Physical activities involving repetitive strain can injure tendons, causing chronic pain and disability. Contrary to previous thinking, chronic overuse tendon injuries do not involve inflammation. Instead, these injuries primarily involve the breakdown and disarray of collagen, a structural protein that is the primary support for tendons as well as bone, cartilage and skin. Recent research associates chronic tendon injury with excessive apoptosis (programmed cell death) among tendon cells. Alexander Scott’s preliminary laboratory studies identified two stressful conditions that can cause the problem: repetitive mechanical strain and lack of oxygen. Now he is investigating the basic mechanisms of tendon degeneration, with the aim of discovering whether abnormal rates of cell death occur in real life models of tendon injury. Alexander is also testing whether IGF-1, a potent growth factor, can help tendons better recover from injury. The research could lead to new treatments for people who suffer from painful tendon injuries.