Why Tendons and Ligaments Heal More Slowly Than Muscle

Hello everyone,

I often get the question why certain injuries take a while to heal. It is very normal to get impatient with healing time and expect some pains to reduce quickly. However, some soft tissue pains or injuries take a longer time that what we would expect or want. What you have to remember is that healing time is a very finite time. With treatment and proper rest and nutrition, healing time soft tissue can be shortened somewhat. Let's discuss why certain soft tissues of the body heal faster than others.

The most common soft tissue injury is the strain of a muscle, or "pulling a muscle". The next most common would be a sprain, or the tearing of a tendon or ligament. Now remember that tears can be very mild to severe, including full avulsion which is when the ligament or tendon completely separates from the bone. Ligaments and tendons are much stronger tissue than muscle, and they are supposed to be because of the function that they perform. Ligaments hold bone to bone together, and tendons hold bone to muscle, so they have to be very strong tissue. Muscles are only meant to contract, not hold things together, and they require a lot of oxygen in order to contract over and over again. To supply this oxygen, they have a very good blood supply. In order to have a good blood supply, there has to be a lot of blood vessels within the tissue. The blood vessels that travel through the muscles are very spongy and therefore make the muscle tissue somewhat spongy, which is what makes them susceptible to injury, but they need the good blood supply to perform properly. The excellent blood supply is also what allows them to heal very quickly when they are injured, and that is why strained muscle tend to feel better even after a week or so, depending on the severity of the injury or strain.

Tendons and ligaments have a very poor blood supply meaning that they do not have any blood vessels that travel through them, which is what makes them very strong and resistant to stretch. This is also why the do not heal quickly, because they lack a direct blood supply. Now some of you may be asking, then how do they get what they need to heal. The materials that they need to heal are supplied to the body in the blood, and then are transferred to the tissue thru the fluid that leaves the blood flow carrying the needed materials. Therefore, ligaments and tendons need to be constantly "bathed" with this fluid since they do not have a direct blood supply within them as muscles do. This is why they take longer to heal than muscle. This is also why movement helps them to heal more quickly because movement of the soft tissue helps with the "bathing" process. To read more in dept on the "bathing" process, please read my article titled "Why I Feel Worse In The Morning".

So...since increased blood flow helps to heal these tissues, any thing that increases blood flow will aid the healing process, such as: applying heat, such as heating pad or hot shower; movement of the body; massage; ect. Please remember that although healing tissue can feel better quickly with home treatment, it is still healing and can be easily injured again if the same force is applied to the tissue. So remember that healing time needs to be kept in mind and adhered to so that full healing is allowed to occur. So don't get frustrated when a bad sprain injury, such as a sprained ankle, can take months to look and feel back to fully normal.

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Thanks for reading,

Dr. Mckim