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Nutrition Joint supplements for golfers elbow - could they make things worse by interfering with processes?

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BennyWalks

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After @LukeV 's post here Joint health supplementation , I got to considering trying supplements to help my golfers elbow rehabilitate faster. Additionally to the glucosamine, chondroitin, hyaluranoic acid, vitamin d, and multivitamin I already take.

First looked at astaxanthin and it looks promising - Knee Pain? Elbow Pain? Astaxanthin Will Help!

Long story short, I'm already on top of a basic rehab protocol, and going to do more research. Additionally, I'm willing to try supplements to help it heal as quickly as possible. I understand that the efficacy of supplements is debated. This is an extreme priority so I don't care about potentially wasting a small amount of money.

My sole concern: if I'm taking something such as astaxanthin...could the healing process actually be disrupted, by the symptoms being masked, resulting in my pushing too hard too early? Astaxanthin is touted as an extreme anti oxidant and increasing blood flow. Other supplements are touted as anti-inflammatory.

It seems common sense that the answer to my question is, 'no, if they do anything they will assist in the natural healing process, this is nothing like medicines which block pain signals (and you are being paranoid).' I was just hoping to get confirmation / refutation / any helpful info from more knowledgeable / experienced / intelligent people than myself, please.
 
Without going into specific supplements, I understand the concern is valid.
 
This was an earlier and more complete post on my recovery from years-long trials with tendonitis

Barbell - Suggestions for training with tendonitis

I was diagnosed with calcific tendonitis in my right elbow a few weeks ago. I know it's in my left elbow as well (old X-rays showed that much). Doc said it's obvious I've had this a very long time. Anyway, I'm not wanting to go the surgery route. He suggested the old ice and ibuprofen routine...
www.strongfirst.com
 
LukeV said:
This was an earlier and more complete post on my recovery from years-long trials with tendonitis

Barbell - Suggestions for training with tendonitis

I was diagnosed with calcific tendonitis in my right elbow a few weeks ago. I know it's in my left elbow as well (old X-rays showed that much). Doc said it's obvious I've had this a very long time. Anyway, I'm not wanting to go the surgery route. He suggested the old ice and ibuprofen routine...
www.strongfirst.com
Click to expand...

Thankyou for this...so as I understand it...

Anti inflammatory drugs not interfering?

(quotes from National Health Service UK)...

'Ibuprofen is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause pain and swelling in the body. ' - So as long as that pain and swelling is not needed for healing- which as far as I know they aren't, no potential problems.

'Paracetamol seems to work by blocking chemical messengers in the brain that tell us we have pain.' - So just steer clear of this sort of thing.

Confused messages

Luke and many others report success with anti-inflammatories. Yet Steven Low's highly regarded article here - Overcoming Tendonitis – Steven Low tells us "There was some debate about whether or not to use NSAIDs on any level for tendinopathy because they decrease inflammation, and inflammation is critical to the healing process. However, since there is limited to no inflammation, analgesics like NSAIDs don’t help with tendinopathy."
 
In my case the advice I received was not just use of anti-inflammatories, but aggressive use of anti-inflammatories. I used ibuprofen at any sign of pain and my doctor was comfortable with me doubling the packet recommended dose for a month or so, when required.

I think perhaps we need to be careful we are talking about the same thing. I consulted a number of health professionals in relation to my elbow tendonitis, over a few years. Every one of whom referred to "inflammation" in the tendon. When I had an ultrasound, the radiologist said she could see the "inflammation" on the scan. At one stage I had a steroid injection that was referred to specifically as a treatment for "inflammation". Perhaps there are tendon issues that do not involve inflammation but mine was not one of those.

As to whether the method of treating the inflammation in order to facilitate tendon healing was the correct approach, I can only speak to my experience which was that it appeared to work.
 
LukeV said:
In my case the advice I received was not just use of anti-inflammatories, but aggressive use of anti-inflammatories. I used ibuprofen at any sign of pain and my doctor was comfortable with me doubling the packet recommended dose for a month or so, when required.

I think perhaps we need to be careful we are talking about the same thing. I consulted a number of health professionals in relation to my elbow tendonitis, over a few years. Every one of whom referred to "inflammation" in the tendon. When I had an ultrasound, the radiologist said she could see the "inflammation" on the scan. At one stage I had a steroid injection that was referred to specifically as a treatment for "inflammation". Perhaps there are tendon issues that do not involve inflammation but mine was not one of those.

As to whether the method of treating the inflammation in order to facilitate tendon healing was the correct approach, I can only speak to my experience which was that it appeared to work.
Click to expand...

I think that time plays into it. For how long did you use the inflammatories?

Some people use some supplements with anti-inflammatory properties year round.

I'd say that in general tendon healing is a very tricky business.
 
Sorry, this turned into a looooong post. I had chronic elbow pain for years and this is what I learned that helped me.

LukeV said:
I think perhaps we need to be careful we are talking about the same thing. I consulted a number of health professionals in relation to my elbow tendonitis, over a few years. Every one of whom referred to "inflammation" in the tendon. When I had an ultrasound, the radiologist said she could see the "inflammation" on the scan. At one stage I had a steroid injection that was referred to specifically as a treatment for "inflammation". Perhaps there are tendon issues that do not involve inflammation but mine was not one of those.
Click to expand...
Agreed. Tendonitis and tendonosis are not the same thing, and so it is important to see if everyone is on the same page regarding the information. I would be curious what those people would say if you asked them to explain what they meant by "inflammation."

Low's article is good, but its long and I don't have the time to re-read the whole thing at the moment, so I'll paraphrase a bit of info that I believe he has somewhere in it.

-Tendonitis = acute inflammation. From what I have read/researched, this kind of injury/condition is the type that reducing stress on the tendon will help heal. The inflammation should do its job and heal an overworked, slightly beat up tendon. The reason the orthos give you cortisone shots is because it reduces acute inflammation. Low calls this phase "reactive tendonopathy."

When I had shoulder issues, they gave me a cortisone shot to test something: if the pain went away after the shot, and I still had pretty good function, then the tendon was still mostly intact. If the pain went away and my shoulder function still suffered, it would mean the tendon was very damaged or torn.

However, most good physios don't seem to think very highly of cortisone these days. In my opinion, if it reduces the pain, and you go back to loading the tendon too much/too early, you are just setting yourself up for a longer haul. So my two cents with anti-inflammatories is: don't use them unless you can't do any day-to-day activities without them. But don't take them to reduce pain and then go do things that would otherwise aggravate the injuries.

-Tendonosis = what most people seem to have. Chronic, long term degeneration of the tissue. At this point, the tendon is a mess. It doesn't work right and hurts because earlier inflammation and continued use of it while it was damaged over time results in collagen fibers being laid down willy-nilly. Low's term "degenerative tendonopathy."

Stephen Low breaks this down:

The best analogies for the fiber structure is:
Healthy tendons: uncooked spaghetti. Long, straight fibers all in line with each other.

Degenerated tendons: Cooked spaghetti; a tangled mess. Does not transfer force well.

The reason for the theory that anti-inflammatories may not work is like Low states: inflammation, rather, the correct amount of inflammation is needed to stimulate repair. By blocking too much of that inflammation, you stall repair.

I believe the theories behind eccentric loading have the most weight. Personally, every time I used heavy eccentrics, it got better. Low also goes into the whole bit about high-rep eccentrics or lower rep, heavy load. The latter seemed to work for me. Eccentrics stimulate the tendon the same way your muscles get stimulated, you are contracting but lengthening. Think as if this action is pulling the cooked spaghetti back into straight strands. This process might stimulate a degree of inflammation that is needed to heal the tendon.

The one thing that many people seem to miss about tendon issues is....biomechanics. Even after resting and doing eccentrics, my elbows would STILL bother me during some moves. Fixing my shoulder biomechanics has eliminated the issue almost entirely. Now it's only extreme load that lights up my elbows (I practice handstands and putting a LOT of pressure into the fingers sometimes does this), but it doesn't stick around.

If you have chronic elbow issues, see a good physio who knows what activities you want to be able to do and have them examine your shoulder mechanics, in pushing and pulling.
 
Sorry that was less about supplementation than tendonophaty in general......

Supplements: there is some debate in the nutrition world as to whether taking collagen supplements helps connective tissue. The reason being that collagen is just made out of proteins. The theory is that if your body is getting enough proteins, it can make its own collagen. Ther have also been studies showing that people/athletes benefitted from taking collagen...... So if you're going to take a supplement, collagen might be good. Otherwise just make sure you're getting lots of whole proteins (read, animal protein).

This article explains that once you ingest collagen, your body just breaks it down into amino acids anyways.... However, perhaps ingesting collagen will give you the amino acids you need?

Dietary Collagen — Should Consumers Believe the Hype? - Today's Dietitian Magazine

Today's Dietitian magazine, the leading news source for dietitians and nutritionists, covering topics such as diabetes management, long-term care, new products and technologies, career strategies, nutrition research updates, supplements, culinary arts, food allergies, fitness, sports medicine...
www.todaysdietitian.com

The other one you commonly see is Vitamin C, which supposedly aids the healing process, thought there seems to be debate as to whether taking large doses of it is necessary. Vitamin C is cheap, however, and so taking it certainly won't hurt.
 
Following on what @bluejeff said, Dr Keith Baar has been doing research on Collagen and VitC supplementation for tendinopathies.

www.ncbi.nlm.nih.gov

Vitamin C–enriched gelatin supplementation before intermittent activity augments collagen synthesis

Background: Musculoskeletal injuries are the most common complaint in active populations. More than 50% of all injuries in sports can be classified as sprains, strains, ruptures, or breaks of musculoskeletal tissues. Nutritional and/or exercise interventions ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
journals.humankinetics.com

Stress Relaxation and Targeted Nutrition to Treat Patellar Tendinopathy

Patellar tendinopathy is one of the most common afflictions in jumping sports. This case study outlines the rehabilitation of a professional basketball player diagnosed by magnetic resonance imaging (MRI) with a central core patellar tendinopathy within the proximal enthesis. The player...
journals.humankinetics.com journals.humankinetics.com
 
Also this write up has interesting info. Part 1 is great too. Talks about anti-inflammatory meds.

www.linkedin.com

All Things Tendinopathy! Part 2.

Produced by Trust me, I’m a Medical Doctor. Welcome to All Things Tendinopathy - Part 2! All Things Tendinopathy - Part 1 can be found here.
www.linkedin.com www.linkedin.com
 
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