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Carbon-14 bomb pulse dating shows that tendinopathy is preceded by years of abnormally high collagen turnover

PainSci » bibliography » Heinemeier et al 2018
Tags: etiology, tendinosis, overuse injury, biology, fun, neat, pro, pain problems, injury

Two articles on PainSci cite Heinemeier 2018: 1. Guide to Repetitive Strain Injuries2. Achilles Tendinitis Treatment Science

PainSci commentary on Heinemeier 2018: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

An earlier study from the same researchers used a rather sensational method to demonstrate that Achilles tendon tissue is forever: what we create when we are young is still there decades later. They know this because they found contamination from nuclear bomb tests, trapped in tendon tissue like a fly in amber.

But those subjects were all healthy. In this follow-up study, they looked at both healthy and unhealthy tendons … and found a surprise.

Un-healthy tendon does get recycled. •mind blown•

This is a hard result to interpret, but the authors take a stab at it. They propose that it means one of two things:

  1. Tendon disease causes tendons to start recycling and regenerating tissue, trying to cope with the load. And then, much later, symptoms.
  2. Tendon turnover is actually a cause of tendinopathy. For unknown reasons, the tendon is trying to rebuild itself, and becomes unhealthy as a result.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Tendons are essential weight-bearing structures that are often affected by tendinopathy, which leads to pain and impaired mobility. In healthy Achilles tendons, no significant renewal of the weight-bearing collagen matrix seems to occur during adult life, but tendinopathy may lead to increased turnover. The carbon-14 ([14C]) bomb pulse method was used to measure lifelong replacement rates of collagen in tendinopathic and healthy Achilles tendons (tendinopathic: n = 25, born 1937-1972. Healthy: n = 10, born 1929-1966). As expected, the healthy tendon collagen had not been replaced during adulthood, but in tendinopathic tendon, a substantial renewal had occurred. Modeling of the [14C] data suggested that one half of the collagen in tendinopathic matrix had undergone continuous slow turnover for years before the presentation of symptoms. This finding allows for a new concept in tendon pathogenesis because it suggests that either the symptoms of tendinopathy represent a late phase of a very prolonged disease process, or an abnormally high collagen exchange could be a risk factor for tendon disorders rather than being a result of disease.

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