BRINGING SCIENCE TO TREATMENT

Post-COVID-19 lockdown tendons may benefit from this key supplement

As athletes return to sport and training after lockdown and isolation due to COVID-19, they will be more susceptible to tendon injury as they experience spikes in their training load. While guidance from a physio will help them adjust their training schedules, they will likely need to change their nutrition as well. Many athletes drink supplemental shakes after exercise to supply muscles with the protein needed for tissue building and recovery. A new study suggests that the ingestion of a collagen supplement before exercise might further help tendons stay healthy and return to full function after injury.

Achilles tendon treatment

Progressive load management is the bedrock of Achilles tendon rehabilitation. Eccentric exercises are a key component of that plan, especially in those seeking a return to running. However, even with a well-managed exercise regimen, Achilles tendons can take 12 weeks or more before they can tolerate pre-injury levels of activity. Therefore, Australian researchers are seeking new ways to supplement a calf strengthening program.

The researchers enrolled 20 subjects with a long history (mean of 54 months) of Achilles mid-portion tendinopathy symptoms in a prospective double-blinded placebo-controlled experiment to evaluate the effect of collagen supplementation on tendon healing. After collecting baseline data including Achilles tendon microvascularity, blood markers, satisfaction and return to running surveys, and the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, the participants were divided into two groups of 10 each. Both groups performed an eccentric calf-strengthening program followed by a progressive return to running protocol once the subjects experienced minimal pain on the hop test.

Twice per day, the AB group ingested 2.5 g of hydrolyzed specific collagen peptides (sCP) 30-minutes before performing their calf exercises. The BA group did the same but received a placebo mixture that looked and tasted like the collagen intervention. The study included a cross-over design with the two subject groups. So, after three months, the researchers repeated the baseline measures and switched the product given to the two groups. The participants were blinded to which product they received as both had identical packaging. At the end of six months, the subjects again received measurements of baseline indicators.

Supplemental benefit?

While this study was small, underpowered, and included twice as many men as women, it offers some interesting insight into tendon healing and functional recovery. The AB group showed greater improvement in their VISA-A scores after the first three months than the placebo group. The AB group continued to make gains during the next three months while taking the placebo; however, the BA group caught up to the AB group during the second three months while receiving the collagen intervention. Though both groups finished with similar means of improvement between the start and the finish of the protocol, they both showed a surge in VISA-A scores while taking the collagen supplement.

Similar results occurred in patient satisfaction and return to running measures. The AB group reported higher satisfaction with the program after the first three months, while the BA group reported identical results after receiving supplementation during the last three months. Similarly, a higher number of subjects returned to running in the AB group after the first three months, but the BA group saw a growth in the number of those who returned to running during the last three months.

A hallmark of tendinopathy is the influx of new vascularization in an attempt to bring healing to the tendon. Its presence signifies an actively diseased tendon. Microvascularity, as measured by contrast-enhanced ultrasound, decreased a more considerable amount in the AB group during the first three months while they received the collagen. However, by the end of the study, both groups demonstrated similar decreases. This study objectively showed that symptoms and function improved as microvascularity decreased.

This observation of more improvement in each group during supplementation is just that, an observation. The study wasn’t large enough to attach real significance to the outcomes. However, in a pathology that proves so difficult to treat (the subjects all had a mean over four-year history of symptoms that prevented a return to running), any edge is welcome. Researchers think that the glycine, an ingredient in collagen supplementation, is what supports the organization of the collagen matrix within the tendon and helps with the remodeling of the tendon tissue. The researchers suggest that the ingestion of 1.1 grams of glycine per day could have helped with the tendon recovery.

Exercise works

No one disputes that tendons are made of mechano-sensitive tissues that respond to the load placed upon them. Injury results if the load is beyond the tolerance of the tendon. Yet, because tendons heal best when appropriately loaded, they require a delicate balance of load management to stay healthy. Adding sCP before exercising could help maintain that healthy balance.

Reference

  1. Nutrients. 2019. 11(76);doi:10.3390/nu11010076
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