I’ve made some adjustments from the video version of this article. I switched out R alpha-lipoic acid for vitamin D3, because although vitamin D3 is a critically important nutrient, it is of benefit more to sufferers of arthritis than tendinitis. I’ve also expanded the list of anti–inflammatory foods. Finally I eliminated the inclusion of types I and II collagen as I could find no compelling evidence to support the beneficial effect of type I collagen on tendinitis and type II collagen, a fantastic supplement, is more beneficial to cartilage and skin than tendons. In their place I substituted ornithine alpha-ketoglutarate (OKG) for nighttime ingestion as it boosts human growth hormone levels which in turn increases the rate of tendon tissue synthesis. The protocol outlined below includes modifications one can make to exercise, diet and supplementation regimes to reduce or eliminate tendinitis and is written in that order.
What is tendinitis?
Tendinitis is an inflammation in a tendon. It is most often the result of micro-tears in the tendon fibers that have not fully healed. It is caused by overuse, particularly by the same repeated motion such as a forehand swing of a tennis racket or barbell curls.
If inflammation is significant, you may want to simply rest the affected area until the inflammation reduces to a manageable level. When you are ready to resume exercising the affected area the following are some adjustments you can make to minimize inflammation and accelerate healing.
A. Compound Movements
Isolation movements involving the muscle to which the tendon attaches should be avoided until the tendon has healed and inflammation has subsided. Compound movements should instead be selected which involve the muscle in a more natural way, but do not put all of the stress directly on the affected muscle and tendon. For instance, if the biceps tendons are inflamed, replacing barbell curls, an exercise which isolates the biceps and put all of the stress on the biceps tendon, with chin-ups is recommended. Chin-ups are a compound movement because they involve more than one joint, in this case the elbow and the shoulder. The biceps participate in the movement, but the lats rear delts, and traps also do a lot of the work relieving the biceps of carrying the full load. This also allows your cerebrum, the part of your brain that coordinates bodily movements, to adjust workload based on incoming data, i.e. how much pain the biceps might be feeling, and to force the lats to work harder to reduce the workload on the biceps. With an isolation movement this is not possible.
An additional benefit of compound movements is that they produce more overall stress on the body and force a stronger adaptive response. One of the ways the body responds to this stress is by producing more anabolic hormones such as human growth hormone and IGF-1 (insulin-like growth factor 1). These two hormones regulate tissue synthesis. More HGH and IGF-1 means more tissue synthesis including tendon tissue (mostly type I collagen) in the damaged area. This increase in tendon tissue synthesis will result in faster healing times, terminating the inflammation response and allowing you to resume normal activity.
B. Heavy Eccentrics
In addition to compound movements, as you enter the latter half of your healing phase and the tendons have had a chance to heal up, you can start to integrate heavy eccentric movements into your exercise regime. It is best to use these sparingly as they cause a great deal of microtrauma to the muscle and tendon, but they have been shown to stimulate faster tendon healing in the case of Achilles tendon injuries. A study reported in the Scandinavian Journal of Medicine & Science in Sports (Landberg, H. et al, (Feb. 2007) “Eccentric rehabilitation exercise increases peritendinous type I collagen synthesis in humans with Achilles tendinosis”) demonstrated that 12 weeks of heavy eccentric training in elite level soccer players increased type I collagen (tendon tissue is 97-98% composed of type 1 collagen by dry mass) synthesis rates in damaged Achilles tendons while undamaged tendons maintained normal synthesis rates. What this means is that heavy eccentric training can stimulate damaged tendons to heal faster.
So what is heavy eccentric training? Eccentric training consists of resisting a load during the phase of an exercise while the muscle is stretching. For instance, eccentric training with barbell curls would consists of starting at the top position, resisting the bar for 5-8 seconds as it descends to your hips and then having a spotter set the weight back to the top position for the next rep. Heavy eccentrics would mean using 70-110% of you 1 rep max (1RM). So of your maximum single rep barbell curl were 100 pounds, you might want to start with 70 lbs. and perform 6-8 reps of heavy eccentrics for 2-3 sets. This type of training should not be performed more than once per week and adequate rest should be give to the tendons and muscles to allow for healing to take place. Avoid putting significant stress (60%+ of 1RM) on the muscles for 3 days after eccentric training.
Consulting a medical professional before engaging in this form of exercise is highly recommended. The tendon must be strong enough to engage in this form of exercise without further damaging it beyond its capacity to repair itself fast enough. If at any time significant pain is experienced, terminate the program altogether or until the tendon is sufficiently healed to withstand the rigors of eccentric training.
If you do integrate it into your training regimen, start slowly and gradually increase the workload and/or volume. The goal is to provide just enough stimulation to accelerate the healing process without overloading the body’s adaptive capacity.
We’ll be looking to reduce inflammation in the body and by extension the inflamed joint/tendon by eating foods that are anti-inflammatory. The Cleveland Clinic defines inflammation as follows:
“Inflammation is a process by which the body’s white blood cells and chemicals protect us from infection and foreign substances such as bacteria and viruses.
In some diseases, however, the body’s defense system (immune system) inappropriately triggers an inflammatory response when there are no foreign substances to fight off. In these diseases, called autoimmune diseases, the body’s normally protective immune system causes damage to its own tissues. The body responds as if normal tissues are infected or somehow abnormal.”
Some foods contribute to inflammation and others reduce it. We’ll be looking to reduce it. Noted author and nutritionist Monica Reinagel created an index that measures the inflammatory or anti-inflammatory effect of foods. You can check the index of any food at nutritiondata.self.com. Just enter the food into the search box on the top right of the page. The database will generate a list of foods that match your entry. Select the appropriate one, click on it and it will give you all of the data for that food including its inflammation score. Positive numbers mean anti-inflammatory and negative ones mean inflammatory. I’ve included a list off common foods that are anti-inflammatory, their IF scores, and broken them down by their macronutrient category.
Salmon, sockeye, cooked, dry: 950, strongly anti-inflammatory
Beef, grass-fed, strip steaks, lean only, raw: 60, mildly anti-inflammatory
Sardines, canned, bone-in: 763, strongly anti-inflammatory
Sweet potato, cooked, baked in skin, without salt: 378, strongly anti-inflammatory
Pineapple, raw, all varieties: 65 mildly anti-inflammatory
Kiwi, fresh, raw: 34 mildly anti-inflammatory
Avacado, raw: 181, moderately anti-inflammatory
Nuts, almond butter, plain, without salt added: 601, strongly anti-inflammatory
Peanut butter, chunk style, without salt: 146, moderately anti-inflammatory
These scores vary by serving size, but they give an idea of what foods to integrate into your diet to reduce inflammation. It’s OK to consume inflammatory foods. The idea is to balance inflammatory foods with anti-inflammatory foods so that each day your next IF score is positive – the more positive the better.
R-alpha-lipoic acid: R-ALA is an anti-oxidant that is both fat and water soluble. As an anti-oxidant it reduces reactive oxygen species (ROS) in the body, including the inflamed tendon area. R-ALA reduces inflammation systemically as well because of its unique capacity to assist in glucose disposal. R-ALA helps channel glucose out of the blood stream and into muscles where it can help muscles to grow or at least not atrophy. High blood glucose levels result in inflammation so reducing blood glucose levels reduces inflammation.
Vitamin C: Vitamin C is a co-factor in collagen synthesis. Collagen comprises 97-98% of the dry mass of tendons. Making sure that you have adequate levels of vitamin C throughout the day ensures that you are creating mew collagen in the damaged tendon at optimal rates. Vitamin C also acts as an anti-oxidant and helps reduce ROS at the site of inflammation.
Glucosamine, chondroitin, and MSM: these three sulphur containing compounds are necessary for collagen production. Collagen is a protein composed (as all proteins are) of amino acids. Some amino acids are bound together molecularly by disulfide bonds. Providing your body an adequate supply of bio-available sulphur will ensure that you can create the collagen proteins that will ultimately be used to heal damaged tendons.
Bromelain: bromelain enhances the absorption of glucosamine, chondroitin, and MSM. It has also been shown to increase the proliferation of tenocytes (tendon cells) in rats with damaged Achilles tendons (Aiyegbusi, et al. (2010) “Bromelain in the early phase of healing in acute crush Achilles tendon injury”). Finally, bromelain also reduces inflammation. Dosing suggestions range from 500-1000mg per day in divided doses.
Ornithine alpha-ketoglutarate (OKG): OKG acts as a human growth hormone secretagogue, meaning it causes the body to secrete more HGH. The best time to take it is 30 minutes prior to sleep as the first 90 minutes of sleep is the time when the body releases its largest pulse of HGH. 5g is sufficient to achieve the effect. This supplement is more effective for those under the age of 45 and has a much reduced effect on those over 45. The effect can be amplified by switching to a low carbohydrate diet for several day (50g or less per day of carbs). Boosting HGH levels will increase the rate of tendon tissue synthesis in the damaged area.