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Musculoskeletal Healing Supplements: A Summary

By Renata Trister, DO


Musculoskeletal Healing Supplements: A Summary

When injury to a ligament or tendon occurs, a sequence of events begins that initiates healing. The healing process involves inflammation, repair, and remodeling. Research suggests that modulation of these events can be achieved nutritionally, to speed up tissue healing and recovery time.

The Inflammatory Response

Inflammation is in fact a protective and restorative response to injury. However, when inflammation becomes excessive or prolonged it may be harmful to the body. The classic signs of inflammation local redness, swelling, heat, pain, and loss of function are caused and regulated by the activity of a large number of chemical mediators, including eicosanoids.

Eicosanoids There are anti-inflammatory eicosanoids and inflammatory eicosanoids. The standard American diet promotes the production of those that are inflammatory. Fortunately, many substances inhibit inflammatory eicosanoids or promote the production of anti-inflammatory eicosanoids a classic mechanism for controlling inflammation.

Nutrients & Herbs That Modulate the Inflammatory Response

Essential Fatty Acids Omega-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are precursors of primarily anti-inflammatory eicosanoids. In addition, the omega-6 fatty acid, gamma-linoleic acid (GLA), also supports the production of anti-inflammatory eicosanoids.

Ginger (Zingiber officinale) and Turmeric (Curcuma longa) These herbs have long been used in folk medicine for a variety of both acute and chronic inflammatory conditions. Studies suggest that both herbs may block activity of the enzymes cyclooxygenase and lipoxygenase. These enzymes are necessary for the production of inflammatory eicosanoids.

Cayenne Pepper (Capsicum annuum) Capsaicin, the main constituent of cayenne pepper, may play a role in inhibiting inflammatory eicosanoid synthesis by blocking cyclooxygenase activity.   Capsaicin may also reduce tissue sensitivity by selectively depleting a neuropeptide needed to transmit pain impulses to the central nervous system.

Boswellia Boswellia gum resin, derived from the Boswellia serrata tree, is a traditional Ayurvedic remedy used for inflammation. Boswellic acids, the main constituents of the gum resin, have been found to specifically inhibit 5-lipoxygenase. Preliminary research also suggests that boswellic acids may inhibit the complement system—a part of the immune system whose sustained activation is implicated in a variety of inflammatory disorders.

Bioflavonoids Bioflavonoids, such as quercetin, are an extensive group of compounds present throughout the plant kingdom.  Their roles in addressing injury, pain, and inflammation include antioxidant activity and protection of connective tissues, inhibition of enzymes involved in inflammatory eicosanoid production, and inhibition of cell movement to the site of inflammation.

Proteolytic Enzymes The anti-inflammatory effects of proteolytic enzymes, flavonoids, and vitamin C in comparison to NSAIDs

The term “proteolytic” refers to the group of enzymes that break down proteins. In the body, proteolytic enzymes including trypsin, chymotrypsin, bromelain, and pancreatin are produced in the pancreas. Because numerous studies have revealed their wide ranging benefits, these enzymes are available in supplemental form.

According to Dr. J.P. Tarayre and Dr. H. Lauressergues in Drug Research, “The proteolytic enzymes, trypsin and chymotrypsin in particular, possess anti-inflammatory properties which have been known for some years now.” Additional research has demonstrated the ability of proteolytic enzymes to accelerate recovery after minor injury and reduce the pain and stiffness that often accompany rheumatoid arthritis.

To further confirm these findings, researchers compared the anti-inflammatory effects of trypsin and chymotrypsin to seven well known non-steroidal anti-inflammatory drugs (NSAIDs). The proteolytic enzymes were combined with flavonoids and vitamin C other substances known to reduce inflammation.

Researchers injected carrageenan a seaweed extract that has been shown to induce inflammation and edema in the hind paw of experimental rats. After determining the degree of inflammation and swelling in each animal, researchers examined the anti-inflammatory effects of trypsin and chymotrypsin combined with flavonoids and vitamin C.

Researchers concluded that “The combination studied…shows a more [profound] action than that of the non-steroidal anti-inflammatory substances [without] any side effects.”


Nutrients Involved in Connective Tissue Repair

Controlling inflammation is directly linked to the next phase of the healing process repair and remodeling. Following connective tissue injury, it is critical to supply the raw materials and proper nutrients that support tissue recovery and new tissue synthesis. These include:

Amino Acids Supplying amino acids may support the formation of collagen a critical connective tissue. Collagen fibers are made up of long chains of amino acids, of which one-third is glycine. Proline, hydroxyproline, and hydroxylysine are also prevalent.

Bioflavonoids Bioflavonoids are thought to benefit connective tissue by preventing the degradation of elastic  fibers via inhibition of enzymes released as a result of inflammation.

Glucosamine and Chondroitin Sulfate Glucosamine and chondroitin sulfate are building materials that are vital for the synthesis of new connective tissue as well as for the healing process. In addition, supplemental use in those with arthritis has been reported to result in decreased pain and inflammation.

Antioxidants It is thought that excessive free radical production is a major consequence of the inflammatory response—may aggravate an injury, propagate the inflammatory process, and delay or prevent adequate healing. Vitamins E and C are major antioxidants that quench free radicals in most tissues. Additionally, vitamin C is required for collagen fiber synthesis, a vital process for tissue repair and healing. Copper, zinc, and manganese further protect tissues by supporting the activity of superoxide dismutase—an enzyme that converts damaging superoxide free radicals into less harmful molecules.

Effects of copper supplementation in rheumatoid arthritis patients

Copper is an essential trace mineral that may facilitate the activity of ceruloplasmin and copper-zinc superoxide dismutase. These compounds have antioxidant and anti-inflammatory properties that may prevent the onset of chronic joint conditions.

However, according to Dr. Robert DiSilvestro and colleagues in the Journal of the American College of Nutrition, “Several surveys have shown that copper consumption of many Americans falls below even the Estimated Safe and Adequate Daily Dietary Intake recommended for healthy people…”

Copper deficiency can be caused by anemia, protein malnutrition, and frequent diarrhea. A deficiency in copper resulting in reduced activity of ceruloplasmin and copper-zinc superoxide dismutase may be associated with the onset and continuation of rheumatoid arthritis. In fact, it has been shown that patients diagnosed with rheumatoid arthritis show serious copper deficiencies.

Investigators conducted a study in which 23 rheumatoid arthritis patients received 2 mg per day of copper supplementation for 4 weeks. As a means of comparison, investigators also recruited 47 healthy volunteers. Upon completion of the study, investigators noted that copper supplementation increased copper-zinc superoxide dismutase activities by 21% in 18 of the 23 rheumatoid arthritis patients.

Homeopathic Remedies

Homeopathic remedies for injury have been used for over 100 years. Believed to provide an “energetic” stimulus to the natural healing qualities of the body, homeopathic remedies are reported to be highly effective and safe.

Muscle Mechanics, Relaxation, and Rest

Proper muscle use, joint alignment, and biomechanics during tissue remodeling are critical for preventing reduced range of motion due to scar tissue formation. In addition, injury can give rise to increased anxiety, stress, and poor sleep, resulting in prolonged and unfavorable healing. Calcium, magnesium, and various herbs, including passion flower, valerian root, hops and kava root, promote relaxation of the muscles and help to reduce the psychological anxiety and stress resulting from injury.


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