Tendon Healing

How is Tendinopathy Treated?

In most cases, you can start treating a tendon injury at home. To get the best results, start these steps right away:

• Rest the painful area, and avoid any activity that makes the pain worse.
• Apply ice or cold packs for 20 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
• Do gentle range-of-motion exercises and stretching to prevent stiffness.
• Have your biomechanics assessed by a sports physiotherapist.
• Undertake an Eccentric Strengthen Program. This is vital!

Tendon healing process

Tendon healing can be largely divided into 3 overlapping phases, inflammatory repairing and remodelling phases:

The initial inflammatory phase, which lasts about 24 hours, erythrocytes, platelets and inflammatory cells (eg: neutrophils, monocytes and macrophages) migrate to the wound site and clean the site of necrotic materials by phagocytosis.  In the meantime, these cells release phaso active and chemo tactic factors which recruit tendon fibroblast to begin collegan synthesis and deposition.

A few days after the injury, the repairing phase begins.  In this phase, which lasts a few weeks, tendon fibroblast synthesise abundant collegan and other extra cellular matrix components such as proteoglycans and deposit them at the wound site.

After about 6 weeks, the remodelling phase starts.  This phase is characterised by decreased cellularity and decreased collagen and glycosaminoglycan synthesis.  During this period, the repair tissue changes to fibrous tissue, this again changes to scar like tendon tissue after 10 weeks.  During the later remodelling phase covalent bonding between the collagen fibres increases resulting in repaired tissue with highest stiffness and tense our strength.  Also, both the metabolism of tenocytes and tendon vascularity decline.

During tissue healing growth factors play an important role in this process.

1:   Platelet Derived Growth Factor (PDGF) is produced shortly after tendon injury and stimulates the production of other growth factors.

2:  TGF-beta is active during the inflammatory and repair phases of tendon healing.  TGF-beta plays a major role in the repair of injured tendons.  TGF-beta 1 aids an extra cellular matrix deposition; however, it’s over expression results in tissue fibrosis.  TGF-beta 2 functions similarly to TGF-beta 1.  However, TGF-beta 3 has been shown to improve tissue scarring.  Peak levels of TGF-beta receptory expression occur at day 14 post injury and decrease until day 56 post injury.

3. Vascular Endothelial Growth Factor (VEGF) stimulates endothelial cell proliferation, enhances angiogenesis and increases capillary permeability.  VEGF RNA expression is detected at the repair site 7 days post injury with peak levels at 10 days post injury.
4. Nitric Oxide Synthase (NOS) isoforms are expressed with differential expression patterns during the 3 phases of tendon healing.

It should be noted that, except for degenerative tendons (tendonosis), injured tendons tend to heal. However, the healing tendon does not reach the biomechanical properties of the tendon prior to surgery.