Vitamin C Dosing for Tendon Rehabilitation
For an otherwise healthy adult undergoing tendon rehabilitation, aim for 200-500 mg of vitamin C daily, ideally combined with 15 grams of gelatin taken 30-60 minutes before rehabilitation exercises. 1
Evidence-Based Rationale
The UEFA expert group statement (British Journal of Sports Medicine, 2021) specifically identifies vitamin C-enriched dietary gelatin as a novel strategy to support tendon repair during rehabilitation. 1 This represents the most direct guideline-level evidence addressing tendon recovery, though it does not specify an exact vitamin C dose in isolation.
Optimal Dosing Strategy
The 200-500 mg/day range is supported by multiple converging lines of evidence:
- General tissue saturation occurs at approximately 200 mg/day, which maximizes collagen synthesis capacity and antioxidant protection. 2
- High-risk populations requiring enhanced collagen synthesis (including post-surgical patients and those with chronic oxidative stress) are recommended to receive 200-500 mg/day indefinitely by nutrition authorities. 2, 3
- This dose range is well below the tolerable upper limit of 2000 mg/day, minimizing gastrointestinal side effects while maximizing absorption efficiency. 2, 4, 5
Supporting Research Evidence
Animal studies demonstrate that high-dose vitamin C supplementation (150 mg every 2 days in rats, equivalent to approximately 500-1000 mg/day in humans when adjusted for metabolic rate) accelerates Achilles tendon healing through enhanced angiogenesis on day 3, increased type I collagen production by day 10, and improved repair tissue structure by day 21. 6 A 2022 scoping review confirms that vitamin C supplementation increases collagen synthesis and improves patient outcomes in tendinopathy recovery. 7
Practical Implementation Algorithm
Follow this structured approach:
Start with 200-500 mg vitamin C daily (can be split into 100-250 mg twice daily for better absorption). 2, 3
Combine with 15 grams of gelatin taken 30-60 minutes before rehabilitation exercises to maximize collagen synthesis at the tendon site. 1
Ensure adequate dietary intake by consuming at least 5 servings of fruits and vegetables daily, including high vitamin C sources (citrus, bell peppers, strawberries). 1, 2
Continue supplementation throughout the rehabilitation period (typically weeks to months depending on injury severity). 1
Maintain adequate protein intake (≥1.6 g/kg body weight daily) as protein provision augments tendon hypertrophy during training. 1
Critical Caveats and Safety Considerations
Screen for contraindications before starting supplementation:
- Avoid doses >1000 mg/day in patients with hemochromatosis, G6PD deficiency, active oxalate kidney stones, or severe renal dysfunction. 2, 3, 8
- Doses above 2000 mg/day may cause gastrointestinal upset and diarrhea due to osmotic effects of unabsorbed vitamin C. 2, 4, 5
- Vitamin C deficiency (intake <40-45 mg/day) significantly impairs tendon repair by reducing procollagen synthesis and hydroxylation of proline and lysine residues. 7
Common Pitfalls to Avoid
Do not exceed 500 mg/day without specific indication, as intestinal absorption saturates and plasma concentrations plateau at intakes of 200-400 mg/day, with diminishing returns above this threshold. 2 Do not rely on vitamin C alone—tendon rehabilitation requires adequate energy balance, protein intake, and progressive mechanical loading as the primary therapeutic interventions. 1 Do not delay standard rehabilitation protocols to focus on supplementation; vitamin C is an adjunct, not a replacement for evidence-based physical therapy. 1