Tendonitis is a common disease affecting tendons, leading to pain with tendon activity. We know that tendons respond to exercise therapy. Sometimes, we add other treatments such as ibuprofen, GTN patches, shockwave therapy, and tendon injections. Recently, there has been an interest in using collagen supplements for tendonitis to speed up healing. Do supplements for tendonitis work, and should you consider taking them?  

Tendonitis: a breakdown in collagen structure 

Tendonitis is a term used to describe the breakdown of collagen proteins within a tendon. We used to think that tendon disease was due to acute inflammation. However, we now believe that inflammation plays a less critical role. Gradual tendon overload or overuse leads to water collecting between the collagen fibres, producing collagen breakdown. Also, metabolic diseases such as obesity or diabetes can accelerate this collagen breakdown. 

Tendonitis presents with pain arising from the tendon during or after activity. Examples of everyday activities that cause pain include running in Achilles tendonitis and jumping in patellar tendonitis. 

 
man grabbing Achilles tendonitis

Exercise: a treatment for tendonitis 

Most tendons that show collagen breakdown do not respond to rest. We also know that traditional anti-inflammatory treatments, such as ibuprofen, once thought to help tendon pain, may delay healing if used excessively. Generally, tendonitis responds to an exercise programme. How and why patients respond to exercise is unknown, but it might be due to the stimulatory effects of exercise on collagen.

Examples of a tendon-loading program for Achilles tendonitis and high hamstring tendonitis are outlined in previous blogs.  

Can supplements for tendons help tendonitis? 

There has been a recent explosion in supplement use for various medical conditions, including musculoskeletal conditions. And tendonitis is no exception. Common supplements for tendonitis include collagen, turmeric and free fatty acids. We outline the evidence for tendon supplements and whether you should consider taking them to accelerate healing.  

Collagen supplements for tendonitis

Collagen supplements are more commonly used for tendonitis. We think taking collagen supplements may reverse collagen breakdown, speeding up healing. When ingesting gelatine or hydrolysed collagen, your body breaks it into simple amino acids. We suspect that increases in amino acids support healthy tendon growth. However, ingesting collagen alone won’t improve collagen structure. It would be best to do the heavy lifting of exercise therapy to achieve these benefits. 

Studies on collagen supplements for tendonitis

One study directed participants to take a gelatine collagen supplement an hour before exercising the Achilles tendon. The study involved three groups (none of whom had an Achilles injury). One group was given a placebo, one group took 5 grams of gelatine collagen, and one took 15 grams of gelatine collagen, each dissolved in a drink containing 48 milligrams of Vitamin C. The participants took the supplement an hour before skipping for 6 minutes. They did this three times a day for three days. Blood samples were taken at various intervals during the experiment. The blood of the group who took 15 grams of gelatine collagen showed a more significant increase in collagen synthesis than the other two groups. The study supports the hypothesis that consuming 15 g of gelatin collagen one hour before exercise results in more remarkable collagen synthesis.

Another study, specifically on mid-portion Achilles tendonitis, found that participants recovered more quickly from their injury when they used a hydrolysed collagen supplement combined with a strength training programme versus those who followed only the strength training programme. This was a six-month study in which two groups took either 2.5 grams of hydrolysed collagen (TENDOFORTE) or a placebo half an hour before they did their Achilles exercises. In the first three months, one group took the placebo and the other the collagen, and in the next three months, they switched around. In both time frames, the group who took the collagen had more significant improvements in tendon pain levels than the placebo group. The authors concluded that taking specific collagen peptides may accelerate the benefits of a well-structured calf-strengthening program in Achilles tendonitis. 

Finally, a study performed by a Spanish group found that taking hydrolysed collagen supplements (TENDOFORTE) with tendon exercises for Achilles tendonitis showed more significant improvements in pain than exercise alone. Moreover, the study discovered that the effect was better in subjects with early or milder tendonitis. 

So, should you use collagen supplements for tendonitis?  

 
collagen supplements for tendons dissolved in a glass of water

Although the evidence is mixed,  these studies suggest that collagen supplements for tendonitis may be helpful. However, remember that these supplements should not be a stand-alone treatment. Like other treatments such as GTN patches, shockwave and tendon injections, we use collagen to enhance the healing effects of tendon-loading exercises.  

Until we see further studies on collagen supplements in tendonitis, it is best to stick with the doses used in the current studies. Notwithstanding the current literature limitations, we recommend the following collagen dose: 

  • 2.5 grams of hydrolysed collagen supplement in a cold water glass about 30 minutes before tendon loading exercises 
  • TENDOFORTE is the brand name for hydrolysed collagen 

We recommend a minimum of 3 months of supplementation.  

Frequently asked questions about supplements for tendons 

Are collagen supplements a valuable addition to exercise therapy or a stand-alone treatment?

Supplements are meant to enhance the effects of your rehab exercises – they are not meant to be used as a stand-alone treatment. In addition to exercise therapy, other treatments we could utilise with collagen supplements include GTN patches, shockwave therapy, and tendon injections. Talk to your doctor about whether these other treatments suit you best. 

Are collagen supplements for tendonitis allowed in elite sports? 

Yes. The International Olympic Committee released a consensus statement on supplements in athletes. They state that supplementation containing hydrolysed collagen could help increase collagen synthesis and reduce tendon and joint-related pain.

What about other supplements for tendons? 

Despite widespread use, no evidence exists that other supplements, such as turmeric or free-fatty acids, help tendon pain or improve tendon healing. 

Final word from Sportdoctorlondon about supplements for tendonitis

Given recent studies on collagen supplementation in tendonitis, we recommend hydrolysed collagen supplements (Brand name TENDOFORTE) for upper and lower limb tendonitis. We should combine these supplements with exercise therapy and other recognised treatments for tendonitis. 

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Dr Masci is a specialist sports doctor in London. 

He specialises in muscle, tendon and joint injuries.

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