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Tendon repair supplements – What does the research say?

Updated: May 24

Are tendon repair supplements a fad, or do they really help you to recover quicker from your tendon injury? We take a look at the research into eight tendonitis supplements and tendon tear recovery supplements. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.


Learn what supplements may help tendonitis recovery.

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Tendon injury overview


Tendon anatomy and function

Our tendons connect our muscles to our bones and therefore play an active role in how we move – every time you contract a muscle, it pulls on its tendon, and something moves. They also act like springs – absorbing forces and then releasing them, for example the Achilles tendon when we walk, run, or jump.

 

Tendons are mostly made up of collagen fibres. Collagen is the most abundant form of protein in our bodies and is also found in various forms in our bones, cartilage, ligaments, and skin.


Anatomy picture showing tendon, muscle and bone.

Types of tendon injury

There are two main types of tendon injury: a tendinopathy (sometimes called a tendonitis or a tendinosis) and a tendon tear or rupture.

 

A tendinopathy occurs when a part of the tendon is injured (most commonly through overuse), causing the collagen fibres to move away from each other and lose their strong, parallel arrangement. This results in the tendon losing strength in that area.


Typical tendinopathies:

 

Tendon tear is self-explanatory, but when the tendon is fully torn, it is usually referred to as a rupture.

 

Research-backed treatments

The best research-backed treatment for a tendinopathy is a progressive rehab programme that consists of the right combination of rest and exercise to replace and strengthen the weakened collagen fibres.

 

Most partial tears will benefit from the same type of rehab programme. On the other hand, some complete ruptures need surgery and others don’t. In any event, a rehab programme as mentioned above will also be necessary post-surgery, after the torn tendon ends have grown back together.



Research on tendon repair supplements

 

Because tendons heal through replacing and strengthening their collagen fibres, the people in the white lab coats are interested in studying the effects of supplements that are known or thought to help with:

  1. the formation of new collagen cells in our bodies or

  2. that might reduce inflammation in the injured tendon.

 

Some of the studies discussed below focused on people with tendinopathies, some on people who have had tendon surgery, and some on healthy people who exercise. The latter is useful, because it is generally accepted that a supplement is not a stand-alone silver bullet that will get your injured tendon back to normal – it is meant to enhance the effects of a recognised tendon rehab treatment such as an exercise programme.

 

Also, most of the studies below had two groups of subjects: a treatment group who was given the supplement plus a conventional tendon rehab treatment, as well as a placebo group who received a “fake” supplement (without knowing it) plus the same conventional treatment. This enabled the scientists to figure out whether a supplement had a real effect or whether any improvements were “all in the mind” and/or thanks to the conventional treatment.



What supplements help tendon repair?

 

Most of the supplements that have been tested either consist of some form of collagen (the main building block of tendons), substances that are known to play a role in creating collagen in the body, or substances that may help to regulate inflammation.


 

1. Hydrolysed collagen

What is hydrolysed collagen? Hydrolysed collagen is collagen that is broken down into smaller particles/peptides, which makes it easier for the body to absorb.



Test subjects: Twenty people with midportion Achilles tendinopathy.


Dosage: 2.5 g of hydrolysed collagen OR a placebo, taken 30 mins before rehab exercises (twice daily) for 6 months.


Additional treatment: Eccentric heel raises and running exercises for the treatment group and the placebo group.


Results: The group receiving the hydrolysed collagen supplement gained more benefits from their rehab exercises than the placebo group.


Limitations of the study: Very small sample size – the results may not be accurate. The study was sponsored by GELITA AG, Germany, a company that sells collagen supplements, so the results may be biased towards showing a positive effect.


The supplement below is similar the one used in the study:


2. Vitamin C-enriched gelatine

What is Vitamin C-enriched gelatine? In addition to its well-known health benefits, Vitamin C is involved in the formation of collagen. Gelatine is a derivative of collagen that is used in food, and therefore easy to ingest.



Test subjects: Eight men, not injured.


Dosage: 5 g of gelatine with 48 mg of Vitamin C OR 15 g of gelatine with 48 mg of Vitamin C OR a placebo, taken one hour before skipping rope.


Additional treatment: Rope skipping for 6 minutes, three times a day, for three days for the treatment group and the placebo group.


Results: The subjects that took 15 g of gelatine had a better increase in collagen formation (due to the rope skipping exercise) than the 5 g group and the placebo group. We cannot say from this study whether Vitamin C played a role.


Limitations of the study: Very small sample size – the results may not be accurate.


This supplement is similar to the one used in the study:


3. Tendoactive®

What is Tendoactive? Tendoactive is a food supplement that has been formulated to help with the formation of connective tissue such as tendons and ligaments. Its main ingredient is mucopolysaccharide, which is thought to play a role in tendon strengthening. It also contains collagen and Vitamin C (see above for an explanation of what these are).



Test subjects: 98 tendinopathy patients (Achilles tendon, patellar tendon, tennis elbow).


Dosage: Three capsules of Tendoactive per day (totalling 435 mg mucopolysaccharide, 75 mg Vitamin C, and 75 mg collagen) for 90 days. (Please note that the manufacturer recommends only two capsules per day for at least 90 days.)


Additional treatment: None.


Results: Reduced pain at rest and during activity, improved tendon function, and reduced tendon swelling.


Limitations of the study: This study didn’t have a placebo group, nor did they ask the participants about other treatments they may have received during this period, so the improved symptoms might have been wholly or partly thanks to the passage of time or something else entirely. There is also no mention of who paid for the research, so we can’t tell whether the results may be biased.

 

4. Tendisulfur® Forte

What is Tendisulfur Forte? According to the manufacturer, it is a food supplement containing methylsulfonylmethane (which has been shown to reduce pain and inflammation in arthritis), hydrolysed collagen, D-glucosamine, chondroitin sulphate, arginine, lysine, with vegetable extracts of Boswellia, turmeric, myrrh, and Vitamin C.

 

This was researched in two studies.

 

A) First study: Vitali et al. (2019)


Test subjects: 90 people: 30 with Achilles tendinopathy, 30 with a shoulder tendinopathy, 30 with tennis elbow.


Dosage: For the treatment groups, two sachets of Tendisulfur Forte per day for a month, and then one sachet per day for a month (see here for sachet contents and the manufacturer’s recommended dosage); for the control groups, zero dosage.


Additional treatment: Shockwave therapy for the treatment and the control groups.


Results: For all three types of injury, a combined treatment of shockwave therapy and the supplement led to a faster recovery than just shockwave therapy.


Limitations: The control group did not receive a placebo supplement, which may mean that the positive results are actually due to a placebo effect rather than a true clinical effect. A medical company sponsored the supplements.

______________


B) Second study: Merolla et al. (2015)


Test subjects: 100 patients who had had surgery to repair torn rotator cuff tendons.


Dosage: Two sachets daily for 15 days OR a placebo, and then one sachet per day for 45 days OR a placebo.


Additional treatment: Painkillers for the treatment group and the placebo group.


Results: The group that received the Tendisulfur Forte had better pain relief in the short term (after 1 week) and somewhat better pain relief in the medium term (after 2 weeks) but no better pain relief than the placebo group after that.


Limitations: No mention of who funded the research.



5. Tenosan®

What is Tenosan? According to the manufacturer, it is a supplement that promotes the formation of collagen. It contains L-arginine alpha ketoglutarate, TruBeet®, ViNitrox®, hydrolysed collagen type I, Vitamin C, and Vitamin D3.



Test subjects: 64 patients with insertional Achilles tendinopathy.


Dosage: Two sachets of Tenosan (500 mg arginine-L-alpha-ketoglutarate, 550 mg methylsulfonylmethane, 300 mg hydrolysed collagen type I, 125 mg Vinitrox, 50 mg bromelain, 60 mg Vitamin C) OR a placebo, every day for 60 days. (See here for sachet contents and the manufacturer’s recommended dosage.)


Additional treatment: Three sessions of shockwave therapy for the treatment group and the placebo group.


Results: There was no significant difference in perceived Achilles pain between the two groups after two months, but after six months, the group that received the real McCoy had less pain. The treatment group had better Achilles tendon function two months after the treatment started and after six months.


Limitations: We don’t know who funded the research.

 

6. Essential fatty acids and antioxidants

What are essential fatty acids and antioxidants? Essential fatty acids are a type of fat essential to several functions in our bodies, but we have to ingest them because our bodies cannot manufacture them. Researchers are interested in fatty acids because they may play a role in controlling inflammation. Antioxidants prevent the formation of free radicals, which can damage our cells; examples of antioxidants are Vitamins A, C, and E.


The main rationale for including them in this supplement was to protect against any negative effects that ingesting such large quantities of fatty acids may have.



Test subjects: 31 recreational athletes with chronic tendon disorders (tendinitis, tendinopathy, para-tenonitis with or without tendinopathy).


Dosage: Daily for 32 days, a placebo OR the following supplement:

  • Essential fatty acids: 376 mg eicosapentaenoic acid, 264 mg docosahexaenoic acid, and 672 mg gamma-linolenic acid.

  • Antioxidants: 100 µg selenium, 15 mg zinc, 1 mg Vitamin A, 2.2 mg Vitamin B6, 90 mg Vitamin C, and 15 mg Vitamin E.


Additional treatment: Ultrasound for the treatment group and the placebo group.


Results: The group treated with essential fatty acids and antioxidants had a greater reduction in pain during activities, and their participation in sports activities increased by more than that of the placebo group.


Limitations: It is a small study, and we don’t know who funded it.

 

7. Omega-3 polyunsaturated fatty acids

What are omega-3 polyunsaturated fatty acids? These are a type of fatty acid, typically found in fish oil and certain plant oils, which plays various roles in human physiology. The rationale underpinning fish oil supplementation lies in the anti-inflammatory effects it may have.



Test subjects: 73 patients with rotator cuff injuries.


Dosage: Nine capsules per day, each containing 170 mg eicosapentaenoic acid (EPA), 115 mg docosahexaenoic acid (DHA), and 2 units/g tocopherols acetate (vitamin E) OR a placebo, for two months.


Additional treatment: Weekly rotator cuff injury exercises for eight weeks for the treatment group and the placebo group.


Results: The treatment group had a slight improvement over the placebo group after three months, but the injuries of both groups showed similar improvements after 12 months.


Limitations: Seven Seas Ltd. provided the active and placebo capsules but did not commission or fund the full study.


This supplement may not have the same concentrations of Omega-3 as that used in the research. Please follow the manufacturer's dosage instructions.

 

8. High-leucine whey protein hydrolysate

What is high-leucine whey protein hydrolysate? Leucine is an essential amino acid (i.e. the body can’t manufacture it; it has to be ingested), and whey (a by-product of cheese production) is one way to ingest it. Hydrolysate is a type of whey that is easily digested. Amino acids have been shown to play a role in collagen production and may hence help tendon repair.



Test subjects: 22 healthy young recreationally active men.


Dosage: 19.5 g high-leucine whey protein hydrolysate OR a placebo, on each of 33 exercise days over 12 weeks.


Additional treatment: Patellar tendon exercises (leg extensions) for the treatment group and the placebo group.


Results: The patellar tendons of the group taking the supplement grew thicker (due to the exercises) than those of the placebo group. The strength of both groups increased about equally (due to the exercises).


Limitations: Again, this was a small study. Arla Foods Ingredients Group P/S DK funded the study, but it is not clear whether they just provided the supplements or actually commissioned the study.


This whey protein supplement may not have the same concentrations as the one used in the study. Please follow the manufacturer's dosage instructions.


Some words of caution

 

Anti-inflammatory effects of some tendon repair supplements

Some of the pain reduction caused by some tendon repair supplements could be due to a reduction in inflammation.

 

However, it should be noted that inflammation plays a vital role in the healing process of a tendon injury (tendon tears specifically), especially in the first few days. So, reducing the inflammation could suppress the healing process.

 

Also, in many cases of tendinopathy, especially chronic / long-term tendinopathy, there is little or no inflammation, even though the tendon might be painful. In such cases, taking a supplement with the sole purpose of reducing inflammation will be useless, and there is some evidence that it may limit your strength gains after workouts, including rehab workouts.

 

Overdosing and interaction with other supplements / medication

It is easy to overdose on certain minerals and vitamins if you take several supplements that contain the same thing – check the contents of any supplements you take carefully.

 

There are also several medications that can be affected by some of the substances included in these supplements (stopping them from working as effectively), so if you are taking any medication, check with your doctor before you start taking supplements.

 

Sports doping

Supplements are not regulated by the USA’s FDA and similar bodies elsewhere, and therefore not all the ingredients have to be listed. This could cause you to test positive for prohibited drugs.

 

Our tendon repair supplement recommendations


As I pointed out above in my discussion of the various research studies, they have some limitations:

  • Some had small sample sizes.

  • Some were sponsored by medical companies with skin in the game, and others didn’t disclose who funded the study.

  • Some lacked a placebo group or a control group.

 

So, at this stage, we can’t tell for sure whether these supplements work or not. However, none of the studies reported any negative effects.


So, this is something that you might add to your treatment, but I would not spend crazy money on it, and I wouldn’t depend on it as a standalone to get my tendon injury to heal properly.


Please follow the dosage instructions on these supplements if you do get them.


How we can help


Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. For help with an Achilles injury, you can head over to our specialists at Treat My Achilles.


The Sports Injury Physio team

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio 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.

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Maryke Louw

About the Author

Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.



References


  1. Praet S, Purdam C, Welvaert M, et al. (2019) “Oral Supplementation of Specific Collagen Peptides Combined with Calf-Strengthening Exercises Enhances Function and Reduces Pain in Achilles Tendinopathy Patients” Nutrients 11(1):76.

  2. Shaw G, Lee-Barthel A, Ross ML, et al. (2016) “Vitamin C–enriched gelatin supplementation before intermittent activity augments collagen synthesis” The American Journal of Clinical Nutrition 105(1):136-43.

  3. Arquer A, García M, Laucirica JA, et al. (2014) “Efficacy and safety of an oral treatment based on mucopolysaccharides, collagen type i and vitamin C in patients with tendinopathies” Apunts Medicina de l’Esport 48(182):31–36.

  4. Vitali, M., Naim Rodriguez, N., Pironti, P., Drossinos, A., Di Carlo, G., Chawla, A., & Gianfranco, F. (2019) “ESWT and nutraceutical supplementation (Tendisulfur Forte) vs ESWT-only in the treatment of lateral epicondylitis, Achilles tendinopathy, and rotator cuff tendinopathy: a comparative study” Journal of Drug Assessment 8(1):77–86.

  5. Merolla, G., Dellabiancia, F., Ingardia, A. et al. (2015) “Co-analgesic therapy for arthroscopic supraspinatus tendon repair pain using a dietary supplement containing Boswellia serrata and Curcuma longa: a prospective randomized placebo-controlled study” Musculoskelet Surg 99 (Suppl 1):43–52.

  6. Notarnicola A, Pesce V, Vicenti G, et al. (2012) “SWAAT study: extracorporeal shock wave therapy and arginine supplementation and other nutraceuticals for insertional achilles tendinopathy” Adv Ther 29(11):992.

  7. Søren Mavrogenis, Egil Johannessen, Pål Jensen, Christian Sindberg (2004) “The effect of essential fatty acids and antioxidants combined with physiotherapy treatment in recreational athletes with chronic tendon disorders: A randomised, double-blind, placebo-controlled study” Physical Therapy in Sport 5(4):194–199.

  8. Farup, J., Rahbek, S.K., Vendelbo, M.H., Matzon, A., Hindhede, J., Bejder, A., Ringgard, S. and Vissing, K. (2014) “Whey protein and tissue hypertrophy” Scand J Med Sci Sports 24:788–798.

  9. Balius R, Álvarez G, Baró F, et al. (2016) “A 3-arm randomized trial for achilles tendinopathy: eccentric training, eccentric training plus a dietary supplement containing mucopolysaccharides, or passive stretching plus a dietary supplement containing mucopolysaccharides” Curr Ther Res Clin Exp 78:1–7.

  10. Hijlkema, A., Roozenboom, C., Mensink, M., & Zwerver, J. (2022). “The impact of nutrition on tendon health and tendinopathy: a systematic review” Journal of the International Society of Sports Nutrition, 19(1):474–504.

  11. Qiu, F.; Li, J.; Legerlotz, K. (2022) “Does Additional Dietary Supplementation Improve Physiotherapeutic Treatment Outcome in Tendinopathy? A Systematic Review and Meta-Analysis” J Clin Med 11(6):1666.


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