The connective tissues (cartilage, tendons and ligaments) are highly important bodily tissues in that they essentially hold our skeleton together. They connect muscles to bone, and provide shock absorbtion for activities like running. Connective tissue is often neglected, and if it hurts, we are told to take an anti-inflammatory, and if it is injured we are told to repair it surgically. Otherwise, it seems, there is no mention of how to keep that tissue functioning well throughout our days.

The purpose of this article is to highlight the many ways in which we can proactively care for our connective tissues, thereby mitigating the need for chronic anti-inflammatory medication. Still, connective tissues by nature can be rather easily injured and are slow to heal, if it all. Taking this and the information herein into account, one may strive to maintain the health of their connective tissue for a lifetime of active use.

The majority of exercise-related injuries occur from overuse stress on the muscles, tendon, bones, or joints. Sporting activities with major risk for pain are not surprisingly those that include repetitive, high intensity, high impact forces through the affected joints, especially where there is a high associated risk of injury. Various nutritional supplements are available to mitigate the effects of exercise-induced wear-and-tear on the body. The mechanism of action for these supplements focuses on ligament and cartilage tissue repair and maintenance.

Glucosamine: a well-known supplement for the repair and maintenance of cartilage damage in joints. Glucosamine has been shown to have both anti-inflammatory and antioxidant activities. Glucosamine's pain-relieving effects appear to be due to its cartilage-rebuilding properties; traditional analgesic therapy does not demonstrate the disease-modifying effects of glucosamine supplementation. Glucosamine is not an immediate fix, however.

Typically, it must be taken for several weeks before symptoms resolve, and symptom resolution lasts only as long as the supplement is continuously taken. For the active athlete, glucosamine can be used as an alternative to anti-inflammatory drugs and analgesics or as a useful adjunct to standard analgesic therapy while supporting cartilage repair and regeneration.

NSAIDs: Nonsteroidal Anti-inflammatory Drugs: Tendonitis, bursitis, arthritis, sprains, strains and other inflammatory conditions resulting from athletic activity have been treated traditionally with over the counter non-steroidal anti-inflammatory drugs (NSAIDS). However, these medications do not provide the most desirable results for inflammatory injuries, as NSAIDS are associated with increased cartilage degeneration via inhibitory effects on cartilage synthesis. Additionally, NSAIDS exert inhibitory effects on the production of the protective gastrointestinal mucosal barrier, resulting in deleterious effects on cellular mechanisms important in mucosal defenses. In other words, NSAIDs can lead to bleeding in the stomach and they are notoriously damaging to the kidneys and liver when taken in excess. The most common NSAID drugs are ibuprofen and aspirin, which are available under a variety of different brand names. Instead of NSAIDs, various plant-derived anti-inflammatories can be used for the pain and inflammation-relieving properties.

Bromelain: A proteolytic enzyme derived from the pineapple (Ananas comosus), bromelain elicits an anti-inflammatory effect. Bromelain inhibits the inflammatory pathways in the body by decreasing the production of molecules in the body responsible for the common signs of inflammation such as pain and swelling, making it an optimal choice for the treatment of sports injuries. Bromelain itself is not without side effects, however. Because this pineapple stem-derived medicine is an enzyme, caution should be used in the athlete prone to gastric mucosal irritation or ulceration, or those who are on anti-clotting regimens, as bromelain can amplify the effects of blood thinning pharmaceuticals.

Curcumin: (Curcuma longa) is the yellow pigment of the spice turmeric. Curcumin displays various properties that are beneficial for the athlete. Namely, curcumin behaves as a stimulator of muscle regeneration after traumatic injury. One recent study showed that muscle regeneration is greatly enhanced following the systemic administration of curcumin. Curcumin’s muscle healing effects were noted after only 4 days of taking it; without curcumin damaged muscles can take more than 2 weeks to completely heal.
Additionally, curcumin has long been known as a potent anti-inflammatory agent, working to inhibit the synthesis and relapses of a large percentage of pro-inflammatory molecules. Similar to bromelain, curcumin shares similar side effects such as gastric irritation and anti-platelet activity and therefore shares the same contraindications as bromelain.

Essential Fatty Acids: These fats are becoming increasingly more important in our diet. Essential Fatty Acids (EFAs) that we need to be concerned with are the Omega-3 and Omega 6 fatty acids. In general, an overabundance of Omega-6 EFAs leads to an inflammatory cascade in the body; this is evidenced by several chronic diseases such as cardiovascular disease, cancer, osteoporosis, and inflammatory and autoimmune conditions. Omega-6 fatty acids are abundant in the Standard American Diet (SAD) as they are found in abundance in foods such as red meats, eggs, wheat, and fried and processed foods.
Omega-3 fatty acids are found in foods such as fish, nuts & seeds, and some vegetables (avocados). These EFAs are anti-inflammatory in nature; an overabundance of Omega-6 to Omega-3 fatty acids set us up more pain and inflammation and for chronic health conditions in the long run. Altering the Omega 6:Omega 3 ratio is of course achieved by consuming more wholesome rather than processed foods. In addition, supplementing the diet with omega-3 fatty acids, several aspects of the production of inflammatory mediators can be reduced. A great supplemental source of healthy EFAs is fish oil. Many commercial preparations are available from a variety of sources today.
The potential for the use of fish and other essential fatty oils in the management of inflammatory processes is well indicated, as it can serve to preventatively modulate unwanted and excessive inflammatory responses to athletic activities.

Hydration: Last but not least is the issue of tissue hydration. Cartilage and other connective tissues are similar to sponges; they will expand and contract depending on hydration status.

Similarly, joint fluid (the fluid inside of our joints that serves as a lubricant) can become adversely affected in states of dehydration. Joint pain and inflammation have been shown to increase in relation to hydration status; meaning that the more dehydrated one is, pain and inflammation will increase.

Dr. Barker is trained as a general practitioner specializing in natural medicine and prevention. He uses several different types of natural medicines to help his patients achieve true health, rather than just throwing another drug at the symptoms.
He utilizes bioidentical hormones, saliva tests, food sensitivity testing, standard blood work and prolotherapy. He treats hormone imbalances, chronic athletic injuries and performance issues, migraines, digestive problems, fatigue, and many other health issues.
Dr. Barker received his Bachelor of Science degree in Exercise and Sport Science with a minor in Anatomy & Neurobiology from Colorado State University and his Doctorate in Naturopathic Medicine from Southwest College of Naturopathic Medicine, and holds a Certificate in Clinical Research from Oregon Health and Sciences University. He also serves as a regular author, lecturer and consultant to the natural medicine industry.