Role of nutritional supplements in the management of tendinopathies: focus on combination of type 1 collagen, vitamin C and mucopolysaccharides


  • Dinesh Agrawal Department of Orthopaedics, Raksha Hospital Pvt. Ltd., Ahmedabad, Gujarat, India
  • Aalok Shah Department of Orthopaedics, GCS Medical College, Naroda, Ahmedabad, Gujarat, India
  • Kapil Dev Mehta Department of Medical Affairs, Wockhardt Ltd., Bandra Kurla Complex, Mumbai, Maharashtra, India
  • Rishi Jain Department of Medical Affairs, Wockhardt Ltd., Bandra Kurla Complex, Mumbai, Maharashtra, India
  • Salman Motlekar Department of Medical Information, Wockhardt Ltd., Bandra Kurla Complex, Mumbai, Maharashtra, India



Tendinopathy, Nutraceuticals, Type I collagen, Vitamin C, Mucopolysaccharides


Tendinopathy is a common disease that is difficult to manage due to its recurrent nature. It is associated with increased healthcare costs and significantly impacts quality of life of patients. Also, according to recent studies patients with high cholesterol and diabetes are at a higher risk of developing tendinopathy. There has been rise in the incidence of tendinopathies due to increase in sport activities, life expectancy and some other factors (environment, diet and some drug therapies). Approximately 30% of visits for musculoskeletal pain in general practice are related to tendon injury. Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids remain the mainstay of treatment. Despite the use of current therapies, there is need of a supportive therapy that can help in the healing process towards development of physiologically normal tendons. Nutraceuticals have been used as supportive therapy for management of tendinopathies. This review focuses on the management of tendinopathy with special attention on role of nutraceuticals such as type I collagen, mucopolysaccharides and vitamin C in the management of tendinopathy. Clinical data suggests that this combination (type I collagen, mucopolysaccharides and vitamin C) promotes the endogenous synthesis of collagen type I, avoiding the accumulation of collagen type III and aggrecan, thus interfering with the degeneration of tendon tissue. Based on the available clinical data, combination of type I collagen, mucopolysaccharides and vitamin C not only reduce the clinical symptoms but also improve structural evolution of different types of tendinopathies as well as plantar fascitis.


Dean BJF, Dakin SG, Millar NL, Carr AJ. Review: emerging concepts in the pathogenesis of tendinopathy. Surgeon. 2017;15(6):349-54.

Wilson JJ, Best TM. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Phys. 2005;72(5):811-8.

Littlewood C, May S, Walters S. Epidemiology of rotator cuff tendinopathy: a systematic review. Shoulder Elb. 2013;5(4):256-65.

Tilley BJ, Cook JL, Docking SI, Gaida JE. Is higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review. Br J Sports Med. 2015;49(23):1504-9.

Andres, BM, Murrell GAC. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Rel Res. 2008;466(7):1539-54.

Best TM, Garrett WE. Basic science of soft tissue: muscle and tendon. In: DeLee JC, Drez D Jr, editors. Orthopaedic sports medicine: principles and practice. Philadelphia: WB Saunders. 1994;1.

Oxlund H. Relationships between the biomechanical properties, composition and molecular structure of connective tissues. Connect Tissue Res. 1986;15:65-72.

Kannus P, Jozsa L, Jarvinnen M. Basic science of tendons. In: Garrett WE Jr, Speer KP, Kirkendall DT, editors. Principles and practice of orthopaedic sports medicine. Philadelphia: Lippincott Williams and Wilkins. 2000;21-37.

Docheva D, Muller SA, Majewski M, Evans CH: Biologics for tendon repair. Adv Drug Deliv Rev. 2015;84:222-39.

Dyment NA, Galloway JL: Regenerative biology of tendon: mechanisms for renewal and repair. Curr Mol Biol Rep. 2015;1(3):124-31.

Kvist M, Jozsa L, Jarvinen M, Kvist H. Fine structural alterations in chronic Achilles paratenonitis in athletes. Pathol Res Pract. 1985;180:416-23.

Williams JG. Achilles tendon lesions in sport. Sports Med. 1986;3:114-35.

Selvanetti A, Cipolla M, Puddu G. Overuse tendon injuries: basic science and classification. Oper Tech Sports Med. 1997;5:110-7.

Archambault J, Tsuzaki M, Herzog W, Banes AJ. Stretch and interleukin-1 beta induce matrix metalloproteinases in rabbit tendon cells in vitro. J Orthop Res. 2002;20:36-9.

Cook JL, Rio E, Purdam CR, Docking SI. Re-visiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med. 2016;50:1187-91.

Langberg H, Ellingsgaard H, Madsen T, Jansson J, Magnusson SP, Aagaard P, Kjaer M. Eccentric rehabilitation exercise increases peritendinous type I collagen synthesis in humans with Achilles tendinosis. Scand J Med Sci Sports. 2007;17:61-6.

Maffulli N, Longo UG. How do eccentric exercises work in tendinopathy?. Rheumatol (Oxford). 2008;47(10):1444-5.

Petri M, Hufman SL, Waser G, Cui H, Snabes MC, Verburg KM. Celecoxib effectively treats patients with acute shoulder tendinitis/bursitis. J Rheumatol. 2004;31:1614-20.

Smidt N, Assendelft WJ, van der Windt DA, Hay EM, Buchbinder R, Bouter LM. Corticosteroid injections for lateral epicondylitis: a systematic review. Pain. 2002;96:23-40.

Kia C, Baldino J, Bell R, Ramji A, Uyeki C, Mazzocca A. Platelet-rich plasma: review of current literature on its use for tendon and ligament pathology. Curr Rev Musculoskeletal Med. 2018;11(4):566-72.

Khan KM, Cook JL, Maffulli N, Kannus P. Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin. Br J Sports Med. 2000;34:81-3.

Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials: The Lancet. 2010;376(9754):1751-67.

Docheva D, Muller SA, Majewski M, Evans CH: Biologics for tendon repair. Adv Drug Deliv Rev. 2015;84:222-39.

Lippiello L. Collagen synthesis in tenocytes, ligament cells and chondrocytes exposed to a combination of glucosamine HCl and chondroitin sulfate. Evid Based Complement Alternat Med. 2007;4(2):219-24.

Berg RA, Kerr JS. Nutritional aspects of collagen metabolism. Annu Rev Nutr. 1992;12:369-90.

Omeroglu S, Peker T, Turkozkan N, Omeroglu H. High-dose vitamin C supplementation accelerates the Achilles tendon healing in healthy rats. Arch Orthop Trauma Surg. 2009;129(2):281-6.

Kao WW, Flaks JG, Prockop DJ. Primary and secondary effects of ascorbate on procollagen synthesis and protein synthesis by primary cultures of tendon fibroblasts. Arch Biochem Biophys. 1976;173:638-48.

Shakibaei M, Buhrmann C, Mobasheri A. Anti-inflammatory and anti-catabolic effects of TENDOACTIVE® on human tenocytes in vitro. Histol Histopathol Cell Mol Biol. 2011;26(9):1173-85.

Omeroğlu S, Peker T, Türközkan N, Omeroğlu H. High-dose vitamin C supplementation accelerates the Achilles tendon healing in healthy rats. Arch Orthop Trauma Surg. 2009;129(2):281-6.

Zanoni JN, Lucas NM, Trevizan AR, Souza ID. Histological evaluation of the periodontal ligament from aged Wistar rats supplemented with ascorbic acid. An Acad Bras Cienc. 2013;85(1):327-35.

Balius R, Álvarez G, Baró F, Jiménez F, Pedret C, Costa E, Martínez-Puig D. A 3-arm randomized trial for achilles tendinopathy: eccentric training, eccentric training plus a dietary supplement containing mucopolysaccharides, or passive stretching plus a dietary supplement containing mucopolysaccharides. Curr Therap Res. 2016;78,1-7.

Binh BH, Ramirez P, Martinez-Puig D. THU0338: A randomized, placebo-controlled study to evaluate efficacy and safety of a dietary supplement containing mucopolysaccharides, collagen type i and vitamin c for management of different tendinopathies. Ann Rheum Dis. 2016;73(2):299-301.

Arquer A, Garcia M, Laucirica JA, Riusd M, Blàviae M, Fontserè J, et al. The efficacy and safety of oral mucopolysaccharide, type I collagen and vitamin C treatment in tendinopathy patients. Apunts Med Esport. 2014;49(182):31-6.

Nadal F, Bové T, Sanchís D, Martinez-Puig D. 473 Effectiveness of treatment of tendinitis and plantar fasciitis by tendoactive™. Osteoarthritis Cartilage. 2009;17:253.






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