Treatment to relieve joint pain during training
just wondering if anyone here takes Glucosamine, or anything similar to help relieve joint pain while they are training?
does anyone know if its safe to take pain relief medicines? i always thought that pain was a good indicator of when to ease off certain exercises (or training altogether), and that maybe reducing the pain would lead to further injury caused because you can't feel the pain and carry on training
I agree with your assessment of the dynamic involving the use of pain killers for dealing with athletic/training problems. The pain feedback is something one should pay attention to - get into a dialogue with, to monitor how things are going and learn how to modify the stresses you are applying - not numb away with drugs.
OTOH, some kinds of joint pain are congenital, degenerative, permanent, or otherwise not going to resolve. In these cases, one may have to look into symptom-mollifying options like drugs or alternative treatments. The important thing is to get an accurate diagnosis of what is actually wrong first. Make sure it is not something that could be corrected by modifying training/movement patterns or doing some kind of exercise or physical therapy regimen before you jump on the symptomatic treatments.
If it turns out to be something like arthritis, I have heard many good reports about Glucosamine/Chondrotin for this type of problem - improved symptoms and low side-effects. The issues with it are that you have to keep taking it for the benefit, it's expensive, and there are serious quality control issues - so you would need to thoroughly research the brand and so-forth.
Ibuprofen is used pretty extensively in our dojo (there is someone who calls it Vitamin I). I'm not sure exactly what I think about that except that I agree with both of what Liane and Kevin said. I have attacks of gout and have to balance between using the ibuprofen to get through them and resting to get over them. It's always a tricky balance.
I take a glucosamine/chondroitine/msm supplement.
I've read a couple of studies that indicate it is effective in slowing degenerative problems.
The mix has been used with great success for years in animal athletes. YMMV ;) ;) .
Glucosamine Sulfate, often found with Chondroitin Sulfate, is really not a pain reliever. It is a nutritional supplement that according to medical studies appears to slow down the deterioration of cartilage. This deterioration is one of the key factors in causing osteoarthritic changes in the joints.
Non-Steriodal Anti-Inflammatories (NSAIDs) are anti-inflammatory medications that often relieve pain. Such as, aspirin, ibuprofen, Aleve, etc. The key concern with such medications is possible problems with stomach lining. such as erosive gastritis or ulcers-and concomitant bleeding, etc. Tylenol is a pain reliever and excess use may cause liver damage, as can any medication used inappropriately.
There are non-drug ways of treating joint pain-exercise, physical medicine modalities (electrical stimulation, ultrasound, temperature therapies), manipulation, acupuncture, deep tissue work (Graston technique, myofascial release techniques, etc.).
Medications are very effective at masking pain and some help relieve inflammation. However, over use of pain medications can ultimately result in causing pain.
My 2 cents.
I am skeptical about the claims that the glucosamine/chondrotin supplements actually slow deterioration of cartilage, or promote repair. If it were truly proven via scientific studies, there would be a medical protocol for it and - given the fact that there are almost no side effects - it would be the first line of treatment in arthritis management. When I have looked into it, I haven't seen any claims of cellular repair, slowed damage, or any other purported physical effects that weren't vaguely referenced and part of advertisements.
Additionally, every anecdotal report and testimonial I've ever heard stated that the perceived benefits of the supplement/medication quickly disappeared as soon as one stopped taking them, which is not consistent with the idea that the stuff was actually implementing mechanical repair. Hence, while there is much speculation about these effects, in practice it seems to be little more than a pain reliever.
If you know of specific studies which show otherwise, please reference them. I dug around for a while via net, and couldn't find such information - especially nothing that used observational methods like biopsies or scans to demonstrate actual cartilage repair or slowed degeneration.
I take Aleve pretty routinely to take care of joint pain (I'm in my 40's, so maybe it also has something to do with just getting older). When I blew out my ACL, the orthopedic surgeon recommended the Aleve twice a day for two months, so obviously he didn't feel it would be too detrimental to my stomach (or that it was just better to reduce the swelling). In any case, that has worked really well for me. I tried the Glucosomine pills for a year, and they didn't do anything for me. Accupuncture has been one of the best ways for me to relieve some of the aches and pains that I have, and really helped me get over a torn rotator cuff (with the help of PT too of course).
Best on this Liane,
With all those torn and worn muscles- ligaments, I hope you do take care of yourself! ;)
wow.. did you get these injuries in training or with no relation to the dojo?
actually, I've had more. And yes, they are almost all aikido related, but I've been training a long time, and therefore have had ample opportunity to hurt myself. I am sure my aikido injuries are no more than had I been playing soccer, or biking, or other physical endeavors (actually, I've taken some pretty wicked falls off horses too).
Thanks for the well wishes, I'm okay (except my feet are now falling apart, but that has nothing to do with aikido practice, just bunions, ouch!).
Here's one article. Medscape has a good list of the recent research. Obviously, it is not all in but the trend lately is that there is a benefit with GS. It's side effects are what is appealing-not many. Whereas, medication for the treatment of OA are more prone to side effects-especially with long term use. This is exerted from Medscape.
An Evidence-Based Assessment of Glucosamine Sulfate, St. John's Wort, and Echinacea
Jack J. Chen, PharmD Disclosures
An Evidence-Based Assessment of Glucosamine Sulfate, St. John's Wort, and Echinacea
Jack J. Chen, PharmD, BCPS, FCPhA
Case Study: Glucosamine Sulfate
Joseph Pepping, PharmD, Pain Management and Nutritional Medicine Consultant for the Kaiser Moanalua Medical Center, Honolulu, Hawaii, reviewed 4 double-blinded, randomized clinical trials on the effect of glucosamine sulfate for the management of knee osteoarthritis (Table 8).[12-15] Particular attention was focused on a well-designed, randomized, double-blind, placebo-controlled trial investigating the long-term effects of glucosamine sulfate. In this study, patients with severe osteoarthritis or morbid obesity were excluded. Symptoms were scored by the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, a well-validated tool for measuring osteoarthritis-related outcomes such as pain, stiffness, and disability. Long-term progression of osteoarthritis was evaluated by measuring the change in width of the medial tibiofemoral joint space using digitized radiographs over a period of 3 years. Treatment with crystalline glucosamine sulfate (Dona, Viartril-S, Xicil, Rotta Research Group, Monza, Italy) 1500 mg once daily for 3 years (normally glucosamine sulfate is administered 500 mg 3 times daily) was well tolerated and associated with beneficial structure- and symptom-modifying effects in patients with mild to moderate osteoarthritis of the knee. The treatment period of 3 years is the longest to date of all studies of glucosamine in the management of osteoarthritis. This study is also remarkable in that the results suggest that oral glucosamine sulfate may act as a disease-modifying agent in patients with mild to moderate osteoarthritis of the knee.
Based on the evidence, Dr. Pepping recommended that stabilized glucosamine sulfate administered at a dosage of 1500 mg/day has beneficial effects on osteoarthritis symptoms (Grade A recommendation) and that long-term treatment is well tolerated (with superior safety over nonsteroidal anti-inflammatory agents) and may slow the progression of cartilage degeneration. Glucosamine sulfate "can be responsibly offered as either a first-line or adjunctive agent in the treatment of osteoarthritis," Pepping said. A caveat is that these studies used the sulfate salt of glucosamine (stabilized with potassium chloride or sodium chloride), and other forms of glucosamine may not be as effective. When counseling patients on glucosamine sulfate, clinicians should emphasize that the product should be taken with meals and routinely (not as needed). Additionally, a trial of at least 4 weeks is necessary to assess benefits. Diabetic patients should be informed that there are case reports of glucosamine sulfate causing an increase in blood glucose levels and that blood glucose levels should be monitored. However, in the 4 large clinical trials that were reviewed, significant changes in blood glucose levels were not noted.
Table 8. Evidence Table: Glucosamine Sulfate in the Long-term Treatment of Osteoarthritis
Study Subjects (N) Results Control LOE Limitations
Reginster 212 Positive Placebo I Minor
Noack 252 Positive Placebo I Minor
Muller-Fassbender 200 Equivalent Ibuprofen I Minor
Qiu 178 Equivalent Ibuprofen II Major
LOE = level of evidence
As scientific evidence on dietary supplements and botanical products become increasingly available, clinicians should use the evidence-based medicine process to objectively evaluate the data and to formulate appropriate recommendations. Based on the available evidence to date, the following recommendations can be made: Echinacea purpurea is effective for reducing the duration of symptoms of the common cold (but not for prevention), St. John's wort is effective for treating mild to moderate depression, and glucosamine sulfate is beneficial for treating osteoarthritis of the knee.
1. Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomized, placebo-controlled clinical trial. Lancet. 2001;357:251-256.
2. Noack W, Fischer M, Forster KK, et al. Glucosamine sulfate in osteoarthritis of the knee. Osteoarthritis Cartilage. 1994;2:51-59.
3. Muller-Fassbender H, Bach GL, Haase W, et al. Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis Cartilage. 1994;2:61-69.
4. Qiu GX, Gao SN, Giacovelli G, et al. Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee osteoarthritis. Arzneimittelforschung. 1998;48:469-474.
Cool. I'll pass this on to my arthritic friend. Thanks.
scientific studies on Alt Therapies for joints
Anecdotally, I've taken Glucosamine and it (along with rehab) was the greatest improvement to my joint problems (had rehab W/o and I didn't improve nearly as well). I have stopped taking GS and kept stable in terms of the rehab level, but if I wanted to really start training daily again, I'd start on the GS again and it'd help (no GS and my training wouldn't progress so quickly due to inflamation etc).
I've also Taken SAMe and it seemed to help but not so much, my mood was great though.
I've had a Chinese Herbalist (who was also a western pharmacist) give me Dit Da Joa which I guess means "Hit and Fall" medicine and it really helped in the short term but only as a stop gap measure.
As for scientific study, I have read of studies where they took a population of osteoarthritis patients and gave them NSAIDS only, NSAIDS and Glucosamine Sulfate, and GS only. They found that the NSAIDS/GS combo improved more quickly, but that the GS only population improved most overall. It'll take some digging to find that old study (circa '96) but I'll try.
Most recently, I've been told of a study (haven't found it yet, but I'll look) on the anti-inflammatory effect in people who continue to train. What they assert is that the inflammation has a minor cushioning effect so when one takes this away, you've got hard stuff grinding against hard stuff. In addition it has been held by most of the Athletic Trainers that I know that if a person takes too many NSAIDS, they don't know what kind of damage they're doing, because they can't feel the pain.
As for the bits and pieces...According to Morelli (et al) in the Jan 2003 issue of the American Family Physician
"In vitro studies have shown that glucosamine stimulates cartilage cells to synthesize increased amounts of glycosaminoglycans and proteoglycan ground substance...High dosages of glucosamine have been shown to have mild anti-inflammatory effects in animal models...Research suggests that the supplement must be taken for at least one month before improvement in symptoms can be expected to occur.
Chondroitin sulfate also has demonstrated efficacy in improving the symptoms of osteoarthritis by acting as a building block of proteoglycan molecules....Like glucosamine, chondroitin's mechanism of action in osteoarthritis may involve both anti-inflammatory properties and substrate provision for proteoglycan synthesis...Comparison of chondroitin with NSAIDs has shown that patients with osteoarthritis have fewer gastrointestinal side effects with chondroitin. Chondroitin is well tolerated; it appears to have a slower onset of action but to work longer than NSAIDS
The use of glucosamine and chondroitin together for the treatment of osteoarthritis has become extremely popular; however, there is little evidence that this combination is any more effective than either supplement alone.
S-adenosylmethionine (SAMe) is a naturally occurring compound found in all living cells that is commercially produced in yeast-cell cultures. A methyl donor, it is important in methylation reactions that aid in the production of cartilage proteoglycans. SAMe has been available by prescription in Europe since 1975, where it is used to treat arthritis and depression. A number of studies have found SAMe to be more effective than placebo in improving pain and stiffness related to osteoarthritis. However, many of these studies were nonrandomized, uncontrolled, and unblinded, and some were flawed statistically."
Glucosamine Sulfate, Chondroitin, and SAMe all have the potential to cause Gastro intestinal problems. GS may have the potential to raise blood glucose levels.
'Medical protocol' (note as a dietary supplement it is a suggestion as opposed to a perscriptive dose):
GS 1500mg in three doses per day
CS 1200mg in three doses per day
SAMe 400 to 1,200 mg per day
As for scientific references here are a few. There are a few meta-studies which should be addressed with a grain of salt as they were sponsored by the supplement industry. Please read with a critical mind.
Resch KL, Hill S, Ernst E. Use of complementary therapies by individuals with 'arthritis'. Clin Rheumatol 1997;16:391-5.
Barclay TS, Tsourounis C, McCart GM. Glucosamine. Ann Pharmacother 1998;32:574-9.
Setnikar I, Pacini MA, Revel L. Antiarthritic effects of glucosamine sulfate studied in animal models. Arzneimittelforschung 1991;41:542-5.
Rindone JP, Hiller D, Collacott E, Nordhaugen N, Arriola G. Randomized, controlled trial of glucosamine for treating osteoarthritis of the knee. West J Med 2000;172:91-4.
Houpt JB, McMillan R, Wein C, Paget-Dellio SD. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee. J Rheumatol 1999;26:2423-30.
Delafuente JC. Glucosamine in the treatment of osteoarthritis. Rheum Dis Clin North Am 2000;26: 1-11.
Qiu GX, Gao SN, Giacovelli G, Rovati L, Setnikar I. Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee osteoarthritis. Arzneimittelforschung 1998;48:469-74.
McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 2000;283:1469-75.
Towheed TE, Anastassiades TP, Shea B, Houpt J, Welch V, Hochberg MC. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2001;1:CD002946.
Lopes Vaz A. Double-blind clinical evaluation of the relative efficacy of ibuprofen and glucosamine sulphate in the management of osteoarthrosis of the knee in out-patients. Curr Med Res Opin 1982;8: 145-9.
Bourgeois P, Chales G, Dehais J, Delcambre B, Kuntz JL, Rozenberg S. Efficacy and tolerability of chondroitin sulfate 1200 mg/day vs chondroitin sulfate 3 x 400 mg/day vs placebo. Osteoarthritis Cartilage 1998;6(suppl A):25-30.
Leeb BF, Schweitzer H, Montag K, Smolen JS. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol 2000;27:205-11.
Morreale P, Manopulo R, Galati M, Boccanera L, Saponati G, Bocchi L. Comparison of the antiinflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis. J Rheumatol 1996;23:1385-91.
Kelly GS. The role of glucosamine sulfate and chondroitin sulfates in the treatment of degenerative joint disease. Altern Med Rev 1998;3:27-39.
Leffler CT, Philippi AF, Leffler SG, Mosure JC, Kim PD. Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study. Mil Med 1999;164: 85-91.
McCarty MF. The neglect of glucosamine as a treatment for osteoarthritis-a personal perspective. Med Hypotheses 1994;42:323-7.
The review of natural products. Drugs Facts and Comparisons. St. Louis, Mo.: Facts and Comparisons, 1996.
Di Padova C. S-adenosylmethionine in the treatment of osteoarthritis. Review of the clinical studies. Am J Med 1987;83:60-5.
Bradley JD, Flusser D, Katz BP, Schumacher HR Jr, Brandt KD, Chambers MA, et al. A randomized, double blind, placebo controlled trial of intravenous loading with S-adenosylmethionine (SAM) followed by oral SAM therapy in patients with knee osteoarthritis. J Rheumatol 1994;21:905-11.
Barcelo HA, Wiemeyer JC, Sagasta CL, Macias M, Barreira JC. Effect of S-adenosylmethionine on experimental osteoarthritis in rabbits. Am J Med 1987;83:55-9.
Konig B. A long-term (two years) clinical trial with S-adenosylmethionine for the treatment of osteoarthritis. Am J Med 1987;83:89-94.
Srivastava KC, Mustafa T. Ginger (Zingiber officinale) in rheumatism and musculoskeletal disorders. Med Hypotheses 1992;39:342-8.
Muller-Fassbender H. Double-blind clinical trial of S-adenosylmethionine versus ibuprofen in the treatment of osteoarthritis. Am J Med 1987;83:81-3.
Vetter G. Double-blind comparative clinical trial with S-adenosylmethionine and indomethacin in the treatment of osteoarthritis. Am J Med 1987; 83:78-80.
Maccagno A, Di Giorgio EE, Caston OL, Sagasta CL. Double-blind controlled clinical trial of oral S-adenosylmethionine versus piroxicam in knee osteoarthritis. Am J Med 1987;83:72-7.
Caruso I, Pietrogrande V. Italian double-blind multicenter study comparing S-adenosylmethionine, naproxen, and placebo in the treatment of degenerative joint disease. Am J Med 1987;83:66-71.
Glorioso S, Todesco S, Mazzi A, Marcolongo R, Giordano M, Colombo B, et al. Double-blind multicentre study of the activity of S-adenosylmethionine in hip and knee osteoarthritis. Int J Clin Pharmacol Res 1985;5:39-49.
Bliddal H, Rosetzsky A, Schlichting P, Weidner MS, Andersen LA, Ibfelt HH, et al. A randomized, placebo-controlled, cross-over study of ginger extracts and ibuprofen in osteoarthritis. Osteoarthritis Cartilage 2000;8:9-12.
Swanson BN. Medical use of dimethyl sulfoxide (DMSO). Rev Clin Basic Pharm 1985;5:1-33.
Santos L, Tipping PG. Attenuation of adjuvant arthritis in rats by treatment with oxygen radical scavengers. Immunol Cell Biol 1994;72:406-14.
Eberhardt R, Zwingers T, Hofmann R. DMSO in patients with active gonarthrosis. A double-blind placebo controlled phase III study [in German]. Fortschr Med 1995;113:446-50.
Newnham RE. Essentiality of boron for healthy bones and joints. Environ Health Perspect 1994; 102(suppl 7):83-5.
Travers RL, Rennie GC, Newnham RE. Boron and arthritis: the results of a double-blind pilot study. In: British Society for Nutritional Medicine. Journal of nutritional medicine. Vol 1. Abingdon, Oxfordshire, U.K.: Carfax, 1990:127-32.
Little CV, Parsons T. Herbal therapy for treating osteoarthritis. Cochrane Database Syst Rev 2001; 1:CD002947.
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:ai: :) :ai:
Pain's purpose is to tell you to SLOW DOWN.
Of course, many such as myself tend to ingnore pain. Ain't I tough (and stupid at the same time)?
For muscular pain I take ibuprofen, and do an ice massage. The message involves working ice over the affected area to produce a chill in the muscle mass. This is not the most comfortable thing to do. YET, what this accomplishes is a response of the body to dialate blood vessels in the affected muscle to warm the muscle back up. (the first response to cold is vasoconstriction, then vasodialation)
Lactic acid builds in overworked and injured muscle. It causes pain and cramps. By "flushing" the muscle by the above mentioned process, pain is lessened, and healing time is reduced.
This, some ibuprofen, and a couple days rest does the trick. IF pain persists it's time to get to a doctor to have the injury evaluated.
I take glucosamine/chondroitin and it seems to help with both my knees (old damage) and my wrists (prevention of new damage)... if anyone IS interested, I get mine through a discount vitamin website, http://www.puritanspride.com - they usually have a good price (buy one bottle, get two free right now) and if you buy the 60ct bottles, it would cost about $30 for a two month supply, or 50 cents a day - not so bad in my book. Just remember to take three tabs a day (1500mg of glucosamine).
Here is a direct link:
Jane: good information. Another input on the glucosamine-it probably should not be taken by diabetics and asthmatics.
Taking the GS with food can help with the GI problems.
Also, I refuse to even try Sam-e due to it's ridiculously high cost.
I heard that GS can make you retain weight (hey, it was a great excuse while I was taking it!), don't know if there is any truth to that one, but if you are on the round side, it is another thing to think about...
Soreness that lingers for hours or days is generally called Delayed Onset Muscle Soreness, or DOMS. This has nothing to do with lactic acid, but is rather thought to be about microtrauma (damage) to muscle and intra-muscular connective tissue. Things like massage, light exercise, and hot-cold contrast baths can help speed healing, but these effects are probably mostly due to increasing overall metabolism/circulation in the muscle.
I'd've put in more but I know that I'm already verbose. As for the diabetics aspect, I've seen a lot of conjecture in that regard (as it is a glucos-amine base in chemical structure) but each time I see this suggestion of caution (possible rise in blood glucose) there is often a following remark that there has yet to be a scientific study in that regard. Maybe there has, let me know if you know of one.
As for asthma, I've got asthma and have loaded the GS with no difficulties. What have you seen in terms of negative effects?
With regard to the SAMe, I got it at Costco so it was about as cheap as the high grade GS. Like I said, the joint status improvement was okay, but it really made a difference in handling the stresses of caca-heads at school. 'Oh, you lost all of my lower-division records?' It just rolled right off, and I didn't even know of the mood altering effects of SAMe.
:ai: :) :ai:
Gloucosamine is a supplement and has no pain analgesic value. Its sole purpose is to strengthen the cartilage in your joints. For pain take Ibuprofen and others with care-- Stay away from prescription pain meds and Acetaminophen if you can. I am personally on a prescription pain killer ( read lortab) and am going through hell with withdrawal ( it's a narcotic, up there with morphine and a few others). Before I was put on Lortab I was taking a lot of acetaminophen-- downside to it, liver damage. I would recommend staying far far far away from Acetaminophen…
My approach to pain relief is more holistic, and if you wish to discuss it please let me know.
I hope you find something that works for you,
Thanks for the clarification. The ice massage was prescribed to me by a physician who is also a triathelete who competes in ironman competitions (running, biking, swimming). Me dumb paramedic. Him doctor. Just passing along something that has worked for me.
NSAID side effects
You're right about acetaminophen especially if it's combined with codeine (double liver whammy). It should be important to note that just about every NSAID has a negative side.
Though acetaminophen is known for liver damage, ibuprophen, naproxen, and aspirin have been linked to kidney damage and in some cases failure. Recently, I've also heard of edema in the legs as a side of ibuprophen, but haven't seen the literature on that yet.
Overall, everything we put in our bodies should be addressed with care (IMHO). Everything we've discussed on this list has it's downside, we just have to keep our eyes wide open as we attempt to treat our bodies.
:ai: :) :ai:
In regards to ice massage, the effect is quicker and more intense than sticking an ice pack on. Generally, with an ice pack the length of application depends on the tissue depth (neck 15 minutes, low back 30). Ice massage however is rarely done for more than 3 to 5 minutes and with a hand lotion application to prevent skin burning.
Regarding the asthma, there was a medscape reference on that a while back. I'm sure the studies are not in on the topic as with the diabetes. However, erring on the caution side when a study shows a possible effect (insulin or asthma impact) I generally advise against it unless the doctor treating the diabetes or asthma gives them clearance (malpractice issues). As a chiropractor I do not prescribe medication so I prefer not to recommend things that mess with the disease. Prescribing nutraceuticals has the same malpractice implications.
As a general rule of thumb, ice is for acute and moist heat for chronic or subacute conditions. Weight lifters frequently get DOMS due to the type of exercise. Sometimes, a preventative dose of ibuprofen (pre-heavy exercise) can also help with the post exercise soreness issue. Again, be cautious about overuse of NSAIDs due to the gastrointestinal and liver issues.
Kaitlin-sorry to hear you are going through withdrawals-your doctor should have warned you of the addictive implications of Lortab-narcotics work for severe pain in most cases but are extremely addictive. I'm not sure what your pain is about but fibromyalgia is a frequently diagnosed problem-especially with women. It lowers one's pain threshhold so that the sufferer feels more pain at a much lower stimulus level. Usually, there a lot of tender points and sleep disturbances involved.
Check you private messages.
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