Joints have gone to s---

[miaou]

I'm not a big supplement guy, but I did see a study on type 2 collagen supplementing that looked really solid: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4731911/

Even with that, there are always a whole host of variables and considerations.

There is very little prior plausibility for something like oral collagen supplementation.

Collagen is a protein. During digestion it breaks down into amino acids, which are absorbed via the intestinal wall and enter into the plasma amino acid pool. Whether it is type-II collagen you are intaking, or any other type of protein, makes no difference.

Even if one argues that ingesting collagen could alter the ratios of different amino acids in plasma, which could have some effect on articular cartilage metabolism, ingesting 40 mg of collagen per day would have completely negligible effects on that.

Add to the above that the study was funded by a supplement company that sells the product.



TL;DR: type-II collagen is the new glucosamine

 

[Phlog]

There is very little prior plausibility for something like oral collagen supplementation.

Collagen is a protein. During digestion it breaks down into amino acids, which are absorbed via the intestinal wall and enter into the plasma amino acid pool. Whether it is type-II collagen you are intaking, or any other type of protein, makes no difference.

Even if one argues that ingesting collagen could alter the ratios of different amino acids in plasma, which could have some effect on articular cartilage metabolism, ingesting 40 mg of collagen per day would have completely negligible effects on that.

Add to the above that the study was funded by a supplement company that sells the product.



TL;DR: type-II collagen is the new glucosamine

Don't shatter my dream man.

 

[miaou]

Don't shatter my dream man.

I had serious patellofemoral cartilage issues.

I operated both knees.

I took glucosamine, chondroitin, msm, cissus, and mega-dosed on fish oil (and possibly a bunch of other stuff I don't recall) for over a year.

I did a fuckload of sessions with several different physiotherapists.

None of the above helped.

Eventually, I gave all that shit up and tried to self-treat with exercise.

2 years later my knees were good as new.

Just sayin'.

 

[Phlog]

I had serious patellofemoral cartilage issues.

I operated both knees.

I took glucosamine, chondroitin, msm, cissus, and mega-dosed on fish oil (and possibly a bunch of other stuff I don't recall) for over a year.

I did a fuckload of sessions with several different physiotherapists.

None of the above helped.

Exercise did.

Just sayin'.

Yeah man I do rehab every day and lift, run etc. I'm just on the edge of having to back off of football games and I'm trying anything

 

[miaou]

Yeah man I do rehab every day and lift, run etc. I'm just on the edge of having to back off of football games and I'm trying anything

Symptoms?

 

[Phlog]

Symptoms?

Patella tendonitis was a thing, pain when bent for any time. Driving is painful and I have to actively focus on knee alignment to avoid debilitating pain. Less pain when squatting with vertical shin, if I do that motion with knee going over toes it hurts too much all below and behind the kneecap.

Pain after running and explosive exercise that can be mitigated with ice a bit, I've recently found.

Lots on crunchy stuff and one of the patella tendons clicks/skips on every parallel squat or single leg thing.

Rehab is for life, it's balance board and 15 sliding back foot lunges with weight increasing over time. It's the main thing that's enabling me to keep on.

 

[Sano]

There is very little prior plausibility for something like oral collagen supplementation.

Collagen is a protein. During digestion it breaks down into amino acids, which are absorbed via the intestinal wall and enter into the plasma amino acid pool. Whether it is type-II collagen you are intaking, or any other type of protein, makes no difference.

Even if one argues that ingesting collagen could alter the ratios of different amino acids in plasma, which could have some effect on articular cartilage metabolism, ingesting 40 mg of collagen per day would have completely negligible effects on that.

Add to the above that the study was funded by a supplement company that sells the product.

TL;DR: type-II collagen is the new glucosamine

In regards to the study being funded by a supplement company, that is definitely important to note. Looking through it, it does seem like a very thoroughly and well done study with double blinding and placebos, not to mention a big sample size for this kind of study, long term followup, lots of measurement parametres including serum, WOMAC and more, and pretty rigorous data analysis. Not often you see something like that. I don't think it's entirely fair to discard the entire thing based on who sponsored it, although I'm sure that they are pleased with the results. Flaws in the methodology is a better way to judge the article I'd say. I haven't gone through it in detail so there might be some obvious ones I missed.

I was just talking to someone the other day about supplementing with collagen and gelatine who pointed me in the direction of this new study from Shaw et al. which is pretty interesting: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5183725/

Gelatine and C vitamin significantly improved collagen synthesis in vitro using serum after indigestion and in vivo showed markedly increased serum markers for collagen synthesis which had a positive correlation with the dosage. I'm still not entirely sold, but it's very interesting.

This talk with one of the co authors is definitely worth a watch too:

 

[miaou]

Patella tendonitis was a thing, pain when bent for any time. Driving is painful and I have to actively focus on knee alignment to avoid debilitating pain. Less pain when squatting with vertical shin, if I do that motion with knee going over toes it hurts too much all below and behind the kneecap.

Pain after running and explosive exercise that can be mitigated with ice a bit, I've recently found.

Lots on crunchy stuff and one of the patella tendons clicks/skips on every parallel squat or single leg thing.

Rehab is for life, it's balance board and 15 sliding back foot lunges with weight increasing over time. It's the main thing that's enabling me to keep on.

Sounds like you need to manage your loads, mate. Patellar tendinitis and patellofemoral pain are both overuse issues.

No amount of magic supplements are going to help you with that. And no amount of "sliding back foot lunges" are going to help you if you then go play football games.


In short (assuming you want to fix it):
1. Stop all exercise/activity that aggravates your symptoms. No football games, no sitting/sleeping with your knee flexed, etc.
2. Supplement with unloaded mobilisation (flexing/extending inside a pool would be best, doing it while lying down will work, pedalling on a stationary bike with minimal/no resistance might also work).
3. Do any movement or activity that involves your knees but produces no symptoms (if walking produces no symptoms, then try to do it often/do more of that, even if you're not sure it helps; if leg curls don't hurt, then do them often; etc.).
4. Allow for a few days of deload/inactivity for your pain to reach to baseline, then start re-introducing loads in a very gradual and very controlled manner, and be patient with it until you manage to build tissue tolerance. "Loads" could be anything from squatting (progress from high box squats to full squats, from hip dominant to quad dominant variations, from light to heavy weights, and from small to large session/week total volumes), to other leg exercises, to explosive lifts/jumps, to running/sprinting. Progress from very low loads (volume, intensity and biomechanical variations) to high loads. When building tissue tolerance, the rule of thumb is that any load that produces pain/aggravation is ok as long as the pain has returned to baseline within 24-48 hours (if the pain remains elevated for longer then the stimuli was more than your tissues could handle and it probably did more harm than good). Wait until the pain has returned to baseline before the next stimuli.


Keep in mind that articular cartilage synthesis is a very slow process. Depending on the severity, it can take weeks, months or years (and, of course, if the damage is extremely advanced, it might never happen).

 

[miaou]

In regards to the study being funded by a supplement company, that is definitely important to note. Looking through it, it does seem like a very thoroughly and well done study with double blinding and placebos, not to mention a big sample size for this kind of study, long term followup, lots of measurement parametres including serum, WOMAC and more, and pretty rigorous data analysis. Not often you see something like that. I don't think it's entirely fair to discard the entire thing based on who sponsored it, although I'm sure that they are pleased with the results. Flaws in the methodology is a better way to judge the article I'd say. I haven't gone through it in detail so there might be some obvious ones I missed.

I was just talking to someone the other day about supplementing with collagen and gelatine who pointed me in the direction of this new study from Shaw et al. which is pretty interesting: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5183725/

Gelatine and C vitamin significantly improved collagen synthesis in vitro using serum after indigestion and in vivo showed markedly increased serum markers for collagen synthesis which had a positive correlation with the dosage. I'm still not entirely sold, but it's very interesting.

This talk with one of the co authors is definitely worth a watch too:

All of this is interesting... for scientists in the field.

When these and/or similar studies have been replicated by independent groups, a "critical mass" of research has been created, and reviews and meta-analyses have shown the effects to be robust, then I will also find this interesting.

Until that happens, the research is in the preliminary stage and results are essentially unintelligible, because they are heavily under the influence of various biases.

 

[Phlog]

Sounds like you need to manage your loads, mate. Patellar tendinitis and patellofemoral pain are both overuse issues.

No amount of magic supplements are going to help you with that. And no amount of "sliding back foot lunges" are going to help you if you then go play football games.


In short (assuming you want to fix it):
1. Stop all exercise/activity that aggravates your symptoms. No football games, no sitting/sleeping with your knee flexed, etc.
2. Supplement with unloaded mobilisation (flexing/extending inside a pool would be best, doing it while lying down will work, pedalling on a stationary bike with minimal/no resistance might also work).
3. Do any movement or activity that involves your knees but produces no symptoms (if walking produces no symptoms, then try to do it often/do more of that, even if you're not sure it helps; if leg curls don't hurt, then do them often; etc.).
4. Allow for a few days of deload/inactivity for your pain to reach to baseline, then start re-introducing loads in a very gradual and very controlled manner, and be patient with it until you manage to build tissue tolerance. "Loads" could be anything from squatting (progress from high box squats to full squats, from hip dominant to quad dominant variations, from light to heavy weights, and from small to large session/week total volumes), to other leg exercises, to explosive lifts/jumps, to running/sprinting. Progress from very low loads (volume, intensity and biomechanical variations) to high loads. When building tissue tolerance, the rule of thumb is that any load that produces pain/aggravation is ok as long as the pain has returned to baseline within 24-48 hours (if the pain remains elevated for longer then the stimuli was more than your tissues could handle and it probably did more hard than good). Wait until the pain has returned to baseline before the next stimuli.


Keep in mind that articular cartilage synthesis is a very slow process. Depending on the severity, it can take weeks, months or years (and, of course, if the damage is extremely advanced, it might never happen).

Thanks. Thats basically what I've been doing up until season accelerated stuff. I think I can get it under control still, it's way better than it was 8 months ago. I am certainly resting more and not pushing it, I just fuck up and push a little to hard.

Also I shit you not those reverse sliding lunges are amazing for building knee strength without pain. If I don't do them it hurts, if I do them it makes everything better.

 

[miaou]

Thanks. Thats basically what I've been doing up until season accelerated stuff. I think I can get it under control still, it's way better than it was 8 months ago. I am certainly resting more and not pushing it, I just fuck up and push a little to hard.

Other than my damaged patellofemoral cartilage, where the damage was pretty advanced (cartilage was so degenerated I got patellar dislocations on a daily basis), I had very severe overuse with bicipital tendonitis (symptoms had lasted for over a decade and posed limitations in exercise/sports/daily life).

Again, I had tried a whole host of stuff (literally countless physiotherapy sessions, long lay-offs from exercise, countless NSAIDs, supplements, PRP injections... even tried "bee sting therapy" back in the day).

Again, nothing had helped; not even a tiny bit.

Again, it took a very long time (over a year) of following the aforementioned instructions.

After 12 years of pain, my bicep tendons have been 100% pain-free for the last two years.

For the previous several years I couldn't do 5 pain-free push ups. Last year I benched 3 plates pain-free.

 

[genecop]

Welcome to the club, at 50 it gets more painful. Not really sure if it is preventable..Excluding injury from poor technique etc....if you live and active , aggressive lifestyle in your youth, whether it be skateboarding, skiing, or hard physical work, there is wear and tear.
I have had to change up the way I do things, but not stopping, ever....just keep pushing and stay within your limits..

 

[Sano]

All of this is interesting... for scientists in the field.

When these and/or similar studies have been replicated by independent groups, a "critical mass" of research has been created, and reviews and meta-analyses have shown the effects to be robust, then I will also find this interesting.

Until that happens, the research is in the preliminary stage and results are essentially unintelligible, because they are heavily under the influence of various biases.

I get your point and I agree that we need to see more. Even then I'm a little torn. While reviews and meta-analysis are at the top of the evidence pyramide, even they can be misleading, non-conclusive and poorly done. This goes hand in hand with the bias argument. Most of the time, you can judge the biases by the quality of the methodology and make up your own mind on if you think that these biases interfere with the results to a degree that makes them unreliable. I think it's important that a meta-analysis by an independent party is judged as stricly as a sponsored study, because biases aside, "bad" science exist everywhere. On a more universal note, I find is that sometimes the biology and physiology tells the a big part of the story and that waiting years for someone else to compile and judge the evidence for you could be valuable time lost. Either way, as far as oral gelatine supplementation is concerned, it's still in the initial stages for sure. I'm not sold yet either, but I find this evidence compelling, and interesting yes, even as a precursor to practical implication.

 

[Sano]

Thanks. Thats basically what I've been doing up until season accelerated stuff. I think I can get it under control still, it's way better than it was 8 months ago. I am certainly resting more and not pushing it, I just fuck up and push a little to hard.

Also I shit you not those reverse sliding lunges are amazing for building knee strength without pain. If I don't do them it hurts, if I do them it makes everything better.

@miaou pretty much hit the nail on the head.

Another thing I'd suggest is manipulating the tempo and ROM of the exercises you are doing. Less knee flexion, less forward drift of your knee, keeping the load on your posterior chain and using isometrics are usually good principles. I take it reverse lunges feels better than forward lunges?

 

[miaou]

I get your point and I agree that we need to see more. Even then I'm a little torn. While reviews and meta-analysis are at the top of the evidence pyramide, even they can be misleading, non-conclusive and poorly done. This goes hand in hand with the bias argument.

This is why I specifically wrote "When [...] reviews and meta-analyses have shown the effects to be robust".

Reviews and meta-analyses are very often junk (especially in the supplement field). For instance, using an aforementioned supplement as an example, you can recent reviews (published within the last five years) that find glucosamine is effective and others that find it has no effect. You always have to read the full papers, and ever the full papers of the main interventions referenced. And, in the example of glucosamine, such a read will make it obvious which review is correct and which isn't.

Most of the time, you can judge the biases by the quality of the methodology and make up your own mind on if you think that these biases interfere with the results to a degree that makes them unreliable.

Even if you read the full text of a study, and even if you are well-versed in the field, there are biases that you cannot be aware of. For example, reading a study might alert you to possible p-hacking but it will not alert you to the existence of a file-drawer effect (or to actual bad implementation of the experimental procedures, for that matter). That is why independent replication until a critical mass of studies is there is necessary. Then a good reviewer can search for trends that might reveal possible bias: if, for instance, better-quality studies tend to hand different results than worse-quality ones, or if industry-funded studies tend to have different results than independent ones, or if specific research groups tend to produce different results, etc. Then you can conclude robust effects.

One or two studies, by the same researchers, funded by the same company... that is relevant to other researchers, not to the consuming public.

 

[MatterOverMind]

I bought some cissus years ago, because @DEVILsSON strongly recommended it at the time. I felt no difference using it.

I stopped taking it, and again noticed no difference.

I may still have some of it somewhere on my fridge shelves.


TL;DR: I should probably clean out my fridge.

FTFY.

 

[Phlog]

@miaou pretty much hit the nail on the head.

Another thing I'd suggest is manipulating the tempo and ROM of the exercises you are doing. Less knee flexion, less forward drift of your knee, keeping the load on your posterior chain and using isometrics are usually good principles. I take it reverse lunges feels better than forward lunges?

Yeah the reverse stuff keeping the knee over the ball of the foot is great. I can hex bar deadlift for 3x5 at 60-80% with no problems as well. Shin angle is key. I'm basically finding stuff that doesn't hurt and increasing load over time.

I appreciate the feedback from you both. Do either of you know if TB500 is reported as successful with such things?

 

[Demogoblin]

join the club

 

[bjjwristlock]

http://www.sherdog.com/news/articles/Is-PlateletRich-Plasma-Therapy-a-Friend-to-MMA-138039

 

[Phlog]

Symptoms?

@miaou pretty much hit the nail on the head.

Another thing I'd suggest is manipulating the tempo and ROM of the exercises you are doing. Less knee flexion, less forward drift of your knee, keeping the load on your posterior chain and using isometrics are usually gofuture.nciples. I take it reverse lunges feels better than forward lunges?

Just an update for no-one in particular, I discovered that I have only been working the upper hamstring for years. Stiff legged deads, squats, deadlift, good mornings, cable pull throughs etc etc. Nothing that targets the bicep femoralis (short head at least) which I believe only gets targeted with knee flexion.

I started to put in leg curls and the improvement is marked, I'm optimistic about the future!