AskAbs, Fitness

#AskAbs – Long Term Tendon Health Strategies

This is another post answering a popular FAQ that I’ve received either as emails or DMs on a regular enough basis that it deserves its own #AskAbs feature post response….

QUESTION: When you returned to competition, did you have pain or discomfort in your tendon? Were you afraid that you would injure that tendon again or even the other tendon?

Answer: Nope! No pain. No fear. Well… not for my ruptured and surgically-repaired achilles anyway… 

Even though it was my right achilles that ruptured in 2016, that one has been fine ever since my surgery and recovery. You can find my full ATR recovery protocol here with videos etc.

My left tendon, on the other hand… 

About three weeks into my winter-training block for the 2022 season, my left achilles flared up for 8+ weeks to a level of pain and discomfort higher than I’d ever previously experienced – to the point where, after about a month with this grumpy tendon, I was crying with frustration (and physical pain), desperate for answers and confused as to why the usual loading work and standard protocol for pain reduction and tendon repair wasn’t working. 

I know the people who have reached out are, or were at the time they got in touch, struggling through, hobbling along, feeling frustrated and tired with the pain, just like I was at that time. So, let me share with you an insight into my tendon recovery program for what you may call tendonitis or tendonopathy. In another post, I’ll also share my thoughts on the four key principles for good tendon health that perhaps will help to give some context to my current tendon loading program.

Practical Tendon Loading Program: Achilles Tendon

I can’t provide you with a hard-and-fast rule for tendon loading, but I can give you an insight into what that generally looks like for me to maintain healthy tendons from the perspective of someone who is 6 years into her achilles tendon rupture recovery.

Ultimately, as a jumper, maintenance for both my previously-ruptured side and the side that didn’t suffer the rupture is key. All my tendons bear the brunt of huge forces going through them when I run and jump and will do for as long as I continue training and competing in high-performance sport. So here’s how I try to maintain healthy tendons to avoid pain and re-injury.

Although it’s not fool-proof, for the most part, it’s quite successful and doing something that works part of the time is preferable to doing nothing and suffering with tendon pain all year round:

Tendon Loading to maintain a Pain-Free Tendon 

Warm-ups 

  • Medium Theraband leaning single leg calf raises with 2-3 second hold at the top of each rep – 2 sets x 8 -10 reps
  • 4 sets x 20 metre (80 metres total) active toe walks – forward, backward, side to side.
  • Skipping rope – build up to a few minutes of varied skips – single and double leg, high knees, back and forth, side to side. E.g. 3 sets x 45 seconds, 15 second rest between sets.

Strength Training

  • 2 x per week loading either seated or standing heavy isometric holds at the end of each session, e.g. 5 sets x 6 second isometric holds – max intensity. 
  • 1 x per week loading standing eccentric single leg lowers, e.g. 3 sets x 6 reps 

Watch my achilles tendon loading programme on TikTok.

Tendon Loading for a Flare-Up, e.g. when your tendon is grumpy and in pain 

In addition to the above…

  • REPLACE theraband leans with: Standing single leg calf raise isometric holds – 5 reps x 30 second per leg (I use the interval timer app with the rest for each leg being the 30 second iso hold on the other leg). The first reps generally feel quite painful and then the pain gradually subsides or lessens by rep 5. 
  • FINISH the above pain-free tendon loading warm-up with: Rudiment mini double then single leg hops – forwards, backwards, lateral plane – 10-15 metres each (100+ metres total). 

Caveat – Understanding Your Pain Thresholds: A Team-Led Approach

Unfortunately, the challenge for loading a grumpy tendon for me is knowing that I have to be able to work through an uncomfortable level of pain for protracted periods because the tendon needed to be loaded and stressed in as close to ‘plan A’ training fashion as possible to heal. At certain points in my winter training this year (2021/22), I worked through whole sessions in pain and was left wondering, ‘Has my pain threshold decreased or is this really that painful?’ (It was really that painful!) But it was a joy and a reminder of the importance of gratitude to be able to see how, over time, the pain period reduced and the pain-free period increased until one day it returned to healthy and happy. 

It’s important to note that this was MY most recent personal experience in a very controlled environment with a program led by my full medical team at British Athletics. 

So, I’d advise working through a tendon loading plan for a grumpy tendon with your physio and medical team to ensure you’re not over-extending yourself and doing yourself more harm than good. 

Supplements: Collagen & Anti-Inflammatory Wraps & Reduced-Sugar Diet

As standard protocol, I use collagen approximately 3 x per week and take that 20-minutes before heavy tendon loading, such as specific calf loading, jumping or bounding sessions. 

Whilst I was in Portugal recently, I ran out of collagen and instead used jelly boxes as my collagen replacement!

Jelly box replacement for collagen

When my tendon is grumpy, we also use anti-inflammatory patches and wraps each night such as Voltarol, Viscopaste and other gel and oral medicinal combinations. 

Other thoughts around anti-inflammation is to reduce sugar content in your diet during any flare-ups or injury because, of course, sugar is inflammatory. I’m generally quite a quick healer because whenever anything hurts or I get injured, I’m a stickler with my diet – no sugar, sweets, chocolate… I know that’s hard because you generally want comfort food when you’re down and out, but seemingly paradoxically, that’s the worst way to pick yourself up after something like this happens. Good diet promotes good recovery. So pretty please don’t bother with the above practices if you nullify it with bad eating habits.

More Questions? Ask Abs… 

Hopefully this post answers quite a few of the questions I’ve been terrible at responding to over the last few weeks and months. 

If you have any other questions that you want me to answer on here or on my YouTube, drop me a message with your tendon challenge and question. 

Read another ‘Ask Abs’ posts here.

2 thoughts on “#AskAbs – Long Term Tendon Health Strategies”

  1. This was very useful information, so thanks for sharing. I’m sure many people will find these steps useful. I’m happy to see you’ve found a strategy that has been working for you!

    Liked by 1 person

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