It is known that tendons and ligaments have a slower and more limited ability to self-repair than other tissues. However, healthy tendons and
ligaments do indeed have an intrinsic capacity for repair, which is controlled by resident fibroblasts and their surrounding extracellular matrix
(ECM). Fibroblasts (e.g., tenocytes) are responsible for producing the ECM and therefore the proteoglycans (protein/mucopolysaccharide
complex) and collagen needed for tissue repair. The key is to stimulate this process. In vitro and in vivo research suggests Tendon &
Ligament Support does just that. This proprietary blend of type I collagen and mucopolysaccharides combined with vitamin C supports the
structural and functional needs of tendons and ligaments.*
Type I Collagen and Mucopolysaccharides Adult tendons are comprised mainly of type-I collagen molecules that are hierarchically
organized into structural units. The molecular structure and organization of tendon and ligament collagen fibrils are key determinants in the
ability of these tissues to endure mechanical force and fuel self-repair. While collagen provides much of tendon/ligament structure and
strength, mucopolysaccharides are said to provide the “glue” that holds them together and allows them to stretch, flex, bend, and maintain
their resilience. Mucopolysaccharides—also known as glycosaminoglycans or GAGs—are a critical component of ECM and are important
in maintaining structural integrity, lubrication, and spacing of collagen fibers. Furthermore, mucopolysaccharides have been shown to
increase collagen and non-collagenous protein synthesis in cultures of bovine tenocytes and ligament cells.*
Vitamin C This vitamin helps maintain tendon/ligament structure and biomechanical properties by stimulating collagen biosynthesis.*[3-5]
In Vitro IL-1beta (interleukin-1beta) is a cytokine associated with adverse tendon/ligament changes. The effect of Tendon & Ligament
Support in the presence of IL-1beta was studied in primary human tenocytes. Tenocyte cultures treated with 250, 500, and 1000 μg/ml of
Tendon & Ligament Support showed no signs of cytotoxicity or other negative effects on the viability of cells. The major findings were that
this formula counteracted the negative effects of IL-1beta by: (1) protecting tenocytes from degenerative morphological changes, cellular
degeneration, and apoptosis, (2) reversing the downregulation of collagen type I and beta 1-integrin receptor expression, (3) increasing
tenomodulin production, and (4) causing a significant dose- and time-dependent increase in proliferation and viability of tenocytes.
These results demonstrated that Tendon & Ligament Support supports tenocyte viability and proliferation and type I collagen synthesis.
Furthermore, the treated cells appeared healthy; displayed an abundant and well-organized ECM; and exhibited high levels of euchromatin,
indicating that the cells were very active and had a high rate of protein (i.e., collagen) biosynthesis. In another in vitro test, human
tenocytes incubated with Tendon & Ligament Support for 10 days showed a strong stimulatory effect on cell proliferation that exceeded
the proliferation seen in cells incubated with (IGF-1) insulin-like growth factor 1 (positive control). In addition, cells remained viable and
showed large amounts of endoplasmic reticulum, which is needed for synthesis of ECM.*
In Vivo A prospective observational study performed by Nadal et al demonstrated the effects of Tendon & Ligament Support on the health
of epicondyles, plantar fascia, Achilles tendons, or supraspinatus tendons. Patients were selected on the basis of clinical assessment
and ultrasound results. For three months, all of the patients received 20 to 30 physical therapy sessions and the study group received
two caps/d of Tendon & Ligament Support. Comfort, quality of life (SF-36), and physiotherapist assessments were performed before
intervention began and also at 30-, 60-, and 90-day intervals during intervention. In every assessment, patients given Tendon & Ligament
Support showed numerical or statistically significant improvements after two to three months of supplementation compared to controls.
Researchers concluded that supplementing with Tendon & Ligament Support improved comfort level and biomechanical properties without
Several other human studies using Tendon & Ligament Support have demonstrated its positive effects on tendon comfort and structure.[8-10]
For instance, in a randomized placebo-controlled study (n = 60) designed to test the effects of Tendon & Ligament Support versus placebo
on Achilles, supraspinatus, lateral epicondyle, and plantar fascia comfort and tendon structure, Binh et al found that subjects taking Tendon
& Ligament Support (two caps/day) had significantly greater comfort at 90 days. At the end of the study, ultrasound assessment showed
no signs of structural issues in the supplemented group. In a prospective, randomized, controlled trial, 59 subjects were assigned to one
of three groups: eccentric training, eccentric training plus Tendon & Ligament Support, or passive stretching plus Tendon & Ligament
Support. Compared to physical therapy alone, the researchers found that supplementation with Tendon & Ligament Support provided
additional benefits associated with comfort at rest and exercise recovery as well as changes in tendon thickness and vascularization in
1. Shakibaei M, Buhrmann C, Mobasheri A. Anti-inflammatory and anti-catabolic effects of TENDOACTIVE® on human tenocytes in vitro.
Histol Histopathol. 2011 Sep;26(9):1173-85. [PMID: 21751149]
2. 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 Jun;4(2):219-24. [PMID: 17549239]
3. Grosso G, Bei R, Mistretta A, et al. Effects of vitamin C on health: a review of evidence. Front Biosci. 2013 Jun 1;18:1017-29. [PMID:
4. Omeroğlu S, Peker T, Türközkan N, et al. High-dose vitamin C supplementation accelerates the Achilles tendon healing in healthy rats.
ArchOrthop Trauma Surg. 2009 Feb;129(2):281-86. [PMID: 18309503]
5. Zanoni JN, Lucas NM, Trevizan AR, et al. Histological evaluation of the periodontal ligament from aged Wistar rats supplemented with
ascorbic acid. An Acad Bras Cienc. 2013 Mar;85(1):327-35. [PMID: 23460436]
6. Shakibaei M, Csaki C, Mobasheri A. In vitro study of tendinopathy in humans: report on adhesion and proliferation assay, electron
microscopy, immunofluorescence, and western blot analysis with Bioiberica compounds. Barcelona, Spain: Bioiberica, S.A.; 2006. [on file]
7. Nadal F, Bové T, Sanchís D, et al. Effectiveness of treatment of tendinitis and plantar fasciitis by Tendoactive™. [OARS abstract 473].
Osteoarthritis Cartilage. 2009 Sept; 17(suppl 1):S253.
8. Hai Binh B, Ramirez P, Martinez-Puig D. 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. 2014;73:299.
9. Balius R, Alvarez G, Barb F, et al. Management of Achilles tendinopathy in reactive versus degenerative stage: a prospective,
randomized, controlled trial evaluating the efficacy of a dietary supplement associated to eccentric training or passive stretching. Ann
Rheum Dis. 2014;73:299-300.
10. Arquer A, Garcia M, Laucirica JA, 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):31-36. http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_
en&fichero=276v49n182a90346457pdf001.pdf. Accessed January 7, 2016.