Can statins cause Achilles tendinopathy?

Yes. The side effects of statins include an increased risk of developing Achilles tendinopathy and of Achilles tendon tears. The complications usually develop within the first year of using statins. Some of the most commonly prescribed ones include Simvastatin, Atorvastatin, and Lovastatin. In this article, we look at the latest research to see how these drugs affect tendons and how big a risk they pose. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.

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The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.

In this article:

1. How does statins affect tendons?

2. Will I definitely get Achilles tendinopathy if I use statins?

3. What should I do if I think statins are causing me tendon pain?

4. How we can help

Here's a video I made about statins and Achilles tendinopathy:

How does statins affect tendons?

There are currently only a handful of studies where researchers have looked at what exactly happens to a tendon when you expose it to statins. Some of the things they’ve found:

• Statins seem to affect the structure of the collagen fibres. Part of the reason why tendons are so strong is that the collagen fibres are all aligned in parallel to each other. When a tendon is exposed to statins the fibres become more disorganised, which causes the tendon to lose some of its tensile strength (it can break more easily).

• It can reduce the collagen content of a tendon.

• It slows down the speed at which new cells are created in the tendon. Our tendons are constantly forming new cells to replace older or damaged ones. By slowing this process down, statins may affect how quickly your Achilles tendon can recover after exercise and ultimately lead to a weaker tendon.

• Cells also have to move around in the tendon to get to where they are needed. Statins seem to decrease the migration of cells, which again means that your ability to repair your tendon decreases, possibly increasing your risk of developing over-use injuries like Achilles tendinopathy.

Will I definitely get Achilles tendinopathy if I use statins?

No. The research is currently reporting conflicting results. I think some of the reasons for this are:

1. The negative effects linked to statins may be dose dependent. Some of the studies that I discuss above only reported changes in tendon structure when the cells were exposed to high doses of statins. But that said, others showed that even low doses could cause changes in tendon cells, so it may also be that your own genetic make-up or the type of statin could be important.

2. It may depend on what sport or activities you do. If you’re a runner or do sports where you jump a lot, your Achilles tendon will work much harder than a person who cycles or just walks for exercise. This means that your Achilles will have more maintenance to do (repair itself) after each exercise bout, in which case statins may have more of a negative effect on your tendons.

What should I do if I think statins are causing me tendon pain?

Speak to your doctor. Treatment for any medical condition is never a clear cut, one-size-fits-all, and there may be alternatives available for you, or you may even be able to manage your cholesterol through lifestyle changes.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author:

Maryke Louw is a chartered physiotherapist and holds an MSc in Sports Injury Management. You can follow her on LinkedIn, Facebook, Twitter, and Instagram.

References

1. De Oliveira L, Vieira C, Guerra F, et al. Structural and biomechanical changes in the Achilles tendon after chronic treatment with statins. Food and Chemical Toxicology 2015;77:50-57.

2. Eliasson P, Svensson RB, Giannopoulos A, et al. Simvastatin and atorvastatin reduce the mechanical properties of tendon constructs in vitro and introduce catabolic changes in the gene expression pattern. PloS One 2017;12(3):e0172797.

3. Kearns MC, Singh VK. Bilateral patellar tendon rupture associated with statin use. Journal of Surgical Case Reports 2016;2016(5)

4. Kuzma‐Kuzniarska M, Cornell HR, Moneke MC, et al. Lovastatin‐Mediated Changes in Human Tendon Cells. Journal of Cellular Physiology 2015;230(10):2543-51.