that a tendon will take a long time to repair if you get an injury. A very common tendon injury is a tendinopathy. This occurs when the tendon renewal and repair system fails to keep up with the day to day demands being put on it. This might be due to a significant increase in the demand or load being put through the tendon. A good example of this is a runner who decides to up their mileage significantly but also chooses a different route to do their new run that takes in more hills. This puts a huge extra demand on the tendon in terms of stress and strain and so the Tenocyte cells have to work hard to repair and turn over the tendon tissue. The poor blood supply and slow speed of repair means this tendon is at risk of not being able to keep up and so it may fail to repair quickly enough if the runner continues to increase the pace or distance too quickly and the tendon becomes degenerate. Pain may or may not occur with this process, pain in tendons is not yet fully understood.

Some Advice on how to keep your tendons healthy

To keep your tendons healthy, think about your tendon anatomy once in a while. Try not to change the loading you are putting through your tendons too quickly or too aggressively. Make small changes steadily towards your goals to ensure the Tenocytes can keep up with the rate of work asked of them. It works to understand your body tissues more, that way you can look after them into older age.

How can Physiotherapy help?

A Physiotherapist can advise you on how to progress your rehab and training to help prevent injuries to the tendons happening.  They can also assess your running style or sporting style as you may be putting extra pressure on some of your tendons and this can be avoided.  One of our sports physios can see you at home at a convenient time.  

CALL 0207 884 03744 or Email us at
Edited by Leanne Plenge
Head of Bristol Branch and Specialist Physiotherapist