Fascia Degeneration

I got a really interesting question a few days ago from a person who saw one of my videos. He asked: "How can there be a quick recovery for tendonosis, which is tendon degeneration, if it takes collagen (what tendons are made of) 100 days on average to regenerate?" This question was about tendons, but it applies equally well to fascia, since fascia are made up of collagen as well.

I have to say, this is a really excellent question, maybe the best one I've ever gotten. First of all, you have to remember that "degeneration" doesn't always equal "destruction". Degeneration in the context of tendonosis (or fasciosis) can mean several things, one of which is the destruction of the collagen fibers. You see this occasionally with Levaquin patients; in those cases, if recovery happens at all it'll generally take months or even years. But most of the time it simply implies a degeneration in function or ease of movement rather than actual damage to the collagen fibers themselves.

What happens is this: in much the same way that adhesions affect muscle tissue, tendons and fascia that are affected by tendonosis or fasciosis develop points or sections along the fibers that begin to clump together. With skeletal muscle fibers, the mechanism is pretty clearly understood: tiny fibers are grouped into bundles to create larger fibers, which are in turn grouped into still larger bundles, until you have a three-tier structure. These bundles slide along each other at every level when a muscle is functioning normally, but when adhesions develop they stick at certain points, which then causes pain during movement. A good physical therapist can normally find these points simply by feeling along the muscle, and then use finger pressure to break up the adhesions and get the muscle back into good working order.

The situation isn't quite as straightforward, though, when it comes to tendons and fascia. For one thing, collagen doesn't contract…but it does stretch. Perhaps because of this, simple finger pressure or massage is normally not enough to break up the adhesions that form. This is partly because collagen isn't as flexible as muscle fiber, and partly because the location of the tendon or fascia itself can be harder to get at. Also, since tendon and fascia fibers don't slide along each other in the same manner muscle fibers do, the hypothesis is that the collagen fibers somehow get intertwined, developing what can be pictured as "crosshatches" of collagen. A method of re-aligning the fibers, so that they no longer interfere with each other, is necessary.

Some sort of "collagen comb" that could go through the fibers and straighten them out would be the best. But since that's not possible, the next best thing is specialized exercises that, over the course of a couple of weeks, will generally have the same effect. You don't have to go to a lot of expense on this, either. There is a extensive body of research that shows that simple collagen strengthening and rehabilitation exercises done at home can be just as effective as platelet-rich plasma, cortisone shots and other such "cutting-edge" tendon and fascia therapies.