Will Brink reviews the range of treatments for one of the most common problems faced by strength training athletes - joint pain.
In the past few years, I have noticed an increase in letters and e-mail from people complaining about their joints. In all honesty, I would estimate 80% or more of most body builder's joint pain is avoidable. If you look at people who have chronic joint pain, nine out of ten times, you can see why they would have an aching appendage that causes them pain. More often than not, they (1) rarely warm-up adequately, (2) they train too long and/or too often, (3) they use overly heavy weights/low reps more often than they should, (4) they don't take time off to allow their joints, tendons, muscles, etc., to recuperate from heavy workouts, (5) they use less than perfect form during heavy lifts, (6) they don't take in adequate nutrients, or (7) all of the above!
Now, of course, we have all had an ache or pain in a knee, elbow, or another joint at times, but the chronic long-term pain is another story. This article is going to assume that the reader has joint pain NOT because he (or she) is making any one of the above seven common mistakes but has joint pain due to some other factor out of their control. If you warm-up and stretch thoroughly, train for no longer than an hour three-four days per week, cycle your weights and reps, take time off when you need it, have good form, take in adequate nutrients, and still have joint problems... than this might be the article for you.
Types of joint problems
There are, of course, different types of problems that cause common joint pain in athletes and "normal" people alike. Bursitis, tendinitis, various types of arthritis, and other afflictions, can be the cause of a person's aching joints. Briefly, here is a description of the most common types and causes of joint pain that afflict athletes:
Arthritis: There are many different forms of arthritis. The two most common are osteoarthritis and rheumatoid arthritis. Of the two, osteoarthritis is by far the most common to bodybuilders and other athletes. Caused by wear and tear on the joints, osteoarthritis is characterized by a deterioration of the cartilage at the ends of the bones. The once smooth cartilage becomes rough, thus causing more and more friction and pain. Left untreated and unchecked, this can become very debilitating for the hard training athlete. Chronic osteoarthritis has ended the career of numerous athletes.
Bursitis: In our joints, there are small fluid-filled sacks called bursae. The bursae's job is to assist in the muscle/joints movement by cushioning the joints and bones against friction. If these sacks become inflamed and/or injured due to various causes (see above training mistakes), a chronic pain called "bursitis" can result. It is most often found in the shoulder or elbow (A.K.A tennis elbow) but can also be found in other joints of the body. It hurts like hell and can ruin a workout quickly if left untreated.
Tendonitis: Tendonitis is the most common cause of pain to bodybuilders and other athletes and is (luckily) the easiest to treat. However, if left untreated and the person "works through the pain," it can become a real problem that will put a quick end to your gains in muscle. Tendinitis means the tendon(s) around a joint have become severely inflamed from overuse, micro-injury, etc. Though it might sound simple enough, for people who suffer from chronic tendinitis, it's no joke and a real pain in the joint!
Again, this article is going to assume that the reader warms up properly before working out, does not severely over train, as mentioned at the beginning of this article. If the reader (you?) is in the gym all day, thinks one set on the bench press is a warm-up and feels anything over three reps is high rep training, then you need go no further to find the answers to what is bothering your joints!
The treatment options we are going to look at, relate to natural compounds, or mixtures of natural compounds, that could save a person with aching joints years of pain and even more. Unfortunately, the treatments offered by traditional medicine at this time are of little use to highly active people. Most of the treatments for joint problems address the symptoms (pain, swelling, etc.) rather than the cause and can often make the problem worse in the long run. Non-steroidal anti-inflammatory, cortical steroid injections, joint replacement, and the always useful "stay off it" advice does not tend to yield the results most athletes want.
If you look at the names of the aforementioned types of joint problems, you will notice they all end with the term "itis," as in tendin-itis, arthr-itis, and burs-itis. The suffix "-itis" means "inflammation of " according to The American Medical Association Encyclopaedia of Medicine. Knowing this, you can see that bursitis means inflammation of the bursae sack, tendinitis means inflammation of the tendons, and arthritis means....well you get the point. Medical terms for afflictions that end in "-itis" tell us that though the causes and manifestations are different, the final problems is one of inflammation.
Inflammation is characterized by pain, swelling, redness, and less obvious symptoms. This leads us finally to our list of natural compounds/products that might save the joints of the person reading this article who thought their workouts would never be the same because their joints are giving them so much trouble. These products tend to address not only the symptoms of the problem that is the inflammation-but the underlying causes as well.
As strange as it might seem, the main ingredient (gelatin) in good old Jello might be just what the doctor ordered for painful joints. Gelatin has been market world-wide for many years as a food and as a supplement. Gelatin is made from animal collagen. In all animals-including man- collagen is an essential structural protein that forms an important part of bones, tendons, and connective tissues. It is a tough insoluble protein that is essential for keeping the many cells and tissues of the body together. Gelatin contains an exceptionally high content of two amino acids that play an important part in collagen formation, namely proline and glycine.
It takes 43 grams of dried egg whites or 35 grams of dried non-fat milk or 89 grams of lean beef to equal the amount of proline in just 10 grams of hydrolyzed gelatin. Though the body can form these two amino acids on its own, it has been suggested that under certain conditions the rate of synthesis may be insufficient to provide essential body requirements and degradation can exceed synthetic processes (i.e. there is a steady loss of body collagen). The intake of hydrolyzed gelatin appears to be an alternative route to getting chondrocytes (cartilage producing cells) and osteoblasts (bone-forming cells) of the body sufficient amounts of these important amino acids for making structural proteins.
Although chondrocytes are critical for collagen formation, their number is limited and their ability to form this much-needed protein is influenced by heredity, age, physical activity (too little or too much), injury, and availability of nutrients. Although bone metabolism is quite complex and not fully understood, there are a growing number of studies showing the intake of just ten grams per day of hydrolyzed gelatin is effective in reducing pain, improving mobility and overall bone/cartilage health. Several randomized, double-blinded, crossover trials have shown improvements in symptoms related to joint pain (Adem et al. Therapiewoche, 1991). The people at Knox (the Jello people) have made a product specifically for bone health and joints called NutraJoint. It contains hydrolyzed gelatin, calcium, and vitamin C. Calcium is of obvious importance to bone health, and vitamin C is an essential and limiting nutrient for connective tissue formation. NutraJoint is cheap, has no side effects, and tastes good. I recommend one packet mixed with OJ with breakfast for people suffering from joint pain.
A fatty acid with the long and hard to pronounce name of Cetyl Myristoleate has been receiving a good deal of attention from researchers concerned with joint pain and health. Being it's difficult for the reader to pronounce-or for me to write for that matter-I will call it CMT for the remainder of this article, OK?
Discovered by a researcher at the National Institutes of Health (NIH), CMT looks very promising as a compound that reduces joint pain due to a variety of causes. In animals, CMT was found to be very protective of joints from different chemicals that would normally cause arthritis in these animals. Though human research at this time is not as solid as we would like, CMT has already developed a following with some alternative medical practitioners and by those who suffer from joint pain. Several bodybuilders, I work with swear by the stuff though I cannot vouch for it at this time as I have had no personal experience with this product. Also, its effects seem to work quickly, and relatively small amounts can be used. 12-15 grams spread out over an entire month appear to be effective. Exactly how CMT works is unclear but it might have something to do with a reduction in pro-inflammatory prostaglandins (see below) or some other mechanism. (Diehl & May 1994; Cochran & Dent 1997)[1,2]
Flaxseed oil for everything!
Many bodybuilders and other athletes are starting to see the many benefits of flaxseed oil for all sorts of uses. One obvious use of flaxseed oil is a reduction in pain due to any inflammatory condition, including joint troubles. To understand why this is so, the reader must now endure a crash course on the topic of essential fatty acids and the many products made by these fatty acids found in the body. If you already know all this stuff, you can skip over this material, but if you don't know it, you will need this information for the rest of the article.
The definition of an essential nutrient is anything the body cannot make itself and therefore, must be obtained from the diet. We need to eat an assortment of vitamins and minerals, nine to eleven amino acids, and two fatty acids to stay alive and healthy. The two essential fatty acids (EFAS) are called linoleic acid and alpha-linolenic acid. The first being an Omega-6 fatty acid and the latter being an Omega-3 fatty acid. If the term "Omega-3 fatty acid" rings a bell for you, it should. Fish oils are also well publicized and researched Omega-3 fatty acids (see below) that have been shown to have many benefits. "So what does all this have to do with my aching joints?" you are thinking. Ok, here is the skinny on why you had to endure that previous section. Flaxseed oil is exceptionally high in Omega-3 fatty acids (alpha-linolenic acid). Omega-3 fatty acids, from fish, flax, etc., have been shown in the scientific/medical literature to reduce inflammation of any kind.
Remember the "-itis" part of the word relating to joint problems? How do you think non-steroidal anti-inflammatories work? They reduce inflammation, but they also come with potential side effects and health problems. So how does flaxseed oil do this wonderful thing? From both of the essential fatty acids, the body makes something called prostaglandins. Prostaglandins are very short-lived hormone-like substances that regulate cellular activity on a moment to moment basis. Prostaglandins are directly involved with regulating blood pressure, inflammatory responses, insulin sensitivity, immune responses, anabolic/catabolic processes, and hundreds of other functions known and yet unknown. The long and the short of all this, without going into a long and boring biochemical explanation, is: Omega 3 fatty acids are responsible for forming the anti-inflammatory prostaglandins, and the Omega-6 fatty acid is responsible for making many of the pro-inflammatory prostaglandins, and other products derived from EFAS. A high intake of Omega 3 oils reduces inflammation (and pain) by this mechanism. It is a lot more complicated than that, but hey, I only have so much space to write.
People, who add in 1 to 3 tablespoons a day of flaxseed oil to a protein drink, or over a salad, often notice a reduction in pain in their joints, not to mention all the other great things EFAS can do for the hard training bodybuilder. Flaxseed oil can be found in any large health food store under such brands as Flora, Omega, Barleans, and several other names. Even better than flax, Udo's Choice oil is a great blend of different oils.
High quality kitchen sink formulas
I call these products "kitchen sink formulas" because they add in about everything you could want in a formula for painful joints. Two-high quality products of this type that come to mind are the Natural Pain Relief products by Inholtra and The Life Extension Foundation. These products contain Glucosamine(s), Chondroitin Sulphate, the fish oils EPA/DHA, Gamma-linoleic acid (GLA), vitamin E, fat-soluble vitamin C (ascorbyl palmitate), and Manganese aspartate. "So, what does all this stuff do?" you are asking yourself. Briefly:
Glucosamine is considered by many as one of the best natural products for the treatment and prevention of cartilage degeneration. It is an essential part of cartilage, synovial fluid, and other components of joints. Chondroitin sulphate is related to glucosamine and is part of a family of modified sugars that form structural molecules in cartilage. As mentioned previously, the Omega 3 fish oils (EPA/DHA) are renowned for improving pain and inflammation in joints and other areas of the body. GLA is a fatty acid derived from the Omega-6 class of fatty acids. Still, it has been shown to have many properties similar to that of the fish oils/flaxseed oil in its ability to reduce inflammation through the production of favourable anti-inflammatory/anti-autoimmune prostaglandins.
The antioxidants vitamin E and C are added because it is well known that free radical pathology is part of the damage that takes place in the joints. Finally, the trace element manganese is needed as a co-factor in many enzymatic processes related to cartilage synthesis and cartilage integrity. Now you know why I call them kitchen sink formulas! Taken singularly, the above ingredients have marginal effectiveness. Taken as complex, they are very synergistic. These are very well rounded and complete-though slightly different-formulas for people looking for some relief to their joint troubles, or any chronic inflammatory condition for that matter. However, I have found most people will need to take more than the manufacturer recommends seeing real results, though this is not true, 100% of the time.
Conclusion and Recommendations
If you are one of the millions of people who suffer from chronic joint pain when you hit the gym, first make sure you are not making any of the most common mistakes outlined at the beginning of this article. Secondly, get an opinion from a good sports medicine doctor as to exactly what your problem is. You don't want to self-diagnose what could be a serious problem. Finally, start with one of the above products and see if it improves your condition. Wait at least a few months before you make your assessment. Add in a second or third product if you don't think you are getting the results you want, which would be of course less pain and greater mobility through the joint in question. Hey, I never said it was going to be cheap and easy, but if the serious joint pain is taking all the fun out of your workouts, it will be worth your time and money. See you at the gym.
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About the Author
William Brinks is a columnist, contributing consultant, and writer for various health/fitness, medical, and bodybuilding publications in the USA. He lectures on the benefits of weight training and nutrition around the U.S. and Canada and has worked with athletes ranging from professional bodybuilders, golfers and fitness contestants.