From the Guidelines
Tendons heal slowly primarily due to their poor blood supply and low cellular activity, and promoting tendon healing requires a combination of controlled early mobilization, proper nutrition, and appropriate medical interventions. To address the slow healing of tendons, it is essential to understand the factors that contribute to this process. The dense collagen structure and limited cell population of tendons restrict their ability to regenerate quickly 1.
Factors Affecting Tendon Healing
- Poor blood supply: Tendons have a limited blood supply, which slows down the delivery of oxygen and nutrients necessary for healing 1.
- Low cellular activity: Tendons have a low cell population, which restricts their ability to regenerate quickly 1.
- Collagen structure: The dense collagen structure of tendons makes it difficult for them to regenerate quickly 1.
Promoting Tendon Healing
To promote tendon healing, the following strategies can be employed:
- Controlled early mobilization: Gradually introduce controlled movement to prevent adhesions while avoiding activities that cause pain 1.
- Proper nutrition: Include adequate protein (1.2-1.6g/kg body weight daily), vitamin C (250-500mg daily), and zinc (15-30mg daily) in the diet 1.
- Appropriate medical interventions: Use anti-inflammatory medications like ibuprofen (400-600mg every 6-8 hours) short-term to manage pain, and consider physical therapy focusing on eccentric strengthening exercises starting around 2-4 weeks post-injury depending on severity 1.
- Medical interventions for severe injuries: Consider platelet-rich plasma injections or extracorporeal shockwave therapy for severe tendon injuries 1.
Rehabilitation Protocols
Rehabilitation protocols should be tailored to the individual's needs and the severity of the injury. Patience and adherence to rehabilitation protocols are essential for optimal recovery. The PRICE protocol (Protection, Rest, Ice, Compression, Elevation) should be followed for acute injuries, typically for 48-72 hours, and then gradually introduce controlled movement to prevent adhesions while avoiding activities that cause pain 1.
Nutritional Support
Nutritional support plays a crucial role in promoting tendon healing. Adequate protein intake is essential for tendon repair, and vitamin C and zinc supplements can also support the healing process 1. The recommended daily protein intake is ≥1.6 g/kg BM, and distributing adequate amounts (20–30 g) of protein throughout the day, including pre-sleep, can help attenuate muscle loss during rehabilitation 1.
Medical Interventions
Medical interventions such as platelet-rich plasma injections or extracorporeal shockwave therapy may be considered for severe tendon injuries. These interventions can promote local angiogenesis, stem cell homing, local cell migration, proliferation, and differentiation, coupled with the deposition of matrix proteins, such as collagen 1. However, the optimal drugs, dosages, techniques, intervals, and post-injection care remain unknown, and more research is needed to establish evidence-based guidelines for the use of local corticosteroid injections in tendinopathy 1.
From the Research
Tendon Healing Process
- Tendon healing is a complex process that involves three successive phases: an inflammatory phase, a proliferative phase, and a remodeling phase 2.
- Despite this process, healed tendon often fails to recover its original mechanical properties 2.
- The healing process is influenced by various factors, including cells, transcription factors, extracellular matrix components, cytokines, growth factors, and vascularization 2.
Factors Affecting Tendon Healing
- Tendon disorders can affect people of all ages, and the healing process can be influenced by the type and severity of the injury, as well as the individual's overall health 2, 3.
- The use of platelet-rich plasma (PRP) has been explored as a potential treatment to promote tendon healing, but the evidence is still limited and inconclusive 4, 5, 6.
- PRP contains tendoinductive factors that can drive the fate of stem cells, but its effectiveness in promoting tendon repair is still being researched 5.
Promoting Tendon Healing
- A better understanding of the tendon healing process could help provide new therapeutic approaches to improve patients' recovery 2.
- The use of PRP has shown some promise in promoting tendon healing, particularly in the treatment of patellar tendinopathy and lateral elbow tendinopathy 6.
- However, more research is needed to fully understand the effects of PRP on tendon healing and to develop effective treatment strategies 4, 5, 6.
- Minimum protective immobilization followed by hand therapy is a general principle of treatment for tendon injury, particularly for acute injuries to the flexor and extensor tendons of the hand 3.