I got a really interesting question a few days back from someone 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.
This question is great. I love it when someone asks about a topic in an informed and constructive manner. First of all, you have to remember that “degeneration” doesn’t always equate to “destruction”. Degeneration in the context of tendonosis (or fasciosis) can mean several things, one of which is the destruction of the collagen fibers. This is sometimes seen with Levaquin patients, and in those cases recovery normally does take several months, if it happens at all. 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 bind 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 competent physical therapist can ordinarily find these areas just by feeling along the muscle. Then s/he can use finger pressure to break up the adhesions and get the muscle back into proper working order.
With tendons and fascia, the situation isn’t as clear. One factor is that collagen doesn’t contract…but it does stretch and have some tensile strength. Perhaps because of this, simple finger pressure or massage is typically 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 the way muscle fibers do, the theory is that the collagen fibers somehow get intertwined, developing what could 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 type of “collagen comb” that could go through the fibers and straighten them out would be ideal. But since that’s not possible, the next best thing is specialized exercises that, over the course of a couple of weeks, will generally accomplish the same effect. You don’t need to go to a lot of expense on this, either. There is a large body of research that indicates 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” treatments.