Hyaluronic Acid for Tendon Health

By: Byron J. Richards, Board Certified Clinical Nutritionist
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(Originally published 5/6/13) Tendons connect the muscles to the bones and their smooth function is vital for pain-free movement. Tendons must glide smoothly while transferring the force of muscle contractions to the bones. Problems are seen in athletes from overuse and begin to occur more frequently in active adults over the age of 40, when tendons start to lose their elasticity. While tendon problems can occur in any joint area, they are most common in the knee, heel, and/or shoulder areas. A new discovery about tendon structure opens the door for more targeted nutrition to help combat tendon inflammation and pain, thereby actually addressing the problem.

The discovery is of a layer of “skin”: epithelial cells that cover the tendons1. This skin has never before been identified. Researchers found that when this skin is compromised then the injured area becomes sticky and starts forming adhesions with surrounding tissues, thus causing inflammation and painful movement. 

Because the integrity of this skin declines with age, our goal should be to maintain it with proper nutrition. The problem is that various areas of the tendon have a poor blood flow, slowing the supply of nutrients to the injured area. 

I found this study fascinating, because I have repeatedly seen in clinical practice that one nutrient stands out above all others in combating this type of inflammation – low molecular weight hyaluronic acid from rooster comb. While various structural support and anti-inflammatory nutrients may be helpful, hyaluronic acid is the only nutrient I have seen perform extremely well in this situation.

Up until this study I never understood why hyaluronic acid was so helpful, other than that it is a basic structural repair nutrient at the most fundamental level. However, its low molecular weight appears to allow easy transport (typically by diffusion) to the inflamed area with poor circulation. While a simple molecule, hyaluronic acid is the foundation for the formation of any new collagen or connective tissue-based structure in the human body. Its properties are also highly lubricating. Thus, it appears to have a unique ability to help tendons and the rejuvenation of this newly discovered skin. Of course, it is also the primary nutrient that lubricates the synovial fluid of joints, so it appears to help joint pain in several different ways.

Currently, there are no studies with hyaluronic acid and tendon inflammation. What I am giving you is front line clinical experience. I have found for many patients that taking three capsules a day of hyaluronic acid is adequate, though some need up to 6 or even 9. On doses ranging from 3-9 per day, improvement should be felt within a few weeks or less. I suggest staying on whatever dose is helpful for at least two months and then lowering to a maintenance dose based on activity level. 

Bromelain is another nutrient that supports tendon healing, most likely by helping to dissolve the adhesions.

Maintaining physical activity level as you age is key. Keeping your tendons in a lubricated and smoothly operating condition is vital. Most likely you will have to cut back on the intensity of what you once did, even if your muscles say you can do more. However, you don’t want to get backed into a corner of pain and injury every time you ramp up your fitness program or perform your favorite sports or physical activity. Hyaluronic acid is my personal favorite supplement in this regard.


Referenced Studies:
  1. ^ The Nature of Tendon IInflammation  PLoS ONE  Susan H. Taylor, Sarah Al-Youha, Tom Van Agtmael, Yinhui Lu, Jason Wong, Duncan A. McGrouther, Karl E. Kadler

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