Supporting Achilles Tendon Injury Rehabilitation With Collagen Nutritional Support

22 June 2023

How marine collagen can be used to provide type I & 3 collagen to support Achilles tendon injury rehabilitation.

What are Achilles tendon injuries?

An Achilles tendon injury is common among athletes who engage in continuous high-intensity activities, such as competitive runners. However, it can happen to anyone regardless of the level of physical activity.

According to the NHS, it affects about 150,000 individuals in the UK. (1) Among these, nearly 11,000 individuals have tendon ruptures (a more severe form). (2)

Men appear to be at a higher risk, perhaps due to more males in sports than females. In European countries, footballers are at the highest risk of having Achilles tendon ruptures. (3)

A quick overview of the Achilles tendon

The Achilles tendon (or simply Achilles) is the thick cord-like band of connective tissue that connects your calf muscles to the back of your heel. You can feel it at the back of your ankle.

This tendon has high tensile strength, meaning that it can withstand a high amount of stress before breaking down. When we walk, run, or engage in any physical activity, the tendon is subjected to varying degrees of load.

For instance, when you walk, your Achilles tendon bears a force of up to 2600 N. Likewise, when running, the force can go as high as 5330 N. (4)

Tensile strength is measured in amounts of force per unit area. Its unit is MPa (MegaPascal). Studies show that the Achilles tendon has a breaking stress of about 100 MPa. (5) During high-intensity activities, the Achilles tendon experiences stress over 70 MPa. For reference, most human tendons experience stresses below 30 MPa.

What are the symptoms?

Pain above the affected heel is the most obvious symptom. If you experience pain below your heel, it is usually due to other conditions. Pain may be mild and improve or worsen over time. A ruptured tendon typically causes sharp pain and a snapping or popping sound.

Other signs and symptoms can include:

  • Stiffness and tenderness in the affected area
  • Swelling with pain that worsens when you move
  • Thickening of the tendon
  • Bone spurs on the heel bone
  • Trouble flexing the affected foot

Types of Achilles tendon injuries

According to the American Academy of Physical Medicine and Rehabilitation, the grades of Achilles tendon injuries based on severity are: (6)

  • Grade 1: Morning discomfort in the affected tendon, which subsides shortly after waking.
  • Grade 2: Pain during sports activities but no effect on performance.
  • Grade 3: Pain affects performance.
  • Grade 4: Pain prevents sports participation.

Another system of classification categorises Achilles injuries into the following types: (7)

  1. Acute Achilles rupture. This severe injury can keep athletes from sports activities for 26 to 39 weeks.
  2. Chronic Achilles tendinitis. This type of injury is less severe and causes the tendon to swell. Depending on the treatment, healing can take several weeks to 3 months.

Note: Tendonitis and tendinitis can be used interchangeably. Do not confuse it with tendinosis, a long-term condition that causes your tendons to break down over time.

Tendinopathy vs tendinitis

Some people use the terms—tendinopathy and tendinitis—synonymously. Though both conditions have nearly identical signs and symptoms, they are not the same.

Tendinopathy is an overuse injury that can eventually lead to minor tears in your tendon. On the other hand, tendinitis means swelling of the tendon.

What is the most effective treatment for Achilles tendon injuries?

Mild injuries typically heal without any specific treatment. Besides, you can speed up the recovery process by:

  • Resting your leg.
  • Applying ice to the affected area for about 20 minutes several times a day.
  • Compressing your leg with an elastic bandage.
  • Elevating your leg.

Non-steroidal anti-inflammatory drugs, such as ibuprofen (Galprofen) and naproxen (Naprosyn) may be used to reduce pain and swelling. Your GP may also recommend stretching/strengthening exercises and low-impact activities. 

For severe cases, exercise rehabilitation is the most effective treatment. (8) It can last several weeks to months and comprises the following phases:

  • Phase I: Symptom-management and load-reduction phase. This phase lasts 1 to 2 weeks or longer if required. It includes activities, such as aquatic therapy, bodyweight exercises, and heel rises.
  • Phase II: Recovery. This phase lasts 2 to 5 weeks. It includes heel rises, plyometric exercises, and strength training.
  • Phases III: Return-to-sport. This phase lasts 3 to 6 months or longer if required. It includes sport-specific movements.

How common are reinjuries?

Recurrences are common even with treatment. According to a 2020 study, reinjury rates can range from 27% to 44%. (9)

Science-backed benefits of collagen supplementation in Achilles tendinopathy

Treating severe cases can be a daunting task for you and your GP. While exercise rehabilitation is known to provide superior benefits, it can be time-consuming and repetitive. Both these factors can be frustrating for the athlete. 

In fact, a team of researchers from Spain revealed that individuals with Achilles tendinopathy are more likely to develop depression, fear of physical activity, and pain catastrophising. (10) Even worse, fear and feeling of hopelessness can impair their ability to perform daily activities.

The good news is that combining exercise rehabilitation with oral collagen supplementation can accelerate healing. Collagen is the building block of the tendon, accounting for over 80% of the tendon weight. (11)

When you have a tendon rupture, collagen type I level drops and collagen type III level increases. (12) This imbalance reduces the tensile strength of your tendon. Likewise, repeated injuries may eventually cause biologically inferior tissues to replace healthy tendons.

Thus, it is logical to nourish damaged tendons with a well-balanced collagen supplement that is readily absorbed into the bloodstream.

Below, we look at the most recent findings that support collagen supplementation for Achilles tendinopathy.

In a 2019 study, participants who received  2.5 g hydrolysed specific collagen peptides for 3 months scored higher on the Victorian Institute of Sports Assessment (VISA-A) rating scale compared to those who received a placebo. (13) On the VISA-A scale, a higher score means fewer symptoms, which indicates accelerated healing.

Similarly, a 2022 study reported that collagen supplementation with strength training reduces tendon stress in healthy individuals. (14)

Does collagen supplementation work for other tendon injuries?

Limited evidence suggests that oral collagen and vitamin C supplementation may strengthen the patellar (kneecap) tendon in specific populations.

Likewise, in 2014, a team of Spanish researchers reported that 435 mg mucopolysaccharides, 75 mg type I collagen, and 60 mg vitamin C daily for 3 months improved clinical symptoms, such as pain and swelling, in individuals with Achilles tendinopathy, tennis elbow, and patellar tendinopathy. (15)


  1. How long does it take to heal Achilles tendinopathy?

With proper treatment and rest, Achilles tendinopathy typically heals within 6 weeks to a few months.

  1. What is the gold standard of treatment for Achilles tendinopathy?

The NHS recommends the eccentric exercise programme as the gold standard of treatment for Achilles tendinopathy. 70 to 90% of individuals respond to this programme.

Supporting tendon injury recovery with Cutizana

Cutizana is a high-strength liquid marine collagen supplement which contains an industry-leading 10 grams (10,000mg) of type I and III collagen per serving with Vitamin C and Hyaluronic acid.

As a liquid, the collagen is dissolved in the blend so that it is readily absorbed. Cutizana is used widely in salons to support skin health but is increasingly used in physiotherapy clinics as part of a holistic rehabilitation programme for tendon and ligament injury recovery.


  1. Achilles Tendinopathy – NHS Lanarkshire.
  2. Achten, Juul et al. “Cast versus functional brace in the rehabilitation of patients treated non-operatively for a rupture of the Achilles tendon: protocol for the UK study of tendo achilles rehabilitation (UK STAR) multi-centre randomised trial.” BMJ open vol. 7,10 e019628. 24 Oct. 2017, doi:10.1136/bmjopen-2017-019628
  3. Józsa, L et al. “The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociological study of 292 cases.” The American journal of sports medicine vol. 17,3 (1989): 338-43. doi:10.1177/036354658901700305
  4. S. Peter Magnusson and others, Increased Cross-sectional Area and Reduced Tensile Stress of the Achilles Tendon in Elderly Compared With Young Women, The Journals of Gerontology: Series A, Volume 58, Issue 2, February 2003, Pages B123–B127,
  5. Kongsgaard, M et al. “Structural Achilles tendon properties in athletes subjected to different exercise modes and in Achilles tendon rupture patients.” Journal of applied physiology (Bethesda, Md. : 1985) vol. 99,5 (2005): 1965-71. doi:10.1152/japplphysiol.00384.2005
  6. American Academy of Physical Medicine and Rehabilitation. Achilles Tendinopathy.
  7. Penn Medicine. Achilles Injuries Treatment.
  8. Silbernagel, Karin Grävare et al. “Current Clinical Concepts: Conservative Management of Achilles Tendinopathy.” Journal of athletic training vol. 55,5 (2020): 438-447. doi:10.4085/1062-6050-356-19
  9. Silbernagel, Karin Grävare et al. “Current Clinical Concepts: Conservative Management of Achilles Tendinopathy.” Journal of athletic training vol. 55,5 (2020): 438-447. doi:10.4085/1062-6050-356-19
  10. Verges, J., Martínez, N., Pascual, A. et al. Psychosocial and individual factors affecting Quality of Life (QoL) in patients suffering from Achilles tendinopathy: a systematic review. BMC Musculoskelet Disord 23, 1114 (2022).
  11. Buckley, Mark R et al. “Distributions of types I, II and III collagen by region in the human supraspinatus tendon.” Connective tissue research vol. 54,6 (2013): 374-9. doi:10.3109/03008207.2013.847096
  12. Maffulli, N et al. “Tendon healing: can it be optimised?.” British journal of sports medicine vol. 36,5 (2002): 315-6. doi:10.1136/bjsm.36.5.315
  13. Praet, Stephan F E et al. “Oral Supplementation of Specific Collagen Peptides Combined with Calf-Strengthening Exercises Enhances Function and Reduces Pain in Achilles Tendinopathy Patients.” Nutrients vol. 11,1 76. 2 Jan. 2019, doi:10.3390/nu11010076
  14. Jerger, Simon et al. “Effects of specific collagen peptide supplementation combined with resistance training on Achilles tendon properties.” Scandinavian journal of medicine & science in sports vol. 32,7 (2022): 1131-1141. doi:10.1111/sms.14164
  15. Arquer, Andreu et al. “The efficacy and safety of oral mucopolysaccharide, type i collagen and vitamin C treatment in tendinopathy patients.” Apunts. Medicina De L’esport 49 (2014): 31-36.