https://podcasts.apple.com/us/podcast/jacked-athlete-podcast/id1462537296?i=1000697422687
Hakan Alfredson approach: “Which was really a breakthrough of treating tendons with eccentric exercise… two third or 70 % got better.
“We are still trying to solve and trying to find out why is it that some are not responding to heavy slow resistance training or perhaps just a slow resistance training because we can debate how high and low should we go or could we actually go lower and there’s some indication that perhaps we could actually go lower.”
“We have some indications that we think that cells are activated by the load and probably and again this is more indication that perhaps the cells need more time to experience the load in order for them to create material.”
“It seems that heavy slow resistance training ismore beneficial in order to improve the structure like cross sectional area, et cetera, than plyometric training. And that would be perhaps because the cells need more time under tension in order for them to produce material or collagen.”
Interfascicular matrix: “it seems to be an important space or area where you have nutrients coming and going. And we know that with aging, that space is actually decreasing, perhaps getting into problems for the nutrients to come and perhaps to leave.”
Animal studies on tendon cells: “We know that if there’s no tension around the cell, that they will very, very fast degrade or very rapidly degrade and go into apoptosis condition, suicide condition. And perhaps in that sense, the material would degrade.”
“We know that it takes time for the tendon to build up, but to get it degraded and where the structure is degraded and materials degrading and also the mechanical properties that goes on just within weeks.”
“There’s no doubt that if you’re lying down still for too long of a time, that has some very negative effects on the tendon, on the structural and mechanical level, that’s for sure.”
“So in the first stage, the immature stage, we know that the tendon is more elastic and then it gets sort of matures because the cross-links are turning into a more mature condition.”
“So we could say that perhaps after the tendon is made within the time of 13 to 17 years old, then the aging perhaps more or less starts.”
“There’s more room for advanced glycation in product to accumulate into the tissue because the turnover just goes down very fast after when the tendon is created.”
AGEs: “The tendon sort of gets more brittle and with time… We know that metabolic issues can influence that and perhaps accelerate the aging condition in people.”
Ruptures happening at an earlier age: “Well, I think the latest data could indicate that it’s an effect from the COVID time. So again, coming back to the immobilization that we had a time where we were not moving so much. So people got immobilized or were moving less. So for that reason, perhaps the tendons got degraded and when they went out and to move and be physically active that perhaps the tendons were not ready for it.”
“Coming back to the heavy slow resistance, it’s true that sort of is a control, very controlled way of stimulating the tendon in order to increase or improving the structure and mechanical properties.”
“If we took a group looking into some people who had never had injured their patellar tendons, how would they look like into the tendons from a structural and mechanical perspective. And there we saw, and the first studies was primarily young, elite athletes or badminton players and fans that they actually had much larger tendon on the, yeah, the lead side. And that we also showed later with, yeah, master athletes for players who have been playing almost their whole life. That was kind of very striking because what was interesting for the elderly players. And they were, you know, European champions and some of them were, yeah, even world champions and so on. And we saw that some of them actually started pretty late in their career, like 14 or 15 years. And there you could speculate that’s where the the tendon is built already. So that could actually indicate that you still have some capacity in the tendon after the tendon is made. And we think or speculate that there might be cells still around in the tendon, perhaps around the fibrils, who can sort of survive and still be used in order to produce a material. That’s our thoughts about it.”
“It seemed that the Achilles, to some extent, were more responsive, to some extent, than the patella. It could indicate that the patella actually needs more load, perhaps more heavy load than the Achilles.”
“Actually implying that they are two different tendencies, so to speak. Yeah. Do you have any any speculation why you think that is? it it? I think one of the it’s again a pure speculation, but that the
“The Achilles tendon seems to contain more of a sheath that the patellar does not have. So in the sheath that contains more cells. So perhaps that could be actually an aid for the tendon to recover better and actually also to improve structure and mechanics.”
“If you add sugar to the tissue, it will stiffen up and so on and create cross-links… We have some indication based on diabetics versus control. And it seems that the material actually is more stiff and to some extent also the structure based on that.”
“It seems that these sugar cross-links is accumulating in the tissue and that seems to get this brittleness of the structure. So we were talking about before about getting the tendon stiffer with training, which could be good in many aspects, but that would be based on that you increase the collagen content, of course. But this stiffening with sugar cross-cutting is perhaps not so good of a thing because the tendon gets brittle and when you load it or stress is getting too high, perhaps it would be more prone to an injury with that respect.”
“I think that the literature now is again accumulating, showing that exercise is quite important in order to improve the mechanical properties and also the structural properties of the tendon. So that you can actually get your tendon younger with that perspective. And we have shown also in these master athletes that they actually have a lower concentration of advanced glycation end products.”
“In several animal studies that if the animals were eating more processed food, so to speak, they get a worse tendons in many aspects.”
“When the turnover goes down, then there’s more room for these cross links to accumulate because they kind of come with the sugar and that comes into contact with protein and that can create these covalent bindings, which are the AGE crossings we are talking about. So when the tissue is turning over, it’s more difficult, but when it’s not turning over, that’s much more room for that to happen. And the turnover kind of goes down with age.”
“When the tissue is kind of not in a homeostatic state or perhaps if the fibrosis is degraded or injured, we know the proteoglycans and the GAGs are upregulated. And that’s probably due to the tenocytes cannot sense that there’s a tension around them. So then they will produce more GAGs or fillers around the tendons. And we know they are negatively charged. And for that reason, that actually make this osmotic mechanism, which creates or in that state, we will have a more fluid into the tendon.”
Christian’s research (Researchgate): https://www.researchgate.net/profile/Christian-Couppe
Christian’s profile: https://researchprofiles.ku.dk/en/persons/christian-couppé
Christian on Twitter: https://x.com/ccouppe
