Surprising Benefits of Vitamin C and Collagen Supplements for Tendon and Ligament Pain

Surprising Benefits of Vitamin C and Collagen Supplements for Tendon and Ligament Pain. 

Tendon and ligament pain are commonly seen in the physical therapy profession. Treatment of tendon and ligament injuries consists of manual therapy, exercise, and modalities for pain relief with good outcomes. However, nutrition is often neglected when encompassing the whole patient during their episode of care and should be used alongside manual therapy, exercise, and modalities. 

Frequency of Tendon and Ligament Injuries 

Notably, more than 50% of injuries in the NFL from 1998-2007 were reported as strains or sprains. Similarly, 66% of injuries over a 2-year span in the English football league were classified as strain or sprain. The NCAA recorded more than 11,000 ankle ligament sprains and 2,000 ACL injuries annually across 15 sports. These injuries extend beyond the realm of sports, with concerns over age and medical history. More than 50% of those aged 60 years or older had damage to the glenohumeral ligaments and the rotator cuff tendons of the shoulder joint, causing pain.

Another study looked at 67 patients with posterior tibial tendon ruptures and found 60% of these patients had one or more of the following:

1. hypertension
2. obesity
3. diabetes mellitus
4. previous surgery or trauma about the medial aspect of the foot
5. steroid exposure.

These co-morbidities are often found in the typical physical therapy clinic, requiring therapists to be aware of possible tendon and ligament dysfunction.

Physiology of Tendon and Ligaments 

Advocating the incorporation of nutritional supplementation in the context of tendon and ligament pain should be performed in the physical therapy profession. Proper guidance with nutritional supplementation may enhance outcomes in tendon or ligament injuries. From a physiological standpoint, the extracellular matrix part of the tendon and ligament consists predominantly of collagen. Collagen microfibrils, the primary unit of mature tendon and ligament tissues, are first formed from collagen I molecules.

Given the accessibility of collagen supplementation, anyone who suspects a tendon or ligament injury should consider supplementing their nutrition. Physical therapists should discuss nutritional intake with their patients and advocate appropriate supplementation.

Collagen Supplementation 

Collagen supplementation has diverse therapeutic advantages encompassing pain alleviation, anti-inflammatory effects, and structural tendon changes creating positive functional outcomes from progressive exercise rehabilitation. The integration of collagen supplementation with resistance training not only increases the cross-sectional area of the patellar tendon but also induces hypertrophy in tendinous and muscular structures. Research showed that over the span of a ten week in-season soccer training regimen, inclusion of collagen enhanced the mechanical and material properties of the patellar tendon, in high-level female soccer players. 

Vitamin C Supplementation

Research also found advantages with ingestion of 15 grams of gelatin containing 225mg of vitamin C one hour before resistance training to be beneficial in the management of patellar tendinopathy and a twofold increase in collagen synthesis. In contrast, other research found 30 grams superior to 15 grams of gelatin for whole-body collagen synthesis. Collagen emerges as a potential mitigator of tendon stress during daily activities and assumes a crucial role in injury prevention and tissue repair. 

Vitamin C supplementation aids tendon healing through its antioxidant activity.  A systematic review examining the impact of vitamin C supplementation revealed accelerated bone healing, an increase in type 1 collagen fibers, scar tissue formation, noteworthy short-term benefits in ACL reconstruction, and a reduction in oxidative stress parameters. The capacity of vitamin C supplementation, whether administered in isolation or in combination with other agents, to enhance collagen synthesis is emphasized. 

Vitamin C deficiency is predominantly linked to a decline in procollagen synthesis and diminished hydroxylation of proline and lysine residues, impeding the tendon repair process. Importantly, ingestion of vitamin C has been reported as a safe practice, with no reported adverse effects. These findings emphasize the impact of vitamin C supplementation on tendon health, its role in various physiological processes, and its potential in rehabilitation. 

Conclusion

Nutritional interventions have a significant role in the comprehensive management of tendon and ligament pain. As outlined by the American Physical Therapy Association (APTA), it is within the professional scope of a physical therapist to screen for and provide information on diet and nutritional issues. Recommendations on appropriate collagen and vitamin C supplementation should be provided to all patients suspected of tendon or ligamentous injuries, not only to assist with recovery but to aid with injury prevention.

If you’re experiencing tendon and ligament pain, we have five physical therapy clinics in Arizona. Click here to schedule your next appointment with one of our licensed physical therapists.

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