Joint pain, tendon pain, and ligament pain are all very common issues that athletes and active people experience on a regular basis. Research has indicated that the best therapies for these conditions include loading exercises and modified levels of activity which ensure that the muscles, joints, tendons and ligaments are receiving nutrients, blood flow, and stimulus for adaptation. But is there a way to get more bang for our buck with our exercises? Recent research has indicated that there may be a supplement that, when used in conjunction with loading exercises, may be beneficial for individuals experiencing tendon pain, as well as joint pain. No this isn’t some newly discovered berry or “superfood,” it is actually just eating the constituents that make up these connective tissues in the first place: collagen.

Collagen is one of the most abundant connective tissues in our bodies. It literally permeates all of our structures including our tendon, muscles, ligaments, and even our bones. Collagen itself is a ropelike protein fiber that adds resilience, as well as some elasticity, to the connective tissues of our body. If we look at tendons, collagen accounts for between 65 and 80% of their total dry weight (weight after we take the water out) (Khatri et al., 2021). So collagen is a protein, but what does that really mean? Well Proteins are one of the four main macromolecules that our bodies are composed of and utilize for structure and energy. Protein itself is a bit of an umbrella term for molecules that are created by amino acids. These amino acids are building blocks that are strung together, held by peptide bonds, to create large molecules which we house under the term protein.

Different proteins are composed of various quantities and formulations of amino acids. These different formulations can change the actions of these molecules in our bodies. Collagen is largely composed of four main amino acids; glycine, proline, hydroxyproline, and hydroxyleucine. Thus, if we are trying to facilitate and enhance collagen synthesis after exercise, it would make sense to ensure that we have the necessary building blocks present to allow collagen synthesis to take place. In some instances, specific amino acids actually act as signaling molecules for protein synthesis to occur. An example of this would be the amino acid Leucine acting as a signaling molecule for muscle protein synthesis (aka GAINS) to occur (Jackman et al., 2017 & Heaton et al., 2017).

So how do we get collagen into our diets? There are a few ways we can accomplish this. The first, and best way, is to get necessary amounts of these amino acids from our food. These amino acids are most easily found in animal meats, chicken, and fish. The concentration of these amino acids are found in even higher concentrations of areas of meat that may not be the most favorable to eat such as the gristle and connective tissue portions which we usually eat around. Another way to ensure we are getting optimal amounts of collagen is to supplement collagen, which is something that I do before rock climbing as my pre workout drink to ensure that I have the necessary amino acids circulating in my bloodstream while I am stressing the tendons and connective tissues of my fingers, hands elbows and shoulders (more on this later). I first learned about collagen supplementation while I was looking for ways to help rehabilitate my achilles tendons during recurrent bouts of achilles tendinopathy I experienced while being a collegiate athlete.

Many people supplement their meals with bone broth as a source of collagen. However, bone broth recipes have variable concentrations of collagen (and the various amino acids that compose it) and are typically found at much lower concentrations than a usual supplemental dose (Alock et al., 2019)

The most Optimal way to supplement collagen is through the supplementation of hydrolyzed collagen peptides. Typically, these collagen peptides are derived by boiling down the tendons, ligaments and bones of animals until all that is left are the remainder collagen proteins. They are “hydrolyzed” to ensure that they do not link together when mixed in a solution. You have probably actually consumed non hydrolyzed collagen before but may know it by its more common name; jello. That’s right, your childhood jiggly sugar enriched jello is a shortened name of gelatin, and was made by boiling down the tendons, ligaments, and bones of animals. In fact, before the information about collagen supplements became popularized and mainstream products were placed on the market, one of the only ways to supplement collagen was to either make concentrated jello concoctions or just empty a gelatin packet into water and drink it straight up (not recommended as it tastes quite bad, and if the water is warm it will start to solidify into gelatin). The hydrolyzation process benefits us by making it easier for collagen to dissolve, while also retaining the consistent dosage of amino acids for collagen synthesis.

Why do we want to shoot for an optimal dosage? Because optimal dosages are more likely to increase the circulating blood levels of collagen while we are performing the activities or rehab exercises (Shaw et al, 2017). This is important because of how these tissues get their nutrients. The tissues that we are often targeting with collagen supplementation, namely tendons and ligaments, are largely avascular; meaning that they do not have a great direct blood supply. How these tissues get their nutrients is through the process of imbibition from their surroundings. Imbibition occurs through stress/relaxation cycles and works similarly to how a sponge absorbs and releases liquids as you squeeze and release it under running water. Theoretically, because of how our tendons and ligaments absorb nutrients, we would want their surroundings to be optimally saturated with collagen peptides while we are performing the loading exercises that would imbibe these specific amino acids in them. Thus optimizing our collagen synthesis rates. Research has shown that when we supplement at least 15-20g of hydrolyzed collagen peptides, we have a significant increase in circulating levels of amino acids in our bloodstream beginning approximately 30 minutes to 1 hour after ingestion, and remaining elevated for 2-4 hours after ingestion (Shaw et al., 2017).

In spite of this evidence, researchers looking at the effectiveness of collagen supplementation in conjunction with loading exercises have often used protocols with lower amounts of supplementation (5-10g) and in an untimed fashion (typically one intake in the early morning). In spite of using supplementation levels that are not clinically supported, a wide variety of researches in labs across the globe have shown benefits in an wide arrangement of musculoskeletal conditions;

• 5g collagen supplementation in combination with achilles tendon resistance training increase achilles cross sectional area (size) and muscle thickness compared to placebo (Jerger et al., 2022)

• 5g of collagen supplementation for 12 weeks improved activity related knee joint discomfort in young athletes compared to placebo (Zdzieblik et al., 2017)

• Daily dose equivalents of 12g of collagen promoted significant improvements in symptoms of osteoarthritis and osteoporosis (Porfirio and Fanaro, 2016)

• Collagen supplementation decreased pain and improved function in a systematic review regarding symptoms related to osteoarthritis (Garcia-Coronado et al., 2019)

• 10g of collagen supplementation per day for 24 weeks decreased activity related joint pain in young athletes (Clark et al., 2008)

• Collagen supplementation combined with calf-strengthening exercise for six months enhanced function and reduced pain in achilles tendinopathy patients in a cross over design study in participants with achilles tendinopathy (Praet et al., 2019)

• 5g of collagen supplementation daily for 6 months improved subjective ankle stability, as well as decreased the frequency of ankle joint injuries in individuals with chronic ankle instability (Dressler et al., 2018)

• 15g of gelatin 1hr prior to loading exercises normalized function and imaging of a central core patellar tendinopathy in a professional basketball player (Baar, 2019)

One final aspect regarding collagen supplements actually does not have to do with collagen at all, but with a vital component of the collagen synthesis formula in our bodies; vitamin C. We all know that vitamin C is an important antioxidant for neutralizing free radicals in our bodies, but it also plays a big role in collagen synthesis in our bodies. We can see this clearly in the effect that vitamin C deficiency has on our bodies, often referred to as scurvy. We often associate scurvy in popular culture with ship bound pirates from the 1800s, and indeed it is from this population that we learned a lot about what happens to the body when it does not have adequate amounts of dietary vitamin C. Think about the image that comes to mind when you think of a scurvy pirate; missing teeth, skin rashes and a proliferation of scrapes and poorly healing scratches, patchy hair loss, and overall unhealthy appearance. These are all manifestations of decreased collagen synthesis from a lack of vitamin C.

When we look at optimal intake of antioxidants like vitamin C, more is not always better, and in fact too high of supplementation of vitamin C (especially in combination with vitamin E) has been shown to decrease our adaptation to physical exercise. High levels of supplementation actually blunts our bodies natural adaptation because these supplements can act as a crutch, decreasing our bodies need to produce our own endogenous antioxidants. Luckily if we are sticking around 250mg a day of vitamin C alone we should be able to avoid scurvy while also facilitating optimal collagen synthesis. Regarding vitamin C supplementation alone, it is likely not worth worrying about too much intake because it is water soluble and can be easily excreted by our bodies, just look out for too high of supplementation of vitamin C in conjunction with vitamin E.

Overall, supplementing collagen has been shown to be effective in reducing pain, while also improving function for a wide variety of muscle and joint issues in a wide variety of body locations. While there may be some benefit to taking certain amounts of collagen at certain times, research has again shown that we can get benefits from collagen taken even in small amounts in every morning. One of the most important things not mentioned previously in the article, is that NONE of the aforementioned studies had ANY negative side effects from supplementing collagen. This makes collagen supplementation in the ranges mentioned above safer than ibuprofen, corticosteroids, Aleve, tylenol, advil, and basically every other medication that is used to counteract joint pain. While this is by no means a magic bullet for joint pain and tendon pain, it is a cheap, easy, and low risk way to reduce our overall body aches and pains while helping us be more functional and active in our daily lives.

Dr. Nic’s Collagen Supplementation Protocol:

• Mix 1 serving (15-20g) of hydrolyzed collagen peptides with 1/2 small shaker bottle of water, then fill the remainder of the bottle with fruit juice of choice (usually either orange juice or grapefruit juice)

• I typically use the brand Vital Proteins as my supplement of choice, but really all that we are looking for is one ingredient; hydrolyzed collagen peptides. Many supplement companies will also add different fillers in the hope of making their collagen supplement “more healthy” such as MCT oil, other amino acids, “superfood antioxidant blends,” powdered ranch dressing etc… Me personally, when I am trying to take a certain supplement, that is only thing I want so that I can mix and match mad-scientist-style my supplements (keep on the lookout for a creatine article in the next few months)

• Proceed with loading activities approximately 30-45 minutes after drinking

• *Disclaimer: I am not affiliated with the vital proteins brand, nor do I receive royalties from this brand, nor am I as attractive as Jennifer Aniston and thus unlikely to be featured in any of their commercials any time soon.

  
  

References:

Jackman, Sarah R., Oliver C. Witard, Andrew Philp, Gareth A. Wallis, Keith Baar, and Kevin D. Tipton. 2017. “Branched-Chain Amino Acid Ingestion Stimulates Muscle Myofibrillar Protein Synthesis Following Resistance Exercise in Humans.” Frontiers in Physiology 8 (June): 390.

Alcock, Rebekah D., Gregory C. Shaw, and Louise M. Burke. 2019. “Bone Broth Unlikely to Provide Reliable Concentrations of Collagen Precursors Compared With Supplemental Sources of Collagen Used in Collagen Research.” International Journal of Sport Nutrition and Exercise Metabolism 29 (3): 265–72.

Shaw, Gregory, Ann Lee-Barthel, Megan Lr Ross, Bing Wang, and Keith Baar. 2017. “Vitamin C-Enriched Gelatin Supplementation before Intermittent Activity Augments Collagen Synthesis.” The American Journal of Clinical Nutrition 105 (1): 136–43.

Zdzieblik, Denise, Steffen Oesser, Albert Gollhofer, and Daniel König. 2017. “Improvement of Activity-Related Knee Joint Discomfort Following Supplementation of Specific Collagen Peptides.” Applied Physiology, Nutrition, and Metabolism = Physiologie Appliquee, Nutrition et Metabolisme 42 (6): 588–95.

Clark, Kristine L., Wayne Sebastianelli, Klaus R. Flechsenhar, Douglas F. Aukermann, Felix Meza, Roberta L. Millard, John R. Deitch, Paul S. Sherbondy, and Ann Albert. 2008. “24-Week Study on the Use of Collagen Hydrolysate as a Dietary Supplement in Athletes with Activity-Related Joint Pain.” Current Medical Research and Opinion 24 (5): 1485–96.

Praet, Stephan F. E., Craig R. Purdam, Marijke Welvaert, Nicole Vlahovich, Gregg Lovell, Louise M. Burke, Jamie E. Gaida, Silvia Manzanero, David Hughes, and Gordon Waddington. 2019. “Oral Supplementation of Specific Collagen Peptides Combined with Calf-Strengthening Exercises Enhances Function and Reduces Pain in Achilles Tendinopathy Patients.” Nutrients 11 (1). https://doi.org/10.3390/nu11010076.

Dressler, Patrick, Dominic Gehring, Denise Zdzieblik, Steffen Oesser, Albert Gollhofer, and Daniel König. 2018. “Improvement of Functional Ankle Properties Following Supplementation with Specific Collagen Peptides in Athletes with Chronic Ankle Instability.” Journal of Sports Science & Medicine 17 (2): 298–304.

Porfírio, Elisângela, and Gustavo Bernardes Fanaro. 2016. “Collagen Supplementation as a Complementary Therapy for the Prevention and Treatment of Osteoporosis and Osteoarthritis: A Systematic Review.” Revista Brasileira de Geriatria E Gerontologia 19 (1): 153–64.

García-Coronado, Juan Mario, Lorena Martínez-Olvera, Rodrigo E. Elizondo-Omaña, Carlos Alberto Acosta-Olivo, Félix Vilchez-Cavazos, Luis Ernesto Simental-Mendía, and Mario Simental-Mendía. 2019. “Effect of Collagen Supplementation on Osteoarthritis Symptoms: A Meta-Analysis of Randomized Placebo-Controlled Trials.” International Orthopaedics 43 (3): 531–38.

Clark, Kristine L., Wayne Sebastianelli, Klaus R. Flechsenhar, Douglas F. Aukermann, Felix Meza, Roberta L. Millard, John R. Deitch, Paul S. Sherbondy, and Ann Albert. 2008. “24-Week Study on the Use of Collagen Hydrolysate as a Dietary Supplement in Athletes with Activity-Related Joint Pain.” Current Medical Research and Opinion 24 (5): 1485–96.

Praet, Stephan F. E., Craig R. Purdam, Marijke Welvaert, Nicole Vlahovich, Gregg Lovell, Louise M. Burke, Jamie E. Gaida, Silvia Manzanero, David Hughes, and Gordon Waddington. 2019. “Oral Supplementation of Specific Collagen Peptides Combined with Calf-Strengthening Exercises Enhances Function and Reduces Pain in Achilles Tendinopathy Patients.” Nutrients 11 (1). https://doi.org/10.3390/nu11010076.

Dressler, Patrick, Dominic Gehring, Denise Zdzieblik, Steffen Oesser, Albert Gollhofer, and Daniel König. 2018. “Improvement of Functional Ankle Properties Following Supplementation with Specific Collagen Peptides in Athletes with Chronic Ankle Instability.” Journal of Sports Science & Medicine 17 (2): 298–304.

Heaton, Lisa E., Jon K. Davis, Eric S. Rawson, Ryan P. Nuccio, Oliver C. Witard, Kimberly W. Stein, Keith Baar, James M. Carter, and Lindsay B. Baker. 2017. “Selected In-Season Nutritional Strategies to Enhance Recovery for Team Sport Athletes: A Practical Overview.” Sports Medicine 47 (11): 2201–18.

Khatri, Mishti, Robert J. Naughton, Tom Clifford, Liam D. Harper, and Liam Corr. 2021. “The Effects of Collagen Peptide Supplementation on Body Composition, Collagen Synthesis, and Recovery from Joint Injury and Exercise: A Systematic Review.” Amino Acids 53 (10): 1493–1506.