Tendon and Fascia Repair

I got a really interesting question a few days back from a person who saw one of my videos. He asked: "How can there be a quick recovery for tendonosis, which is tendon degeneration, if it takes collagen (what tendons are made of) 100 days on average to regenerate?" This question was about tendons, but it applies equally well to fascia, since fascia are made up of collagen as well.

This question made me very happy. I genuinely enjoy it when someone asks about a topic in an informed and constructive manner. To start with, it's important to remember that "degeneration" doesn't always mean "destruction". Degeneration in the context of tendonosis (or fasciosis) can mean several things, one of which is the destruction of the collagen fibers. You see this occasionally with Levaquin patients; in those cases, if recovery happens at all it'll ordinarily take months or even years. But most of the time it simply implies a degeneration in function or ease of movement rather than actual damage to the collagen fibers themselves.

What happens is this: in much the same way that adhesions affect muscle tissue, tendons and fascia that are affected by tendonosis or fasciosis develop points or sections along the fibers that begin to bind together. When it comes to muscle fibers, the mechanism is reasonably clear. Small fibers are grouped into bundles (like piano wires) to create larger fibers, which are in turn grouped into still larger bundles (like bridge cables), until you have a three-part structure, which is what most people think of as "the muscle". These bundles slide along each other at every level when a muscle is functioning normally, but when adhesions develop they stick at certain points, which then causes pain during movement. A competent physical therapist can ordinarily find these areas just by feeling along the muscle. Then s/he can use finger pressure to break up the adhesions and get the muscle back into proper working condition.

The situation isn't quite as straightforward, though, when it comes to tendons and fascia. For one thing, collagen doesn't contract…but it does stretch. Perhaps because of this, simple finger pressure or massage is ordinarily not enough to break up the adhesions that form. This is partly because collagen isn't as flexible as muscle fiber, and partly because the location of the tendon or fascia itself can be harder to get at. Also, since tendon and fascia fibers don't slide along each other the way muscle fibers do, the theory is that the collagen fibers somehow get intertwined, developing what could be pictured as "crosshatches" of collagen. What's needed is a way to re-align the fibers so that they no longer interfere with each other.

If you could somehow run a comb through the collagen and "comb it out straight", that would be ideal. But since that's not possible, the next best thing is specialized exercises that, over the course of a couple of weeks, will typically have the same effect. You don't have to go to a lot of expense on this, either. There is a extensive body of research that shows that simple collagen strengthening and rehabilitation exercises done at home can be just as effective as platelet-rich plasma, cortisone shots and other such "cutting-edge" tendon and fascia therapies.

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