How Tendons Heal

There are three overlapping phases of tendon healing:

Inflammation –> Repair –> Remodeling

  1. Inflammation
    1. During the inflammation stage, swelling takes place as fluid rushes into the area. Coming with that fluid are multiple inflammatory mediators (such as neutrophils, monocytes, and macrophages) that help clean out the area of damaged tissue.
      1. *There have been speculations on whether decreasing the length and severity of this stage would be beneficial. Studies have shown that the use of NSAIDs during this initial stage result in much weaker tendons than if it was left on its own. However, after 6 days the use of NSAIDs has been shown to help improve the healing. The first few days of this initial inflammatory response is important and appears to help support natural tendon healing!*
    2. Repair
      1. In this stage, water content is very high. One of the migrated cells in the area, fibroblasts (specifically specialized fibroblasts known as tenocytes), start to deposit fresh immature type III collagen while reabsorbing old fibrils. These collagen fibers are heavily deposited, but randomly oriented. Leucine-rich proteoglycans (decorin, biglycan, fibromodulin, lumican) help to organize the collagen assembly while ascorbic acid (Vitamin C) helps with increasing the cross-linking between the fibers.
    3. Remodeling
      1. As the collagen starts to mature, it orients itself along the direction of force through the tendon. The ratio of type I- to type-III collagen changes in preference to type I due to maturation of the immature collagen and physiological mediators that cause the tenocytes to start depositing type I instead of the type III.


Tenocytes and Collagen
Tenocytes and Collagen


Can you maximize tendon healing?

  • As discussed above, there are some important factors that play a role in tendon healing. Water content, leucine-rich proteoglycans, ascorbate, and collagen deposition are all necessary for proper healing. So, logically it make’s sense that if one injures a tendon, they should:
  1. Consume plenty of water
  2. Supplement with Leucine (a great option here), Vitamin C (like this one), Collagen (here), and Gelatin (here)
    1. Multiple studies have shown increased collagen deposition and number of crosslinks, as well as improved functionality of tendons with all 4 of these supplements.
  3. Undergo therapy that can aid in collagen deposition and orientation of the fibers
    1. Including exercise and scraping (get a personal tool here).



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Written by Dr. Brandon Buchla, DC, CSCS

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