Why Do Torn Tendons Heal So Slowly?
The Science, the Risks, and the Human Side of Recovery
If you’ve ever torn a tendon—whether from sports, an accident, or just the unpredictability of life—you know how long and frustrating the healing process can be. I’m living this right now: after a recent bicycle accident, I injured my shoulder and am feeling firsthand how slow, uncertain, and sometimes worrying recovery can be. Let’s explore why tendons heal so slowly, the real risks (including surgery), and what happens in our minds as we come to terms with injury.
Why Tendons Take So Long to Heal
Tendons are the tough, fibrous tissues connecting muscle to bone. Their dense structure makes them incredibly strong, but also notoriously slow to heal.
Low Blood Supply: Tendons don’t get much blood flow, so healing cells and nutrients arrive slowly (Kjaer et al., 2009).
Complex Collagen Structure: Repairing and realigning the tough collagen fibers takes time—often months, sometimes longer (Jarvinen et al., 2002).
Constant Stress: Every movement puts your tendons under tension. Even small, everyday motions can disrupt early healing, while too much rest can lead to stiffness and scar tissue (Magnusson et al., 2010; Schleip et al., 2010).
The Healing Process
Tendon healing happens in three overlapping phases:
1. Inflammation: The body clears out damaged tissue (a few days to a week) (Hyman & Rodeo, 2000).
2. Proliferation: New collagen is laid down—initially weak and disorganized (several weeks) (Kjaer et al., 2009).
3. Remodeling: The new collagen aligns and strengthens, but this can take months or even years (Hyman & Rodeo, 2000).
The Real Risk: Re-Injury and Rupture
Here’s something I’m acutely aware of with my own shoulder: after an injury, the tendon is vulnerable.
Further Damage: If you push too hard or move in the wrong way, the healing tendon can tear again—or, in the worst case, rip completely away from the bone (a rupture) (Hyman & Rodeo, 2000).
Surgery May Be Needed: A full rupture almost always requires surgery to reattach the tendon, followed by a long rehab process (AAOS, 2024).
Shoulder Example
The shoulder is a classic trouble spot. After a fall or accident, tendons like the rotator cuff are at risk. Any sharp pain or “warning signal” from your body is there for a reason: it’s your system telling you to stop and protect the healing tissue (Magnusson et al., 2010).
What If a Tendon Tears Completely? Surgery, Success Rates, and Recovery
When Is Surgery Needed?
If a tendon fully ruptures (tears away from the bone), surgery is usually needed to reattach it. This is common with severe shoulder injuries, such as rotator cuff or biceps tendon tears (AAOS, 2024).
How Successful Is the Surgery?
Shoulder (Rotator Cuff) Repairs:
About 80–90% of people experience significant pain relief and improved function after surgery (DeOrio & Cofield, 1984; Galatz et al., 2004).
Most regain good use of their shoulder, though full strength and flexibility can take 6–12 months of rehab (AAOS, 2024).
The risk of the tendon re-tearing after surgery is about 10–30%, higher for older adults or those with severe tears (Galatz et al., 2004).
Other Tendons (e.g., Biceps, Achilles):
Success rates for restoring function and reducing pain are also very high—typically 80–95% (AAOS, 2024).
Most people return to daily activities and, with commitment to rehab, even sports (AAOS, 2024).
What to Expect from Rehab:
Physical therapy starts gently, focusing first on protecting the repair, then gradually restoring movement and strength (AAOS, 2024).
It’s a marathon, not a sprint—most people need at least 6 months, sometimes up to a year, too feel “normal” again (AAOS, 2024).
Commitment and patience really pay off (AAOS, 2024).
Living With the Worry: The Psychology of Injury
Since my accident, I’ve been hyper-aware of every movement—especially those that trigger that sharp, unmistakable pain. It’s not just physical; there’s a lot of anxiety that comes with the fear of making things worse, or even needing surgery.
What Happens in Our Minds?
Vigilance: After injury, it’s natural to constantly monitor your body for danger signals. Pain becomes a warning system, sometimes making us overly cautious (Engel, 1977).
Fear and Anxiety: Worry about re-injury or surgery can be overwhelming. Sometimes, the mind gets stuck in a cycle of “What if?”—what if I damage it again, what if I never recover? (Lugg, 2022).
Identity and Acceptance: Injuries can shake our sense of self, especially if we’re active or rely on our bodies for work or joy. Accepting new limitations—even temporarily—can feel like a loss (Lugg, 2022).
The Biopsychosocial Model: Recovery isn’t just about the biology of healing. Our thoughts, emotions, and social support all play a huge role in how we experience pain and how well we recover. Anxiety, stress, and fear can actually amplify pain signals and slow healing (Engel, 1977; Lugg, 2022).
How Do We Cope?
Listening to Pain: That sudden, sharp pain is your body’s way of saying “not yet”—a built-in safety mechanism to prevent further injury (Magnusson et al., 2010).
Self-Compassion: It’s okay to feel worried or frustrated. Acknowledging your concerns is part of the healing process (Lugg, 2022).
Support: Talking to professionals, friends, or others who’ve been through similar injuries can help you process the emotional side (Lugg, 2022).
Gradual, Guided Movement: Movement is essential—but only within a safe, pain-free range. Overdoing it can set healing back, but total rest can lead to stiffness and adhesions (Schleip et al., 2010).
Key Takeaways
Torn tendons heal slowly due to limited blood flow, dense structure, and constant mechanical stress (Kjaer et al., 2009; Jarvinen et al., 2002.
After injury, tendons are at real risk of further tearing or even rupture—especially in high-mobility joints like the shoulder (Magnusson et al., 2010).
Surgery for tendon reattachment is highly effective, especially when followed by proper rehab, but recovery takes time and patience (AAOS, 2024; Galatz et al., 2004)
Recovery is not just physical—managing fear, anxiety, and expectations is a vital part of the healing journey (Engel, 1977; Lugg, 2022)
If you’re recovering from a tendon injury or facing surgery, you’re not alone. Support, patience, and self-compassion are as important as any treatment (Lugg, 2022).
If you’re dealing with a tendon injury—especially in a complex joint like the shoulder—know that you’re not alone. If you have questions or want support (physical or emotional) during your recovery, feel free to reach out or book a session.
Read more:
Blog Post: Unveiling the mystery of wound-healing
References
- American Academy of Orthopaedic Surgeons (AAOS). (2024). [Rotator Cuff Repair](https://orthoinfo.aaos.org/en/treatment/rotator-cuff-repair/) & [Achilles Tendon Repair](https://orthoinfo.aaos.org/en/treatment/achilles-tendon-repair-surgery/)
- DeOrio, J.K., & Cofield, R.H. (1984). Results of a Second Attempt at Surgical Repair of a Failed Initial Rotator-Cuff Repair. _The Journal of Bone and Joint Surgery_, 66(4), 563-567.
- Engel, G. (1977). The Need for a New Medical Model: A Challenge for Biomedicine. _Science, 196_(4286), 129–136.
- Galatz, L.M., et al. (2004). The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. _J Bone Joint Surg Am_, 86(2), 219-224.
- Hyman, J., & Rodeo, S.A. (2000). Injury and repair of tendons and ligaments. _Physical Medicine and Rehabilitation Clinics of North America, 11_, 267–288.
- Jarvinen, T.A. et al. (2002). Organization and distribution of intramuscular connective tissue in normal and immobilized skeletal muscles. _Journal of Muscle Research and Cell Motility, 23_, 245–254.
- Kjaer, M., et al. (2009). From mechanical loading to collagen synthesis, structural changes and function in human tendon. _Scandinavian Journal of Medicine & Science in Sports, 19_, 500–510.
- Lugg, A. (2022). Chronic pain and the biopsychosocial model. _Structure, Function, Integration_.
- Magnusson, S.P., Langberg, H., Kjaer, M. (2010). The pathogenesis of tendinopathy: balancing the response to loading. _Nature Reviews Rheumatology, 6_, 262–268.
- Schleip, R., Zorn, A., Klingler, W. (2010). Biomechanical Properties of Fascial Tissues and Their Role as Pain Generators. _Journal of Musculoskeletal Pain, 18(4)_, 393–395.
Professional qualifications
- Sharon Wheeler's ScarWork™ refers to the specific methodology developed by Sharon Wheeler
- All trademarks mentioned remain the property of their respective owners
Professional standards All medical and scientific statements are based on current research and professional experience. As an alternative practitioner in training, I work according to the strict guidelines of the German Alternative Practitioners Act.
About the author:
Tobias Elliott-Walter is a certified Rolfer® (European Rolfing® Association, Munich) and ScarWork™ practitioner for integrative scar work. His expertise is based on practical experience and continuous training in fascia work. As a practicing therapist in Saarbrücken, he combines scientific knowledge with practical application.
His qualifications include:
- Certified Rolfer® (European Rolfing® Association, Munich)
- ScarWork™ practitioner for integrative scar work
- Certified Sivananda Yoga Teacher (Bahamas Ashram, 2018)
- Alternative practitioner in training
His holistic approach is based on the conviction that physical and mental well-being are inextricably linked. Thanks to his international professional experience, he offers treatments in both German and English.
Important note:
This article is for information purposes only and does not replace medical advice. The information shared here is based on current scientific research and practical experience. If you have any health complaints, please consult your doctor or therapist.
© 2025 Tobias Elliott-Walter. All rights reserved.
