What’s the Difference Between Tendons and Ligaments?

Tendons and ligaments are connective tissues that help support muscles and bones. Tendons are attached to muscles and bones to aid their movement, while ligaments help support and stabilize joints. Tendon and ligament fibers can become damaged from trauma or overuse injuries and are slower to heal than muscle fibers due to their decreased blood supply. 

This article will compare the differences between tendons and ligaments, types of injuries, and treatment options. 

Older man holding knee in pain

Anchalee Phanmaha / Getty Images

What Are Tendons and Ligaments?

Tendons and ligaments are forms of connective tissue that connect muscles and bones to form the musculoskeletal system. Both tendons and ligaments are similar in composition and are primarily made of collagen fibers. Collagen is a protein found in various body parts that provides strength, flexibility, and elasticity to connective tissue.

Tendons and ligaments differ based on their points of connection. Tendons attach muscles to the bone throughout the skeleton, while ligaments attach bones to bones to support and stabilize joints.

How They Work

Tendons and ligaments function to support muscles and joints. Tendons attach muscles to bone, transmitting force from a contracting muscle to a bone to move the body. Without tendons, muscles would not be able to transfer the energy needed for movement properly.

Most ligaments connect bone to bone. They hold joints together and stabilize joints with movement and while at rest. Ligaments can connect bones on the outside of joints or from within the joints.

While both tendons and ligaments have some elasticity, they can only be stretched slightly before damage occurs. Stretching movements target muscle fibers that can lengthen and shorten to change in length and improve flexibility. 

Common Injuries

Injuries to tendons and ligaments make up about 50% of all musculoskeletal injuries. Injuries to tendons and ligaments occur when their fibers tear or become damaged from repeated stress. Because tendons and ligaments have decreased blood supply compared to muscles, they tend to heal slowly after injury or damage.

Ligaments

When stressed and damaged from being overstretched with quick movements or overuse over time, ligaments can become sprained. Ligament sprains cause pain from damage to the collagen fibers of a ligament, which reduces its ability to stabilize a joint.

With significant trauma, a ligament can tear, causing the collagen fibers to rip off of the bone. Ligament tears can be partial, in which only a portion of the ligament detaches from the bone, or full, in which the ligament completely ruptures off the bone.

Tendons

"Tendinopathy" is a broad term that refers to any condition that affects a tendon, causing pain and dysfunction. Tendonitis is a type of tendinopathy characterized by short-term onset of tendon pain and inflammation, while "tendinosis" describes abnormal tendon tissue from tendon degeneration and a poor healing process.

Areas of the body where tendinopathies commonly occur include the Achilles tendon of the ankle, patellar tendon of the knee, common tendons of the elbow (i.e., golfer's elbow or tennis elbow), or biceps tendon of the arm.

Tendons, like ligaments, can also tear with significant trauma. Tendon tears can be partial, in which only a portion of the tendon detaches from the bone, or full, in which the tendon completely ruptures off of the bone. Commonly injured tendons include the rotator cuff tendons of the shoulder, Achilles tendon of the ankle, quadriceps tendon of the knee and biceps tendon of the arm.

Differences in Treatment

Some treatment methods overlap between ligament and tendon injuries, although there are distinct differences in promoting ligament and tendon recovery.

Rest, application of ice to the affected area and pain medications are used at the beginning of rehabilitation from injury to protect the damaged area and help relieve pain. At first, you will have to rest your injured ligament or tendon, but you will gradually increase the amount and intensity of activity over time as you start to heal.

For ligament sprains, rehabilitative exercises to increase the strength of surrounding muscles can help support the affected ligament and joint to provide stability. Sprained ligaments remain weaker for an extended period after injury, so muscle strengthening is especially important to support the stability of your joints.

For tendinopathies, rest from aggravating activities is needed to decrease stress on the tendon. Progressive strengthening exercises, especially eccentric strengthening, of the tendon’s associated muscle is then needed since tendon loading is essential for tendon healing.

Ligament rehabilitation focuses on strengthening surrounding muscles to compensate for lack of joint stability, while tendon rehabilitation focuses on strengthening the tendon’s associated muscle to decrease stress on the tendon.

For severe ligament or tendon tears, surgery may be needed to reattach the torn ligament or tendon to bone, followed by several weeks of protection in a cast or brace and rehabilitation with physical therapy.

Sprain and Strain Prevention

Certain precautions and healthy habits can be used to help prevent injuries like sprains and strains. These include:

  • Stretching your muscles and moving your joints through their full range of motion
  • Wearing supportive and properly fitting shoes, especially when exercising
  • Getting adequate rest to allow muscles to recover and to prevent overuse injuries
  • Strengthening your muscles to improve tendon health and support your joints
  • Gradually increasing activity frequency, intensity, and duration to prevent excess stress to tendons

Summary

Tendons and ligaments are types of connective tissue made of collagen fibers. Tendons attach muscles to bones while ligaments attach bones to bones. Tendons and ligaments can become injured from trauma or overuse over time. Rest is needed following injuries to promote healing, while muscle strengthening is needed to return to unrestricted activity.

Ligaments become weaker after injury and require increased support from surrounding muscles while tendons require appropriate loading over time to increase strength. For severe tendon and ligament tears, surgery may be needed to reattach the connective tissue back to bone.

Frequently Asked Questions

  • What are three differences between a tendon and a ligament?

    A tendon attaches a muscle to bone while a ligament attaches a bone to bone. Tendons are inflexible and ligaments are flexible. Tendons are white and ligaments are yellowish.

  • Is it worse to tear a ligament or a tendon?

    Tearing a ligament and tendon are both injuries that can cause pain, joint instability, and physical limitations.

  • How can you tell a tendon injury from a ligament injury?

    A tendon injury will typically cause increased pain with contraction of the tendon’s associated muscle, while a ligament injury will not cause pain since ligaments attach bone to bone. Both types of injuries, however, can result in increased pain with joint movement.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Asahara H, Inui M, Lotz MK. Tendons and ligaments: Connecting developmental biology to musculoskeletal disease pathogenesis. J Bone Miner Res. 2017 Sep;32(9):1773-1782. doi: 10.1002/jbmr.3199.

  2. Leong NL, Kator JL, Clemens TL, James A, Enamoto-Iwamoto M, Jiang J. Tendon and ligament healing and current approaches to tendon and ligament regeneration. J Orthop Res. 2020 Jan;38(1):7-12. doi: 10.1002/jor.24475.

  3. Institute for Quality and Efficiency in Health Care (IQWiG). What are ligaments? 2018.

  4. Cornwell Health. Ligament tears.

  5. Wu F, Nerlich M, Docheva D. Tendon injuries: Basic science and new repair proposalsEFORT Open Reviews. 2017;2(7):332-342. doi:10.1302/2058-5241.2.160075

  6. Kane SF, Olewinski LH, Tamminga KS. Management of chronic tendon injuries. Am Fam Physician. 2019 Aug 1;100(3):147-157.

  7. Mass General Brigham. Rehabilitation protocol for anterior cruciate ligament (ACL) reconstruction.

By Kristen Gasnick, PT, DPT
Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.