Nutrition important to tendon repair

To play guitar like Django Reinhardt you need healthy tendons. To jump as high as Michael Jordan, throw as hard and fast as Brendon McCullum or flik flak like Olga Korbut, you would want tendons with integrity. A few years ago, at a workshop on tendons, Jill Cook outlined a facet of tendon management that changed the way I looked at rehab. Suddenly, as she implicated diet and BMI (body mass index) in tendon injury, I realised that to pigeon hole injury to just mechanics was naive and short sighted. We ignore nutrition at our peril when we consider the breakdown of one of our body's most crucial soft tissues.
Like a lot of tissues in the body, tendon relies on a balance of deterioration and rebuilding. This is the process of adaptation. Tendon cells and the structureless gel they inhabit (called extracellular matrix or ECM) experience load, and they are designed to adapt to reasonable loading in a way you would recognise as strengthening. In everyday life, sometimes loads exceed the tissue's ability to regenerate. Tendon is known to have slow regenerative powers, so it is possible in human endeavours we attempt to exceed the balance of breakdown and rebuild. This would explain well the frustrating dilemma of overuse conditions, where use outstrips recuperation, causing the seesaw to tip to the negative side permanently. Rest and careful exercise strategies are the best way known to return the person to normal function, but we must address work loads and demand on the human.
Short of replacing clerical staff with robots - and in no way do I say this as a proposition - as an employer, you have to consider the balance between number of staff and volume of work. In any business operation, it should be common sense to limit the times of working at computers, and consider fostering an environment of support rather than hammering deadlines, KPIs and superhuman expectation. As I said earlier, tendons will eventually lose the battle of breakdown and repair with overuse. This is the clinical disaster known as tendonopathy which is all too common in my clinic sadly. Tendonopathy is the abnormal tissue product of this imbalance. The ECM has altered. It has developed more blood vessels and its structure is erratic.
This is where nutrition is important as we are now realising the medicinal properties of food, but as James Crownover MD shows in his article Your Tendons on Cake, what we eat and our body size has large impact on our tendons' status or recuperative powers.
Jill Cook postulated adipocytokines as an irritant factor for tendons. Fat cells make them. One cytokine in particular, Visfatin, has been linked to upper limb tendon pain. Where does Visfatin come from? Abdominal fat.
So not only should you seek physical therapies to address your tendon problems, but you should also look at the quality of your diet. Crownover advocated a diet low in carbohydrate, seeking to attain an optimal body mass, and supplementation of green tea, turmeric and glycine (found in bone broths).
Diabetics are at higher risk of tendon issues, and according to studies, their tendons are stiffer. Having higher sugar levels in their blood, diabetics' glucose can bind to proteins creating damaging substances which can cause inflammation and alter the normal behaviour of the tendons (AGEs or Advanced Glycation End Products). Increased inflammation and hyperglycaemia inhibit the remodelling of the tendon so blood sugar normalisation would seem logical in tendon management. Crownover also shows that non diabetics with high fasting glucose levels had a higher risk for rotator cuff tears, so for everyone, sugar in the diet is something not just invoking cardiovascular, obesity and metabolic disease, but now also your mechanical you. It is strongly recommended that you look at Nigel Latta's documentary on sugar, and Damon Gameaus' That Sugar Film, and the ground breaking Fructose 2.0 by paediatrician Robert Lustig. Food is medicine. This is clear. Doesn't it then make sense to look at food that resembles its most natural state? Highly processed carbohydrate rich foods are falling out of favour and now we have another health consequence for eating foods laden with sugars. It's not really surprising when you study the ingredients of a packaged food versus a whole vegetable in your hand.
Glycine, mentioned earlier, was found to improve the cellular matrix (ECM) in rat achilles tendons.
Viera and colleagues found glycine in the diet "provided beneficial effects against toxicity and inflammation since glycine may restructure the collagen molecules faster due to its broad anti-inflammatory effects". According to Crownover, glycine is made by our body, but in not sufficient quantities for repair, so supplementation is effective. It increases components of the ECM, helps repair the ECM, improves the tendon quality and mechanical properties. Bone broth is rich in glycine among other bone and joint goodies. Green tea seems to work well with glycine, and also shares anti-inflammatory properties and turmeric offers benefits against AGEs.
Physiotherapy offers mechanical solutions for tendon pain and damage, but there is definite wisdom in looking at the recent results of studies on nutritional approaches. A comprehensive list is at the conclusion of Crownover's excellent article - Your Tendons on Cake.
Greg Bell is a physiotherapist practising at Bell Physiotherapy. www.bellphysio.co.nz