Wash Out the Lesion, Don't Jam the Signal | The Pained Brain, Chapter 14

Insulin resistance and tendon pain

Insulin Resistance and Tendon Pain: What Your Numbers Can Show

Insulin resistance is tied to tendon pain: an A1c in the prediabetic band carried about three times the rate of leg tendon injury, and Achilles tendinopathy tracks high triglycerides and low HDL even at a matched weight. The numbers to ask for are A1c, triglycerides, HDL and body composition.

A tendon that stays painful for years is treated as a local problem. The blood work and body composition around it may explain why the same exercise program helps one person and stalls in another.

Tendon pain that lasts for years is usually handled as a problem at one spot: the elbow, the heel, the point of the hip. The insulin resistance tendon connection says the spot sits inside a larger system, and that system shows up in blood work and body composition long before anyone calls it disease. The video above, Wash Out the Lesion, Don’t Jam the Signal, covers chapter 14 of The Pained Brain by Dr. Gurpreet Singh Padda, MD, MBA, MHP, and Dr. KrisJay Fucanan, MD. The procedures it describes are done by an interventional physician. What follows is about the numbers that sit around that decision, and the full study detail is in the book’s companion for chapter 14.

Why does tendon pain last for years?

The word most people hear is tendinitis, which suggests a hot, inflamed tendon that rest will cool. Under the microscope, a chronically painful tendon looks different: disorganized collagen, cells that have turned cartilage-like, and new blood vessels and nerve fibers growing into damaged tissue. There is inflammation, but it is the low, unfinished kind rather than a flare. The book’s word for that slow burn across the whole body is metaflammation.

Tendon also rebuilds far more slowly than people assume. Carbon dating from atmospheric bomb tests showed the core collagen of adult Achilles tendons was laid down at a median of 8 years after birth and essentially not renewed afterward. Plantar fasciitis confirmed on ultrasound was still present in 80.5 percent of patients one year after onset and in 45.6 percent at ten years. Pain that stays that long is not bad luck. It is a repair process that never got what it needed to finish.

Is insulin resistance linked to tendon pain?

Several separate lines of evidence point at metabolism. In a Danish population cohort, a hemoglobin A1c above 5.7 percent, the prediabetic band, was tied to about three times the rate of tendon injury in the legs, and the metabolic syndrome roughly two and a half times the risk in both arms and legs. People with Achilles tendinopathy showed higher triglycerides, lower HDL cholesterol and a higher ratio between the two than controls matched for body mass index, which is the lipid pattern of insulin resistance. Pooled across studies, people with tendon pain or altered tendon structure ran 0.33 millimoles per liter higher in triglycerides and 1.00 higher in LDL cholesterol.

These are observational findings, so they show association rather than proof of cause. They are also consistent, and they describe exactly the person who is told everything looks fine because no single value crossed a diagnostic line.

Can tendon pain be metabolic at a normal weight?

Weight matters. Obesity raised the odds of Achilles tendinopathy 3.81-fold in class I and 6.56-fold in class III. But the lipid study above matched patients and controls for body mass index, and the metabolic difference remained. Two people at the same weight can carry very different amounts of muscle and fat, and store that fat in very different places.

That is what bioimpedance body composition measures: fat mass, lean mass and body water, estimated from a small, painless electrical signal. Lean mass is the part that loads a tendon well, and fat mass is the part tied to the metabolic pattern. Body composition is not the same as weight, and for tendon pain that difference is the point.

Why does rehab help one tendon and stall in another?

Tendon rebuilds in response to load. Cells sense force and answer it with repair, which is why a structured loading program is the core treatment rather than an afterthought. In a trial of people with gluteal tendon pain at the hip, education plus exercise worked for 51 of 66 people by week eight; a steroid shot worked for 38 of 65, and waiting for 20 of 68.

Metabolism changes how well that program works. When patients with the metabolic syndrome went through the same eccentric exercise program as matched controls, their pain stayed higher throughout, satisfaction was lower, and they used more pain medication. In the other direction, after bariatric surgery and a 51.0 percent loss of excess weight, 90 percent of patients with plantar fasciitis saw their symptoms resolve. That study could not separate less load from better metabolism, but both moved together.

There is a behavioral trap under all of this. A lab threshold turns a gradient into a yes or a no. A person told they are not diabetic hears that nothing needs to change, keeps eating and sleeping the same way, and keeps loading a tendon that sits in the same terrain. The label ends the conversation the numbers were trying to start.

Where a procedure fits, and where measurement fits

For a damaged tendon that has not responded to loading, removing degenerated tissue with a needle-based device is one option, and the book is candid that its evidence is early and has no sham-controlled trial yet. In one series, physical therapy after the procedure accounted for 60 percent of the reduction in elbow pain, while only 44 percent of published tenotomy studies prescribed a structured rehabilitation program. The procedure opens a window. The loading, and the metabolism underneath it, decide what fills it.

Measura [Cardiometabolic and Autonomic Health Analysis] does not perform that procedure or any treatment. It measures, and the results go to your physician. The measurements that fit here are laboratory panels for the metabolic picture and body composition for the tissue picture, taken before a procedure decision and repeated as rehabilitation goes on.

What to ask your physician for

My hemoglobin A1c as a number, not only whether it was flagged.
My triglycerides and HDL, and the ratio between them.
A fasting insulin, which the book treats as the starting point for a tendon rehabilitation plan.
A body composition measurement, so lean and fat mass are tracked separately from weight.
A review of my medication list. Fluoroquinolone antibiotics raised the odds of Achilles tendinitis 3.95-fold in pooled studies. Discuss any concern with your physician and do not stop anything on your own.

If those numbers look like the pattern above, insulin resistance before diabetes explains what the early stage looks like. Physicians can read the screening version for practices.

Frequently asked questions

Can insulin resistance make tendon pain worse?

The evidence links the two. People with Achilles tendinopathy carry the lipid pattern of insulin resistance even at a matched body mass index, a prediabetic A1c came with about triple the rate of leg tendon injury in a Danish cohort, and patients with the metabolic syndrome kept more pain through the same exercise program. The background is covered in insulin resistance and metabolic health.

Which blood tests matter for chronic tendon pain?

The markers tied to tendon problems in the studies are hemoglobin A1c, triglycerides, HDL and LDL cholesterol, with the triglyceride-to-HDL ratio as a simple summary of the insulin resistance pattern. A fasting insulin adds an earlier signal. Your physician decides what to order, and the tests available through Measura are described on the laboratory panels page.

I am not overweight. Can metabolism still affect my tendons?

Yes. In the lipid study, patients with Achilles tendinopathy were matched to controls for body mass index and still showed higher triglycerides and lower HDL. Weight and height cannot show how much of the body is muscle and how much is fat, which is why a measured body composition says more than a normal-looking scale. See body composition, not BMI.

Does Measura treat tendinopathy?

No. Measura is a testing service. It measures metabolic, body composition, vascular, autonomic, nerve and cognitive function and sends the results to your physician, who decides on treatment, including rehabilitation or any procedure. What the numbers mean, and how they are reported back, is explained in understanding your results.

Why did a steroid injection only help for a few weeks?

In tennis elbow trials, steroid gave strong short-term relief that turned worse than placebo later, with more recurrence at one year, because it quiets the signal without changing the damaged tissue. Sometimes the needle also never reached the right structure. Why a failed shot is not proof the diagnosis was wrong is covered in what a failed injection does and does not prove.

What is tendinosis?

It is the long-running tendon damage most people still call tendinitis. Tendinitis suggests a hot, inflamed tendon that rest will cool. A tendon that stays painful for years looks different under the microscope: disorganized collagen, cells that have turned cartilage-like, and new blood vessels and nerve fibers growing into damaged tissue. The inflammation is the low, unfinished kind, a repair that never finished, not a flare.

What is the fastest way to get rid of tendonitis?

For a tendon that keeps hurting, loading beats waiting and beats a shot. In a trial of gluteal tendon pain at the hip, education plus exercise worked for 51 of 66 people by week eight, a steroid shot for 38 of 65, and waiting for 20 of 68. Tendon rebuilds in response to force, so a structured loading program is the core treatment.

Can chronic Achilles tendonitis be cured?

A chronic tendon is a repair that stalled, and it rebuilds slowly: the core collagen of adult Achilles tendons is laid down in childhood and barely renewed. Loading is what restarts the repair. Metabolism decides how far it gets, because patients with the metabolic syndrome kept more pain through the same exercise program. That is why the numbers belong in the plan.

Put numbers on the terrain around your tendon

Ask about metabolic labs and body composition testing before your next tendon decision. Measura sends every result to your physician.

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References

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