You asked for it: more on ligaments. My heart did a little pitter-patter when the response to my last Mini Pause was a resounding YES.

Most people overlook them, but I love ligaments. They're the unsung heroes that literally hold us together. While muscles are like a bouncy, eager puppy ready to play, your ligaments are more like the loyal family dog: slower to adapt, but dedicated to being there for you 24/7.

WHY

Ligaments connect bone to bone, stabilizing your joints like a seatbelt and giving your body that sixth sense of where it is in space (proprioception).

They don't get much blood flow, which means they heal and adapt slowly. Ligament injuries can take months, even years, to fully remodel. In midlife, with our lower estrogen causing slower collagen turnover, the process can be even longer.

Translation: We need to give these tissues extra care, patience, and respect.

HOW

Here's what the science says about taking care of your ligaments:

Progressive Loading, but Slowly

Deep breath. We need some patience with these ligaments of yours. We want to apply progressive tension over the course of months. Yes, “months” with an S.

Start with isometric holds, then move into heavy-slow resistance, followed by eccentrics, and only later into plyometrics, deceleration, and balance drills.

This stepwise approach tells your fibroblasts (the cells that rebuild collagen) how to lay down stronger fibers along the right lines of stress. Ligaments will remodel along lines of stress of the movement, not necessarily along the original architecture of the ligament, so form and slow progression are key.

Bad movement pattern habits can accelerate injury risk and take years to unlearn and relearn.

Nutrition

Collagen is not the be-all-and-end-all for muscle protein synthesis, but there's good data supporting collagen supplementation for ligament health.

I know, I know. Every online fitfluencer wants to tell you that collagen is garbage, and in the context of muscle, there is an argument to be made that it's not worth your money.

But stay with me. Studies show an increase in circulating markers of collagen synthesis in human ligaments when we ingest ~15 g of gelatin (or collagen peptides) plus vitamin C 30-60 minutes before short bouts of loading. PMC This is undeniably helpful while training, rehabbing an injury, or preventing an injury.

So, its an and/both approach. It's wise to supplement with both protein that will upregulate muscle synthesis AND collagen to support ligaments.

Post-Injury

Okay, so you got injured. You went for a PR right after a PR. Or your coffee hit just right one morning, so you jumped right into track sprints, and now your knee feels wonky. Been there, done that, got the rehab notes to prove it.

First off, let me just exhale a giant ARGUHHGHHHHHH of frustration with you. It is SO annoying to feel like you're being punished for doing something positive for your body. I don't want you to get discouraged. Let's put together a plan to get you back to business.

Remodeling and coming back stronger is going to look something like this:

A few days of inflammation. Then a few weeks of proliferation. Then, a few months to a year (or more) of remodeling and maturation. PMC+1

PEACE & LOVE, not RICE

You've heard about Rest, Ice, Compression, and Elevation for injuries, but the British Journal of Sports Medicine has a new acronym for you:

Protection, Elevation, Avoid Anti-Inflammants, Compression, Education (PEACE) followed by Load, Optimism, Vascularization (cardio), and Exercise (LOVE).

In PEACE, we want to protect the joint and compress it.

To ease discomfort, I'll often wrap the injured joint or compress it to manage swelling. I love the knee compression sleeve from Incrediwear, and I use it pretty regularly post-sprinting as a preventative measure. It'll work well if you're acutely injured as well.

In LOVE, we want to nix old ways of thinking and actually load the ligament as soon as possible. British Journal of Sports Medicine

You can do this by starting with isometrics, then slowly moving to load-bearing exercises and eccentrics, and eventually gently resuming higher-impact activities.

The Midlife Caveat

For women in midlife like us Bettys, estrogen matters and will most certainly impact your healing time.

Higher estrogen can reduce ligament stiffness and alter collagen turnover. Our knee laxity fluctuates across the cycle, and therefore, so does risk. (I wrote about this in The Betty Body.)

In perimenopause and menopause, lower estrogen will impair collagen turnover and healing, making the months monthier and the years yearsier. It just takes longer to heal without the anabolic influence of estrogen.

This is why I will die on the hill of technique. Your ego is your enemy in the gym and on the track. I will absolutely insist that you develop neuromuscular control and year-round strength and balance. Frontiers+1

NOW

The overarching principle of PEACE & LOVE is to protect the ligament, compress it, and return to activity as soon as possible.

The following is an example of how I might structure this for rehabbing a ligamentous injury. This is for demonstrative purposes only on how I might progress through a program:

• Angle-Specific Isometrics
  30-45 second holds x 3-5 sets x 3-5x/wk initially

  Start these as soon as possible and do them at positions that lightly tension the target ligament. It's good for pain modulation and early load tolerance. If available, I would do these on a vibration plate.

• Heavy-Slow Resistance (HSR)
  6-8 controlled reps x 3-5 sets x 2-3x/week; ~3-5 seconds down, 1-2 seconds up

  These exercises will build tendon-muscle unit capacity and apply a steady collagen stimulus across joint angles.

• Eccentrics
  8-12 slow reps x 3-4 sets x 2-3x/week

  Do these exercises to improve strain tolerance and control. I would also incorporate vibration plate training with these eccentrics.

• Plyometrics & Deceleration

  Once foundational strength and balance are solid, start adding in hops, land-and-stick, and cutting mechanics. Gradually increase the speed and directional variability.

• Balance and Proprioception

  Start adding in single-leg stance progressions, with eyes open or closed. I'd likely incorporate vibration plate training here, too.

• Movement Quality

  Focus on tracking knees over toes, hitting soft landings (triple flexion), and maintaining trunk/hip control. Mobility training becomes super important here.

• Nutrition

  Supplement with gelatin/collagen + vitamin C 30-60 min pre-load, and make sure your total daily protein intake is 1.6-2.2 g/kg of body weight to support remodeling. PMC

I've kind of been itching to talk more about arthritides like osteoarthritis, rheumatoid arthritis, and psoriatic arthritis. How about you? What should we get geeky about next?

 

 

Sending you PEACE & LOVE,

Dr. Stephanie

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🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

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