The Center for Podiatric Care and Sports Medicine

High Cholesterol? It Could Be Affecting Your Tendons: New Research Suggests Tendon Pain and Cholesterol Are Linked

Posted by on Monday, December 28th, 2015


Cholesterol gets a bad rap, but without it, we’d be doomed! This soft waxy substance is found within every living cell of the body, where it produces vitamin D, hormones, cell membranes, and bile acids to help you digest fat.1 Too much cholesterol is most notoriously associated with cardiovascular disease, but researchers from the University of Canberra and Monash University in Australia have also linked it to an increased risk of tendon pain and injury.

tendon pain
Cholesterol–shown, as crystals–can not only clog arteries, it also seems to make tendons more susceptible to injury. Image source: Flickr CC user Ed Uthman

Cholesterol and Tendon Problems Linked, Study Says

In a review of 17 separate studies (including more than 2,000 people) examining cholesterol and tendon structure, James E. Gaida found that “the pattern of cholesterol changes seen with tendinopathy was similar to that which increases cardiovascular disease risk.”2

When blood levels of cholesterol were high, excess cholesterol was deposited within the tendon matrix. Scientists theorized that these cholesterol deposits prompt inflammation, which in turn causes structural changes in the tendons that make them more vulnerable to injury.

These cholesterol disturbances can affect any tendon in the body, but was particularly observed in the shoulder’s rotator cuff tendon and the Achilles tendon in the heel, which is already somewhat susceptible to injury.

What Came First — The Chicken or the Egg?

Though the findings are interesting, researchers say that they are still far from proving a direct causal link. There is no proof that high cholesterol directly causes tendon problems. Study authors said the opposite effect could also be true — that perhaps tendon injury limits physical activity, which causes higher cholesterol in the body. Accumulation of cholesterol can also have genetic or dietary components.

“The association between cholesterol and tendinopathy needs further investigation, including whether lowering lipids through lifestyle changes, such as diet and physical activity patterns, could help treat tendon pain,” Gaida told Reuters.3

What Does The Cholesterol and Tendon Relationship Mean?

At this point, there are a few takeaways:

  • First, some data suggests that statin use can increase tendon and muscle pain as well, so its benefit in preventing or healing tendon injuries is not entirely clear. Doctors must exercise care in the prescription of statins for cholesterol patients with a history of tendon pain.
  • Second, sports medicine doctors should consider screening tendon pain patients for high cholesterol to determine risk of injury and cardiovascular disease. “One of the challenges orthopedists have is developing tunnel vision. We see the tendon, we see the bone, and that’s all we focus on. Often, we fix a tendon without exploring the underlying etiology for that tendon disease,” explains Dr. Joseph A. Abboud who is also studying the link between cholesterol and tendons. He adds, “Orthopedists may have the opportunity to treat a patient before the cardiovascular manifestations of hypercholesterolemia become obvious.”
  • Thirdly, people recently diagnosed with high cholesterol who start a new exercise program should do so gradually to give their tendons time to adapt to the change in activity. Low-impact activities like cycling, elliptical training, and swimming are often best for beginners.

NYC Tendon Pain Treatments

Tendon treatments are one of the specialties at The Center for Podiatric Care and Sports Medicine in New York City. We typically begin with conservative therapies like rest, ice, compression, elevation, and physical therapy. From there, we can move to advanced therapies like the Tenex/FAST Procedure of cleaning up scarred tendons, or platelet rich plasma and shockwave/ultrasound treatments that stimulate natural healing processes. Contact our team of experienced, board-certified podiatrists, surgeons, and sports medicine doctors to discuss any pain or issue related to the foot or ankle.



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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.