LL-37 alongside oral BPC arginate for a slow-healing Achilles, redundant or actually useful?

Question

To be fair I've been stuck on this Achilles tendinopathy for like 4 months now, oral BPC arginate has helped but I keep hitting a plateau around week 10ish. Doing the boring rehab stuff too, heavy slow resistance, calf eccentrics, the whole deal. Been reading up on LL-37 since it's supposedly antimicrobial AND promotes angiogenesis and re-epithelialization, which sounds like it could move the needle on the stubborn tissue remodeling part. My logic is BPC is doing the growth factor / NO modulation side of things and LL-37 might bring the immune signaling + new blood vessel piece. Anyone actually stacked these two or am I overthinking it? Curious if LL-37 is something people run for tendon stuff or if it's mostly a wound healing / skin thing. Also wondering about timing, like would morning LL-37 and evening BPC make sense or does that even matter at the 4-6hr half life range.

patient_codes · Accepted Answer

Honestly LL-37 is mostly studied in skin/wound models, not tendon, so you're kind of extrapolating there. The angiogenic piece does show up in some of the animal literature but that's a big leap to a human Achilles 🧠 What actually broke my plateau on a cranky tib post was honestly just adding isometrics, like a 45 second wall sit type hold for the calf, 2x a day for 2 weeks before I even started loading. Pain dropped noticeably, then the BPC seemed to actually have something to work with. On timing I don't think splitting them AM/PM is doing much mechanistically, the half life thing you're talking about applies to plasma levels not necessarily local tissue effect. If you're gonna run both I'd probably just keep it simple, same time daily, and see if the plateau budges in another 4-6 weeks before adding another variable. Have you tried blood flow restriction on the calf work? That was the other thing that seemed to help me.

leah_vo2max · Answer

Yeah the extrapolation thing is fair, I kinda knew that going in but was hoping someone had tried it anyway. To be fair the skin wound literature is pretty robust but tendon is a different animal literally. The isometric angle is interesting though, I've been going straight into eccentrics without really doing a loaded hold phase first. When you say wall sit type hold, are you talking like a single leg calf raise hold at the top or literally a wall sit with feet flat? Cause I could see the sustained tension hitting the achilles differently than the eccentric drop. Might try adding that in for a couple weeks before I scrap the BPC and try something else.

grinder265 · Answer

Yeah the skin vs tendon gap is real, ngl that's the part that gives me pause too. But the angiogenic mechanism is at least general enough that I'd expect some carryover, not trying to oversell it. Isometrics before loading is interesting tho, I've been skipping straight to HSR. Gonna try wall sit holds first for a couple weeks and see if the tissue calms down before I load. Does it matter if I'm doing them on a step vs flat floor for the Achilles specifically?

leah_vo2max · Answer

To be fair the angiogenesis argument is what keeps me from fully dismissing it too, like the mechanism should theoretically apply to tendon even if most of the data is skin and wound stuff. For the isometrics, flat floor is probably safer to start, doing them on a step puts you straight into dorsiflexion stretch which is basically loading + stretch at the same time and that kinda defeated the whole point for me when I tried it too early. Wall sit holds or just standing bilateral calf holds on flat ground, 45 sec x 5, that calmed mine down way more than I expected before I went back to HSR. Are you doing both legs or just the injured side? Bilateral lets you keep the total load lower which helped me not flare it up.

LL-37 alongside oral BPC arginate for a slow-healing Achilles, redundant or actually useful?

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