Tendons are fibrous connective tissue that connect muscle to bone and exemplify high tension strength due to their dense, parallel Type-1 collagen fiber composition. The strength and stiffness of a tendon enables you to experience the positive mechanical advantage of transferring load to your bone, resulting in bone movement during a muscle contraction. Injuries to tendons are usually the result of an acute injury, such as immediate trauma or chronic injury, such as tendon degeneration from failure to repair repetitive micro tears to the tendon.
As with any type of connective tissue, tendons are capable of self-repair, however many factors play a significant role in tissue healing and repair. Unlike muscles, tendons typically have relatively poor blood supply, which is an extremely important factor during the healing and repair process.
Tendon healing usually follows three main stages:
- Inflammation – Inflammatory cells rush in to the injury site in order to initiate the healing process, stimulate repair cells, and get rid of the damaged tissue.
- Repair – This is where the Tenocytes (tendon cells), which are responsible for synthesizing new collagen, begin to proliferate, synthesize and lay down new strands of collagen along the torn ends of the tendon.
- Maturation/Remodeling – The newly synthesized collagen matures into strong fibers that begin aligning themselves in the direction of mechanical stress that is experienced at the injury site. Further remodeling and cross-linking takes place in order to form a strong bond between the torn ends of the tendon.
The non-surgical approach may be successful in healing a torn tendon, as would be randomly placing a piece of duct tape on a torn piece of paper; however we do not consider this to be the only goal when “adequately” healing your injury. Our definition of “adequate” healing must include restoring the function of the new tendon as close as possible to the function of the old, healthy tendon. The self-repair process does not account for the full extent of the injury, which may include excess scar formation, degenerative tissue, adhesion factors and misalignment of the collagen fibers, which can ultimately all affect the overall function.