The Keith Baar Protocol

Evidence-Based Tendon Rehabilitation for Tendinitis & Tendinosis

Based on research from UC Davis Functional Molecular Biology Laboratory

Understanding Tendon Injuries

Why traditional treatments often fail

Tendinitis (Acute)

⚡ Inflammatory response to micro-tears
⚡ Sudden onset from acute overload
⚡ Swelling, redness, warmth present
⚡ Heals in days to 6 weeks with rest

Tendinosis (Chronic)

✓ Collagen degeneration without inflammation
✓ Gradual from repetitive overuse
✓ Pain and stiffness, no swelling
✓ Requires 3-6 months for recovery

Research shows most chronic tendon pain is actually tendinosis, not tendinitis

Why Traditional Treatments Fall Short

💊

NSAIDs Can Inhibit Healing

Anti-inflammatory drugs may inhibit collagen repair in tendinosis, potentially worsening the condition long-term.

💉

Corticosteroids Risk

Steroid injections are associated with inhibited collagen repair and may predict later tendon tears.

🛋️

Rest Alone Isn't Enough

Complete rest causes tendons to lose collagen synthesis by up to 50% within 10 days of immobilization.

🔄

Wrong Loading Patterns

Standard rehab often lacks the specific loading protocols needed to stimulate directional collagen synthesis.

The Keith Baar Approach

A science-based framework combining targeted nutrition and mechanical loading

🧬

Collagen Building Blocks

Provide the exact amino acids (glycine, proline, lysine) needed for collagen synthesis through gelatin or hydrolyzed collagen.

🍊

Vitamin C Co-Factor

Essential for prolyl 4-hydroxylase enzyme function, required for procollagen synthesis and secretion.

💪

Strategic Loading

Isometric exercises with stress relaxation to direct collagen synthesis along the line of force.

⏰

Optimal Timing

6-10 minute sessions with 6+ hour rest periods to maximize the anabolic window for tendon adaptation.

The Science Behind the Protocol

"Ingestion of 15g of gelatin 1 hour before 6 minutes of jump rope is able to double collagen synthesis."

— Shaw et al., 2017 (Randomized double-blind crossover trial)

🔬 Collagen is a triple-helix protein with glycine at every third position
🔬 Tendons have poor blood supply — exercise-induced fluid flow delivers nutrients
🔬 Loading activates tenocytes, signaling directional collagen production
🔬 Tendons become refractory to stimulus after ~10 minutes of loading
🔬 Peak collagen synthesis occurs ~24 hours after the loading stimulus

Nutrition Protocol

Priming the tendon with building blocks before loading

Pre-Exercise Supplementation

1 15g Gelatin or Hydrolyzed Collagen — From skin sources (bovine, porcine, or fish) to avoid heavy metals from bone sources

2 200-500mg Vitamin C — Essential co-factor for collagen hydroxylation and secretion

3 Consume 30-60 minutes before exercise — Allows amino acids to reach peak blood levels during loading

Research shows no significant difference between cooking gelatin and hydrolyzed collagen — both work equally well

The Loading Protocol

Isometric exercises designed for maximum stress relaxation

Optimal Loading Parameters

1 Duration: 6-10 minutes total loading time per session

2 Hold Time: 30 seconds for injured tendons (up to 45 seconds for maintenance)

3 Sets: 1 set of 6-12 repetitions at 2/10 perceived exertion

4 Force Application: Slowly apply force over 3-5 seconds, hold, slowly release

5 Rest: Minimum 6-8 hours between sessions (can do twice daily)

Stress Relaxation: The Key Mechanism

How isometric holds heal damaged tendon regions

📊 When force is applied to a tendon, tension peaks then gradually decreases (stress relaxation)
📊 Relaxation reaches ~60% within the first 30 seconds of holding
📊 As healthy tissue relaxes, damaged scar tissue begins to bear more load
📊 This directional loading signals cells to synthesize collagen along the force line
📊 Result: New collagen integrates with existing tissue, restoring tendon integrity

"The scar gets a pull on it, directionally oriented along the line of force, and now the cells say 'That's where the force goes. That's the direction we need to synthesize collagen.'"

— Dr. Keith Baar

Two Types of Isometric Loading

Overcoming Isometrics

→ Push against an immovable object
→ Excellent for chronic injuries
→ Controls force application precisely
→ Example: Pushing into a wall

Yielding Isometrics

→ Hold a weight in a fixed position
→ Better for maintenance phase
→ Provides consistent resistance
→ Example: Holding a heavy pan mid-raise

For chronic tendon injuries, overcoming isometrics are generally preferred as they allow better force control

Sample Daily Protocol

Optimal timing for tendon rehabilitation sessions

6:00 AM — Morning Session

15g collagen + Vitamin C in juice or water. Wait 30-60 minutes.

7:00 AM — Loading

6-10 minutes of targeted isometric exercises for injured tendon.

1:00 PM — Evening Session (Optional)

Repeat nutrition protocol if doing second session (6+ hours after first).

2:00 PM — Second Loading

Optional second loading session targeting the same or different positions.

Condition-Specific Applications

🎾

Tennis Elbow (Lateral Epicondylitis)

Overcoming isometrics targeting wrist extension and forearm rotation. Multiple arm positions: bent, straight, overhead.

🦶

Achilles Tendinopathy

Heel raises with long holds at mid-range. Plantarflexion isometrics even post-surgery for early loading.

🏀

Patellar Tendinopathy (Jumper's Knee)

Heavy mid-range isometric holds in squat or leg press position. Spanish squat wall holds.

👟

Plantar Fasciitis

Isometric toe extension against resistance. Towel curl holds targeting the plantar fascia.

Case Study: Professional Basketball Player

Published peer-reviewed research demonstrating protocol efficacy

🏀

Central Core Patellar Tendinopathy

18-month rehabilitation program with heavy isometric loading + gelatin supplementation

Normal

MRI Result

↓ Pain

Decreased

↑ Thick

Tendon Structure

↑ Perf

Performance

Baar (2019): "Stress Relaxation and Targeted Nutrition to Treat Patellar Tendinopathy" — Int J Sport Nutr Exerc Metab

Case Study: Elite Rock Climber

Integrating tendon-specific protocols with athletic performance

🧗

Emil Abrahamsson — Professional Boulderer

High-level athlete experiencing finger tendon strain from dynamic loading

10 min

Sessions Daily

↑ Grip

Strength Gains

↓ Injury

Wear & Tear

Competed

World's Strongest Grip

Short isometric sessions added the force transfer capacity missing from dynamic training alone

Expected Outcomes & Timeline

📅

Weeks 1-2: Pain Modulation

Isometric loading has analgesic effects. Many patients report reduced pain during and after sessions.

📅

Weeks 2-6: Collagen Activation

Cells begin producing new collagen along the direction of loading. Early structural improvements begin.

📅

Weeks 6-12: Remodeling Phase

Collagen maturation and cross-linking. Tendon strength and stiffness begin to normalize.

📅

Months 3-6+: Full Recovery

Complete tissue remodeling for chronic tendinosis. Continued maintenance sessions recommended.

Early-stage tendinosis (recognized quickly): 6-10 weeks | Chronic tendinosis: 3-6 months

Key Principles for Success

✅ Consistency over intensity: Regular short sessions outperform infrequent intense workouts
✅ Pain as a guide: Stay within pain-free range. Mild soreness is acceptable, sharp pain is not
✅ Progressive loading: Gradually increase perceived effort, not necessarily weight or duration
✅ Position variety: Cycle through different joint angles to engage the full muscle-tendon unit
✅ Respect the refractory period: More than 10 minutes of loading provides no additional benefit
✅ Load as medicine: Controlled loading acts as an anti-inflammatory, promoting healing

Biomechanical & Physiological Effects

🔗

Collagen Fibril Alignment

Directional loading promotes parallel alignment of collagen fibers along the axis of force transmission.

⚡

Cross-Link Optimization

Exercise increases lysyl oxidase, adding cross-links that strengthen tendon structure without excessive stiffness.

🎯

Regional Stiffness Gradients

Promotes appropriate compliance near muscle and stiffness near bone attachment — essential for energy transfer.

🛡️

Muscle-Tendon Matrix

Isometric loading also strengthens the collagen network within the muscle, improving force transmission connections.

Important Considerations

⚠️ Avoid

✗ Long-term NSAID use for chronic tendinosis
✗ Repeated corticosteroid injections
✗ Bone-based collagen sources (heavy metal risk)
✗ Loading sessions longer than 10 minutes
✗ Ignoring pain signals during exercise

✓ Embrace

✓ Skin-source collagen (fish, bovine skin)
✓ Consistent daily supplementation
✓ Early loading even post-surgery
✓ Multiple joint positions over days
✓ Patience — tendons heal slowly

The Complete Protocol Summary

Keith Baar Tendon Rehabilitation Protocol

1 Supplement: 15g gelatin/collagen + 200-500mg Vitamin C, 30-60 min pre-exercise

2 Load: 6-10 min of isometric holds (30 sec each), low intensity (2/10 effort)

3 Rest: Minimum 6-8 hours between sessions (optional 2x daily)

4 Progress: Gradually increase perceived effort while staying pain-free

5 Duration: Continue for 6-10 weeks (early) or 3-6 months (chronic)

Rebuild. Strengthen. Perform.

Evidence-based tendon rehabilitation that addresses the root cause — not just the symptoms.

The Athlete's Forge — Elite Rehabilitation & Sports Performance Lab