What helps tendons heal faster?

The ladder's first two rungs: isometrics for pain and capacity, heavy slow resistance for strength

What helps tendons heal faster is a question the supplement aisle answers with a tub and the physiotherapy literature answers with a ladder, and the honest page gives the ladder, because the only thing that makes a tendon heal faster is climbing the right rung at the right time and the only thing that reliably makes it slower is skipping one, which most lifters do at least once. The ladder is the tendinopathy rehabilitation continuum, four stages of loading that rebuild a painful tendon's capacity in the order the tissue can take it. Rung one is isometrics. A painful tendon starts here: heavy static holds against an immovable or very heavy load, around five holds of forty-five seconds at roughly seventy percent of maximum with rests between, a wall sit or a leg extension hold for a patellar tendon, a heavy standing calf hold for an Achilles, a static wrist hold for an elbow. The isometric literature found these holds reduce tendon pain immediately and for around forty-five minutes afterwards, more than isotonic work does, so rung one does two jobs at once, it relieves the pain that stops a lifter moving and it begins rebuilding the tendon's capacity to take load, and because it provokes little it can be done daily and used before training as an analgesic while the rest of the ladder is built. Rung two is isotonic heavy slow resistance, the rung on which most of the remodelling happens: slow, heavy, controlled concentric and eccentric work through range, around three seconds up and three seconds down, loads heavy enough to be hard for six to fifteen repetitions, three sessions a week, squats, leg presses and leg extensions for a patellar tendon, seated and standing calf raises for an Achilles, wrist curls and extensions for an elbow, progressed in load as the tendon tolerates over weeks to months, with the eccentric heel-drop tradition for the Achilles the ancestor of the rung and heavy slow resistance its modern form, the two performing similarly in trials. This is where the tendon's collagen realigns to the load and its stiffness and strength return toward normal, and it is a rung measured in months, not weeks, which is the first place the calendar and the tissue disagree.

The third and fourth rungs, the rule of progression, the rung lifters skip, and the adjunct timed to each session

Rung three is energy-storage loading, and it is the rung lifters skip. A tendon in sport is a spring, storing energy as it stretches under load and returning it as it recoils, and the loads that store the most energy, jumping, hopping, bounding, sprinting, cutting, landing from a box, are the loads that overloaded the tendon in the first place and the loads it must be retrained for before it can go back to them. Rung three introduces them deliberately and progressively, low jumps before high, two legs before one, a few before many, with days between sessions for the tendon to recover, and only once rung two has made the tendon strong and pain-stable, since energy-storage loading on a tendon that has not rebuilt its strength is the commonest re-injury in tendon rehabilitation. Rung four is return to sport: the sport's own demands, volume, intensity and unpredictability, reintroduced by criteria rather than by date, strength symmetry between the sides, the ability to perform the sport's energy-storage movements without a pain flare, and the confidence to do so, the return-to-sport literature's finding that criteria-based return re-injures less than calendar-based. The rule of progression binds the ladder together and is the single most useful thing on this page: a lifter climbs from one rung to the next, and adds load within a rung, according to the tendon's pain response within twenty-four hours of a session, pain during and after being acceptable if it settles to its baseline by the next morning and a sign to hold or step back if it does not, and according to strength criteria, never according to how many weeks have passed. Skipping a rung, usually from one straight to three because the pain has eased or from two straight to four because the calendar says the injury should be over, is the way most lifters make tendon healing slower, since it loads a tendon with a capacity it has not yet rebuilt, provokes a flare, and sends the lifter back down the ladder to rung one, the restart cycle that turns months into years. Nutrition holds the floor beneath the ladder, protein at 1.6 to 2.2 grams per kilo, the cofactors from food, no smoking, and collagen's protocol is an adjunct timed to each rung's session, around fifteen grams of gelatin or hydrolysed collagen with roughly 50mg of vitamin C an hour before the isometrics, the heavy slow resistance or the hopping, on the strength of a marker trial and one small outcome trial beside loading, improving perhaps the tissue each rung produces and never the speed of the climb. The worked example is that adjunct on its true terms: two capsules, 1200mg hydrolysed type 1 marine collagen with 12mg vitamin C plus zinc, 120 for £16.99 at 28p a day, lab tested and UK made, below the protocol's grams, taken for vitamin C's collagen formation sentence through the months the ladder takes. What helps tendons heal faster: climbing the four rungs in order, earning each with the next morning's pain and the strength numbers, and never skipping the one that stores energy.

What to check on the label