Diet can have a significant influence on tendons. Being overweight will increase the load on a tendon, increasing risk of injury. High levels of blood sugar, such as seen in diabetes, can also damage tendons. Enzymes which contribute to the breaking down of tendons are also released in higher amounts with a fatty liver, which is associated with central obesity. A properly supervised low carbohydrate diet can lead to improvement in these factors and should be a part of any comprehensive tendon rehabilitation program.
Research has demonstrated that whey protein can increase the cross sectional size of tendons associated with resistance training. This may be due to the presence of amino acid leucine, which is found in whey protein, and has been shown to induce a positive anabolic stimulus to connective tissues. High doses of fish oil have also been observed to be anti-inflammatory and may also be beneficial. Reduction or elimination of vegetable or seed oils which can be very high in omega 6 fatty acids can also reduce inflammations.
Anti-inflammatory medications have been shown in some studies to impair the healing of tissue. Furthermore, anti-inflammatory medications have side effects which can include increased risk of heart disease, kidney problems and stomach ulcers. In general, use of such medications should be short term and be recommended under competent medical supervision.
Corticosteroid injections can provide rapid, short-term pain relief and reduce acute swelling, but whether they are the right choice depends heavily on your specific injury, which tendon is affected, and how long the issue has been present.
Furthermore, longer term outcomes are likely to be worse. The practice of injecting directly into the tendon is now only rarely performed due to a delayed risk of tendon rupture. In some circumstances it is reasonable to inject into the sheath around the tendon but only under prescription of a medical professional.
Potential Benefits (Short-Term)
Critical Risks & Considerations Potential Benefits (Short-Term)
Warning: Corticosteroid injections around tendons carry notable long-term risks, which is why medical guidelines generally urge caution.
How can I keep track of my progress?
It is often difficult to detect the improvements that occur in symptoms with time. A standard assessment questionnaire will often demonstrate improvement and assist with motivation and compliance. This is usually performed monthly.
Phase 1: isometric exercises
Phase 2: introduction of dynamic exercise
Phase 3: progression of dynamic exercise (energy storage and release)
Phase 4: return to sport
