When I started lifting, I was pretty concerned with my joint health. I definitely didn’t want to become one of those old guys always complaining about his back, knees, shoulders, and elbows, warning the young’uns to take it easy in the weight room lest they become like me.
On the other hand, I also knew plenty of middle-aged guys who never seemed to have joint pain and who had been lifting their entire lives.
What gives? Luck? Genetics? Is weightlifting inherently bad for our joints and we just have to hope for the best?
Let’s find out.
At first glance, it would seem to make sense that weightlifting would, over time, give us joint problems.
I mean how good can it possibly be for our joints to squat, push, and pull hundreds of pounds over and over? Wouldn’t it speed up the “wear and tear” on the joint and thus the onset of osteoarthritis (the degradation of the joints)?
Interestingly enough, research doesn’t support these assumptions.
For example, this study was conducted with 25 competitive weightlifters–people that spend a lot more time training and lift a lot more weight than you or I do–and researchers found that on the whole, the subjects’ joints were as healthy, or healthier, than other people their age. (Researchers found the Olympic lifters had the most joint problems out of the group, however, which isn’t surprising considering the nature of these movements and the sheer amount of weight competitive lifters throw around.)
Furthermore, about half of the subjects admitted they were using anabolic steroids regularly, which means their joints were under even more strain than usual from the excessive weights lifted.
One other point worth noting is researchers found that previously injured joints were more susceptible to joint degeneration than healthy joints. So if you’ve sustained joint injuries in the past, lifting heavy weights week after week may aggravate them.
- Even in extreme cases of squatting, such as powerlifters lifting 2.5 times bodyweight, the compressive forces placed on the knee and its tendons are well within its ranges of ultimate strength.
- Stress placed on the ACL is negligible considering its ultimate strength (in one study, the highest ACL force recorded when squatting was a mere 6% of its ultimate strength). Highest recorded PCL forces were well within natural strength limits as well.
- There’s plenty of research demonstrating that strength training, and squatting in particular, is an effective treatment for osteoarthritis, both in terms of reducing pain and improve function.
- Research conducted by scientists at the University of Waterloo used real-time x-ray imaging (called fluoroscopy) to watch the spines of elite powerlifters while they fully flexed their spines with no weights, and while they deadlifted over 400 pounds. With the exception of one subject, all men completed their deadlifts within the normal range of motion during full flexion. Ligament lengths were unaffected, indicating that they don’t help support the load, but instead limit range of motion.
- A study conducted by researchers at the University of Valencia found that the deadlift is an extremely effective way to train the paraspinal muscles, which run down both sides of your spine and play a major role in the prevention of back injuries.
So then, if weightlifting isn’t inherently bad for your joints, why do so many weightlifters seem to have shoulder, knees, and lower back problems?
That said, like with any physical activity, the occasional ache or strain is inevitable, but if you do certain things wrong, you can get hurt. And with weightlifting, the common ways to get hurt involve injuring a joint like the shoulder or knee or the lower back.
Well, in most cases of joint injury that I’ve come across, the person was…
1. Attempting to lift too much weight; and…
2. Doing it with poor form
Simply put, weightlifting is not a forgiving sport if you don’t “respect” it. That is, if you get sloppy with heavy weights, bad things can happen. And ironically, this doesn’t just apply to free weights–machines are just as “dangerous” when used improperly.
So, take the time to learn proper form, especially on your big compound lifts and leave your ego at the door when you lift, and you’ll dramatically decrease your chance of getting hurt.
Pushing yourself in the gym is good, so long as you always maintain proper form as well. Go for that extra rep on your Squat or Deadlift…so long as you don’t have to hunch over to do it or turn the exercise into a Good Morning. Try to hit that PR on your Bench Press…so long as you don’t flare your elbows out or roll your shoulders in the process.
There’s also the matter of ignoring signs that it’s time to back off. “No pain, no gain,” right? Not really. Pain means something is wrong, and if you ignore it and try to push through, you can get hurt. As I said earlier, if you lift weights regularly, you’re going to strain muscles now and then. Maybe it’ll affect your shoulder or knee, maybe your back, or even something random like your wrist or brachialis.
The key to dealing with pain is treating it like an injury until it’s better. Avoid exercises that aggravate it, ice it and apply heat accordingly, and let it heal. If that means no deadlifting or squatting for a few weeks, so be it. Find alternative exercises that you can do. Annoying, yes, but an injury that sets you back several months is much more frustrating.
Ask the wrong “expert” about what you should do to relieve your joint pain and you’re going to hear drugs or surgery or both.
The problems with anti-inflammatory drugs are they just mask the problem and long-term use is a bad idea.
The problem with surgery is obvious: it’s a traumatic, risky experience that we would all rather avoid if at all possible.
Well, short-term use of drugs can give some relief and some situations necessitate surgery but if yours doesn’t (and a good sports doc can tell you), there’s a good chance the following 5 pain-relief strategies can help.
“Unsticking” soft tissues (muscles, tendons, ligaments, skin, and fascia) and improving movements patterns and range of motion can be very effective in relieving joint pain.
The type of exercises that accomplish this are commonly referred to as “mobility exercises,” and the right ones can work wonders.
Check out this article to learn more about how to use mobility exercises to reduce or even eliminate your joint pain.
Rest, Ice, and Heat
The most important part of recovery is rest.
That doesn’t mean immobility but it does mean you have to not do things that are going to impair healing and recovery.
Violate this simple principle and injuries can become chronic and debilitating.
Once a joint has fully healed and you’re ready to start training again, it’s a good idea to start with lighter weights and see how you feel over the next several days (no pain is a good sign), and gradually work back into your normal routine.
Ice helps you recover by reducing inflammation and swelling as well as internal bleeding from injured capillaries and blood vessels.
As long as there is pain and inflammation, ice will help.
Don’t apply ice for more than 15 to 20 minutes at a time, but you can rotate on and off all day.
Heat stimulates blood flow, which helps your body bring nutrients to and remove waste products from the area faster.
Heat shouldn’t be introduced immediately following an injury, however.
The general advice is to ice only for the first 3 days to bring down swelling and, once this has been accomplished, introduce heat. Alternate between 15 to 20 minutes of ice and heat.
As you know, abnormalities in soft tissues can cause joint pains, and research shows acupuncture can help treat this.
Specifically, needling can help release “trigger points” in the body, which are tight, painful areas of muscle that refer pain to other areas of the body.
For example, when you press on a trigger point in your neck, you might also feel pain in your shoulder (I’ve personally experienced that one).
The key here is obviously the skill and knowledge of the acupuncturist. Look for someone trained in using acupuncture for myofascial release.
Like acupuncture, research shows that massage is another effective strategy for releasing trigger points.
This can not only relieve pain but can help prevent muscular problems from developing in the first place that can, in time, cause joint pains.
Arnica gel is produced from the Arnica Montana plant and has long been used to treat inflammation and pain in the muscles and joints.
Here’s the product I use when I have joint pain:
Bone and joint health supplements comprise a multi-billion dollar market that is only getting bigger and bigger.
When people are in pain and looking for a solution, they’ll buy and try just about anything.
Before you jump on the joint supplement bandwagon, though, let’s go over your options.
As you probably know, the supplement industry is notorious for its lies and shenanigans. The truth is the majority of the supplements you see in the magazines and on the shelves aren’t going to help you reach your goals faster.
That’s why I decided to create the products I myself have always wanted: science-based formulations, clinically effective dosages of all ingredients, no fillers or unnecessary junk, and natural sweetening and flavoring.
If you like what you see and decide to support my work…you’re awesome. 🙂
It’s because of people like you that I get to spend my time writing articles like this that help others get into the best shape of their lives.
(And if you feel confused about what supplements you should take to reach your goals, take the Legion Supplement Finder Quiz to learn exactly what supplements are right for you. It’s the best way to ensure you get the most out of your supplement regimen.)
My primary recommendation is Legion Fortify, which is a 100% natural joint supplement that enhances joint health and function by reducing inflammation and preserving cartilage.
That is, Fortify helps produce happier, healthier joints that ache less and function better.
The reason it’s so effective is simple:
Every ingredient is backed by peer-reviewed scientific research and is included at clinically effective levels.
That means the ingredients and doses in Fortify are based on published scientific research demonstrating real benefits, not the restrictions of razor-thin production budgets or gluttonous profit margins.
In other words, Fortify is backed up with real science and real numbers.
Let’s cover each ingredient individually.
Curcumin is the yellow pigment found in the turmeric plant, which is the main spice in curry. It has been used therapeutically in Ayurvedic medicine for thousands of years.
Its health benefits are extensive, and scientific researchers around the world are investigating applications for fighting a variety of diseases such as cancer, cardiovascular disease, osteoporosis, diabetes, Alzheimer’s, and more.
One reason for this is that curcumin has powerful anti-inflammatory effects, which are exerted by inhibiting proteins that trigger the production of inflammatory chemicals.
Fortunately, there’s an easy solution for increasing bioavailability: black pepper extract.
Research shows that pairing black pepper extract with curcumin increases bioavailability twentyfold. And when you do that, curcumin becomes an effective joint support supplement.
Studies show that supplementation with curcumin and black pepper extract reduces inflammatory signals in the joints and, in those with arthritis, relieves pain and stiffness and improves mobility.
When paired with piperine, the clinically effective dosages of curcumin range between 200 and 500 milligrams.
Given its powerful anti-inflammatory effects and long list of additional health benefits, curcumin is on my “highly recommended” list for both joint and general health.
And that’s why I included 500 mg of curcumin and 25 mg of piperine in each serving of my joint supplement, FORTIFY.
That’s only the beginning of what FORTIFY has to offer, though.
It also contains clinically effective dosages of three more molecules shown to alleviate joint pain and improve joint health.
Let’s take a look at each.
Undenatured Type II Colagen
Collagen is the main protein of the various connective tissues in animals and type II collagen (CII) is a type of collagen that makes up your joint cartilage.
“Undenatured” is more than a fancy word—it’s vitally important to the effectiveness of the product.
Denaturization is the alteration of the natural structure of a substance, usually by the addition of another chemical or heat that changes the substance’s physical properties.
Typical commercial processing of collagen causes alterations to its basic form (denaturization), and research shows that denatured collagen has no beneficial effects on joint inflammation.
Undenatured collagen, however, is a more natural form of the substance and research shows that the UC II® undenatured type II collagen is highly effective for regulating the immune response that inflames joints and destroys cartilage and bone, which further inflames the joints and starts a degenerative cycle.
And the best part about undenatured type II collagen is that these effects have been demonstrated in people with arthritic conditions and people with healthy joints.
It accomplishes this by “teaching” the body’s immune system to stop attacking collagen as a foreign substance, which is the cause of some arthritic conditions. Orally ingesting CII works almost like a vaccine, resulting in less of an inflammatory response to your own collagen because the body now recognizes it.
The clinically effective dosages of undenatured type II collagen range between 10 and 40 milligrams.
Undenatured type II collagen isn’t cheap but research shows it’s one of the most effective supplements you can take for preserving your joint health. I highly recommend it.
That’s why my joint supplement FORTIFY contains 10 milligrams of undenatured type II collagen per serving.
I chose the lower end of the clinically effective dosage because it isn’t clear if more is better. Research clearly shows that 10 mg is effective but not that two, three, or four times that amount is more so.
Boswellia serrata is a plant that produces an aromatic substance known as frankinsence, which has been used for thousands of years in Ayurvedic medicine to treat various disorders related to inflammation.
Thanks to modern science, we now know why.
Frankinsence contains molecules known asboswellic acids. Research shows that, like curcumin, boswellic acids—and one in particular known as acetyl-keto-beta-boswellic acid, or AKBA—inhibit the production of several proteins that cause inflammation in the body.
And in case you’re wondering, the difference between the anti-inflammatory mechanisms of curcumin and boswellic acids is they work on different enzymes. Curcumin inhibits an enzyme known as cyclooxygenase, or COX, and boswellic acids inbhibit lysyl oxidase, or LOX (and, most notably, 5-LOX).
These anti-inflammatory properties extend to the joints, which is why studies show that Boswellia serrata is an effective treatment for reducing joint inflammation and pain as well as inhibiting the autoimmune response that eats away at joint cartilage and eventually causes arthritis.
The clinically effective dosages of boswellia serrata range between 100 and 200 milligrams.
What can I say…I’m a fan of this molecule. Its powerful anti-inflammatory effects are not only good for your joints but for your entire body, as systemic inflammation is a known contributor to many types of disease.
FORTIFY contains 125 mg of boswellia serrata per serving.
Find the Best Diet for You in Just 60 Seconds
How many calories should you eat? What about "macros?" What foods should you eat? Take our 60-second quiz to get science-based answers to these questions and more.Take the Quiz
Grape Seed Extract
Grape seed extract is a substance derived from the ground-up seeds of red wine grapes, which have been used in European medicine for thousands of years.
There are two molecules in grape seed extract that account for most of its health benefits: tannins, which are bitter compounds that make wine taste dry, and procyanidins, which are chains of antioxidants found in some plants.
Much of the research on grape seed extract’s beneficial effects on joint health is extrapolated from research on a similar molecule known as pycnogenol, which is also a potent source of procyanidins. Pycnogenol is significantly more expensive than grape seed extract, however, which is why GSE is preferable for supplementation needs.
Research shows that the primary way grape seed extract helps protect joint cartilage from damage caused by the pro-inflammatory immune response that can develop into arthritis.
Studies also show that supplementation with grape seed extract confers other health benefits, including the following:
- Better eye health.
- A reduced risk of heart disease.
- Greater blood glucose control.
- Improved blood flow to the extremities, which can reduce the appearance of varicose veins.
- Potential anti-cancer activities.
Clinically effective dosages of grape seed extract range from 75 to 300 mg.
You get a lot for your money with grape seed extract. Like curcumin and boswellia serrata, it improves both joint and overall health, and is a worthwhile inclusion in your supplementation regimen.
Now that you know about all of the effective ingredients in Fortify, let’s cover a few other joint supplement options.
(Oh, and if you aren’t sure if FORTIFY is right for you or if another supplement might be a better fit for your budget, circumstances, and goals, then take the Legion Supplement Finder Quiz! In less than a minute, it’ll tell you exactly what supplements are right for you. Click here to check it out.)
If you’re boning up on joint health (har har har), you’ve probably heard about glucosamine.
It’s a supplement derived from shellfish and is often sold as a sure bet for relieving joint pain and improving joint health.
Well, studies show that while it can provide minor pain relief, it’s unreliable. Research also shows that glucosamine can reduce the rate of collagen loss, which is particularly relevant to people that run or participate in other high-impact activities regularly. Its collagen-preserving effects are relatively weak, though.
The bottom line is glucosamine isn’t worthless but also isn’t nearly as effective as many people think. Glucosamine is cheap, however, so if your budget allows, I think it’s a worthwhile addition.
Personally, I take glucosamine sulfate, which I buy from a company called Jarrow, because they’ve proven themselves to be a trustworthy source of high-quality ingredients.
If you want to get the absolute most out of a joint supplementation regimen and don’t have a budget, it makes sense to include glucosamine in it.
The clinically effective dosage of glucosamine is 900 to 1,500 mg per day, and here’s the product I personally use:
Chondroitin is an major constituent of collagen and is frequently paired with glucosamine to treat the symptoms of arthritis.
Based on the scope and quality of the more recent research on chondroitin, my recommendation is save your money.
MSM is a sulfur-containing chemical found in plants, animals, and humans. It’s often paired with glucosamine because of its antioxidative and anti-inflammatory properties.
Studies show that MSM has promise for treatment of arthritis but more rigorous research is needed.
Many people report that MSM relieves their joint pain so, like glucosamine, I think it’s worth including if budget isn’t a concern.
If you are on a budget, however, then the following supplements will give you the most bang for your buck.
The clinically effective dosage of MSM appears to be around 3,000 mg per day, and again, here’s the product I personally use:
Spirulina is a non-toxic blue-green algae that is very similar to fish oil in its health benefits.
Research has shown that supplementation with spirulina can…
- Reduce muscle damage caused by exercise
- Improve exercise performance
- Increase strength
- Improve cholesterol and triglyceride levels
- Reduce blood pressure
- Improve blood sugar control
- Reduce systemic inflammation
- Improve allergy symptoms
- Improve insulin sensitivity
The anti-inflammatory effects are what help with reducing joint pain, and animal research has shown that spirulina supplementation improves joint health.
Spirulina has a lot to offer, which is why it’s in my cabinet and on my list of supplements everyone should take. Here’s the product I use:
Some Nutritionists Charge Hundreds of Dollars for This Diet "Hack" . . .
. . . and it's yours for free. Take our 60-second quiz and learn exactly how many calories you should eat, what your "macros" should be, what foods are best for you, and more.Take the Quiz
The next type of general health supplement that I highly recommend is fish oil, because it’s a great source of “omega-3 fatty acids.”
Omega-3 fatty acids (eicosapentaenoic acid–EPA–and docosahexaenoic acid–DHA) are an essential type of fat, meaning they can’t be synthesized by the body and must be obtained from the diet.
Research shows that fish oil has powerful anti-inflammatory effects and can significantly reduce joint pain.
Studies also show that supplementation with fish oil can…
- Increase muscle protein synthesis
- Reduce muscle soreness, inflammation, and anxiety
- Reduce blood pressure, depression, the negative effects of stress, and the risk for kidney and cardiovascular disease, as well as stroke and metabolic syndrome
- Improve glucose uptake and insulin sensitivity in people with impaired insulin response and metabolism, and preserve it in the metabolically healthy
- Improve memory and cognitive performance
- Help prevent weight gain
- Speed up fat loss
If you don’t get enough omega-3 fatty acids in your diet (2 to 3 grams per day is a good target), I strongly suggest that you take a fish oil supplement.
Not all fish oils are made the same, though. There are two important things to consider when choosing one:
You want to know how the oil has been processed.
There are two forms of fish oil on the market today: the triglyceride form, and the ethyl ester form.
The triglyceride form is fish oil in its natural state, and the ethyl ester form is a processed version of the triglyceride form that includes a molecule of ethanol (alcohol).
While plenty of studies have proven the benefits of supplementation with fatty acid ethyl esters (FAEEs), research has shown that the triglyceride form is better absorbed by the body.
One of the reasons for this is the ethyl ester form is much more resistant to the enzymatic process by which the body breaks the oil down for use.
Another downside to the ethyl ester form is during the digestive process, your body converts it back to the triglyceride form, which results in the release of the ethanol molecule.
Although the dose is small, those with alcohol sensitivity or addiction can be negatively affected. Furthermore, research has provided evidence of cellular and organic toxicity and injury resulting from the ingestion of FAEEs
You want to know the EPA/DHA content of each serving.
Because of the varying quality of fish oils on the market, it’s important that you look at how many milligrams of EPa and DHA (omega-3 fatty acids) are actually in each serving.
Lower quality supplements might have as little as 150 – 200 milligrams per 1 gram of fat, which makes them nearly worthless as you have to take far too much every day to get enough omega-3s (you want a minimum of 2 – 3 grams of omega-3s per day).
A high-quality fish oil can be quite a bit more money than a low-quality one, but when you look at how much you’re getting for that money in terms of omega-3 fatty acids, the price makes more sense.
For example, here’s the label from a cheap, low-quality (ethyl ester) fish oil product:
This product costs about $11, and comes with 100 pills containing 300 mg of omega-3 fatty acids each. This means you’re getting 30 grams of omega-3 fatty acids per bottle, and paying about 37 cents per gram.
Now, here’s the label from a high-quality triglyceride fish oil product that I use, Nordic Naturals’ Ultimate Omega:
This product costs about $40, and comes with 120 pills containing 640 mg of omega-3 fatty acids each.
This means you’re getting about 77 grams of omega-3 fatty acids per bottle, and paying about 52 cents per gram.
So, as you can see, the initial price difference of $11 vs. $40 isn’t as drastic when you look at what you’re getting:
37 cents per gram of low-quality oil that isn’t likely to deliver all of the benefits you’re looking for vs. 52 cents per gram for the highest quality oil on the market that will.
Thus, I recommend you go with the high-quality product whose nutrition facts label I showed above:
+ Scientific References
- Best CA, Laposata M. Fatty acid ethyl esters: toxic non-oxidative metabolites of ethanol and markers of ethanol intake. Front Biosci. 2003;8. https://www.ncbi.nlm.nih.gov/pubmed/12456329. Accessed January 30, 2020.
- Dyerberg J, Madsen P, Møller JM, Aardestrup I, Schmidt EB. Bioavailability of marine n-3 fatty acid formulations. Prostaglandins Leukot Essent Fat Acids. 2010;83(3):137-141. doi:10.1016/j.plefa.2010.06.007
- Beckermann B, Beneke M, Seitz I. [Comparative bioavailability of eicosapentaenoic acid and docasahexaenoic acid from triglycerides, free fatty acids and ethyl esters in volunteers]. Arzneimittelforschung. 1990;40(6):700-704. http://www.ncbi.nlm.nih.gov/pubmed/2144420. Accessed January 30, 2020.
- Couet C, Delarue J, Ritz P, Antoine JM, Lamisse F. Effect of dietary fish oil on body fat mass and basal fat oxidation in healthy adults. Int J Obes. 1997;21(8):637-643. doi:10.1038/sj.ijo.0800451
- Buckley JD, Howe PRC. Anti-obesity effects of long-chain omega-3 polyunsaturated fatty acids. Obes Rev. 2009;10(6):648-659. doi:10.1111/j.1467-789X.2009.00584.x
- Muldoon MF, Ryan CM, Sheu L, Yao JK, Conklin SM, Manuck SB. Serum Phospholipid Docosahexaenonic Acid Is Associated with Cognitive Functioning during Middle Adulthood. J Nutr. 2010;140(4):848-853. doi:10.3945/jn.109.119578
- Narendran R, Frankle WG, Mason NS, Muldoon MF, Moghaddam B. Improved Working Memory but No Effect on Striatal Vesicular Monoamine Transporter Type 2 after Omega-3 Polyunsaturated Fatty Acid Supplementation. Le Foll B, ed. PLoS One. 2012;7(10):e46832. doi:10.1371/journal.pone.0046832
- Haugaard SB, Vaag A, Mu H, Madsbad S. Skeletal muscle structural lipids improve during weight-maintenance after a very low calorie dietary intervention. Lipids Health Dis. 2009;8. doi:10.1186/1476-511X-8-34
- Huang T, Wahlqvist ML, Xu T, Xu A, Zhang A, Li D. Increased plasma n-3 polyunsaturated fatty acid is associated with improved insulin sensitivity in type 2 diabetes in China. Mol Nutr Food Res. 2010;54(SUPPL. 1). doi:10.1002/mnfr.200900189
- Huang T, Bhulaidok S, Cai Z, et al. Plasma phospholipids n-3 polyunsaturated fatty acid is associated with metabolic syndrome. Mol Nutr Food Res. 2010;54(11):1628-1635. doi:10.1002/mnfr.201000025
- Simopoulos AP. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med. 2008;233(6):674-688. doi:10.3181/0711-MR-311
- Hamazaki T, Itomura M, Sawazaki S, Nagao Y. Anti-stress effects of DHA. In: BioFactors. Vol 13. IOS Press; 2000:41-45. doi:10.1002/biof.5520130108
- Sublette ME, Ellis SP, Geant AL, Mann JJ. Meta-analysis of the effects of Eicosapentaenoic Acid (EPA) in clinical trials in depression. J Clin Psychiatry. 2011;72(12):1577-1584. doi:10.4088/JCP.10m06634
- Ramel A, Martinez JA, Kiely M, Bandarra NM, Thorsdottir I. Moderate consumption of fatty fish reduces diastolic blood pressure in overweight and obese European young adults during energy restriction. Nutrition. 2010;26(2):168-174. doi:10.1016/j.nut.2009.04.002
- Kiecolt-Glaser JK, Belury MA, Andridge R, Malarkey WB, Glaser R. Omega-3 supplementation lowers inflammation and anxiety in medical students: A randomized controlled trial. Brain Behav Immun. 2011;25(8):1725-1734. doi:10.1016/j.bbi.2011.07.229
- Bloomer RJ, Larson DE, Fisher-Wellman KH, Galpin AJ, Schilling BK. Effect of eicosapentaenoic and docosahexaenoic acid on resting and exercise-induced inflammatory and oxidative stress biomarkers: A randomized, placebo controlled, cross-over study. Lipids Health Dis. 2009;8. doi:10.1186/1476-511X-8-36
- Tartibian B, Maleki BH, Abbasi A. The Effects of Ingestion of Omega-3 Fatty Acids on Perceived Pain and External Symptoms of Delayed Onset Muscle Soreness in Untrained Men. Clin J Sport Med. 2009;19(2):115-119. doi:10.1097/JSM.0b013e31819b51b3
- Smith GI, Atherton P, Reeds DN, et al. Omega-3 polyunsaturated fatty acids augment the muscle protein anabolic response to hyperinsulinaemia-hyperaminoacidaemia in healthy young and middle-aged men and women. Clin Sci. 2011;121(6):267-278. doi:10.1042/CS20100597
- Remirez D, González R, Merino N, Rodriguez S, Ancheta O. Inhibitory effects of Spirulina in zymosan-induced arthritis in mice. Mediators Inflamm. 2002;11(2):75-79. doi:10.1080/09629350220131917
- Marcel AK, Ekali LG, Eugene S, et al. The effect of Spirulina platensis versus soybean on insulin resistance in HIV-infected patients: A randomized pilot study. Nutrients. 2011;3(7):712-724. doi:10.3390/nu3070712
- Cingi C, Conk-Dalay M, Cakli H, Bal C. The effects of spirulina on allergic rhinitis. Eur Arch Oto-Rhino-Laryngology. 2008;265(10):1219-1223. doi:10.1007/s00405-008-0642-8
- Park HJ, Lee YJ, Ryu HK, Kim MH, Chung HW, Kim WY. A randomized double-blind, placebo-controlled study to establish the effects of spirulina in elderly Koreans. Ann Nutr Metab. 2008;52(4):322-328. doi:10.1159/000151486
- Parikh P, Mani U, Iyer U. Role of Spirulina in the control of glycemia and lipidemia in type 2 diabetes mellitus. J Med Food. 2001;4(4):193-199. doi:10.1089/10966200152744463
- Torres-Duran P V., Ferreira-Hermosillo A, Juarez-Oropeza MA. Antihyperlipemic and antihypertensive effects of Spirulina maxima in an open sample of mexican population: A preliminary report. Lipids Health Dis. 2007;6. doi:10.1186/1476-511X-6-33
- Lee EH, Park J-E, Choi Y-J, Huh K-B, Kim W-Y. A randomized study to establish the effects of spirulina in type 2 diabetes mellitus patients. Nutr Res Pract. 2008;2(4):295. doi:10.4162/nrp.2008.2.4.295
- Kalafati M, Jamurtas AZ, Nikolaidis MG, et al. Ergogenic and antioxidant effects of spirulina supplementation in humans. Med Sci Sports Exerc. 2010;42(1):142-151. doi:10.1249/MSS.0b013e3181ac7a45
- Lu HK, Hsieh CC, Hsu JJ, Yang YK, Chou HN. Preventive effects of Spirulina platensis on skeletal muscle damage under exercise-induced oxidative stress. Eur J Appl Physiol. 2006;98(2):220-226. doi:10.1007/s00421-006-0263-0
- Dinicola S, Pasqualato A, Cucina A, et al. Grape seed extract suppresses MDA-MB231 breast cancer cell migration and invasion. Eur J Nutr. 2014;53(2):421-431. doi:10.1007/s00394-013-0542-6
- Sano A, Tokutake S, Seo A. Proanthocyanidin-rich grape seed extract reduces leg swelling in healthy women during prolonged sitting. J Sci Food Agric. 2013;93(3):457-462. doi:10.1002/jsfa.5773
- Sapwarobol S, Adisakwattana S, Changpeng S, Ratanawachirin W, Tanruttanawong K, Boonyarit W. Postprandial blood glucose response to grape seed extract in healthy participants: A pilot study. Pharmacogn Mag. 2012;8(31):192-196. doi:10.4103/0973-1296.99283
- Olas B, Wachowicz B, Stochmal A, Oleszek W. The polyphenol-rich extract from grape seeds inhibits platelet signaling pathways triggered by both proteolytic and non-proteolytic agonists. Platelets. 2012;23(4):282-289. doi:10.3109/09537104.2011.618562
- Yang H, Lee BK, Kook KH, Jung YS, Ahn J. Protective effect of grape seed extract against oxidative stress-induced cell death in a staurosporine-differentiated retinal ganglion cell line. Curr Eye Res. 2012;37(4):339-344. doi:10.3109/02713683.2011.645106
- Raina K, Tyagi A, Kumar D, Agarwal R, Agarwal C. Role of oxidative stress in cytotoxicity of grape seed extract in human bladder cancer cells. Food Chem Toxicol. 2013;61:187-195. doi:10.1016/j.fct.2013.06.039
- Glurich I, Grossi S, Albini B, et al. Systemic inflammation in cardiovascular and periodontal disease: comparative study. Clin Diagn Lab Immunol. 2002;9(2):425-432. doi:10.1128/cdli.9.2.425-432.2002
- Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee - A randomized double blind placebo controlled trial. Phytomedicine. 2003;10(1):3-7. doi:10.1078/094471103321648593
- Sailer ER, Subramanian LR, Rall B, Hoernlein RF, Ammon HPT, Safayhi H. Acetyl-11-keto-β-boswellic acid (AKBA): Structure requirements for binding and 5-lipoxygenase inhibitory activity. Br J Pharmacol. 1996;117(4):615-618. doi:10.1111/j.1476-5381.1996.tb15235.x
- Siddiqui MZ. Boswellia serrata, a potential antiinflammatory agent: An overview. Indian J Pharm Sci. 2011;73(3):255-261. doi:10.4103/0250-474X.93507
- Bayrak Ş, Mitchison NA. Bystander suppression of murine collagen-induced arthritis by long-term nasal administration of a self type II collagen peptide. Clin Exp Immunol. 1998;113(1):92-95. doi:10.1046/j.1365-2249.1998.00638.x
- Lugo JP, Saiyed ZM, Lau FC, et al. Undenatured type II collagen (UC-II®) for joint support: A randomized, double-blind, placebo-controlled study in healthy volunteers. J Int Soc Sports Nutr. 2013;10. doi:10.1186/1550-2783-10-48
- Nagler-Anderson C, Bober LA, Robinson ME, Siskind GW, Thorbecke GJ. Suppression of type II collagen-induced arthritis by intragastric administration of soluble type II collagen. Proc Natl Acad Sci U S A. 1986;83(19):7443-7446. doi:10.1073/pnas.83.19.7443
- Jackson JK, Higo T, Hunter WL, Burt HM. The antioxidants curcumin and quercetin inhibit inflammatory processes associated with arthritis. Inflamm Res. 2006;55(4):168-175. doi:10.1007/s00011-006-0067-z
- Shoba G, Joy D, Joseph T, Majeed M, Rajendran R, Srinivas PSSR. Influence of piperine on the pharmacokinetics of curcumin in animals and human volunteers. Planta Med. 1998;64(4):353-356. doi:10.1055/s-2006-957450
- Garcea G, Berry DP, Jones DJL, et al. Consumption of the putative chemopreventive agent curcumin by cancer patients: Assessment of curcumin levels in the colorectum and their pharmacodynamic consequences. Cancer Epidemiol Biomarkers Prev. 2005;14(1):120-125. https://www.ncbi.nlm.nih.gov/pubmed/15668484. Accessed January 30, 2020.
- Anand P, Kunnumakkara AB, Newman RA, Aggarwal BB. Bioavailability of curcumin: Problems and promises. Mol Pharm. 2007;4(6):807-818. doi:10.1021/mp700113r
- Aggarwal S, Ichikawa H, Takada Y, Sandur SK, Shishodia S, Aggarwal BB. Curcumin (diferuloylmethane) down-regulates expression of cell proliferation and antiapoptotic and metastatic gene products through suppression of IκBα kinase and Akt activation. Mol Pharmacol. 2006;69(1):195-206. doi:10.1124/mol.105.017400
- Aggarwal BB, Sundaram C, Malani N, Ichikawa H. Curcumin: The Indian solid gold. Adv Exp Med Biol. 2007;595:1-75. doi:10.1007/978-0-387-46401-5_1
- Brien S, Prescott P, Bashir N, Lewith H, Lewith G. Systematic review of the nutritional supplements dimethyl sulfoxide (DMSO) and methylsulfonylmethane (MSM) in the treatment of osteoarthritis. Osteoarthr Cartil. 2008;16(11):1277-1288. doi:10.1016/j.joca.2008.03.002
- Reichenbach S, Sterchi R, Scherer M, et al. Meta-analysis: Chondroitin for osteoarthritis of the knee or hip. Ann Intern Med. 2007;146(8):580-590. doi:10.7326/0003-4819-146-8-200704170-00009
- McAlindon TE, La Valley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: A systematic quality assessment and meta-analysis. J Am Med Assoc. 2000;283(11):1469-1475. doi:10.1001/jama.283.11.1469
- Wandel S, Jüni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: Network meta-analysis. BMJ. 2010;341(7775):711. doi:10.1136/bmj.c4675
- Momomura R, Naito K, Igarashi M, et al. Evaluation of the effect of glucosamine administration on biomarkers of cartilage and bone metabolism in bicycle racers. Mol Med Rep. 2013;7(3):742-746. doi:10.3892/mmr.2013.1289
- Band (Musical group), Bowman RMJ, Hawkins R, et al. The Band a musical history. 2005;(72435-77409-0-6 Capitol). https://www.ncbi.nlm.nih.gov/pubmed/17265490. Accessed January 30, 2020.
- Knuesel O, Weber M, Suter A. Arnica montana gel in osteoarthritis of the knee: An open, multicenter clinical trial. Adv Ther. 2002;19(5):209-218. doi:10.1007/BF02850361
- Widrig R, Suter A, Saller R, Melzer J. Choosing between NSAID and arnica for topical treatment of hand osteoarthritis in a randomised, double-blind study. Rheumatol Int. 2007;27(6):585-591. doi:10.1007/s00296-007-0304-y
- Kong LJ, Zhan HS, Cheng YW, Yuan WA, Chen B, Fang M. Massage therapy for neck and shoulder pain: A systematic review and meta-analysis. Evidence-based Complement Altern Med. 2013;2013. doi:10.1155/2013/613279
- Liu L, Huang QM, Liu QG, et al. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: A systematic review and meta-analysis. Arch Phys Med Rehabil. 2015;96(5):944-955. doi:10.1016/j.apmr.2014.12.015
- Noten S, Meeus M, Stassijns G, Van Glabbeek F, Verborgt O, Struyf F. Efficacy of Different Types of Mobilization Techniques in Patients with Primary Adhesive Capsulitis of the Shoulder: A Systematic Review. Arch Phys Med Rehabil. 2016;97(5):815-825. doi:10.1016/j.apmr.2015.07.025
- Zheng XQ, Li K, Wei YD, Tie HT, Yi XY, Huang W. Nonsteroidal anti-inflammatory drugs versus corticosteroid for treatment of shoulder pain: A systematic review and meta-analysis. Arch Phys Med Rehabil. 2014;95(10):1824-1831. doi:10.1016/j.apmr.2014.04.024
- Requa RK, Deavilla LN, Garrick JG. Injuries in recreational adult fitness activities. Am J Sports Med. 1993;21(3):461-467. doi:10.1177/036354659302100323
- Stone MH. Muscle conditioning and muscle injuries. Med Sci Sports Exerc. 1990;22(4):457-462. doi:10.1249/00005768-199008000-00007
- Kerr ZY, Collins CL, Dawn Comstock R. Epidemiology of Weight Training-Related Injuries Presenting to United States Emergency Departments, 1990 to 2007. Am J Sports Med. 2010;38(4):765-771. doi:10.1177/0363546509351560
- Colado JC, Pablos C, Chulvi-Medrano I, Garcia-Masso X, Flandez J, Behm DG. The progression of paraspinal muscle recruitment intensity in localized and global strength training exercises is not based on instability alone. Arch Phys Med Rehabil. 2011;92(11):1875-1883. doi:10.1016/j.apmr.2011.05.015
- Cholewicki J, McGill SM. Lumbar posterior ligament involvement during extremely heavy lifts estimated from fluoroscopic measurements. J Biomech. 1992;25(1):17-28. doi:10.1016/0021-9290(92)90242-S
- Uthman OA, Van Der Windt DA, Jordan JL, et al. Exercise for lower limb osteoarthritis: Systematic review incorporating trial sequential analysis and network meta-analysis. BMJ. 2013;347(7928). doi:10.1136/bmj.f5555
- Escamilla RF, Fleisig GS, Zheng N, et al. Effects of technique variations on knee biomechanics during the squat and leg press. Med Sci Sports Exerc. 2001;33(9):1552-1566. doi:10.1097/00005768-200109000-00020
- Toutoungi DE, Lu TW, Leardini A, Catani F, O’Connor JJ. Cruciate ligament forces in the human knee during rehabilitation exercises. Clin Biomech. 2000;15(3):176-187. doi:10.1016/S0268-0033(99)00063-7
- Nagura T, Dyrby CO, Alexander EJ, Andriacchi TP. Mechanical loads at the knee joint during deep flexion. J Orthop Res. 2002;20(4):881-886. doi:10.1016/S0736-0266(01)00178-4