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Stability pact: Ligaments and Tendons
Ligaments provide the flexible link between bones and other bones. Tendons are their partners in this process and connect muscles to bones. Together, ligaments and tendons keep the musculoskeletal system stable and ensure that movements are fluid and effective.
Photo: © Festo
The two shells of a mussel are joined together by a ligament. Similarly, our joints have ligaments consisting of connective tissue formed of collagenous fibres. As with the mussel, ligaments provide a flexible bone-tobone connection and effectively regulate movement – after all, humans are not required to point backwards with the end of their feet! Tendons are part of this stability pact; they keep the musculoskeletal system stable and allow it work. Tendons connect muscles and bones and are made up of closely packed connective fibres. These fibrous bundles are covered by a tendon sheath, which increases the stability of tendons and their resistance to tearing.
Suspend a car from a tendon!
Our strongest tendon is the Achilles tendon which is 12 cm in length. It connects the heel to the triceps surae muscle and we use it to walk and run. It can withstand a tensile load in excess of one tonne and so you could hang a VW Beetle from it. Tendon lengths vary but here too nature has devised an ingenious and yet economic system. Muscles need space and the body ensures that they are not packed into a space that is too small for them. We need long and narrow fingers as otherwise we would be unable to play the piano and so the thick belly of the muscles required for finger movement are located in the forearm. The connection with the bones in the finger is provided by long tendons.
What strengthens or weakens the stability pact?
Tendons and ligaments are living tissue and so need care and attention. As with any other biological system, their response to a carefully measured load is to increase functional capacity. In other words, if you subject them to weights, they become stronger and more resistant. Function improves. However, if tendons are subject to an excessive load, e.g. the constant stop and go movements involved in squash, tennis, football or monotonous movements at work (keyboard marathons) they become irritated and inflamed. Moreover, if calcium is also deposited, the symptoms become chronic. This happens particularly with the shoulder, hip and knee tendons and also the forearm and Achilles tendons. Although the Achilles tendon is extremely strong, it is actually a weak point and so is vulnerable. It derives its name from the Trojan hero Achilles who was killed by an arrow in the ankle. In fact, it tears regularly – 20,000 times per year in Germany alone. This happens mainly with those who are overweight and do not exercise. If the tendon is strengthened by strength training, this does not happen.
What effect does Kieser Training have on …
… Ligaments and Tendons?
It’s so practical: When it comes to strength and the body’s ability to withstand loads, there is no need to train ligaments and tendons separately. They are part of the musculoskeletal stability pact that is kept in tiptop form by muscle training – provided we follow certain rules.
A stimulating liaison
When we tension muscles, we also train ligaments and tendons. This is because the process of muscle contraction also stretches and stimulates ligaments and tendons. This stretching stimulus improves their metabolism, which can be somewhat sluggish. The resultant secretion of growth hormones means that tissue forms new cells and increases its strength and load tolerance. At the same time our susceptibility to injury is reduced.
Slow is best
Strength training stimulates the growth of ligaments and tendons – like muscles they become thicker. However, the process is much slower. This is one reason why we shouldn’t increase training workload too quickly as ligaments and tendons lag behind muscles in their response to stimuli. Tendons require about 10 weeks to increase strength and to increase thickness requires longerterm training.
5% rule
Quite often, our muscles cope well with training and we are tempted to up the weight: however, the crux of the matter is that tendons represent a weak point as it is they who transfer weight to the bones. If you increase the load too quickly, you can trigger painful irritations and inflammation. So, stick to the 5% rule when doing Kieser Training: If you can work for at least 90 seconds on a machine, you may allow yourself a 5% increase in weight at your next session – but no more.
Connection with bones
In addition, strength training strengthens the connection between bones and tendons and in some cases, bones form a prominence that provides a better attachment with the tendon. This also protects against injury and increases load tolerance.
Significant performance plus
When we do fast or even explosive movements, strength is transferred more easily from muscles to bones as we “lose” less energy in our firmer ligaments and tendons as they are better able to withstand loads: The results are impressive: response times are shorter, speed in sports increases and we are better protected in the event of a fall.
Doctor’s Tip
Torn ligament – what now?
Ligaments and muscles are a continuous double act: our ligaments secure and our muscles move and stabilise joints. In reality, most of us don’t give ligaments a second thought until we injure one. For example, if we stumble, our muscle reflexes should provide protection. If they don’t, the associated ligament has to withstand the entire load on its own. This can overstretch the ligament and tear it. However, a torn ligament does not have to mean surgery.
Whenever there is a tear to the anterior cruciate ligament in the knee, specialists are all too keen to recommend sophisticated surgery – and what patient would not be beguiled by modern minimally invasive techniques? However, studies have shown that although surgery restores the stability of the knee, it is not so good at preventing wear, i.e. the arthrosis. It has also been clearly established that what the knee requires is active muscle stabilisation; if the biceps muscle of the thigh is strong, it can compensate almost 100% for damage to the anterior cruciate ligament – even without surgery – and the joint can even cope with sports such as tennis. B7 (seated leg curl), B1 (leg extension) and B6 (leg press) are useful exercises to include in your strength training programme although it may be necessary to adjust the range of motion and training weight if you have pre-existing arthrosis in the knee. If we injure the lateral ligaments in the ankle, the recognised standard treatment – fortunately – is rest and an orthesis (orthopaedic device): Unlike the powerful muscles and short strong tendons that move the knee, the ankle is moved and stabilised by somewhat slender muscles and long and thin tendons running from the ankle to the foot. This remains a weak point in human anatomy. So, if we injure our lateral ligaments or if they are constitutionally weak, it is worth trying to improve muscle stabilisation by training on the B8 (tibia dorsiflexion) and the J1 (calf raise).
Dr. med. Falk-Christian Heck, Muelheim, Germany
Specialist in orthopaedics and trauma surgery, Chirotherapy, sports medicine Medical Strengthening Therapy
