Zyglamail
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Ive been on the internet forums since the internet became mainstream and one common thread that appears over and over and over is talk of injuries and how to get back to 100%. This post is to help demystify the healing process so that you can make a more informed decision in the route you chose to address your sports injuries. Armed with a basic understanding of the healing cascade most people will quite quickly come to realize the commonly accepted recommendations from the well meaning typical medical community and forum members really is not in your best interest.
The medical community has for decades, and still does, promote R.I.C.E which is a mnemonic for Rest, Ice, Compression and Elevation. Lets break this down and look at the various components and what they strive to accomplish.
Rest: clearly exerting 100% effort with an injury is going to exacerbate the injury and likely cause additional pain and discomfort.
Ice: Ice is used to reduce inflammation which is often associated with localized pain. This is accomplished by the cold causing the capillaries and blood vessels to constrict.
Compression: This is another method of keeping blood and fluid from pooling at the site of the injury.
Elevation: Like compression raising the injury reduces lymph and blood flow to the injury to help control pain and inflammation.
A closer look at the healing process:
Cells of the body are divided into 3 groups depending on their regenerative properties, Labile, Stable and Permanent:
Labile: These cells proliferate throughout life, blood cells would be a good example and are replaced approx every 4 months.
Stable: Stable cells retain the capacity to replicate although normally do not.
Permanent: These cells do not reproduce themselves after birth. Heart cells, central nervous system cells etc.
In regards to connective tissue such as muscle, fascia, ligaments, tendons and cartilage, the majority of these cells are fibroblasts and chondrocytes. Fibroblasts synthesize collagen and proteoglycans in the muscle, fascia, ligaments and tendons. Chondrocytes are involved in the formation of cartilage. fibroblasts and chondrocytes are considered stable cells in that they normally demonstrate a low level of replication. The natural cellular turnover rate of these cells is 300-500 days. This is one reason why injuries to these tissues takes so long to heal.
Although these cells have a very slow natural turnover rate, they can undergo rapid division in response to a variety of stimuli and in turn can regenerate the tissue of origin. The connective tissue in adults is generally quite but in response to an injury the fibroblasts in particular will proliferate widely resulting in connective tissue growth in response to inflammation(1).
The inflammatory response is closely intertwined with the process of repair. The inflammation serves to destroy, dilute or wall off the injurious agent but in turn sets off a complex series of events that attempt to heal and reconstruct the damaged tissue. Repair begins during the very early phases of inflammation but c an take some time to reach completion.
When we sustain an acute sports injury the cells are injured and broken. They contain arachidonic acid and that along with other factors like glycosylated protiens, attract granulocytes and fibroblasts to the injured area. Granulocytes include macrophages and neutrophils which clean up the damaged debris from the injury. Granulocytes are cirulating in the blood but need to be stimulated to goto the site of injury and then they must stay. Granulocytes have a special lectins on their surface that participate in their cellular adhesion. Once attached they specifically "look" for glycosylated proteins on cell surfaces to bind.
Stages of Healing:
There are generally accepted 3 phases to healing, the inflammatory phase, the proliferation phase and the remodeling phase. The image below highlights duration and the major players in each phase(2).
Chronic wound environment and impaired healing
A chronic wound is defined as one in which the normal process of healing is disrupted at one or more points in the phases of homeostasis, inflammation, proliferation and remodeling (4). In most chronic wounds, however, the healing process is thought to be 'stuck' in the inflammatory or proliferative phases. As growth factors, cytokines, proteases, and cellular and extracellular elements all play important roles in different stages of the healing process, alterations in one or more of these components could account for the impaired healing observed in chronic wounds. In addition, oxidative damage by free radicals or condition-specific factors such as neuropathy in diabetes or ischaemia in peripheral vascular disease may lead to the non-healing nature of chronic wounds. Healing may also be impeded by the accumulation of necrotic tissue or slough, a feature of chronic wounds.
Rethinking R.I.C.E
Granted the above is a birds eye overview of a very complex process but even so, armed with the above information lets take a closer look at the so often recommended R.I.C.E protocol. Rest, Ice, Compression and elevation. By and large what does each aspect of the R.I.C.E protocol do? It reduces blood and lymph flow to the injury does it not? What effect does that have? For one, it will reduce pain and discomfort but more importantly it will hinder healing as it disrupts the healing cascade.
Now, for the average person, one that is not an avid athlete or gym rat, the tradeoff of comfort for reduced healing is acceptable. They likely hurt themselves doing yard work, falling or whatnot and likely wont be in a position to stress the injured area again anytime soon. That differs from the athlete however who wants to get back in the gym tomorrow or the next day. Trying to use an injured limb before healing is complete is going to stress an already injured area adding further injury and just prolonging the overall time to heal. Adding R.I.C.E or worse nsaids and/or cortisone to the equation will address the pain and allow one, to varying degrees depending on the injury, the ability to return to action but at what cost?
Ignoring the pain, killing the inflammation with drugs or R.I.C.E will give the false impression of injury improvement which will lead to activity, additional damage and the vicious cycle continues until permanent irreversible damage occurs. The image below highlights the healing process. the arrows in the image splitting off from the center section at "ECM" up to the right corner indicate the path taken by an athlete using the R.I.C.E method alone or combined with nsaids and/or corticosteroids (ie cortisone shots etc).
A little disclaimer here, when I talk about R.I.C.E being bad for the athlete I am generally referring to chrinic type repetitive stress injuries. Usually elbow, shoulder, knee etc. Stuff that just kind of comes on after a good workout or maybe from a quick lapse in form due to fatigue etc. Generally the type of injury that does not result in large amounts of localized visible swelling or bruising. For more traumatic injuries such as an ankle sprain that results in massive swelling and bruising an initial treatment with ice to prevent OVER swelling can be beneficial. Too much swelling can have the same affect as no inflammation at all and can hinder healing.
Okay, so if R.I.C.E is bad then what the heck am I supposed to do??
It should be obvious from the above that the best way to heal is to support the process and not hamper it. Modern medicine has made a paradigm shift from treating problems to treating symptoms. R.I.C.E addresses the symptom of pain but does so at the expense of healing. In very simple terms in order for healing to take place certain entities need to be able to get to the site of the injury, remove debris, deliver oxygen and raw materials needed to repair the damage.
Another oversimplified analogy/comparison:
Scenario #1:
You have a cabin way out in the woods, miles of narrow winding dirt roads lead to dirt lot and from there a 100 yard long walking trail finally take you do the door of the cabin. A huge old oak falls in a bad storm and lands on the cabin basically destroying it.
Scenario #2:
You have a home in the burbs, 1/4 mile from a major highway, a strong storm feels a huge tree in your yard demolishing your home.
Which of the 2 scenarios would be easier, cheaper and faster to repair?
Clearly the suburban home, close to major roads and sources for building materials would be much easier to get not only building materials to but also the expert workers to perform the repairs. An athlete who relies on R.I.C.E is basically that cabin out in the woods. Restricting blood flow with ice, elevation etc all slow the healing.
It should be obvious by now that we do not want to hinder any of the steps involved in healing but is there anything we can do to promote healing? If reducing blood flow reduces healing then it would make sense that improving blood flow would increase the bodies ability to heal. What happens when you get up and move around? Is your heart rate higher when lounging in a chair watching TV or when your walking around the block? Clearly any activity that raising your heart rate will increase blood flow and in turn oxygen, removal of debris and delivery of healing raw materials. So clearly "rest" isnt in our best interest. Granted you do want to take it easy and not try and aggravate an injury by causing additional damage but there are often many other things you can still do.
An additional benefit of moving and an aspect not often discussed is the bodies lymphatic system. This system is important for getting rid of debris but unlike the circulatory system that has the heart pumping the blood 24x7x365 the lymphatic system relies largely on muscle contractions to move fluid. So moderate exercise and movement all helps.
Another aspect that is largely ignored when it comes to these chronic collagen tissue injuries is the raw materials for repair. These raw materials are the essential vitamins and minerals that are the cornerstone of life itself. Most athletes eat to perform but when it comes to bodybuilders performance seems to take a back seat to aesthetics which means that diets are usually very limited in scope and in turn so is the nutritional value. Most people on bodybuilding forums only focus on macros and getting that balance right. They avoid many fruits and veggies and in turn rob themselves of a vast array of essential nutrients, many of which are critical in the repair of tissue. Its well documented that the average person often has many nutritional deficiencies and its also documented that athletes not only have increased caloric needs but also increased micro-nutrient needs as well(5). Its this shortage, that in my personal opinion, is what largely contributes to the huge number of people suffering from chronic injuries.
So exactly what nutrients are needed to promote healing? The long answer is all of them!! The short answer is the primary nutrients involved in collagen synthesis. Next to people being told to use R.I.C.E the next most common recommendation is MSM, chondroiten and glucosamine and while I wont argue that they can be of some benefit they are not the primary factors in collagen synthesis and therefor offer at best minor benefit when used alone.
MSM, chondroiten and glucosamine do play a role in collagen health but they usually are not what is lacking. Taking a boat load of MSM, chondroiten and glucosamine is like dropping off a pallet of nails at a job site to repair one of the damaged homes in the above scenarios. Sure, the nails will be needed at some point but without workers to use them or the other materials that the nails will fasten together they really are not of much help.
So if MSM, chondroiten and glucosamine is not the key than what is??
Vitamin C (specifically ascorbic acid) and to a lesser degree Lysine and proline are the key players and the ones often in short supply(6). As eluded to above the bodybuilding diet is usually sorely lacking in fruits and veggies which are the primary sources for vitamin C. Couple that with the increased demands for collagen repair due to exercise induced damage and you have a perfect storm of increased demand with reduced supply.
Over the years I have been continually challenged by those that believe essential nutrients are easily obtained from diet alone. They throw studies at me showing little to no benefit from supplementation but in nearly every case the study author has an agenda or there was some other glaring fault with the study in question. Supplements don't work in a vacuum, many require ample amounts of other nutrients to properly do their job and many of these studies ignore or gloss over that.
The truth of the matter is that people knew the importance of citrus fruit and its aid in avoiding scurvy back in the middle of the 1700's. Later study revealed it was actually vitamin C and later narrowed down to just ascorbic acid that was the critical element needed for the prevention of scurvy. Like most diseases the medical community looks at it as black and white, yes or no. You have scurvy or you don't. The truth of the matter is there are a vast array of subclinical symptoms that are associated with lack of vitamin C but are not recognized or severe enough to be classified by the medical community as being diagnosed with scurvy.
Just as the lack of vitamin C impacts the connective tissue of athletes it also impacts the arterial health of everyone and its hypothesized that the large number of deaths due to cardiovascular disease is a direct result of a life with a chronic vitamin C deficiency. To date there are no major studies done to prove this however thousands of reports from people diagnosed with CVD and having major arterial blockages have been collected along with their progress and reversal by using vitamin C, lysone and proline.
The fact of the matter is there is no money in a healthy population. There is no money in pushing cheap and readily available supplements. Heart disease is the #1 killer in the USA, that means big money for big pharma, doctors and hospitals.
So how much Ascorbic Acid do I need?
The short answer is as much as you can tolerate!
The FDA says we only need like 60mg a day. We know that that amount will certainly stop the clinical disease scurvy but I think that anyone who has done research on the subject will come to understand is that's not enough to provide the body, especially the athlete, with enough to meet their increased demands for optimal health and performance.
Animal studies have shown that, when adjusted for weight, animals produce many times more ascrobic acid than us humans are told we need so one has to wonder where the FDA and other organization came to the conclusion that humans need sop little?
Ascorbic acid has been shown to be as non toxic as tap water with the most common sides to its use are stomach upset due to the acidity and lose stools. Detractors will often spout claims that high levels of AA (ie ascorbic acid) causes kidney stones because kidney stones are significantly more likely to occur in acidic urine. The stomach upset and acidic urine can both addressed by buffering the ascorbic acid with baking soda, potassium bicarbonate (my personal favorite since most people dont get enough potassium) or even by taking sodium ascorbate or magnesium ascorbate instead.
The lose stools happen when the ascorbate makes it through the digestive system and into the colon, there it will draw in water from the surrounding tissue and result in the urge to purge and watery stools. The good news is thie is very short lived and addressed by lowering your dose and/or increasing the time between doses.
With the above in mind I find I personally tolerate 2 grams 3 to 5 times a day for 6-10 grams a day total. Most people tolerate that dose well with some exceptions. I would start with a low dose and work your way up. 1g of proline and 1g of lysine 3x a day go a long way to help with collagen repair and synthesis.
My personal Experience:
Ive been an avid lifter all of my adult life and As I am now much closer to 50 than I am to 40 that equates to a lot of time under the bar, a lot of trial and error and a lot of injuries as well as a lot of ups and downs. It was in my early 30's that I really began to feel my age. I didn't recover like I used to and I developed severe tendinitis in both my elbows so bad that I walked into a couple doors as my arm buckled due to sharp stabbing pains just pushing the door opened caused.
Like most I sought medical advice and got the the old R.I.C.E treatment along with double up nsaid use. I took a couple weeks off from lifting and let things "heal" while taking copious amounts of nsaids as per the doctors order Man I felt great!......that was until after my first workout when all the pain came rushing back and persisted. I was offered cortisone but was well read enough to know that wasnt a road I wanted to go down and thus began my search for a better solution.
This is when I found prolotherapy which did wonders and I had many treatments for many injuries over the years. While it didnt totally cure everything it was enough for me to get by but since it wasnt covered by insurance it was getting a a bit spendy. I did extensive research on prolo and unlike the regular docs the prolo docs seems to have a pretty good grasp on the importance nutrition plays in the role of healing. But like so many others I still didn't buy into it.
Fast forward a few years, now early 40's and I was, knock on wood, by and large able to work out regularly but had bouts of pain here and there that affected my progress in the gym but I by and large wrote it off as getting old. It wasnt until a couple years later when I was diagnosed with AFIB that I began to really dig deep into the nutritional aspects of health. For many many months on end I spent upwards of 20+ hours a week researching and reading about the roles the various essential nutrients played in our bodies. I was told nothing could be done for my afib and it just "happens to some people". As the role of vitamin C, proline and lysine became apparent in cardiovascular health I gave it a shot. Note that my supplement routine is very extensive and involved a lot of trial and error but since this post is focused on collagen based tissue I will keep focused on that.
Over the next couple years my multiple daily bouts of afib faded away to the point where I am at now where I notice an episode maybe once a week. At present I really dont feel the afib was benefitted greatly by the vitamin C, lysine and proline but many other changes took place as well. For one, I have not gotten sick in over 2 years. Vitamin C is a very powerful electron donor to the immune system (ill save that for another post) but even more importantly all the aches and pains in my joints which I had chalked up to getting old were nearly nonexistent. Did my workouts change? Well, yes the did I went form a more crossfit style workout to more of a strength oriented workout. I was now working all my compound lifts in the 5 rep or less range, day in and day out for months on end. Historically, even back in my early 30's I could not maintain workouts working in the high percentile weight range because the stress on my joints would eventually catch up to me forcing me to lighten the load and increase reps.
I thought to myself, could it be the vit C? On at lest 2 different occasions I stopped taking the vit C for a few weeks and both times my joints began to ache, especially my elbows that I had issues with a decade before only for the pain to slowly subside after restarting the supplement intake. Coincidence? I think now.
For me personally I have read enough and experimented enough myself that I believe so many of the joint issue we see people suffer from here on the forums is all by and large simply due to the lack of essential raw materials the body needs to keep up with joint repair and collagen synthesis.
(1) Robbins. S. Pathalogical Basis of Disease, third edition. Philadelphia, PA. W.B Sanders, 1984, pp 40-84
(2) http://www.worldwidewounds.com/2004/august/Enoch/Pathophysiology-Of-Healing.html
(3) Nelzén 0, Bergqvist D, Lindhagen A, Hallbook T. Chronic leg ulcers: an underestimated problem in primary health care among elderly patients. J Epidemiol Community Health 1991; 45: 184-87.
(4) Lazarus GS, Cooper DM, Knighton DR, Margolis DJ, Pecoraro RE, Rodeheaver G, Robson MC. Definitions and guidelines for assessment of wounds and evaluation of healing. Arch Dermatol 1994; 130(4): 489-93.
(5) Med Sci Sports Exerc. 1989 Aug;21(4):441-9. Vitamin status of young athletes including the effects of supplementation.
(6) Proc Natl Acad Sci U S A. 1981 May; 78(5): 2879–2882. PMCID: PMC319462 Regulation of collagen synthesis by ascorbic acid.
The medical community has for decades, and still does, promote R.I.C.E which is a mnemonic for Rest, Ice, Compression and Elevation. Lets break this down and look at the various components and what they strive to accomplish.
Rest: clearly exerting 100% effort with an injury is going to exacerbate the injury and likely cause additional pain and discomfort.
Ice: Ice is used to reduce inflammation which is often associated with localized pain. This is accomplished by the cold causing the capillaries and blood vessels to constrict.
Compression: This is another method of keeping blood and fluid from pooling at the site of the injury.
Elevation: Like compression raising the injury reduces lymph and blood flow to the injury to help control pain and inflammation.
A closer look at the healing process:
Cells of the body are divided into 3 groups depending on their regenerative properties, Labile, Stable and Permanent:
Labile: These cells proliferate throughout life, blood cells would be a good example and are replaced approx every 4 months.
Stable: Stable cells retain the capacity to replicate although normally do not.
Permanent: These cells do not reproduce themselves after birth. Heart cells, central nervous system cells etc.
In regards to connective tissue such as muscle, fascia, ligaments, tendons and cartilage, the majority of these cells are fibroblasts and chondrocytes. Fibroblasts synthesize collagen and proteoglycans in the muscle, fascia, ligaments and tendons. Chondrocytes are involved in the formation of cartilage. fibroblasts and chondrocytes are considered stable cells in that they normally demonstrate a low level of replication. The natural cellular turnover rate of these cells is 300-500 days. This is one reason why injuries to these tissues takes so long to heal.
Although these cells have a very slow natural turnover rate, they can undergo rapid division in response to a variety of stimuli and in turn can regenerate the tissue of origin. The connective tissue in adults is generally quite but in response to an injury the fibroblasts in particular will proliferate widely resulting in connective tissue growth in response to inflammation(1).
The inflammatory response is closely intertwined with the process of repair. The inflammation serves to destroy, dilute or wall off the injurious agent but in turn sets off a complex series of events that attempt to heal and reconstruct the damaged tissue. Repair begins during the very early phases of inflammation but c an take some time to reach completion.
When we sustain an acute sports injury the cells are injured and broken. They contain arachidonic acid and that along with other factors like glycosylated protiens, attract granulocytes and fibroblasts to the injured area. Granulocytes include macrophages and neutrophils which clean up the damaged debris from the injury. Granulocytes are cirulating in the blood but need to be stimulated to goto the site of injury and then they must stay. Granulocytes have a special lectins on their surface that participate in their cellular adhesion. Once attached they specifically "look" for glycosylated proteins on cell surfaces to bind.
Stages of Healing:
There are generally accepted 3 phases to healing, the inflammatory phase, the proliferation phase and the remodeling phase. The image below highlights duration and the major players in each phase(2).
Chronic wound environment and impaired healing
A chronic wound is defined as one in which the normal process of healing is disrupted at one or more points in the phases of homeostasis, inflammation, proliferation and remodeling (4). In most chronic wounds, however, the healing process is thought to be 'stuck' in the inflammatory or proliferative phases. As growth factors, cytokines, proteases, and cellular and extracellular elements all play important roles in different stages of the healing process, alterations in one or more of these components could account for the impaired healing observed in chronic wounds. In addition, oxidative damage by free radicals or condition-specific factors such as neuropathy in diabetes or ischaemia in peripheral vascular disease may lead to the non-healing nature of chronic wounds. Healing may also be impeded by the accumulation of necrotic tissue or slough, a feature of chronic wounds.
Rethinking R.I.C.E
Granted the above is a birds eye overview of a very complex process but even so, armed with the above information lets take a closer look at the so often recommended R.I.C.E protocol. Rest, Ice, Compression and elevation. By and large what does each aspect of the R.I.C.E protocol do? It reduces blood and lymph flow to the injury does it not? What effect does that have? For one, it will reduce pain and discomfort but more importantly it will hinder healing as it disrupts the healing cascade.
Now, for the average person, one that is not an avid athlete or gym rat, the tradeoff of comfort for reduced healing is acceptable. They likely hurt themselves doing yard work, falling or whatnot and likely wont be in a position to stress the injured area again anytime soon. That differs from the athlete however who wants to get back in the gym tomorrow or the next day. Trying to use an injured limb before healing is complete is going to stress an already injured area adding further injury and just prolonging the overall time to heal. Adding R.I.C.E or worse nsaids and/or cortisone to the equation will address the pain and allow one, to varying degrees depending on the injury, the ability to return to action but at what cost?
Ignoring the pain, killing the inflammation with drugs or R.I.C.E will give the false impression of injury improvement which will lead to activity, additional damage and the vicious cycle continues until permanent irreversible damage occurs. The image below highlights the healing process. the arrows in the image splitting off from the center section at "ECM" up to the right corner indicate the path taken by an athlete using the R.I.C.E method alone or combined with nsaids and/or corticosteroids (ie cortisone shots etc).
A little disclaimer here, when I talk about R.I.C.E being bad for the athlete I am generally referring to chrinic type repetitive stress injuries. Usually elbow, shoulder, knee etc. Stuff that just kind of comes on after a good workout or maybe from a quick lapse in form due to fatigue etc. Generally the type of injury that does not result in large amounts of localized visible swelling or bruising. For more traumatic injuries such as an ankle sprain that results in massive swelling and bruising an initial treatment with ice to prevent OVER swelling can be beneficial. Too much swelling can have the same affect as no inflammation at all and can hinder healing.
Okay, so if R.I.C.E is bad then what the heck am I supposed to do??
It should be obvious from the above that the best way to heal is to support the process and not hamper it. Modern medicine has made a paradigm shift from treating problems to treating symptoms. R.I.C.E addresses the symptom of pain but does so at the expense of healing. In very simple terms in order for healing to take place certain entities need to be able to get to the site of the injury, remove debris, deliver oxygen and raw materials needed to repair the damage.
Another oversimplified analogy/comparison:
Scenario #1:
You have a cabin way out in the woods, miles of narrow winding dirt roads lead to dirt lot and from there a 100 yard long walking trail finally take you do the door of the cabin. A huge old oak falls in a bad storm and lands on the cabin basically destroying it.
Scenario #2:
You have a home in the burbs, 1/4 mile from a major highway, a strong storm feels a huge tree in your yard demolishing your home.
Which of the 2 scenarios would be easier, cheaper and faster to repair?
Clearly the suburban home, close to major roads and sources for building materials would be much easier to get not only building materials to but also the expert workers to perform the repairs. An athlete who relies on R.I.C.E is basically that cabin out in the woods. Restricting blood flow with ice, elevation etc all slow the healing.
It should be obvious by now that we do not want to hinder any of the steps involved in healing but is there anything we can do to promote healing? If reducing blood flow reduces healing then it would make sense that improving blood flow would increase the bodies ability to heal. What happens when you get up and move around? Is your heart rate higher when lounging in a chair watching TV or when your walking around the block? Clearly any activity that raising your heart rate will increase blood flow and in turn oxygen, removal of debris and delivery of healing raw materials. So clearly "rest" isnt in our best interest. Granted you do want to take it easy and not try and aggravate an injury by causing additional damage but there are often many other things you can still do.
An additional benefit of moving and an aspect not often discussed is the bodies lymphatic system. This system is important for getting rid of debris but unlike the circulatory system that has the heart pumping the blood 24x7x365 the lymphatic system relies largely on muscle contractions to move fluid. So moderate exercise and movement all helps.
Another aspect that is largely ignored when it comes to these chronic collagen tissue injuries is the raw materials for repair. These raw materials are the essential vitamins and minerals that are the cornerstone of life itself. Most athletes eat to perform but when it comes to bodybuilders performance seems to take a back seat to aesthetics which means that diets are usually very limited in scope and in turn so is the nutritional value. Most people on bodybuilding forums only focus on macros and getting that balance right. They avoid many fruits and veggies and in turn rob themselves of a vast array of essential nutrients, many of which are critical in the repair of tissue. Its well documented that the average person often has many nutritional deficiencies and its also documented that athletes not only have increased caloric needs but also increased micro-nutrient needs as well(5). Its this shortage, that in my personal opinion, is what largely contributes to the huge number of people suffering from chronic injuries.
So exactly what nutrients are needed to promote healing? The long answer is all of them!! The short answer is the primary nutrients involved in collagen synthesis. Next to people being told to use R.I.C.E the next most common recommendation is MSM, chondroiten and glucosamine and while I wont argue that they can be of some benefit they are not the primary factors in collagen synthesis and therefor offer at best minor benefit when used alone.
MSM, chondroiten and glucosamine do play a role in collagen health but they usually are not what is lacking. Taking a boat load of MSM, chondroiten and glucosamine is like dropping off a pallet of nails at a job site to repair one of the damaged homes in the above scenarios. Sure, the nails will be needed at some point but without workers to use them or the other materials that the nails will fasten together they really are not of much help.
So if MSM, chondroiten and glucosamine is not the key than what is??
Vitamin C (specifically ascorbic acid) and to a lesser degree Lysine and proline are the key players and the ones often in short supply(6). As eluded to above the bodybuilding diet is usually sorely lacking in fruits and veggies which are the primary sources for vitamin C. Couple that with the increased demands for collagen repair due to exercise induced damage and you have a perfect storm of increased demand with reduced supply.
Over the years I have been continually challenged by those that believe essential nutrients are easily obtained from diet alone. They throw studies at me showing little to no benefit from supplementation but in nearly every case the study author has an agenda or there was some other glaring fault with the study in question. Supplements don't work in a vacuum, many require ample amounts of other nutrients to properly do their job and many of these studies ignore or gloss over that.
The truth of the matter is that people knew the importance of citrus fruit and its aid in avoiding scurvy back in the middle of the 1700's. Later study revealed it was actually vitamin C and later narrowed down to just ascorbic acid that was the critical element needed for the prevention of scurvy. Like most diseases the medical community looks at it as black and white, yes or no. You have scurvy or you don't. The truth of the matter is there are a vast array of subclinical symptoms that are associated with lack of vitamin C but are not recognized or severe enough to be classified by the medical community as being diagnosed with scurvy.
Just as the lack of vitamin C impacts the connective tissue of athletes it also impacts the arterial health of everyone and its hypothesized that the large number of deaths due to cardiovascular disease is a direct result of a life with a chronic vitamin C deficiency. To date there are no major studies done to prove this however thousands of reports from people diagnosed with CVD and having major arterial blockages have been collected along with their progress and reversal by using vitamin C, lysone and proline.
The fact of the matter is there is no money in a healthy population. There is no money in pushing cheap and readily available supplements. Heart disease is the #1 killer in the USA, that means big money for big pharma, doctors and hospitals.
So how much Ascorbic Acid do I need?
The short answer is as much as you can tolerate!
The FDA says we only need like 60mg a day. We know that that amount will certainly stop the clinical disease scurvy but I think that anyone who has done research on the subject will come to understand is that's not enough to provide the body, especially the athlete, with enough to meet their increased demands for optimal health and performance.
Animal studies have shown that, when adjusted for weight, animals produce many times more ascrobic acid than us humans are told we need so one has to wonder where the FDA and other organization came to the conclusion that humans need sop little?
Ascorbic acid has been shown to be as non toxic as tap water with the most common sides to its use are stomach upset due to the acidity and lose stools. Detractors will often spout claims that high levels of AA (ie ascorbic acid) causes kidney stones because kidney stones are significantly more likely to occur in acidic urine. The stomach upset and acidic urine can both addressed by buffering the ascorbic acid with baking soda, potassium bicarbonate (my personal favorite since most people dont get enough potassium) or even by taking sodium ascorbate or magnesium ascorbate instead.
The lose stools happen when the ascorbate makes it through the digestive system and into the colon, there it will draw in water from the surrounding tissue and result in the urge to purge and watery stools. The good news is thie is very short lived and addressed by lowering your dose and/or increasing the time between doses.
With the above in mind I find I personally tolerate 2 grams 3 to 5 times a day for 6-10 grams a day total. Most people tolerate that dose well with some exceptions. I would start with a low dose and work your way up. 1g of proline and 1g of lysine 3x a day go a long way to help with collagen repair and synthesis.
My personal Experience:
Ive been an avid lifter all of my adult life and As I am now much closer to 50 than I am to 40 that equates to a lot of time under the bar, a lot of trial and error and a lot of injuries as well as a lot of ups and downs. It was in my early 30's that I really began to feel my age. I didn't recover like I used to and I developed severe tendinitis in both my elbows so bad that I walked into a couple doors as my arm buckled due to sharp stabbing pains just pushing the door opened caused.
Like most I sought medical advice and got the the old R.I.C.E treatment along with double up nsaid use. I took a couple weeks off from lifting and let things "heal" while taking copious amounts of nsaids as per the doctors order Man I felt great!......that was until after my first workout when all the pain came rushing back and persisted. I was offered cortisone but was well read enough to know that wasnt a road I wanted to go down and thus began my search for a better solution.
This is when I found prolotherapy which did wonders and I had many treatments for many injuries over the years. While it didnt totally cure everything it was enough for me to get by but since it wasnt covered by insurance it was getting a a bit spendy. I did extensive research on prolo and unlike the regular docs the prolo docs seems to have a pretty good grasp on the importance nutrition plays in the role of healing. But like so many others I still didn't buy into it.
Fast forward a few years, now early 40's and I was, knock on wood, by and large able to work out regularly but had bouts of pain here and there that affected my progress in the gym but I by and large wrote it off as getting old. It wasnt until a couple years later when I was diagnosed with AFIB that I began to really dig deep into the nutritional aspects of health. For many many months on end I spent upwards of 20+ hours a week researching and reading about the roles the various essential nutrients played in our bodies. I was told nothing could be done for my afib and it just "happens to some people". As the role of vitamin C, proline and lysine became apparent in cardiovascular health I gave it a shot. Note that my supplement routine is very extensive and involved a lot of trial and error but since this post is focused on collagen based tissue I will keep focused on that.
Over the next couple years my multiple daily bouts of afib faded away to the point where I am at now where I notice an episode maybe once a week. At present I really dont feel the afib was benefitted greatly by the vitamin C, lysine and proline but many other changes took place as well. For one, I have not gotten sick in over 2 years. Vitamin C is a very powerful electron donor to the immune system (ill save that for another post) but even more importantly all the aches and pains in my joints which I had chalked up to getting old were nearly nonexistent. Did my workouts change? Well, yes the did I went form a more crossfit style workout to more of a strength oriented workout. I was now working all my compound lifts in the 5 rep or less range, day in and day out for months on end. Historically, even back in my early 30's I could not maintain workouts working in the high percentile weight range because the stress on my joints would eventually catch up to me forcing me to lighten the load and increase reps.
I thought to myself, could it be the vit C? On at lest 2 different occasions I stopped taking the vit C for a few weeks and both times my joints began to ache, especially my elbows that I had issues with a decade before only for the pain to slowly subside after restarting the supplement intake. Coincidence? I think now.
For me personally I have read enough and experimented enough myself that I believe so many of the joint issue we see people suffer from here on the forums is all by and large simply due to the lack of essential raw materials the body needs to keep up with joint repair and collagen synthesis.
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