Tendon injury recovery: How combining collagen supplementation with shockwave therapy can help patients recover faster

16 July 2023

“Growing evidence shows that using a collagen supplement with shockwave therapy (SWT) is more beneficial than SWT alone.”

Whether from overuse or trauma, tendon injuries can impact a patient’s everyday activities.  In sports, tendon problems can impair performance, have long recovery time and are susceptible to re-injury.  Hence a carefully managed rehabilitation programme is essential to ensure the quickest and lasting recovery. 

In the past, physiotherapists used rest and ice combined with specific exercises to treat tendon injuries.  In the past two decades and especially in recent years, shockwave therapy or extracorporeal shockwave therapy (SWT) has become a mainstay in the rehabilitation of soft tissue injuries, including tendon injuries.

This article looks at how SWT works, its benefits and potential side effects.  It also examines tissue fiber proteins in tendons and how combining SWT with collagen supplementation can shorten the recovery period for patients.

A quick overview of tendon injuries

Tendinopathy or tendon injuries are common, accounting for 30 to 50 per cent of all sports injuries. (1) They can happen due to gradual wear and tear associated with ageing, repetitive movements or trauma.

Most cases involve the joints of the shoulder, elbow, knee, and ankle. Examples include:

What is shockwave therapy?

Shockwave therapy uses high uses high-energy sound waves to treat various musculoskeletal conditions, such as: (2)

  • Plantar fasciitis (heel pain)
  • Shoulder tendinopathy (shoulder pain)
  • Elbow tendinopathy (tennis and golfer’s elbow)
  • Patellar tendinopathy (jumper’s knee)
  • Achilles tendinopathy
  • Calcific tendinitis

Though primarily used to treat tendon injuries, shockwave therapy also effectively treats ligament injuries. For instance, in a 2021 case report, the participant with a medial collateral ligament (MCL) injury reported a complete absence of knee pain during the 4 months after starting SWT. (3)

How does SWT work?

Researchers are yet to fully understand how SWT works. However, they believe shock waves can promote tendon repair and improve symptoms by: (4)

  • Enhancing multiplication of collagen-producing cells.
  • Increasing collagen I and III.
  • Upregulating tendon cells (tenocytes).
  • Reducing pain perception.
  • Decreasing inflammation and soft-tissue calcification.
  • Promoting formation of new blood vessels, a crucial step in wound healing.
  • Decreasing collagen-degrading enzymes.

A tendon consists of 70% of water and 30% of dry mass, which is composed of 60–80% of type I collagen and 2% of elastin.  Amongst others, it also includes type III collagen fibers.  The structure of the collagen in tendons is complex and multi-layered.  The fibers are primarily made from type I collagen which provides tensile strength whilst type III has several roles including the extensibility of the tendon.

Top 5 benefits of SWT in tendon injuries and beyond

A patient with a (chronic) tendon injury might consider SWT, especially when other therapies have failed. (2) Treatment involves a series of sessions; each session lasts approximately 10 minutes and most experts recommend one weekly session for 3 to 5 weeks.

The benefits of SWT include:

  1. It is a non-invasive, low-cost treatment with a high success rate. According to a 2012 study, the success rate is between 60 to 80 per cent in Achilles tendinopathy, jumper’s knee, shoulder impingement, and plantar fasciitis. (5)
  2. SWT is devoid of surgery-associated risks and postoperative pain.
  3. It is typically safe with minimal side effects, such as mild bruising, swelling, pain, or numbness in the treated area. Some people may experience side effects including headaches or migraines. (6)
  4. SWT offers an innovative treatment option with a short recovery period.
  5. It also reduces pain, improves mobility, and reduces stiffness in knee osteoarthritis.

How a collagen supplement can support SWT in tendon injuries

Supporting shockwave treatment with a collagen supplement is a way to provide nutritional building blocks for tendon repair and aid and even accelerate the healing process.

In a 2012 trial, investigators randomly assigned 64 patients with Achilles tendinopathy into two groups, each containing 32 participants. (7)

The experimental group received two daily doses of a nutritional supplement with collagen type I and other nutrients for 60 days with SWT. The control group received SWT with a placebo.

At the 60-day follow up, participants who received SWT with supplement had better outcomes in terms of pain reduction and improved joint function.

A 2019 study revealed similar results.  In the study, participants (with shoulder tendinopathy, tennis elbow, and Achilles tendinopathy) who received SWT with a collagen Type I and III supplement had: (8)

  • Faster recovery
  • Better treatment outcomes
  • Reduced use of pain medicines

According to a 2021 study, a 60-day collagen supplementation with SWT resulted in reduced pain and better functional recovery in people with plantar fasciitis (heel pain). This is compared to those who received only SWT. (9)

Moreover, the researchers noted that SWT with supplementation can accelerate the healing of tendinopathies by helping the body form new blood vessels, ultimately leading to better absorption of dietary nutrients.

Supporting tendon injury recovery with Cutizana

In the studies examining collagen supplementation with treatments, the amount of collagen used ranged from 300 mg to 1,000 mg and the collagen was ingested in tablet form.  

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

Type I and III collagen supplements are well established in the aesthetics industry for the formation of collagen, elastin and keratin to support the skin, hair and nails.  Cutizana is used widely in beauty clinics because of its industry-leading quantity of type I and III collagen, delivered in combination with other nutrients including hyaluronic acid, vitamin C and biotin. 

However, clinicians are increasingly turning to type I and III collagen in Cutizana to support soft tissue treatments, notably SWT.  

There is no clear evidence indicating the optimum amount of collagen needed to support tendon injury recovery.  Dry-compressed tablets have a size- limited-capacity of not more than 1,000mg per tablet.  However, by dissolving nutrients in a liquid, a greater quantity of collagen can be delivered in a single serving with the added benefit of superior bio-availability of nutrients dissolved in a liquid.   

Cutizana is increasingly used in physiotherapy clinics as part of a holistic programme of rehabilitation for tendon and ligament injuries.


Shockwave therapy (SWT) significantly reduces pain, improves functional ability, and enhances quality of life in people with tendon injuries. Moreover, SWT is affordable and has few side effects.

Clinicians can shorten the recovery period for their patients by adding a collagen supplement alongside SWT.  Because collagen is an integral part of the tendon and its levels change when a patient has a tendon injury, taking a collagen supplement (type I & III) can aid recovery and reduce pain.


  1. Lipman, Kelsey et al. “Tendinopathy: injury, repair, and current exploration.” Drug design, development and therapy vol. 12 591-603. 20 Mar. 2018, doi:10.2147/DDDT.S154660
  2. Dedes, Vasileios et al. “Effectiveness and Safety of Shockwave Therapy in Tendinopathies.” Materia socio-medica vol. 30,2 (2018): 131-146. doi:10.5455/msm.2018.30.141-146
  3. Tognolo, Lucrezia, et al. “Treatment of Medial Collateral Ligament Injuries of the Knee with Focused Extracorporeal Shockwave Therapy: A Case Report.” Applied Sciences, vol. 12, no. 1, Dec. 2021, p. 234. Crossref, https://doi.org/10.3390/app12010234.
  4. Tenforde, Adam S et al. “Best practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration.” PM & R : the journal of injury, function, and rehabilitation vol. 14,5 (2022): 611-619. doi:10.1002/pmrj.12790
  5. Notarnicola, Angela, and Biagio Moretti. “The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue.” Muscles, ligaments and tendons journal vol. 2,1 33-7. 17 Jun. 2012
  6. Mayo Clinic. Sports medicine practitioners embrace benefits of extracorporeal shock wave therapy. https://www.mayoclinic.org/medical-professionals/physical-medicine-rehabilitation/news/sports-medicine-practitioners-embrace-benefits-of-extracorporeal-shock-wave-therapy/mac-20454275
  7. Notarnicola, Angela et al. “SWAAT study: extracorporeal shock wave therapy and arginine supplementation and other nutraceuticals for insertional Achilles tendinopathy.” Advances in therapy vol. 29,9 (2012): 799-814. doi:10.1007/s12325-012-0046-4
  8. Vitali, Matteo et al. “ESWT and nutraceutical supplementation (Tendisulfur Forte) vs ESWT-only in the treatment of lateral epicondylitis, Achilles tendinopathy, and rotator cuff tendinopathy: a comparative study.” Journal of drug assessment vol. 8,1 77-86. 3 May. 2019, doi:10.1080/21556660.2019.1605370
  9. Notarnicola, Angela, et al. ‘Efficacy of Shock Waves Combined with Adjuvant Therapy with Tendon Supplement in the Treatment of Plantar Fasciitis: A Prospective Randomized Study.’ Journal of Food and Nutrition Research 9.3 (2021): 148-153.