I posted this in the nutrition Q/A but it got locked before I could clarify (I assume it was posted in the wrong forum? Or maybe Jordan is cuing me to stop asking so many questions hint hint).
Dr. Feigenbaum mentioned there’s no good evidence that any individual or combo of MSM/Glucosamine/Fish oil/etc reduces injury risk, and mentioned that “joint health” isn’t a meaningful term (you know bro, like coffee enemas for your joints).
To clarify (“health” being a somewhat arbitrary term): is there any evidence that some combo of typically touted “joint supplements” reduce chronic or otherwise non-acute inflammatory issues (i.e. arthritis, chronic low-grade inflammation, etc) in any population, by way of pain reduction, specifically? And if so/if not, does the existing body of research fall into “needs more research/insufficient evidence” or “no difference between placebo”?
There’s a lot of research into interventions purported to reduce pain and improve functional outcomes in arthritis, and the vast majority of it is disappointing.
I reviewed one relatively large analysis that looked at a large variety of compounds for the research review a few years back, with null/weak results for the majority of included supplements. There are also a few Cochrane reviews of certain interventions, including glucosamine & chondroitin, based on low-quality evidence, that suggest a possible, small effect on pain compared with placebo, that are of debatable clinical significance (e.g., improving pain by an average of 8 points on a 0 to 100 scale). To the extent you are interested in this topic, you can dig through the included studies in these analyses.
I don’t care if someone wants to spend their money on these supplements (although the contamination risk is ever present), but the best summation of how we think about & approach osteoarthritis is described in this article, and we would prioritize these factors over anything else.
Thanks for the thorough reply! Hadn’t found that large analysis previously, that was insightful. Seems like it’s not a very worthwhile avenue to put any significant amount of money or attention into given the effect sizes.
Your overall approach to pain management and conceptualizing “injury” has been the most helpful takeaway in dealing with anything, and that in and of itself has been the most productive route when it comes to pain management and dealing with new or recurring issues (whether back pain, nonspecific knee pain, etc) as per the general principles outline in the article you attached. I’m less concerned about larger-joint “problems” now as the general principles of load management, scaling activity/workarounds, and addressing various lifestyle factors are fairly easily applicable in any non-acutely pathological context.
My main concern regarding aforementioned questions is more to do with small-joint pain (i.e. fingers for musicians) and potential considerations there, but I assume the overall principles are more or less the same. I haven’t been able to find much literature on the topic, but most of the generalized recommendations around acute injuries seem to be akin to that of larger joint injuries with questionable evidence backing (surgery, splinting, etc), and prolonged or chronic issues seem to be addressed with similar biopsychosocial principles and improving load management over time. Trials on GS seemed to amount to about the same effect size as what you mentioned (8/100 improvement or so).
Do you have any ideas for resources on this topic, or would you generally consider it the same as anything else? I.e. adjust activity to tolerable pain levels that don’t exacerbate (but keep active), avoid NSAIDs, scale activity to “return to sport” and potentially add general load capacity over time (in addition to addressing basic lifestyle factors)? Are there any particular activity considerations for improving tendon pain as part of a recovery process (i.e. isometric holds)? If this is more appropriate for a general thread in the “training” or “rehab” forums I can move discussion there.
Do you have any ideas for resources on this topic, or would you generally consider it the same as anything else? I.e. adjust activity to tolerable pain levels that don’t exacerbate (but keep active), avoid NSAIDs, scale activity to “return to sport” and potentially add general load capacity over time (in addition to addressing basic lifestyle factors)? Are there any particular activity considerations for improving tendon pain as part of a recovery process (i.e. isometric holds)? If this is more appropriate for a general thread in the “training” or “rehab” forums I can move discussion there.
I view it as quite similar, in the absence of underlying medical contributors such as autoimmune diseases that would require unique treatment. With respect to the fingers, I wonder whether some grip training may be beneficial, but that’s just an idea.
To clarify: I do not universally recommend avoiding NSAIDs in all scenarios.
And regarding tendons: this is covered in our tendinopathy article. The evidence for isometrics was wildly overstated in the aftermath of its publication, whereas individual subject-level data showed marked variation in effects with some patients reporting a decrease in pain, some reporting an increase in pain, and some reporting no effect. So I do not view isometrics as anything unique with respect to tendinopathy management, but can be experimented with if desired on a case by case basis.
Haven’t experimented with this specifically, but it seems to be fairly common that musicians who get injuries from stressful overplaying (i.e. in a conservatory setting practicing 6-7h/day) who then go on to adopt basic workout programs tend to do better, unsurprisingly. I would think some more “directed” grip training might be helpful (i.e. gripping plates with fingertips rather than conventional grip training) but I’m not sure about this either or if specificity would be necessary. Not sure to what degree extensor training would be either (with rubber bands or similar). Will try to do some directed work and see if it makes a difference. Importantly, it seems like the principle of avoiding excessive load or novel stimuli extends to end-range activities, like bigger stretches on piano or guitar. I’ve definitely hurt myself this way and attempting Rachmaninoff pieces too quickly has ended more than a few piano players’ academic performance prospects.
To clarify: I do not universally recommend avoiding NSAIDs in all scenarios.
And regarding tendons: this is covered in our tendinopathy article. The evidence for isometrics was wildly overstated in the aftermath of its publication, whereas individual subject-level data showed marked variation in effects with some patients reporting a decrease in pain, some reporting an increase in pain, and some reporting no effect. So I do not view isometrics as anything unique with respect to tendinopathy management, but can be experimented with if desired on a case by case basis.
In regard to NSAIDs: good to know, was just citing Jordan’s reference to a change in the RICE acronym (don’t recall what it was now). Also good to know regarding isometrics.