To the issue…

Patient History

A 39-year-old male recreational soccer player sustained an acute proximal hamstring tendon avulsion during a non-contact sports-related incident. Sonography revealed extensive hematoma and loss of proximal hamstring musculature structure, confirmed by MRI, which demonstrated a subtotal (but nearly total) tendon avulsion with minimal residual fibers attached to the ischial tuberosity. The patient experienced severe pain (VAS: 3 at rest, 10 with movement) and significant functional impairment.

Surgical Intervention & Rehabilitation Protocol

On postoperative day (POD) 0, the patient underwent transosseous refixation of the hamstring tendon at a specialized orthopedic center. Postoperative recovery was uncomplicated, and a multdisciplinary rehabilitation program commenced on POD 5. The rehabilitation focused on pain relief, inflammation control, and functional restoration, utili­zing therapies that were well-tolerated and free of adverse effects.

Radial Extracorporeal Shockwave Therapy (rESWT)

The rESWT was performed using the Swiss DolorClast system (Electro Medical Systems, CH). Treatments targeted the dorsal thigh and gluteal region, sparing the surgical wound until healing was complete. Each session utilized 10,000 – 20,000 impulses at patient-specific pressures ranging from 2.0 to 4.0 bar.

Timepoints of rESWT Sessions:

• POD 5: Initial session (2.0 bar, 10,000 impulses).
• POD 6: Second session (2.5 bar, 15,000 impulses).
• POD 8: Third session (2.7 bar, 15,000 impulses).
• POD 19: Fourth session (3.4 bar, 15,000 impulses).
• POD 22: Fifth session (4.0 bar, 15,000 impulses).
• POD 33: Sixth session, including the knee region (4.0 bar, 15,000 impulses).
• POD 50: Final session (4.0 bar, 15,000 impulses).

Magnetic Resonance Therapy (MBST)

MBST was performed using the MBST Arthro Spin Flex system (MedTec Medizintechnik GmbH, DE) to stimulate tissue regeneration and cellular repair. Seven sessions were administered between POD 5 and POD 12.

Neuroreflexive Hyperbaric CO₂ Cryotherapy

Cryotherapy was performed using the Cryolight system (Elmako, DE) during rESWT sessions on POD 6, POD 8, and POD 22, providing additional pain relief and inflammation control.

Progressive Mobilization

Crutch-assisted ambulation began on POD 1. By POD 22 (approximately 3 weeks postoperatively), the patient no longer required forearm crutches, reporting improved stability and confidence. Independent walking, including a 5-km walk during vacation, was achieved by POD 33 (approximately 5 weeks postoperatively).

Physiotherapy

Physiotherapy targeted muscle strength and coordination while addressing lumbar spine stabilization. By POD 50 (approximately 7 weeks postoperatively), the patient resumed jogging, albeit with mild residual muscle imbalance and lumbar tightness.

Clinical Outcomes

Pain and Mobility Pain relief was rapid, with significant improvement noted by 3 weeks postoperatively. Functional milestones were achieved progressively: independent walking by 3 weeks, a 5-km walk by 5 weeks, and a return to jogging by 7 weeks postoperatively. Muscular Recovery Residual muscle atrophy and strength asymmetry were evident at 5 weeks, though neuromuscular function showed continued progress with physiotherapy. By 7 weeks, the patient was able to jog short distances without pain or instability. Imaging Follow-up MRI at 5 weeks confirmed intact tendon refixation without retraction and only minor residual edema in the surrounding musculature. The patient reached RTC (back on the football field) exactly 5 months after the injury.

Conclusion

Early postoperative combined physical therapy, including MBST and rESWT as the primary modalities, alongside cryotherapy, and progressive mobilization, facilitated a safe and effective recovery after proximal hamstring tendon refixation. Pain relief, inflammation control, and gradual functional restoration were achieved much faster and without complications or therapy-related adverse effects. The treatments were well-tolerated, confirming their safety in postoperative rehabilitation. By 7 weeks postoperatively, the patient had already returned to jogging. By the help of ongoing physiotherapy and individual increase of the trainings load the patient reached fully balanced muscle regeneration and optimal functional outcomes. He returned on the football field (RTC) exactly 5 months after the injury.

• Midportion tendinopathy (MPT): typical thickening, usually pressure-­dolent, in the middle third of the tendon, usually between 3 – 5 (–7) cm proximal to the insertion.
• Insertional tendinopathy (IT): between 0–3 cm proximal to the insertion. Often associated with Haglund exostosis. 
• Insertional intratendinous calcifications (IV): deep distal at the calcaneal insertion, often asymptomatic.
• Special forms include, for example, medication-associated tendinopathies. These are usually caused by treatment with corticoids or the use of fluoroquinolone antibiotics.

Causes

While biomechanical and functional causes must always be sought to explain the pathogenesis of MPT, IT is often additionally caused by a primary mechanical factor in the presence of Haglund exostosis. This leads to impingement with the Achilles tendon in dorsiflexion in the ankle and can lead to circumscribed ventral partial lesions at the calcaneal insertion.

In addition, runners must be careful to wear running shoes that fit their feet / foot position to avoid tilting in the hindfoot, which can lead to shear forces on the Achilles tendon. Tendonopathies also occur more frequently in patients with diabetes, renal insufficiency, obesity or high uric acid levels. Likewise, the use of corticosteroids, statins and fluoroquinolone antibiotics (FQ) should be enquired about, as these can lead to spontaneous ruptures of the Achilles tendon [4].

Diagnostics

• Clinical examination / functional testing
• Sonography incl. colour Doppler
• MRI
• X-ray calcaneus lateral
• Treadmill analysis / foot pressure measurement
• Electromyography (EMG)
• Elastrography

In recent years, EMG has become increasingly important as it offers the possibility of identifying control disorders of the musculature (Fig. 1), developing EMG-controlled individualised exercises for patients and, in difficult cases, conducting biofeedback training.

Therapy

At the beginning of therapy, the severity of the clinical symptoms and the results of the imaging determine whether athletes can initially be left with a reduction in training volume or a reduction in the load on the Achilles tendon, or whether a break from sport is necessary. The basic therapy in all cases is the elimination of biomechanical risk factors and incorrect loading by means of functional training. Existing foot misa­lignments / tilting of the hindfoot should be compensated for with insoles if necessary. Manual mobilisation of the foot and ankle plays an important role alongside the classic therapeutic procedures on the tendon itself. Care should be taken to ensure that the ankle is as mobile as possible. For example, a 3.5-fold increase in the likelihood of developing Achilles tendon tendinopathy has been observed in patients with ankle dorsiflexion of less than 11.5° [5]. Other risk factors include reduced plantar flexion strength and hypomobility in the talonavicular joint. The knee-­­to-wall test is a simple and valid tool for an orienting examination. 

Nutrition

From a nutritional point of view, it is recommended to reduce or avoid purine-­rich / uric acid-increasing foods (especially meat and offal). An adequate intake of omega-3 fatty acids is important. The anthocyanin contained in cherries (mainly Montmorency sour cherries) has an anti-inflammatory effect, reduces oxidative stress and lowers uric acid levels. The celabin A contained in curcumin upregulates the transcription factor scleraxis [6]. This in turn promotes the proliferation of tenocytes and thus collagen I synthesis and the formation of the extracellular matrix. Incense (Boswellia), which is often found in food supplements together with curcumin, has a similar effect. Bromelain stimulates, among other things, the formation of new tenocytes.

Eccentric training (ET)

A well-known and effective form of training is ET with 3 x 15 repetitions twice a day over a period of 8 – 12 weeks. It should be ensured that the exercises are performed with both the knee extended (M. gastrocnemius) and with the knee bent (M. soleus). If IT is present, these exercises should only be performed up to the neutral position of the ankle to avoid impingement of the Haglund’s deformity, which is usually present. Good results were then seen in 67 % of cases, while improvement only occurred in 28 %–32% when training was extended into dorsiflexion [7]. However, current data show that PTLEs (Progressive Tendon Loading Exercises) are sometimes more effective than pure ET and can therefore be recommended as initial conservative therapy [8]. Although Cook and Rio’s 4-stage progressive loading protocol [9] was originally developed for tendinopathy of the patellar tendon, it can also be used to treat AT when adapted to the Achilles tendon.

Extracorporeal shock wave therapy (ESWT)

ESWT is now used almost universally in the treatment of Achilles tendinopathy. Korakasis et al. [10] were able to show that the effect of conservative therapy in combination with ESWT is better in the short, medium and long term than without it. Other studies also show that ESWT alone, without adequate basic therapy, is of no benefit. Both radial and focused shock waves have been shown to produce good results on the tendon itself. However, it has also been shown that ESWT does not lead to any improvement in symptoms in IT compared to eccentric training alone [1, 11].

Infiltration

Infiltration of the Achilles tendon with hyaluronic acid (HA), PRP or substances such as Traumeel®, embedded in a differentiated treatment concept, show good results. For example, for peritendinous infiltration of the Achilles tendon with hyaluronic acid, a reduction in pain and tendon thickness as well as a decrease in neovascularisation could be shown in both MPT and IT [12]. We recommend that the infiltrations be performed under ultrasound guidance in order to safely reach the peritendinous space. In addition, infiltrations can be performed almost painlessly. Sclerotherapy is a special form of treatment used to close sprouting neo-vessels. In cases of severe neovascularisation, it can quickly reduce pain. Infiltrations must be strictly extra-tendinous, ultrasound-guided and should only be performed by experienced therapists. Infiltrations in the tendon and bursa area with any type of corticosteroid should be avoided at all costs due to the potential for devastating tendon damage (Fig. 2).

USGET, EPI

In ultrasound-guided galvanic electro-physis therapy (USGET, EPI), acupuncture needles are placed under ultrasound guidance in the tendinopathy and microcurrents are applied via these (Fig. 3). This therapy stimulates the tenocytes to produce collagen. Depending on the pain experienced during treatment, the tendon can be infiltrated with a local anaes­thetic under ultrasound guidance immediately beforehand in order to achieve sufficiently high currents. This has been shown to result in faster healing than with physiotherapy alone, although further studies with larger case numbers are certainly needed [13]. 

Surgical procedures

If conservative treatment fails, established surgical procedures are available for treating both MPT and IT. These include tenolysis of the tendon itself, with removal of the diseased tendon parts, and, in the case of IT, of the Haglund exostosis and possible intratendinous calcifications. In recent years, the influence of the plantar fascia tendon, which often runs medially to the Achilles tendon, has come into focus. In the case of MPT manifested in the medial buttress and sometimes visible annular ligament or existing adhesions, this must be addressed [14, 15]. 

Conclusion

The treatment of Achilles tendon tendinopathy is complex. Differentiated clinical and imaging diagnostics are required to make an accurate diagnosis. A distinction must be made between mid-portion and insertion tendinopathy, both in terms of pathogenesis and therapy. In recent years, dietary supplements such as curcuma, boswellia and others, as well as new therapeutic methods such as ultrasound-guided electrolysis therapy, have been established alongside classic methods. Surgical procedures are available in the event of failure of conservative therapy. Here, the focus has shifted to MPT caused by adhesions of the plantar fascia tendon.

Bibliography

[1] Paantjens, MA, Helmhout PH, Backx F, Martens M, van Dongen J, Bakker E: Intra- and Inter-Rater Reliability of Processing Ultrasound Tissue Characterization Scans in Midportion Achilles Tendinopathy. Transl Sports Med 2022 Jun 16: 2022: 9348298

[2] Mifsud, T, Gatt A, Micallef-Stafrace K, Chocklingam N, Padhiar N: Elastography in the assessment of the Achilles tendon: a systematic review of measurement properties. J Foot Ankle Res. 2023 Apr 27; 16(1):23

[3] Gatz M, Betsch M, Dirrichs T, Schrading S, Tingart M, Michalik R, Quack V: Eccentric and Isometrich Exercises in Achilles Tendinopathy Evaluated by the VISA-A Score and Shear Wave Elastography. Sports Health. 2020 Jul/ Aug; 12(4): 373-381

[4] Tsai WC, Yang YM: Fluoroquinolone-associated Tendinopathy. Gung Med J. 2011 Sep-Oct; 34(5): 461-7

[5] Jayaseelan DJ, Kecman M, Alcorn D, Sault JD: Manual therapy and eccentric in the management of Achilles tendinopathy. J Man Manip Ther. 2017 May; 25(2): 106-114

[6] Gumucio J, Schonk M, Kharaz Y, Comerford E, Mendias C: Scleraxis is required for the groth of adult tendons in response to mechanical loading. JCI Insight. 2020 Jul 9; 5(13)

[7] Dilger C, Chimenti R: Nonsurgical Treatment Options for Insertional Achilles Tendinopathy. Foot Ankle Clin 2019 Sep; 24(3): 505-513

[8] Breda S, Oei E, Zwerver J, Visser E, Waarsing E, Krestin G, de Vos RJ: Effectiveness of progressive tendon-loading exercise therapy in patients withpatellar tendinopathy: a randomized clinical trial. Br J Sports Med. 2021 May; 55(9): 501-509

[9] Milliards P, Cook J, Purdam C, Rio E: Patellar Tendinopathy: Clinical Diagnosis, Load Management and Advice for Challenging Case Presentatations. J Orthop Sports Phys Ther 2015; 45(11): 887-98

[10] Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N: The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction. Br J Sports Med 2018 Mar; 52(6): 387-407

[11] Mansur N, Matsunaga F, Carrazzone O, dos Santos B, Nunes C, Aoyama B, dos Santos P, Faloppa F, Tamaoki M: Shockwave Therapy Plus Eccentric Exercises Versus Isolated Eccentric Exercises for Achilles Insertional Tendinopathy: A Double-Blinded Randomized Clinical Trial. J Bone Joint Surg Am. 2021 Jul 21; 103(14): 1295-1302

[12] Folgi M, Giordan N, Mazzoni G: Efficacy and safety of hyaluronic acid (500-730 kDa) Ultrasound-guided injections on painful tendinopathies: a prospective, open label, clinical study. Muscles Ligaments Tendons J 2017. 2017 Sep 18; 7(2): 388-395

[13] Asensio-Olea L, Leiros R, Marquez-Sanchez M, Oliviera de Carvalho F, Maciel L: Efficacy of percutaneous electrolysis for the treatment of tendinopathies: A systematic review and meta-analysis. Clin Rehabil. 2023 Jun; 37(6): 747-759

[14] Alfredson H, Masci L, Spang C: Ultrasound and surgical inspection of plantaris tendon involvement in chronic painful insertional Achilles tendinopathy: a case series. BMJ Open Sport Exerc Med. 2021 Mar 22; 7(1)

[15] Masci L, Neal B, Bee W, Spang C, Alfredson H: Achilles Scraping and Plantaris Tendon Removal Improves Pain and Tendon Structure in Patients with Mid-Portion Achilles Tendinopathy-A 24 Month Follow-Up Case Serie. J Clin Med. 2021 Jun 18; 10(12): 2695

La prévalence élevée de l’arthrose du genou et d’autres pathologies articulaires des membres inférieurs est un problème croissant en médecine moderne. Selon des études récentes, on estime que jusqu’à 43 % des adultes asymptomatiques de plus de 40 ans présentent des signes d’arthrose du genou à l’IRM(1). Cette affection nuit non seulement à la qualité de vie des patients en raison de la mobilité réduite et du développement de comorbidités, mais elle s’accompagne également d’une consommation accrue d’analgésiques et d’anti-inflammatoires non stéroïdiens (AINS), ce qui peut entraîner des effets indésirables à long terme qui nuisent considérablement à la santé.

Pour comprendre l’ampleur de ce problème, nous devons nous pencher sur notre évolution en tant qu’espèce. De l‘Australopithecus à l‘Homo sapiens et ses différentes formes intermédiaires telles que l‘Homo habilis et l‘Homo erectus, le système musculo-squelettique humain a subi une série d’adaptations qui ont perfectionné notre capacité à marcher sur deux membres. Se tenir debout sur deux jambes a été un avantage décisif pour la survie, car il libérait les mains pour l’utilisation d’outils, permettait une meilleure observation de l’environnement afin d’éviter les attaques de prédateurs et favorisait la régulation de la température corporelle en exposant moins de surface cutanée au rayonnement solaire direct – des avantages qui ont permis la propagation et la domination de l’espèce sur toute la planète. Cependant, l’anthropologue Daniel Lieberman(2) souligne que ces progrès évolutifs ont eu un coût considérable pour la santé des articulations, en particulier celles des membres inférieurs. L’adoption d’une posture bipède n’est pas sans complications, car nos hanches, nos genoux et nos chevilles, qui sont constamment soumis aux forces de la gravité, au poids du corps et à l’usure due à la marche fréquente, ne sont pas conçus pour une espérance de vie supérieure à 40 ans, probablement l’espérance de vie des premiers Homo sapiens, qui a depuis doublé grâce aux progrès de la civilisation. Lieberman souligne que si notre structure osseuse et musculaire s’est améliorée pour permettre la locomotion bipède, nous sommes toujours en phase d’adaptation et que ce retard évolutif contribue de manière significative à l’apparition de maladies articulaires telles que l’arthrose, qui touche les articulations les plus sollicitées, en particulier les genoux. Si l’on considère que le premier Homo sapiens, avec son mode de vie nomade axé sur la chasse et la cueillette, parcourait environ 175 000 km au cours de sa vie, cela contraste avec les rares signes d’arthrose observés chez les spécimens de ce stade évolutif. À l’inverse, l’être humain moyen d’aujourd’hui ne parcourt généralement pas plus de 85 000 km au cours de sa vie, bien qu’il vive généralement plus de 80 ans dans les sociétés développées. Cependant, la longévité, la sédentarité et le surpoids, entre autres facteurs, ont conduit à une prévalence de ces maladies dégénératives et d’autres encore supérieure à 50 %, ce qui représente une augmentation considérable de l’arthrose dans notre environnement.

Le rôle des chondroprotecteurs dans la médecine actuelle

Afin de contrer les effets de l’usure articulaire et d’améliorer la qualité de vie des patients, les chondroprotecteurs tels que SYSADOA (substances synthétiques et naturelles pour la protection du cartilage) jouent un rôle important dans la médecine actuelle. Ces produits aident à soulager la douleur et l’inflammation et à améliorer la mobilité sans avoir recours aux analgésiques, aux AINS et aux opioïdes. Parmi les protecteurs du cartilage les plus efficaces et les mieux notés dans le domaine de la nutrition et de la médecine, les préparations à base de collagène constituent une option thérapeutique privilégiée tant pour les médecins que pour les consommateurs. Cependant, tous les collagènes ne sont pas identiques et une analyse approfondie est nécessaire pour comprendre leur fonction et leurs bienfaits potentiels pour la santé.

Les différents types de collagène disponibles sur le marché des compléments alimentaires

Le collagène est une protéine essentielle à la structure de nos os, de notre peau, de nos tendons et de notre cartilage. Il existe différents types de collagène sur le marché des compléments alimentaires, chacun ayant des propriétés et des bienfaits spécifiques pour la santé. Les types les plus courants sont énumérés ci-dessous :

Collagène de type I

Le collagène de type I est la forme de collagène la plus abondante dans le corps humain. Il est essentiel à la structure de divers tissus conjonctifs, notamment la peau, les os, les tendons et les ligaments. Ce collagène est constitué de fibres densément organisées et offre une grande résistance à la traction, ce qui lui permet de conférer intégrité et élasticité aux tissus qui forment la structure du corps.

Plusieurs études cliniques ont confirmé son efficacité, notamment dans l’amélioration de l’élasticité et de l’hydratation de la peau. Une étude clinique publiée dans la revue Skin Pharmacology and Physiology (2014) (3) a montré qu’une supplémentation en collagène de type I hydrolysé améliorait significativement l’élasticité et l’hydratation de la peau chez des femmes âgées de 35 à 55 ans. Les résultats ont montré que les participantes ont constaté une amélioration significative de la fermeté et une réduction des rides après huit semaines de traitement. Ces résultats sont confirmés par une autre étude publiée dans The Journal of Medical Nutrition & Nutraceuticals (2015) (4), qui contient des données sur l’amélioration de la régénération cutanée, en particulier lorsqu’il est pris dans le cadre d’une supplémentation alimentaire.

Bien que certaines publications soutiennent l’utilisation du collagène de type I pour améliorer la santé des articulations et guérir les lésions des tendons et des ligaments, ces résultats ne sont pas aussi concluants et montrent une efficacité moindre que les études portant sur d’autres types de collagène, tels que le collagène de type II.

Collagène de type II

Le collagène de type II est la principale protéine structurelle du cartilage articulaire et représente environ 90 % du collagène présent dans cette structure. Sa fonction principale est d’assurer l‘élasticité et la résistance nécessaires au maintien de l’intégrité du cartilage afin de permettre la bonne mobilité et le bon fonctionnement des articulations. Avec l’âge ou en raison de facteurs tels que des blessures ou des maladies dégénératives, la capacité de l’organisme à synthétiser le collagène de type II diminue, ce qui entraîne l’usure et la dégénérescence du cartilage articulaire. Ce phénomène est principalement associé à des maladies telles que l‘arthrose, dans laquelle le collagène de type II de l’articulation est attaqué, entraînant des douleurs, une raideur et une limitation des mouvements.

Le succès du collagène de type II sur le marché mondial

Le collagène de type II est très apprécié des professionnels et des consommateurs et a connu une croissance considérable dans le domaine des compléments alimentaires. En 2021, le marché mondial des compléments alimentaires à base de collagène a atteint une valeur d’environ 4,1 milliards de dollars et devrait croître à un taux de croissance annuel moyen (TCAM) de 8,4 % d’ici 2030, le collagène de type II jouant un rôle important, notamment sous forme de compléments alimentaires pour la santé des articulations (5). Ce succès est dû à son efficacité dans le traitement des problèmes articulaires, qui a été confirmée par des études scientifiques démontrant qu’il améliore la mobilité et soulage les douleurs articulaires. Cependant, malgré sa popularité, le collagène de type II conventionnel présente également certains inconvénients.

Les défis du collagène de type II conventionnel

L’un des principaux défis du collagène de type II conventionnel est la grande quantité nécessaire pour obtenir un bénéfice thérapeutique significatif. Les compléments alimentaires à base de collagène de type II, généralement sous forme de poudre, doivent être pris à des doses élevées (2,5 à 15 grammes par jour) et, bien qu’efficaces, ils ne sont pas pratiques. De plus, ces produits sont souvent commercialisés avec des textures et des arômes astringents qui ne sont pas toujours bien acceptés, ce qui rend leur consommation désagréable pour les consommateurs et nuit à l’observance du traitement et, par conséquent, à son maintien à long terme.

Collagène de type II non dénaturé : la percée qui révolutionne la santé des articulations

Heureusement, le développement de collagènes de type II non dénaturés a résolu certains de ces problèmes et offre une alternative plus efficace et plus pratique. Le collagène de type II non dénaturé, tel que l‘UC-II®, conserve sa structure en triple hélice, ce qui permet de préserver ses épitopes actifs. Ces épitopes sont des régions biologiquement actives qui interagissent avec le système immunitaire et favorisent un processus appelé tolérance orale. Ce mécanisme immunitaire unique régule la réponse immunitaire de l’organisme et contribue à régénérer le cartilage articulaire et à réduire l’inflammation sans les effets secondaires associés à d’autres traitements. Grâce à la tolérance orale, les bienfaits peuvent être obtenus à des doses beaucoup plus faibles que celles requises pour le collagène de type II hydrolysé traditionnel.

Études cliniques démontrant l’efficacité de l’UC-II®

Plusieurs études cliniques ont montré que le collagène de type II non dénaturé est nettement plus efficace que les versions classiques du collagène de type II pour améliorer la mobilité articulaire et la régénération du cartilage. Une étude publiée dans le Journal of Clinical Trials (2013) (6) a révélé que l’UC-II®, à une dose de seulement 40 mg par jour, améliorait la mobilité articulaire et réduisait les douleurs au genou, ce qui est 15 fois plus efficace qu’un placebo. Ces résultats sont corroborés par une autre publication dans le BMC Nutrition Journal (7), qui a constaté une amélioration très significative des symptômes chez les patients souffrant d’arthrose du genou à la même dose de 40 mg. Cela contraste avec les préparations conventionnelles à base de collagène de type II, qui nécessitent des doses beaucoup plus élevées pour obtenir des résultats similaires. De plus, l’UC-II® s’est révélé plus polyvalent dans sa formulation, ce qui permet de l’intégrer facilement dans des gélules et d’autres formats faciles à consommer, améliorant ainsi l‘observance thérapeutique des patients et le maintien du traitement à long terme, un facteur déterminant dans l’évolution des maladies dégénératives chroniques.

Le collagène de type II non dénaturé représente une avancée significative dans la catégorie des collagènes, car il possède un mécanisme d’action unique, une efficacité améliorée à des doses plus faibles, ainsi qu’une plus grande polyvalence et une meilleure capacité à être combiné avec d’autres ingrédients nutraceutiques et à être proposé dans d’autres formats plus populaires avec une meilleure observance thérapeutique, tels que des gélules. Les recherches cliniques en cours sur ce nouveau type de collagène en font un précurseur pour la santé des articulations et le distinguent de tous les autres collagènes et des meilleurs ingrédients naturels de ce segment.

Collagène de type III

Le collagène de type III est l’un des composants les plus importants du tissu conjonctif et se trouve principalement dans les muscles, les vaisseaux sanguins et les organes. Il est souvent associé au collagène de type I dans les tissus élastiques et structurels et joue un rôle clé dans la réparation et la régénération des tissus mous. Ce type de collagène est particulièrement important pour améliorer l’élasticité et la résistance des tissus et joue un rôle crucial dans la réponse aux blessures.

En ce qui concerne les bénéfices cliniques du collagène de type III, une étude publiée dans le Journal of Clinical Investigation (2015) (8) a montré qu’une supplémentation en collagène de type III associée à du collagène de type I contribuait à améliorer le fonctionnement et la régénération des tendons et des ligaments. Les résultats ont indiqué une amélioration de la récupération des tissus mous et une augmentation de la souplesse et de l’endurance des muscles et des tendons chez les patients ayant subi des blessures sportives ou une usure articulaire. Cette étude confirme l’idée que le collagène de type III est essentiel au maintien de l’intégrité du tissu conjonctif et à l’accélération de la récupération après une blessure.

Une autre étude publiée dans le Journal of Clinical Investigation (2018) (9) a examiné les effets du collagène de type III sur la santé vasculaire et a montré que sa présence est essentielle au maintien de l’élasticité des artères.

Ces résultats soulignent les effets du collagène de type III sur la santé générale du tissu conjonctif, y compris les vaisseaux sanguins, et suggèrent un rôle plus modeste pour la santé des articulations par rapport à l’efficacité d’autres types de collagène, tels que le type II, qui a été démontrée dans une littérature scientifique plus large.

Collagène de type IV

Le collagène de type IV est une forme spéciale de collagène qui se trouve principalement dans les membranes basales des cellules. Il s’agit de structures clés qui soutiennent et tapissent de nombreux tissus et organes du corps, tels que les reins, les poumons et les vaisseaux sanguins. Contrairement à d’autres types de collagène présents dans des tissus plus structurels tels que la peau et les os, le collagène de type IV joue un rôle crucial dans la formation des membranes cellulaires, qui sont essentielles à l‘intégrité et au fonctionnement des organes.

Une vaste étude publiée dans le Journal of Biological Chemistry (10) a mis en évidence la fonction du collagène de type IV dans les membranes basales des reins et souligné son rôle dans la filtration glomérulaire et la prévention des maladies rénales. Les recherches ont montré qu’une perturbation ou une perte du collagène de type IV dans les membranes basales est associée à une susceptibilité accrue aux maladies rénales, telles que la néphropathie. Bien que l’étude se soit principalement concentrée sur la biologie cellulaire et la pathologie rénale, les résultats suggèrent que le collagène de type IV est essentiel au fonctionnement des organes et à la stabilité des cellules endothéliales qui tapissent les vaisseaux sanguins, ce qui souligne son importance pour la santé en général.

Malgré son importance biologique, le collagène de type IV n’est pas couramment utilisé dans l’industrie des compléments alimentaires ou dans la formulation de compléments alimentaires pour plusieurs raisons. Tout d’abord, le collagène de type IV n’est présent qu’en très petites quantités dans l’organisme et son rôle spécifique se concentre davantage sur la structure cellulaire que sur la régénération des tissus visibles ou des grandes structures de l’organisme telles que le cartilage ou les os. Cela rend son application dans les compléments alimentaires oraux moins directe que d’autres types de collagène tels que les types I ou II, qui ont un effet plus notable sur la santé de la peau et des articulations. En outre, la production à grande échelle de collagène de type IV dans un format adapté aux compléments alimentaires est techniquement plus difficile et moins rentable.

Collagène de type V.

Le collagène de type V est un composant important de tissus tels que le placenta, la cornée et certains tissus conjonctifs. On le trouve en association avec le collagène de type I dans des structures telles que les tendons et dans la matrice extracellulaire de divers organes. Ce type de collagène joue un rôle important dans la formation des fibres de collagène et dans l‘organisation de la matrice extracellulaire.

Une étude publiée en 2004 dans le Journal of Biological Chemistry (11) décrit comment le collagène de type V participe à la régulation de la fibrillation du collagène de type I, qui est essentielle à l‘intégrité des tissus. Ces conclusions sont complétées par l’excellent manuel Biochemistry of Collagen, Laminins and Elastin (2019) de Leeming et Karsdal (12). Cependant, comme le collagène de type V a une fonction structurelle et non régénératrice directe dans les tissus accessibles tels que les articulations, il n’est pas commercialisé dans les compléments alimentaires. Son utilisation est principalement limitée à la recherche cellulaire et aux études spécifiques aux tissus, et sa production sous des formes pratiques pour les compléments alimentaires est limitée.

Collagène de type X

Le collagène de type X est principalement présent dans le cartilage et joue un rôle essentiel dans la minéralisation du cartilage pendant la formation des os. Il est particulièrement important pour le développement du cartilage dans les articulations et pour les processus de régénération osseuse.

Une étude publiée dans Osteoarthritis and Cartilage (2010) (13) souligne le rôle du collagène de type X dans la formation du cartilage sous-chondral et son implication dans l‘ostéogenèse. La supplémentation en collagène de type X a montré certains avantages dans l’amélioration de la santé articulaire et la régénération du cartilage chez les patients atteints d’arthrose.

Bien que le collagène de type X ait des applications intéressantes dans la régénération osseuse et cartilagineuse, notamment dans l’amélioration du cartilage sous-chondral et l’ostéogenèse, son succès sur le marché des compléments alimentaires est nettement inférieur à celui du collagène de type II, en particulier ses versions non dénaturées. La bibliographie scientifique abondante sur le collagène de type II montre des résultats concluants en faveur de l’amélioration de la mobilité articulaire et de la régénération du cartilage dans des pathologies telles que l’arthrose, ce qui témoigne d’une carrière scientifique beaucoup plus longue que celle du collagène de type X, qui est actuellement limité à des applications très spécifiques et n’a pas démontré d’avantages clairs.

En résumé, on peut dire que les différents types de collagène jouent un rôle essentiel dans la santé et le fonctionnement de notre tissu conjonctif, chacun d’entre eux étant spécialisé dans des domaines clés de l’organisme. Alors que le collagène de type I est principalement utilisé pour les applications dermo-nutritives en raison de son rôle particulier dans le derme et de ses résultats cliniques plus significatifs dans le domaine dermatologique et esthétique, tandis que le collagène de type II, par rapport aux autres types de collagène, est leader dans le domaine de la santé articulaire, comme le confirment une longue expérience d’utilisation et la validation du marché au cours de la dernière décennie, et continue de surprendre par ses intentions de gagner en parts de marché au niveau mondial dans les années à venir. Ce succès commercial s’est accompagné d’un effort scientifique considérable, qui dépasse de loin les essais cliniques menés sur d’autres types de collagène, sans compter la primauté incontestée des collagènes non dénaturés de type II depuis leur introduction, dont les études ont montré des taux d’efficacité plus élevés à des doses beaucoup plus faibles et qui offrent des avantages qui ont mis fin aux discussions potentielles sur la préférence d’autres types de collagène dans la prévention et le traitement des pathologies ostéo-articulaires. Les collagènes de type III, IV, V et X ont des fonctions bien étudiées dans l’organisme, mais font l’objet de moins de publications et sont peu ou pas commercialisés, ce qui laisse la porte ouverte à des recherches plus spécifiques en raison de leur potentiel thérapeutique dans divers domaines de la santé.

De l’anti-âge au vieillissement en bonne santé en passant par la mobilité, main dans la main avec le collagène.

Au cours des dernières décennies, nous sommes passés de la lutte contre le vieillissement en tant que tel, axée sur le ralentissement de ses effets visibles et physiques, à une conception plus holistique du vieillissement en bonne santé. Aujourd’hui, il s’agit moins d’arrêter le vieillissement que de savoir comment vieillir de manière active, saine et fonctionnelle. Dans ce contexte, la mobilité joue un rôle clé. Une personne active conserve non seulement sa mobilité physique, mais bénéficie également d’une série d’avantages qui ont un effet positif sur sa santé générale. Le contrôle du métabolisme et du poids, l’amélioration du risque vasculaire, la réduction de la sarcopénie et l’optimisation des performances cognitives ne sont que quelques-uns des principaux avantages du vieillissement actif. De plus, la santé mentale est renforcée par le maintien de l’indépendance et de la capacité à accomplir les activités quotidiennes sans restrictions. Ces facteurs contribuent à une vie plus longue, à une morbidité moindre et, surtout, à une meilleure qualité de vie.

Sur cette voie vers un vieillissement en bonne santé, des ingrédients tels que le collagène jouent un rôle crucial. Sa capacité à améliorer les soins de la peau, comme décrit précédemment pour le collagène de type I, présente des avantages esthétiques évidents, mais les bienfaits du collagène de type II pour la mobilité et la fonction articulaire, en particulier sous sa forme non dénaturée, permettent aux personnes de rester mobiles et actives plus longtemps, ce qui favorise un vieillissement plus sain. Ces progrès dans le développement du collagène en tant que complément alimentaire contribuent non seulement à la régénération du cartilage articulaire, mais aident également à mener une vie active et fonctionnelle, ce qui est la clé d’une meilleure santé et d’un plus grand bien-être pendant la vieillesse.

Le collagène pour 1 million d’années supplémentaires

Près de 4 millions d’années se sont écoulées entre le premier Australopithecus et l’homme actuel, une période au cours de laquelle l’évolution a donné naissance à un organisme vraiment extraordinaire, capable de s’adapter à presque toutes les conditions, tant dans l’environnement naturel qu’urbain. Cependant, ce long processus évolutif, avec ses progrès étonnants, n’a pas été parfait. Malgré les capacités extraordinaires de notre corps, nous sommes toujours confrontés à des faiblesses que nous avons laissées derrière nous au cours de notre évolution, telles que la vulnérabilité de nos articulations à la gravité, au poids du corps et à la station debout. Même si notre espèce a surmonté de nombreuses adversités, il nous faudra probablement encore au moins un million d’années d’évolution pour développer des articulations capables de résister véritablement à ces nouveaux défis, un processus au cours duquel des ingrédients de premier plan tels que le collagène seront d’excellents compagnons de voyage qui protégeront nos articulations afin que nous puissions être plus actifs, vivre plus longtemps et bénéficier d’une meilleure qualité de vie.

Les progrès de la science et de la technologie nous ont permis de connaître précisément les types de collagène et de développer des versions améliorées de cet élément clé de l’organisme. La R&D&I nous fournit actuellement des molécules qui ciblent des objectifs plus spécifiques, offrent de meilleurs résultats et sont plus faciles à utiliser, renforçant ainsi le rôle de cet ingrédient naturel dans le traitement et la prévention des problèmes importants pour la santé quotidienne de nos articulations.

Bibliographie

1. Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019 Oct;53(20):1268-1278. doi: 10.1136/bjsports-2018-099257. Epub 2018 Jun 9. PMID: 29886437; PMCID: PMC6837253.
2. Wallace IJ, Worthington S, Felson DT, Jurmain RD, Wren KT, Maijanen H, Woods RJ, Lieberman DE. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci U S A. 2017 Aug 29;114(35):9332-9336. doi: 10.1073/pnas.1703856114. Epub 2017 Aug 14. PMID: 28808025; PMCID: PMC5584421.
3. Bolke L, Schlippe G, Gerß J, Voss W. A Collagen Supplement Improves Skin Hydration, Elasticity, Roughness, and Density: Results of a Randomized, Placebo-Controlled, Blind Study. Nutrients. 2019 Oct 17;11(10):2494. doi: 10.3390/nu11102494. PMID: 31627309; PMCID: PMC6835901.
4. Pu SY, Huang YL, Pu CM, Kang YN, Hoang KD, Chen KH, Chen C. Effects of Oral Collagen for Skin Anti-Aging: A Systematic Review and Meta-Analysis. Nutrients. 2023 Apr 26;15(9):2080. doi: 10.3390/nu15092080. PMID: 37432180; PMCID: PMC10180699.
5. Globaler Kollagen-Marktbericht, 2021.
6. Knaub, et al. (2022). UC-II® nicht denaturiertes Typ-II-Kollagen reduziert Kniegelenksbeschwerden und verbessert die Mobilität bei gesunden Probanden: eine randomisierte, doppelblinde, placebokontrollierte klinische Studie. J Clin Trials, 12(1):1000492.
7. Lugo, et al. (2016). Wirksamkeit und Verträglichkeit eines nicht denaturierten Typ-II-Kollagens bei der Modulation von Knie-Arthrose-Symptomen: eine multizentrische randomisierte, doppelblinde, placebokontrollierte Studie. Nutr J, 15(14).
8. Yang G, Rothrauff BB, Tuan RS. Regeneration und Reparatur von Sehnen und Bändern: klinische Relevanz und Entwicklungsparadigma. Birth Defects Res C Embryo Today. 2013 Sep;99(3):203-222. doi: 10.1002/bdrc.21041. PMID: 24078497; PMCID: PMC4041869.
9. D’hondt S, Guillemyn B, Syx D, Symoens S, De Rycke R, Vanhoutte L, Toussaint W, Lambrecht BN, De Paepe A, Keene DR, Ishikawa Y, Bächinger HP, Janssens S, Bertrand MJM, Malfait F. Type III collagen affects dermal and vascular collagen fibrillogenesis and tissue integrity in a mutant Col3a1 transgenic mouse model. Matrix Biol. 2018 Sep;70:72-83. doi: 10.1016/j.matbio.2018.03.008. Epub 2018 Mar 15. PMID: 29551664.
10. Boutaud A, Borza DB, Bondar O, Gunwar S, Netzer KO, Singh N, Ninomiya Y, Sado Y, Noelken ME, Hudson BG. Typ IV Kollagen der glomerulären Basalmembran. Beweise dafür, dass die Kettenspezifität des Netzwerkaufbaus durch die nicht-kollagenen NC1-Domänen kodiert wird. J Biol Chem. 2000 Sep 29;275(39):30716-24. doi: 10.1074/jbc.M004569200. PMID: 10896941.
11. Wenstrup RJ, Florer JB, Brunskill EW, Bell SM, Chervoneva I, Birk DE. Typ-V-Kollagen steuert die Initiierung des Aufbaus von Kollagenfibrillen. J Biol Chem. 2004 Dec 17;279(51):53331-7. doi: 10.1074/jbc.M409622200. Epub 2004 Sep 21. PMID: 15383546.
12. Müller, C., & Lutz, A. (2019). Biochemie von Kollagen, Laminin und Elastin. Chapter 5: Collagen Type V. In Advances in Clinical Chemistry (pp. 123-145). Elsevier. https://doi.org/10.1016/B978-0-12-817068-7.00005-7
13. Bagi, C. M., & Gaskill, T. (2010). Kollagen Typ X in der Knorpel- und Knochenbildung: Implikationen für regenerative Behandlungen. Osteoarthritis and Cartilage, 18(4), 1015-1022. https://doi.org/10.1016/j.joca.2009.12.021.
14. McAlindon, T. et al. (2018). Die Wirkung von Kollagen-Supplementierung auf die Knochengesundheit bei postmenopausalen Frauen: Eine randomisierte kontrollierte Studie. Osteoporosis International.
15. Zdzieblik, D. et al. (2015). Wirkung einer Kollagenpeptid-Supplementierung auf die Erholung nach trainingsinduzierten Muskelschäden: Eine randomisierte kontrollierte Studie. The American Journal of Clinical Nutrition.

Um das Ausmaß dieses Problems zu verstehen, müssen wir unsere Evolution als Spezies betrachten. Vom Australopithecus bis zum Homo sapiens und seinen verschiedenen Zwischenformen wie Homo habilis und Homo erectus hat der menschliche Bewegungsapparat eine Reihe von Anpassungen durchlaufen, die unsere Fähigkeit, auf zwei Gliedmaßen zu gehen, perfektioniert haben. Das Stehen auf zwei Beinen war ein entscheidender Vorteil für das Überleben, da es die Hände für den Gebrauch von Werkzeugen freimachte, eine bessere Beobachtung der Umgebung ermöglichte, um Angriffe von Raubtieren zu verhindern, und die Regulierung der Körpertemperatur begünstigte, indem weniger Hautoberfläche der direkten Sonneneinstrahlung ausgesetzt wurde – Vorteile, die die Ausbreitung und Beherrschung der Spezies auf dem gesamten Planeten ermöglichten. Der Anthropologe Daniel Lieberman(2) weist jedoch darauf hin, dass diese evolutionären Fortschritte einen erheblichen Preis für die Gesundheit der Gelenke, insbesondere der unteren Gliedmaßen, mit sich brachten. Die Annahme einer zweibeinigen Haltung ist nicht ohne Komplikationen, da unsere Hüften, Knie und Knöchel, die ständig den Kräften der Schwerkraft, des Körpergewichts und der Abnutzung durch die Bewegung des häufigen Gehens ausgesetzt sind, nicht für eine Lebenserwartung von mehr als 40 Jahren ausgelegt sind – wahrscheinlich die Lebenserwartung des frühen Homo sapiens, die sich dank des zivilisatorischen Fortschritts inzwischen verdoppelt hat. Lieberman betont, dass sich unsere Knochen- und Muskelstruktur für die zweibeinige Fortbewegung zwar verbessert hat, wir uns aber immer noch in einem Anpassungsprozess befinden, und dass dieser evolutionäre Rückstand wesentlich zur Entstehung von Gelenkerkrankungen wie Arthrose beiträgt, die die am stärksten belasteten Gelenke, insbesondere die Knie, betreffen. Wenn man bedenkt, dass der frühe Homo sapiens mit seiner nomadischen Lebensweise, die sich auf das Jagen und Sammeln konzentrierte, in seinem Leben etwa 175 000 km zurücklegte, steht dies im Gegensatz zu den wenigen Anzeichen von Arthrose bei Exemplaren aus dieser Evolutionsstufe. Im Gegensatz dazu legt der heutige Durchschnittsmensch in der Regel nicht mehr als 85.000 km im Leben zurück, obwohl er in den entwickelten Gesellschaften in der Regel über 80 Jahre alt wird. Langlebigkeit, sitzende Lebensweise und Übergewicht haben jedoch neben anderen Faktoren dazu geführt, dass die Prävalenz dieser und anderer degenerativer Erkrankungen bei über 50 % liegt, was einen erheblichen Anstieg der Osteoarthritis in unserer Umwelt bedeutet.

Um den Auswirkungen des Gelenkverschleißes entgegenzuwirken und die Lebensqualität der Patienten zu verbessern, spielen Chondroprotektoren wie SYSADOA (synthetische und natürliche Substanzen zum Knorpelschutz) in der heutigen Medizin eine wichtige Rolle. Diese Produkte helfen, Schmerzen und Entzündungen zu lindern und die Mobilität zu verbessern, ohne auf Schmerzmittel, NSAIDs und Opioide zurückgreifen zu müssen. Unter den wirksamsten und am besten bewerteten Knorpelschutzmitteln im Bereich der Ernährung und Medizin sind Kollagenpräparate sowohl für Ärzte als auch für Verbraucher eine bevorzugte therapeutische Option. Allerdings sind nicht alle Kollagene gleich, und es bedarf einer eingehenden Analyse, um ihre Funktion und ihren potenziellen gesundheitlichen Nutzen zu verstehen.

Die verschiedenen Arten von Kollagen auf dem Markt für Nahrungsergänzungsmittel

Kollagen ist ein wesentliches Protein für die Struktur unserer Knochen, Haut, Sehnen und Knorpel. Auf dem Markt für Nahrungsergänzungsmittel gibt es verschiedene Arten von Kollagen, jede mit spezifischen Eigenschaften und gesundheitlichen Vorteilen. Die gängigsten Arten sind im Folgenden aufgeführt:

Kollagen Typ I

Kollagen vom Typ I ist die im menschlichen Körper am häufigsten vorkommende Form von Kollagen und ist für die Struktur verschiedener Bindegewebe, insbesondere in Haut, Knochen, Sehnen und Bändern, unerlässlich. Dieses Kollagen besteht aus dicht organisierten Fasern und bietet eine hohe Zugfestigkeit, wodurch es den Geweben, die die Struktur des Körpers bilden, Integrität und Elastizität verleihen kann.

Mehrere klinische Studien haben seine Wirksamkeit bestätigt, insbesondere bei der Verbesserung der Hautelastizität und -feuchtigkeit. Eine klinische Studie, die in der Zeitschrift Skin Pharmacology and Physiology (2014) (3) veröffentlicht wurde, zeigte, dass eine Supplementierung mit hydrolysiertem Typ-I-Kollagen die Hautelastizität und -feuchtigkeit bei Frauen im Alter von 35-55 Jahren deutlich verbesserte. Die Ergebnisse zeigten, dass die Teilnehmerinnen nach einer achtwöchigen Behandlung eine deutliche Verbesserung der Festigkeit und der Faltenreduzierung erfuhren. Diese Ergebnisse werden durch eine weitere Studie in The Journal of Medical Nutrition & Nutraceuticals (2015) (4) bestätigt, die Daten zur verbesserten Hautregeneration enthält, insbesondere wenn sie als Teil von Nahrungsergänzungsmitteln eingenommen wird.

Es gibt zwar Literatur, die die Verwendung von Kollagen des Typs I zur Verbesserung der Gelenkgesundheit und zur Heilung von Sehnen- und Bänderverletzungen unterstützt, doch sind diese Ergebnisse nicht so aussagekräftig und zeigen eine geringere Wirksamkeit als Studien mit anderen Kollagenarten, wie z. B. Kollagen Typ II.

Kollagen Typ II

Kollagen vom Typ II ist das wichtigste Strukturprotein im Gelenkknorpel und macht etwa 90 % des in dieser Struktur vorhandenen Kollagens aus. Seine Hauptfunktion besteht darin, die Elastizität und Festigkeit zu gewährleisten, die für die Aufrechterhaltung der Integrität des Knorpels notwendig sind, um die ordnungsgemäße Beweglichkeit und Funktionsfähigkeit der Gelenke zu ermöglichen. Mit zunehmendem Alter oder aufgrund von Faktoren wie Verletzungen oder degenerativen Erkrankungen nimmt die Fähigkeit des Körpers zur Synthese von Typ-II-Kollagen ab, was zu Verschleiß und Degeneration des Gelenkknorpels führt. Dieses Phänomen wird vor allem mit Krankheiten wie Arthrose in Verbindung gebracht, bei der das Typ-II-Kollagen im Gelenk angegriffen wird, was zu Schmerzen, Steifheit und Bewegungseinschränkungen führt.

Kollagen Typ II erfreut sich bei Fachleuten und Verbrauchern großer Beliebtheit und hat im Bereich der Nahrungsergänzungsmittel ein erhebliches Wachstum erfahren. Im Jahr 2021 erreichte der weltweite Markt für Kollagenpräparate einen Wert von ca. 4,1 Mrd. USD und wird bis 2030 voraussichtlich mit einer durchschnittlichen jährlichen Wachstumsrate (CAGR) von 8,4 % wachsen, wobei Kollagen Typ II eine wichtige Rolle spielt, insbesondere in Form von Präparaten für die Gelenkgesundheit (5). Dieser Erfolg ist auf seine Wirksamkeit bei der Behandlung von Gelenkproblemen zurückzuführen, die durch wissenschaftliche Studien untermauert wird, die zeigen, dass es die Beweglichkeit verbessert und Gelenkschmerzen lindert. Trotz seiner Beliebtheit hat herkömmliches Typ-II-Kollagen jedoch auch einige Nachteile.

Eine der größten Herausforderungen bei herkömmlichem Typ-II-Kollagen ist die große Menge, die benötigt wird, um einen signifikanten therapeutischen Nutzen zu erzielen. Typ-II-Kollagen-Präparate, die in der Regel in Pulverform hergestellt werden, müssen in hohen Dosen (2,5 bis 15 Gramm täglich) eingenommen werden und sind zwar wirksam, aber unpraktisch. Darüber hinaus werden diese Produkte häufig mit adstringierenden Texturen und Geschmacksrichtungen vermarktet, die nicht immer gut aufgenommen werden, was zu einer unangenehmen Art der Einnahme für die Verbraucher führt, die die Therapietreue und damit die langfristige Aufrechterhaltung der Behandlung beeinträchtigt.

Glücklicherweise hat die Entwicklung von nicht denaturierten Typ-II-Kollagenen einige dieser Probleme gelöst und bietet eine wirksamere und praktischere Alternative. Nicht denaturiertes Typ-II-Kollagen, wie UC-II®, behält seine Triple-Helix-Struktur bei, so dass seine aktiven Epitope erhalten bleiben. Diese Epitope sind biologisch aktive Regionen, die mit dem Immunsystem interagieren und einen Prozess fördern, der als orale Toleranz bezeichnet wird. Dieser einzigartige Immunmechanismus reguliert die körpereigene Immunreaktion und trägt dazu bei, den Gelenkknorpel zu regenerieren und Entzündungen zu verringern, ohne dass es zu den Nebenwirkungen kommt, die bei anderen Behandlungen auftreten können. Dank der oralen Toleranz können die Vorteile auch bei viel niedrigeren Dosen als bei herkömmlichem hydrolysiertem Typ-II-Kollagen erzielt werden.

Mehrere klinische Studien haben gezeigt, dass nicht denaturiertes Typ-II-Kollagen bei der Verbesserung der Gelenkbeweglichkeit und der Knorpelregeneration deutlich wirksamer ist als herkömmliche Versionen von Typ-II-Kollagen. In einer Studie, die im Journal of Clinical Trials (2013) (6) veröffentlicht wurde, wurde festgestellt, dass UC-II® bei einer Dosis von nur 40 mg täglich die Gelenkbeweglichkeit verbessert und Knieschmerzen reduziert, was 15-mal wirksamer ist als Placebo. Diese Ergebnisse werden durch eine weitere Veröffentlichung im BMC Nutrition Journal (7) untermauert, in der eine sehr signifikante Verbesserung der Symptome bei Patienten mit Kniearthrose bei derselben Dosis von 40 mg festgestellt wurde. Dies steht im Gegensatz zu konventionellen Kollagenpräparaten vom Typ II, die viel höhere Dosen benötigen, um ähnliche Ergebnisse zu erzielen. Darüber hinaus hat sich UC-II® als vielseitiger in der Formulierung erwiesen, so dass es leicht in Kapseln und andere leicht zu verzehrende Formate integriert werden kann, was die Therapietreue der Patienten und die langfristige Aufrechterhaltung der Behandlung verbessert, ein entscheidender Faktor im Verlauf chronisch degenerativer Erkrankungen.

Undenaturiertes Typ-II-Kollagen stellt einen bedeutenden Fortschritt in der Kollagenkategorie dar, denn es verfügt über einen einzigartigen Wirkmechanismus, eine verbesserte Wirksamkeit bei niedrigeren Dosen sowie eine größere Vielseitigkeit und Fähigkeit, mit anderen nutrazeutischen Inhaltsstoffen kombiniert und in anderen populäreren Formaten mit besserer therapeutischer Adhärenz, wie z. B. Kapseln, angeboten zu werden. Die laufende klinische Forschung zu dieser neuen Art von Kollagen macht es zu einem Vorreiter für die Gesundheit der Gelenke und hebt es von allen Kollagenen und den besten natürlichen Inhaltsstoffen in diesem Segment ab.

Kollagen Typ III

Typ-III-Kollagen ist einer der wichtigsten Bestandteile des Bindegewebes und kommt hauptsächlich in Muskeln, Blutgefäßen und Organen vor. Es kommt häufig in Kombination mit Typ-I-Kollagen in elastischen und strukturellen Geweben vor und spielt eine Schlüsselrolle bei der Reparatur und Regeneration von Weichgewebe. Diese Art von Kollagen ist besonders wichtig für die Verbesserung der Gewebeelastizität und -festigkeit und spielt eine entscheidende Rolle bei der Reaktion auf Verletzungen.

Was den klinischen Nutzen von Typ-III-Kollagen betrifft, so hat eine im Journal of Clinical Investigation (2015) (8) veröffentlichte Studie gezeigt, dass eine Supplementierung mit Typ-III-Kollagen in Kombination mit Typ-I-Kollagen zu einer verbesserten Funktion und Regeneration von Sehnen und Bändern beiträgt. Die Ergebnisse deuteten auf eine Verbesserung der Erholung des Weichgewebes und eine Zunahme der Flexibilität und Ausdauer von Muskeln und Sehnen bei Patienten hin, die Sportverletzungen oder Gelenkverschleiß erlitten hatten. Diese Studie untermauert den Gedanken, dass Kollagen vom Typ III für die Aufrechterhaltung der Integrität des Bindegewebes und die Beschleunigung der Genesung nach einer Verletzung unerlässlich ist.

Eine weitere Studie im Journal of Clinical Investigation (2018) (9) untersuchte die Auswirkungen von Typ-III-Kollagen auf die Gesundheit der Gefäße und zeigte, dass sein Vorhandensein für die Aufrechterhaltung der Elastizität der Arterien wesentlich ist.

Diese Ergebnisse verdeutlichen die Auswirkungen des Kollagentyps III auf die allgemeine Gesundheit des Bindegewebes, einschließlich der Blutgefäße, und belegen eine bescheidenere Rolle für die Gesundheit der Gelenke im Vergleich zur Wirksamkeit anderer Kollagenarten, wie z. B. des Typs II, die in einer breiteren wissenschaftlichen Literatur nachgewiesen wurde.

Kollagen Typ IV

Typ-IV-Kollagen ist eine spezielle Form von Kollagen, die vor allem in den Basalmembranen von Zellen vorkommt. Diese sind Schlüsselstrukturen, die viele Gewebe und Organe im Körper stützen und auskleiden, z. B. die Nieren, die Lunge und die Blutgefäße. Im Gegensatz zu anderen Kollagenarten, die in eher strukturellen Geweben wie Haut und Knochen vorkommen, spielt Typ-IV-Kollagen eine entscheidende Rolle bei der Bildung von Zellmembranen, die für die Integrität und Funktion der Organe unerlässlich sind.

In einer großen Studie, die im Journal of Biological Chemistry (10) veröffentlicht wurde, wurde die Funktion des Typ-IV-Kollagens in den Basalmembranen der Nieren hervorgehoben und seine Rolle bei der glomerulären Filtration und der Vorbeugung von Nierenerkrankungen unterstrichen. Die Forschungsarbeiten zeigten, dass eine Störung oder ein Verlust des Typ-IV-Kollagens in den Basalmembranen mit einer erhöhten Anfälligkeit für Nierenerkrankungen, wie z. B. Nephropathie, verbunden ist. Obwohl sich die Studie in erster Linie auf die Zellbiologie und die Nierenpathologie konzentrierte, deuten die Ergebnisse darauf hin, dass Typ-IV-Kollagen für die Organfunktion und die Stabilität der Endothelzellen, die die Blutgefäße auskleiden, wesentlich ist, was seine Bedeutung für die allgemeine Gesundheit unterstreicht.

Trotz seiner biologischen Bedeutung wird Typ-IV-Kollagen aus mehreren Gründen nicht häufig in der Nahrungsergänzungsmittelbranche oder bei der Formulierung von Nahrungsergänzungsmitteln verwendet. Erstens kommt Typ-IV-Kollagen nur in sehr geringen Mengen im Körper vor, und seine spezifische Rolle konzentriert sich eher auf die Zellstruktur als auf die Regeneration von sichtbarem Gewebe oder großen Strukturen des Körpers wie Knorpel oder Knochen. Dies macht seine Anwendbarkeit in oralen Nahrungsergänzungsmitteln weniger direkt im Vergleich zu anderen Kollagenarten wie Typ I oder II, die einen spürbareren Einfluss auf die Gesundheit von Haut und Gelenken haben. Darüber hinaus ist die Herstellung von Typ-IV-Kollagen in großem Maßstab in einem für Nahrungsergänzungsmittel geeigneten Format technisch schwieriger und weniger kosteneffizient.

Kollagen Typ V.

Typ-V-Kollagen ist ein wichtiger Bestandteil von Geweben wie der Plazenta, der Hornhaut und bestimmten Bindegeweben. Es findet sich in Kombination mit Typ-I-Kollagen in Strukturen wie Sehnen und in der extrazellulären Matrix verschiedener Organe. Diese Art von Kollagen spielt eine wichtige Rolle bei der Bildung von Kollagenfasern und bei der Organisation der extrazellulären Matrix.

In einer 2004 im Journal of Biological Chemistry veröffentlichten Studie (11) wird beschrieben, wie Typ-V-Kollagen an der Regulierung der Kollagenfibrillierung des Typs I beteiligt ist, die für die Integrität des Gewebes unerlässlich ist. Diese Erkenntnisse werden durch das ausgezeichnete Handbuch Biochemistry of Collagen, Laminins and Elastin (2019) von Leeming und Karsdal (12) ergänzt. Da Typ-V-Kollagen jedoch eine strukturelle und keine direkte regenerative Funktion in zugänglichen Geweben wie Gelenken hat, wird es nicht in Nahrungsergänzungsmitteln vermarktet. Seine Verwendung ist hauptsächlich auf die Zellforschung und gewebespezifische Studien beschränkt, und seine Herstellung in praktischen Formen zur Nahrungsergänzung ist begrenzt.

Kollagen Typ X

Kollagen vom Typ X kommt hauptsächlich im Knorpel vor und ist für die Knorpelmineralisierung während der Knochenbildung von entscheidender Bedeutung. Es ist besonders wichtig für die Entwicklung des Knorpels in den Gelenken und für Knochenregenerationsprozesse.

Eine in Osteoarthritis and Cartilage (2010) (13) veröffentlichte Studie unterstreicht die Rolle von Typ-X-Kollagen bei der subchondralen Knorpelbildung und seine Beteiligung an der Osteogenese. Eine Supplementierung mit Typ-X-Kollagen hat einige Vorteile bei der Verbesserung der Gelenkgesundheit und der Knorpelregeneration bei Patienten mit Osteoarthritis gezeigt.

Obwohl Typ-X-Kollagen wertvolle Anwendungen in der Knochen- und Knorpelregeneration hat, insbesondere bei der Verbesserung des subchondralen Knorpels und der Osteogenese, ist sein Erfolg auf dem Markt für Nahrungsergänzungsmittel deutlich geringer als der des Typ-II-Kollagens, insbesondere seiner nicht denaturierten Versionen. Die umfangreiche wissenschaftliche Bibliographie über Typ-II-Kollagen zeigt schlüssige Ergebnisse der Wirksamkeit zugunsten der Verbesserung der Gelenkbeweglichkeit und der Knorpelregeneration bei Pathologien wie Arthrose, was eine viel längere wissenschaftliche Karriere als die des Typ-X-Kollagens zeigt, das derzeit auf sehr spezifische Anwendungen beschränkt ist und keine eindeutigen Vorteile nachgewiesen hat.

Zusammenfassend lässt sich sagen, dass die verschiedenen Kollagenarten eine wesentliche Rolle für die Gesundheit und die Funktionalität unseres Bindegewebes spielen, wobei jede von ihnen auf Schlüsselbereiche des Körpers spezialisiert ist. Während Typ-I-Kollagen aufgrund seiner besonderen Rolle in der Dermis und der aussagekräftigeren klinischen Ergebnisse im dermatologischen und ästhetischen Bereich in erster Linie für die dermo- und nutritiven Anwendungen eingesetzt wird, ist Typ-II-Kollagen im Vergleich zu anderen Kollagenarten führend in der Gelenkgesundheit, was durch die langjährige Erfahrung in der Anwendung und die Marktvalidierung in den letzten zehn Jahren untermauert wird, und hat nach wie vor die überraschende Absicht, in den kommenden Jahren weltweit an Umsatz zu gewinnen. Dieser kommerzielle Erfolg wurde von einem großen wissenschaftlichen Aufwand begleitet, der die klinischen Studien mit anderen Kollagenarten bei weitem übertrifft, abgesehen von der unbestrittenen Vorrangstellung der nicht denaturierten Kollagene vom Typ II seit ihrer Einführung, deren Studien höhere Wirksamkeitsraten bei viel niedrigeren Dosen gezeigt haben und die Vorteile bieten, die die potenziellen Diskussionen über die Bevorzugung anderer Kollagenarten bei der Vorbeugung und Behandlung von Osteoartikularpathologien gelöst haben. Die Kollagene des Typs III, IV, V und X weisen zwar gut untersuchte Funktionen im Organismus auf, haben aber weniger Veröffentlichungen und werden kaum oder gar nicht vermarktet, so dass die Tür für spezifischere Forschungen aufgrund ihres potenziellen therapeutischen Nutzens in verschiedenen Gesundheitsbereichen noch offen steht.

Von Anti-Ageing zu Health-Ageing über Mobilität, Hand in Hand mit Kollagen.

In den letzten Jahrzehnten haben wir uns von der Bekämpfung des Alterns an sich, die sich auf die Verlangsamung seiner sichtbaren und körperlichen Auswirkungen konzentriert, zu einem ganzheitlicheren Konzept des gesunden Alterns entwickelt. Heute geht es weniger darum, das Altern zu stoppen, sondern vielmehr darum, wie man aktiv, gesund und funktionell altern kann. In diesem Zusammenhang spielt die Mobilität eine Schlüsselrolle. Ein Mensch, der aktiv ist, bewahrt nicht nur seine körperliche Beweglichkeit, sondern erfährt eine Reihe von Vorteilen, die sich positiv auf seine allgemeine Gesundheit auswirken. Stoffwechsel- und Gewichtskontrolle, Verbesserung des Gefäßrisikos, Verringerung der Sarkopenie und Optimierung der kognitiven Leistungsfähigkeit sind nur einige der wichtigsten Vorteile des aktiven Alterns. Darüber hinaus wird die psychische Gesundheit gestärkt, indem die Unabhängigkeit und die Fähigkeit, tägliche Aktivitäten ohne Einschränkungen durchzuführen, erhalten bleiben. Diese Faktoren tragen zu einem längeren Leben, weniger Morbidität und vor allem zu einer höheren Lebensqualität bei.

Auf diesem Weg zum gesunden Altern spielen Inhaltsstoffe wie Kollagen eine entscheidende Rolle. Seine Fähigkeit, die Hautpflege zu verbessern, wie zuvor für Kollagen vom Typ I beschrieben, hat offensichtliche ästhetische Vorteile, aber die Vorteile von Kollagen vom Typ II für die Mobilität und die Gelenkfunktion, insbesondere in seiner nicht denaturierten Form, ermöglichen es den Menschen, länger beweglich und aktiv zu bleiben, was ein gesünderes Altern fördert. Diese Fortschritte in der Entwicklung von Kollagen als Nahrungsergänzungsmittel tragen nicht nur zur Regeneration des Gelenkknorpels bei, sondern helfen auch, ein aktives und funktionelles Leben zu führen, was der Schlüssel zu mehr Gesundheit und Wohlbefinden im Alter ist.

Kollagen für 1 Million weitere Jahre

Vom ersten Australopithecus bis zum heutigen Menschen sind fast 4 Millionen Jahre vergangen, eine Zeitspanne, in der die Evolution einen wahrhaft außergewöhnlichen Organismus hervorgebracht hat, der in der Lage ist, sich an fast alle Bedingungen sowohl in der natürlichen als auch in der städtischen Umwelt anzupassen. Dieser lange Evolutionsprozess mit seinen erstaunlichen Fortschritten ist jedoch nicht perfekt gewesen. Trotz der außergewöhnlichen Fähigkeiten unseres Körpers haben wir immer noch mit Schwächen zu kämpfen, die wir auf unserem Weg zurückgelassen haben, wie z. B. die Anfälligkeit unserer Gelenke gegenüber der Schwerkraft, dem Körpergewicht und dem Stehen. Auch wenn unsere Spezies viele Widrigkeiten überwunden hat, werden wir wahrscheinlich noch mindestens eine Million Jahre der Evolution benötigen, um Gelenke zu entwickeln, die diesen neuen Herausforderungen wirklich standhalten, ein Prozess, in dessen Verlauf prominente Inhaltsstoffe wie Kollagen ausgezeichnete Reisebegleiter sein werden, die unsere Gelenke schützen, damit wir aktiver und damit langlebiger werden und eine höhere Lebensqualität haben.

Die Fortschritte in Wissenschaft und Technik haben es uns ermöglicht, die Arten von Kollagen genau zu kennen und verbesserte Versionen dieses Schlüsselelements des Körpers zu entwickeln. Die F+E+I liefert uns derzeit Moleküle, die auf spezifischere Ziele ausgerichtet sind, bessere Ergebnisse liefern und besser anwendbar sind, wodurch die Rolle dieses natürlichen Inhaltsstoffs bei der Behandlung und Vorbeugung von Problemen, die für unsere tägliche Gelenkgesundheit von Bedeutung sind, weiter gestärkt wird.

Literatur

1. Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019 Oct;53(20):1268-1278. doi: 10.1136/bjsports-2018-099257. Epub 2018 Jun 9. PMID: 29886437; PMCID: PMC6837253.
2. Wallace IJ, Worthington S, Felson DT, Jurmain RD, Wren KT, Maijanen H, Woods RJ, Lieberman DE. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci U S A. 2017 Aug 29;114(35):9332-9336. doi: 10.1073/pnas.1703856114. Epub 2017 Aug 14. PMID: 28808025; PMCID: PMC5584421.
3. Bolke L, Schlippe G, Gerß J, Voss W. A Collagen Supplement Improves Skin Hydration, Elasticity, Roughness, and Density: Results of a Randomized, Placebo-Controlled, Blind Study. Nutrients. 2019 Oct 17;11(10):2494. doi: 10.3390/nu11102494. PMID: 31627309; PMCID: PMC6835901.
4. Pu SY, Huang YL, Pu CM, Kang YN, Hoang KD, Chen KH, Chen C. Effects of Oral Collagen for Skin Anti-Aging: A Systematic Review and Meta-Analysis. Nutrients. 2023 Apr 26;15(9):2080. doi: 10.3390/nu15092080. PMID: 37432180; PMCID: PMC10180699.
5. Globaler Kollagen-Marktbericht, 2021.
6. Knaub, et al. (2022). UC-II® nicht denaturiertes Typ-II-Kollagen reduziert Kniegelenksbeschwerden und verbessert die Mobilität bei gesunden Probanden: eine randomisierte, doppelblinde, placebokontrollierte klinische Studie. J Clin Trials, 12(1):1000492.
7. Lugo, et al. (2016). Wirksamkeit und Verträglichkeit eines nicht denaturierten Typ-II-Kollagens bei der Modulation von Knie-Arthrose-Symptomen: eine multizentrische randomisierte, doppelblinde, placebokontrollierte Studie. Nutr J, 15(14).
8. Yang G, Rothrauff BB, Tuan RS. Regeneration und Reparatur von Sehnen und Bändern: klinische Relevanz und Entwicklungsparadigma. Birth Defects Res C Embryo Today. 2013 Sep;99(3):203-222. doi: 10.1002/bdrc.21041. PMID: 24078497; PMCID: PMC4041869.
9. D’hondt S, Guillemyn B, Syx D, Symoens S, De Rycke R, Vanhoutte L, Toussaint W, Lambrecht BN, De Paepe A, Keene DR, Ishikawa Y, Bächinger HP, Janssens S, Bertrand MJM, Malfait F. Type III collagen affects dermal and vascular collagen fibrillogenesis and tissue integrity in a mutant Col3a1 transgenic mouse model. Matrix Biol. 2018 Sep;70:72-83. doi: 10.1016/j.matbio.2018.03.008. Epub 2018 Mar 15. PMID: 29551664.
10. Boutaud A, Borza DB, Bondar O, Gunwar S, Netzer KO, Singh N, Ninomiya Y, Sado Y, Noelken ME, Hudson BG. Typ IV Kollagen der glomerulären Basalmembran. Beweise dafür, dass die Kettenspezifität des Netzwerkaufbaus durch die nicht-kollagenen NC1-Domänen kodiert wird. J Biol Chem. 2000 Sep 29;275(39):30716-24. doi: 10.1074/jbc.M004569200. PMID: 10896941.
11. Wenstrup RJ, Florer JB, Brunskill EW, Bell SM, Chervoneva I, Birk DE. Typ-V-Kollagen steuert die Initiierung des Aufbaus von Kollagenfibrillen. J Biol Chem. 2004 Dec 17;279(51):53331-7. doi: 10.1074/jbc.M409622200. Epub 2004 Sep 21. PMID: 15383546.
12. Müller, C., & Lutz, A. (2019). Biochemie von Kollagen, Laminin und Elastin. Chapter 5: Collagen Type V. In Advances in Clinical Chemistry (pp. 123-145). Elsevier. https://doi.org/10.1016/B978-0-12-817068-7.00005-7
13. Bagi, C. M., & Gaskill, T. (2010). Kollagen Typ X in der Knorpel- und Knochenbildung: Implikationen für regenerative Behandlungen. Osteoarthritis and Cartilage, 18(4), 1015-1022. https://doi.org/10.1016/j.joca.2009.12.021.
14. McAlindon, T. et al. (2018). Die Wirkung von Kollagen-Supplementierung auf die Knochengesundheit bei postmenopausalen Frauen: Eine randomisierte kontrollierte Studie. Osteoporosis International.
15. Zdzieblik, D. et al. (2015). Wirkung einer Kollagenpeptid-Supplementierung auf die Erholung nach trainingsinduzierten Muskelschäden: Eine randomisierte kontrollierte Studie. The American Journal of Clinical Nutrition.

Tipp für weiterführende Literatur der Redaktion: Kollagene und Enzyme – Nahrungsergänzungsmittel – was kommt im Knie an? 

So I was all the more delighted when Javier Crupnik from Buenos Aires, Argentina, approached me a few years ago to ask if I would be willing to co-supervise his doctoral thesis in sports medicine. Javier Crupnik is not just anyone; among other things, he was the head physiotherapist for Argentina’s men’s national volleyball team. His many contacts in professional Argentinian sports enabled him to treat players from a prominent club in the province of Buenos Aires who had suffered acute type 3b hamstring injuries according to Müller-Wohlfahrt, as part of a randomized controlled study. All patients were at the level of US college athletes and had received scholarships for their studies, for example. 

Now we really wanted to know: what can radial extracorporeal shockwave therapy (rESWT) (3 times a week, a total of 9 therapy sessions) achieve as an add-on to an absolute high-end physiotherapy and rehabilitation programme for such injuries? It is certainly no secret that the con­ditions in Buenos Aires are much more difficult than here in Germany. 

Thanks to generous funding from Robert Erbeldinger (sportärztezeitung; Mainz, Germany) and Berthold Nickl (PRO Profil Gesellschaft für individuelles Karriere­management mbH; Putzbrunn near Munich, Germany), we were able to conduct the study at an extremely high level.

And we were not disappointed. A mean time to return to sport of 28.3 ± 4.5 days (mean ± standard deviation), achieved only by the high-end physiotherapy and rehabilitation programme, had not yet been reported in the international lite­rature; many reported mean times to return to sport are sometimes signi­ficantly higher. And here, rESWT was even able to improve on this, reducing the mean time to return to sport to 25.4 ± 3.5 days. rESWT did not replace physiotherapy and the rehabilitation programme, but rather complemented it in a meaningful way.

Now, one could argue that the reduction of the mean time to return to sport by three days is not really significant and that the additional effort for the rESWT can be saved. In many cases, however, every single day counts (again for different reasons), and for an athlete’s annual salary of $250,000 or more, the additional expense of rESWT is also financially worthwhile for the club. It was a great time with Javier and we all say ‘Buenos días Argentina y gracias al Dr. Crupnik!’

Another study discussed here was much less spectacular, but certainly of equal relevance, albeit for a completely different patient group. In patients with tendino­pathies of the supraspinatus tendon, in which partial tears have already formed, various physical measures, such as interference current therapy, short-wave diathermy and magnetic therapy, are often used, with good results. The main disadvantage of these therapies is the amount of work involved. So colleagues from the best medical school in China (Shanghai Jiao Tong University School of Medicine) approached me with the question of whether rESWT could help here – and it could. With 6 x rESWT (once a week for 5 minutes each time) the colleagues in Shanghai were able to achieve better results than with 30 x physical therapy (5 x per week for 45 minutes each time). In other words: treatment duration was reduced by 98 % and yet a better result was achieved… especially in China, but perhaps also for us, such improvements in treatment efficiency are of enormous importance.

Combined shock wave therapy for acute injury to the thigh muscle (type 3b)

In this controlled study of 36 semi-professional athletes (football, hockey, rugby), the hypothesis was tested that radial extracorporeal shock wave therapy (rESWT) + specific rehabilitation programme (RP) is more effective than sham rESWT + RP for acute hamstring injuries (type 3b). The results showed that the median time frame for return to sport was 25.4 days for the rESWT group and 28.3 days for the sham group, with the difference being statistically significant (p = 0.037). Both groups had similar satisfaction scores and only one patient from each group suffered a re-injury during the six-month follow-up period.

• Radial ESWT combined with a specific rehabilitation program (rESWT + RP) is more effective than sham rESWT + RP for acute hamstring muscle complex injury type 3b: a randomized, controlled trial
• Javier Crupnik, Santiago Silveti, Natalia Wajnstein, Alejandro Rolon, Tobias Wuerfel, Peter Stiller, Antoni Morral, John P. Furia, Nicola Maffulli, Christoph Schmitz
• medRxiv 2025.01.03.24319763; doi: https://doi.org/10.1101/2025.01.03.24319763

Radial extracorporeal shock wave therapy for rotator cuff injuries

In this study, 60 patients with rotator cuff injuries without complete tears were randomly assigned to either radial extracorporeal shock wave therapy (rESWT) or treatment with physical therapy methods (PTMs). The results showed that the rESWT group had significantly higher ASES total scores and lower VAS pain scores compared to the PTM group at 6 and 12 weeks post-treatment initiation. rESWT also resulted in a significant reduction in the thickness of the supraspinatus tendon and an increase in the acromiohumeral distance. This study suggests that rESWT is a more effective treatment method, which is also accompanied by a drastic reduction in treatment time.

• Radial extracorporeal shock wave therapy is more effective than a combination of physical therapy modalities for rotator cuff injury: a randomized controlled trial
• Zheng Wang, Lan Tang, Ni Wang, Lihua Huang, Christoph Schmitz, Jun Zhou, Yingjie Zhao, Kang Chen, Yanhong Ma
• medRxiv 2025.01.07.25320065; doi: https://doi.org/10.1101/2025.01.07.25320065

Radial extracorporeal shock wave therapy for Achilles tendinopathy

Radial extracorporeal shock wave therapy (rESWT) is an established treatment for Achilles tendinopathy. A recent investigation reported that the addition of rESWT to a specific training programme did not result in significant improvements in pain and function compared to placebo treatment. The main criticism of the authors is that the energy density of the radial extracorporeal shock waves generated with the rESWT device used in this study (ope­rated at air pressure between 2 and 5 bar at 10 Hz frequency) was too low to achieve positive clinical results. Thus, the recent study by Alsulaimani and colleagues discussed here may not fully reflect the effect of rESWT, and it is suggested that further studies be conducted to investigate the energy flux density (EFD) of the rESWT device used by Alsulaimani and colleagues.

• Radial Extracorporeal Shock Wave Therapy for Insertional Achilles Tendinopathy: Energy Matters.
• Schmitz, C.; Crupnik, J.; Morgan, D.; Silk, E.; Maffulli, N.; Morral, A. 
• Clin Rehabil. 2025 Feb 21:2692155251321013. Epub ahead of print. 

To understand the magnitude of this problem, we must consider our evolution as a species. From Australopithecus to Homo sapiens, through its various intermediate versions such as Homo habilis and Homo erectus, the human locomotor apparatus has undergone a series of adaptations that have perfected our ability to walk on two limbs. Standing on two legs was a key advantage in terms of survival, as it freed the hands for the use of tools, allowed a greater ability to observe the environment to prevent attack by predators and favoured the regulation of body temperature by exposing less skin surface to direct sunlight, advantages that made possible the expansion and domination of the species throughout the planet. However, as anthropologist Daniel Lieberman(2) points out, these evoluti   onary advances have come at a significant cost to joint health, especially the joints of the lower limbs. Adopting a bipedal posture is not without its complications, as our hips, knees and ankles, constantly subjected to the forces of gravity, body weight and wear and tear from the motion of frequent walking, were not designed for individuals to live beyond 40 years, probably the life expectancy of early homo sapiens, having now doubled that figure thanks to the advances of civilisation. Lieberman stresses that, although our bone and muscle structure has improved for bipedal locomotion, we are still in a process of adaptation, and this evolutionary lag contributes significantly to the development of joint diseases, such as osteoarthritis, which affect the most heavily loaded joints, especially the knees. Considering that early homo sapiens, with a nomadic lifestyle centred on hunting and gathering, travelled some 175,000 km in their lifetime, this contrasts with the few findings of osteoarthritic signs in specimens from that stage of evolution. In contrast, the average human today does not usually exceed 85,000 km in a lifetime, even though they typically exceed 80 years of age in developed societies. However, longevity, sedentary lifestyles and overweight, among other factors, have led to prevalences of this and other degenerative disorders exceeding 50%, a very significant increase in osteoarthritis in our environment.

The Role of Chondroprotectors in Today’s Medicine

To counteract the effects of joint wear and tear and improve patients‘ quality of life, chondroprotectors such as SYSADOA (synthetic and natural substances for cartilage protection) play a key role in today’s medicine. These products help to reduce pain and inflammation, improving mobility without resorting to painkillers, NSAIDs and opioids. Among the most effective and highly rated chondroprotectants in the field of nutrition and medicine, collagen supplements stand out as a preferred therapeutic option for both clinicians and consumers. However, not all collagens are the same and an in-depth analysis is needed to understand their function and potential health benefits.

The Different Types of Collagen on the Nutraceutical Market

Collagen is an essential protein for the structure of our bones, skin, tendons and cartilage. In the supplement market, there are different types of collagen, each with specific characteristics and health benefits. The most common types are listed below:

Collagen type I

Type I collagen is the most abundant form of collagen in the human body and is essential for the structure of various connective tissues, especially in skin, bones, tendons and ligaments. Composed of densely organised fibres, this collagen offers high tensile strength, enabling it to provide integrity and elasticity to the tissues that make up the structure of the body.

Several clinical studies have validated its efficacy, especially in improving skin elasticity and hydration. A clinical trial published in Skin Pharmacology and Physiology (2014) (3) showed that supplementation with hydrolysed type I collagen significantly increased skin elasticity and hydration in women aged 35-55 years. The results showed that, after 8 weeks of treatment, participants experienced a marked improvement in firmness and wrinkle reduction, results that are confirmed by another study in The Journal of Medical Nutrition & Nutraceuticals (2015) (4) including data on improved skin regeneration, especially when consumed as part of nutritional supplements.

Although there is literature supporting the use of type I collagen for the improvement of osteoarticular health and recovery of tendon and ligament injuries, these findings are not as significant, showing less potency than studies with other types of collagen, such as type II collagen.

Collagen Type II

Type II collagen is the main structural protein in articular cartilage, constituting approximately 90% of the collagen present in this structure. Its primary function is to provide the elasticity and strength necessary to maintain the integrity of cartilage, allowing for proper joint mobility and functional performance. As we age, or due to factors such as injury or degenerative diseases, the body’s ability to synthesise type II collagen decreases, leading to wear and tear and degeneration of articular cartilage. This phenomenon is mainly associated with pathologies such as osteoarthritis, where type II collagen is affected in the joint, causing pain, stiffness and loss of mobility.

The Success of Type II Collagen in the Global Marketplace

Collagen type II enjoys great popularity among professionals and consumers and has experienced significant growth in the supplementation sector. In 2021, the global collagen supplement market reached a value of approximately $4.1 billion, and is expected to grow at a compound annual growth rate (CAGR) of 8.4% through 2030, driven largely by type II collagen, especially in the form of supplements targeting joint health (5). This success is due to its efficacy in treating joint problems, backed by scientific studies showing its ability to improve flexibility and reduce joint pain. However, despite its popularity, conventional type II collagen has certain drawbacks.

Challenges of Conventional Collagen Type II

One of the main challenges with conventional type II collagen is the large amount needed to obtain significant therapeutic benefits. Type II collagen supplements, usually manufactured in powder form, must be consumed in high doses (2.5 to 15 grams daily) and are effective but impractical. In addition, these products are often marketed with astringent textures and flavours that are not always well received, resulting in uncomfortable modes of use for consumers that affect adherence to treatment and, therefore, long-term maintenance.

Undenatured Type II Collagen: The Breakthrough Revolutionising Joint Health

Fortunately, the development of non-denatured type II collagens has solved some of these problems, offering a more potent and practical alternative. Non-denatured type II collagen, such as UC-II®, keeps its triple helix structure intact, allowing it to retain its active epitopes. These epitopes are biologically active regions that interact with the immune system, promoting a process called oral tolerance. This unique immune mechanism regulates the body’s immune response, helping to regenerate joint cartilage and reduce inflammation without the side effects that can occur with other treatments. Oral tolerance also allows benefits to be achieved at much lower doses than those required for conventional hydrolysed type II collagen.

Clinical Studies Supporting UC-II® Efficacy

Several clinical studies have shown that undenatured type II collagen is significantly more effective in improving joint flexibility and cartilage regeneration than conventional versions of type II collagen. In a study published in The Journal of Clinical Trials (2013) (6), UC-II® was found to improve joint flexibility and reduce knee pain at a dose of only 40 mg daily, 15 times more effective than placebo. These findings are reinforced by another publication in the BMC Nutrition Journal (7), which found very significant symptomatic improvement in patients with knee osteoarthritis at the same dose of 40 mg. This contrasts with conventional type II collagen supplements, which require much higher doses to achieve similar results. In addition, UC-II® has proven to be more versatile in formulation, allowing it to be easily integrated into capsules and other easy-to-consume formats, which improves patients‘ adherence to treatment and long-term maintenance, a determining factor in the course of chronic degenerative pathologies.

Undenatured type II collagen represents a significant advance in the collagen category due to a unique mechanism of action, improved effectiveness at lower doses, as well as versatility and greater ability to be combined with other nutraceutical ingredients and presented in other more popular formats with better therapeutic adherence, such as capsules. Ongoing clinical research into this new type of collagen places it at the forefront of joint health, standing out among all collagens and the best natural ingredients in the segment.

Collagen Type III

Type III collagen is one of the most important components of connective tissue, present mainly in muscles, blood vessels and organs. It is often found in combination with type I collagen in elastic and structural tissues, and plays a key role in soft tissue repair and regeneration. This type of collagen is particularly relevant in improving tissue elasticity and strength, and is crucial in the response to injury.

Regarding the clinical benefits of type III collagen, a study published in The Journal of Clinical Investigation (2015) (8) showed that supplementation with type III collagen, in combination with type I collagen, contributes to improved function and regeneration of tendons and ligaments. The results indicated an improvement in soft tissue recovery and an increase in muscle and tendon flexibility and endurance in patients who had suffered sports injuries or joint wear and tear. This study supported the idea that type III collagen is essential for maintaining the integrity of connective tissues and speeding recovery after injury.

Another study in The Journal of Clinical Investigation (2018) (9) assessed the effects of type III collagen on vascular health, showing that its presence is essential for maintaining the elasticity of arteries.

These findings highlight the impact of type III collagen on the overall health of connective tissues, including blood vessels, and evidence of a more modest role in joint health compared to the effectiveness of other types of collagen, such as type II, demonstrated in a wider scientific literature.

Collagen type IV

Type IV collagen is a specialised form of collagen found predominantly in the basement membranes of cells, which are key structures that support and line many tissues and organs in the body, such as the kidneys, lungs and blood vessels. Unlike other types of collagen found in more structural tissues such as skin and bone, type IV collagen plays a critical role in the formation of cell membranes, which are essential for organ integrity and function.

A major study published in The Journal of Biological Chemistry (10) highlighted the function of type IV collagen in the basement membranes of the kidneys, underlining its role in glomerular filtration and the prevention of kidney disease. The research showed that disruption or loss of type IV collagen in basement membranes was associated with increased susceptibility to kidney disorders, such as nephropathy. Although the study focused primarily on cell biology and renal pathology, the results suggest that type IV collagen is essential for organ function and the stability of endothelial cells lining blood vessels, underscoring its importance for overall health.

Despite its biological importance, type IV collagen is not commonly used in the nutraceutical sector or in supplement formulation for several reasons. Firstly, type IV collagen is found in very small amounts in the body, and its specific role is more focused on cell structure than on the regeneration of visible tissues or large structures of the body, such as cartilage or bones. This makes its applicability in oral supplements less direct compared to other types of collagen such as type I or II, which have a more tangible impact on skin and joint health. In addition, large-scale production of type IV collagen in a format suitable for supplementation is technically more challenging and less cost-effective.

Collagen Type V.

Type V collagen is a key component in tissues such as the placenta, cornea and certain connective tissues. It is found in combination with type I collagen in structures such as tendons and in the extracellular matrix of various organs. This type of collagen plays an important role in the formation of collagen fibres and in the organisation of extracellular matrices.

A study published in the Journal of Biological Chemistry in 2004 (11) describes how type V collagen is involved in the regulation of type I collagen fibrillation, which is essential for tissue integrity, findings that are complemented by the excellent handbook Biochemistry of Collagen, Laminins and Elastin (2019) by Leeming and Karsdal (12). However, because type V collagen has a structural and not a direct regenerative function in accessible tissues such as joints, it is not marketed in nutraceutical supplements. Its use is mainly limited to cellular research and tissue-specific studies, and its production in practical forms for supplementation is limited.

Collagen Type X

Type X collagen is mainly found in cartilage and is crucial in cartilage mineralisation during bone formation. It is especially relevant in the development of cartilage in joints and in bone regeneration processes.

A study published in Osteoarthritis and Cartilage (2010) (13) highlighted the role of type X collagen in subchondral cartilage formation and its involvement in osteogenesis. Supplementation with type X collagen has shown some benefits in improving joint health and cartilage regeneration in patients with osteoarthritis.

Although type X collagen has valuable applications in bone and cartilage regeneration, especially in the improvement of subchondral cartilage and osteogenesis, its success in the dietary supplement market is considerably less than that of type II collagen, especially its undenatured versions. The extensive scientific bibliography on type II collagen shows conclusive results of effectiveness in favour of improving joint flexibility and cartilage regeneration in pathologies such as osteoarthritis, demonstrating a much longer scientific career than that of type X collagen, currently relegated to very specific applications and without having demonstrated clear advantages.

In summary, the different types of collagen play essential roles in the health and functionality of our connective tissues, each specialising in key areas of the body. While type I collagen has been primarily focused on dermo-cosmetic and nutricosmetic use due to its special role in the dermis and more significant clinical results in the dermatological and aesthetic area, type II collagen leads the way in joint health care compared to other types of collagen, backed by long experience of use and market validation over the last decade, and still retains a surprising intention to grow in sales worldwide in the coming years. This commercial success has been accompanied by a great scientific investment that far exceeds the clinical trials carried out with other types of collagens, in addition to the undisputed prominence of non-denatured type II collagens since their inception, whose studies have shown higher rates of effectiveness with much lower doses and providing advantages that have resolved the potential discussions surrounding the predilection of other types of collagens for the prevention and treatment of osteoarticular pathologies. Collagens type III, IV, V and X, although they show well-studied functions within the organism, have fewer publications and little or no commercialisation, still leaving the door open for more specific research due to the potential therapeutic use they could provide in various areas of health.

From anti-ageing to healthy-ageing via mobility, hand in hand with collagen.

Over the past decades, we have moved from fighting ageing per se, focusing on slowing down its visible and physical effects, to a more holistic concept of healthy ageing. Today, the focus is less on stopping ageing and more on how to age in an active, healthy and functional way. In this context, mobility plays a key role. A person who is active not only preserves physical agility, but experiences a number of benefits that positively impact on his or her overall health. Metabolic and weight control, improved vascular risk, reduced sarcopenia and optimised cognitive performance are just some of the key benefits of active ageing. In addition, mental health is strengthened by maintaining independence and the ability to perform daily activities without restrictions. These factors contribute to a longer life, less morbidity and, most importantly, a higher quality of life.

On this path to healthy ageing, ingredients such as collagen play a crucial role. Its ability to improve skin care, as previously discussed for type I collagen, has obvious aesthetic benefits, but the mobility and joint function benefits of type II collagen, especially in its undenatured forms, allow people to remain agile and active for longer, promoting healthier ageing. These advances in the development of collagen as a nutritional supplement not only contribute to the regeneration of joint cartilage, but also help to maintain an active and functional life, which is key to achieving greater levels of health and well-being as we age.

 Collagen for 1 million more years

From the first Australopithecus to the present-day human being, almost 4 million years have passed, a period in which evolution has forged a truly exceptional organism, capable of adapting to almost any condition in both natural and urban environments. However, this long evolutionary process, full of astonishing advances, has not been perfect. Despite our body’s extraordinary capabilities, we continue to struggle with weaknesses left behind along the way, one of the most prominent being the fragility of our joints under gravity, body weight and standing. While our species has managed to overcome many adversities, it is likely that we will need at least another million years of evolution to develop joints that are truly resistant to these new challenges, a process during which prominent ingredients such as collagen will be excellent travelling companions that protect our joints to keep us more active, therefore longer-lived and with a higher quality of life.

Advances in science and technology have enabled us to gain in-depth knowledge of the types of collagen and to develop improved versions of this key element in the body. R+D+I currently provides us with molecules that are aimed at more specific targets, with better results and greater usability, further increasing the role of this natural ingredient in the treatment and prevention of problems as relevant as those faced in our day-to-day joint health.

Literature

1. Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019 Oct;53(20):1268-1278. doi: 10.1136/bjsports-2018-099257. Epub 2018 Jun 9. PMID: 29886437; PMCID: PMC6837253.
2. Wallace IJ, Worthington S, Felson DT, Jurmain RD, Wren KT, Maijanen H, Woods RJ, Lieberman DE. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci U S A. 2017 Aug 29;114(35):9332-9336. doi: 10.1073/pnas.1703856114. Epub 2017 Aug 14. PMID: 28808025; PMCID: PMC5584421.
3. Bolke L, Schlippe G, Gerß J, Voss W. A Collagen Supplement Improves Skin Hydration, Elasticity, Roughness, and Density: Results of a Randomized, Placebo-Controlled, Blind Study. Nutrients. 2019 Oct 17;11(10):2494. doi: 10.3390/nu11102494. PMID: 31627309; PMCID: PMC6835901.
4. Pu SY, Huang YL, Pu CM, Kang YN, Hoang KD, Chen KH, Chen C. Effects of Oral Collagen for Skin Anti-Aging: A Systematic Review and Meta-Analysis. Nutrients. 2023 Apr 26;15(9):2080. doi: 10.3390/nu15092080. PMID: 37432180; PMCID: PMC10180699.
5. Globaler Kollagen-Marktbericht, 2021.
6. Knaub, et al. (2022). UC-II® nicht denaturiertes Typ-II-Kollagen reduziert Kniegelenksbeschwerden und verbessert die Mobilität bei gesunden Probanden: eine randomisierte, doppelblinde, placebokontrollierte klinische Studie. J Clin Trials, 12(1):1000492.
7. Lugo, et al. (2016). Wirksamkeit und Verträglichkeit eines nicht denaturierten Typ-II-Kollagens bei der Modulation von Knie-Arthrose-Symptomen: eine multizentrische randomisierte, doppelblinde, placebokontrollierte Studie. Nutr J, 15(14).
8. Yang G, Rothrauff BB, Tuan RS. Regeneration und Reparatur von Sehnen und Bändern: klinische Relevanz und Entwicklungsparadigma. Birth Defects Res C Embryo Today. 2013 Sep;99(3):203-222. doi: 10.1002/bdrc.21041. PMID: 24078497; PMCID: PMC4041869.
9. D’hondt S, Guillemyn B, Syx D, Symoens S, De Rycke R, Vanhoutte L, Toussaint W, Lambrecht BN, De Paepe A, Keene DR, Ishikawa Y, Bächinger HP, Janssens S, Bertrand MJM, Malfait F. Type III collagen affects dermal and vascular collagen fibrillogenesis and tissue integrity in a mutant Col3a1 transgenic mouse model. Matrix Biol. 2018 Sep;70:72-83. doi: 10.1016/j.matbio.2018.03.008. Epub 2018 Mar 15. PMID: 29551664.
10. Boutaud A, Borza DB, Bondar O, Gunwar S, Netzer KO, Singh N, Ninomiya Y, Sado Y, Noelken ME, Hudson BG. Typ IV Kollagen der glomerulären Basalmembran. Beweise dafür, dass die Kettenspezifität des Netzwerkaufbaus durch die nicht-kollagenen NC1-Domänen kodiert wird. J Biol Chem. 2000 Sep 29;275(39):30716-24. doi: 10.1074/jbc.M004569200. PMID: 10896941.
11. Wenstrup RJ, Florer JB, Brunskill EW, Bell SM, Chervoneva I, Birk DE. Typ-V-Kollagen steuert die Initiierung des Aufbaus von Kollagenfibrillen. J Biol Chem. 2004 Dec 17;279(51):53331-7. doi: 10.1074/jbc.M409622200. Epub 2004 Sep 21. PMID: 15383546.
12. Müller, C., & Lutz, A. (2019). Biochemie von Kollagen, Laminin und Elastin. Chapter 5: Collagen Type V. In Advances in Clinical Chemistry (pp. 123-145). Elsevier. https://doi.org/10.1016/B978-0-12-817068-7.00005-7
13. Bagi, C. M., & Gaskill, T. (2010). Kollagen Typ X in der Knorpel- und Knochenbildung: Implikationen für regenerative Behandlungen. Osteoarthritis and Cartilage, 18(4), 1015-1022. https://doi.org/10.1016/j.joca.2009.12.021.
14. McAlindon, T. et al. (2018). Die Wirkung von Kollagen-Supplementierung auf die Knochengesundheit bei postmenopausalen Frauen: Eine randomisierte kontrollierte Studie. Osteoporosis International.
15. Zdzieblik, D. et al. (2015). Wirkung einer Kollagenpeptid-Supplementierung auf die Erholung nach trainingsinduzierten Muskelschäden: Eine randomisierte kontrollierte Studie. The American Journal of Clinical Nutrition.

Diagnosis After a thorough functional diagnosis and imaging procedures, patellar ten­dinitis (jumper’s knee) was diagnosed.

Treatment plan Due to the previous cortisone injections, an alternative form of therapy was sought to alleviate the symptoms and support healing. However, the possibi­lity of using shockwave therapy was ruled out because it is contraindicated within six weeks of a cortisone injection.

1. HIGH PEAK POWER LASER THERAPY

• Goal: Reduction of inflammation and pain relief.
• Application: The laser is positioned on the affected area. Daily sessions (5 x) of 19 minutes

Anti-inflammatory treatment protocol (EMS 905 nm High Peak Power Laser):

1. Wavelength: the 905 nm wavelength is in the near infrared range and is the best compromise with the least absorption in the tissue.

2. Application: Laser therapy is used for pain relief (Mezawa et al.; Arch Oral Biol 1988;33:693–694), inflammation reduction (Bjordal et.al; Br J Sports Med 2006;40:76–80) and in combination with other therapeutic procedures (e.g. shockwave therapy).

2. NUTRITIONAL SUPPLEMENTS Phytopharmaceuticals

• Aim: to improve tissue regeneration and reduce inflammation.
• How to use: 1 x daily, mix one shake with 10 g of powder  in 200 ml of water (Insumed PHYTOSHAKE mit Curcumin, Boswellia und Bromelain)

1. Anti-inflammatory effect: Curcumin has been shown to have anti-inflammatory properties that help reduce swelling and pain associated with sports injuries.

2. Pain relief: Due to its anti-inflammatory properties, curcumin can also help relieve pain. It can reduce the need for painkillers and provide a natural alternative for treating pain.

3. Support healing: Curcumin promotes the healing processes in the body by supporting the regeneration of tissue and cells. This can speed up the reco­very process after injuries and make it easier to return to sport.

4. Antioxidant properties: Curcumin acts as an antioxidant and can help reduce oxidative damage to cells that can result from injuries and inflammation. 

Outcome

After one week of combined therapy, the player reported significant pain relief (VAS 1 / 10). A follow-up examination showed a significant reduction in the signs of inflammation in the affected area. In close consultation with the athletic trainer, he was able to return to full training and then full return to competition without pain. The intake of the nutritional supplement was continued (a total of 30 shakes).

Conclusion

The combination of High Peak Power Lasertherapie and PHYTOSHAKE proved to be an effective and conservative treatment method for patellar tip syndrome for the athlete. This treatment protocol enabled a faster recovery and return to competitive sports.

Prevalence of osteoarthritis

In 2020, approximately 595 million people worldwide – about 7.6 % of the total population – were affected by osteo­arthritis. A forecast published in the Lancet (2023) estimates that if current trends continue, around 1 trillion people worldwide could be affected by osteo­arthritis by 2050 [3] due to demographic change [4].

The knee is the most affected joint. The age-standardized prevalence of knee oste­oarthritis (KOA) in 2020 was around 4,307 cases per 100,000 people worldwide. Symptomatic KOA often leads to severe pain, limited mobility and significant limitations in quality of life due to reduced independence in everyday activities [5, 6].

Given the high socio-economic burden of musculoskeletal diseases, the World Health Organization (WHO) launched the Bone and Joint Decade to improve research and address the growing challenges in the healthcare system [4].

Currently, the treatment of OA primarily focuses on symptom control. The development of disease-modifying osteoarthritis drugs is complicated by factors such as the complexity of the disease and the heterogeneity of patient populations. Nevertheless, promising results are being observed in clinical trials involving new combinations of active ingredients targeting cartilage repair, cellular senescence, and homeostasis [7].

Current recommendations

The efficacy of IA-HA remains controversial in scientific literature and requires a differentiated consideration of the existing evidence. International clini­cal guidelines differ considerably regar­ding the recommendations for IA-HA use in KOA [8].

A recent review of ‚current clinical practice guidelines‘ indicates that IA-HA is widely part of the treatment management of KOA in global guidelines [9].

Based on the results of a ‚Delphi consensus process‘, an expert panel of the EUROVISCO group published consensus guidelines for IA-HA in KOA in 2024. The resulting 34 statements include for instance strong recommendations for IA-HA injections [10], can serving as a valuable resource for clinicians deve­-lo­ping individualized treatment algorithms.

The German Society for Orthopedics and Trauma Surgery (DGOU) is expec­ted to publish the S3 guideline “Prevention and treatment of osteoarthritis of the knee” shortly. Until then, the recommendations will continue to be based on the S2k guideline ‘Osteoarthritis of the knee’, which makes the open recommendation “can be considered” for IA-HA.

When selecting a VS, the cost-effectiveness of hyaluronic acid products should also be taken into account, considering factors like biochemical composition, combinations of active ingredients, and different patient populations [2].

Regarding pain outcomes, a network meta-analysis following IA-HA application indicated a minimal clinically important difference (MCID) and an effect size of 0.34 – 0.63 (modest / moderate effects), showing better results than in control groups treated with corticoste­roids and paracetamol [11]. However, other systematic evidence suggests only a slight reduction in pain following IA-HA treatment, leading to concerns about clinical significance [12]. Short-term pain relief after IA-HA was shown in a systematic review of RCTs published in 2024 [13]. A literature analysis from 2024 presents varying data on effect sizes and describes indications of publication bias [14]. Given these findings, clinical relevance should be critically assessed and treatment recom­­mendations individually discussed with the patients.

Properties of HYALURONIC ACID and predictors of response

To enhance the effectiveness of IA-HA injections, it is important to consider several predictors of response, inclu­ding the stage of disease, age, body mass index, comorbidities and radiological findings [10].

Product Overview

Table 1 provides an overview of different HA products (based on the manufacturer’s specifications) for IA use, specifically used in sports medicine to help healthcare professionals select the most appropriate product.

The products are categorized based on their structure and formulation, which includes linear HA, cross-linked HA, and combination types. Each product is categorized by its dosage (mg / ml) in kDa, reflecting the molecular weight of the HA. The origin of the HA is noted, distinguishing between fermented and avian sources, influencing the product’s properties and suitability for different treatments and populations (e.  g., regar­ding intolerances). 

Given HA’s slow-release properties, it is recommended to combine it with supportive components or agents. Currently available combination products can be found in Table 1 (Structure – Combination). 

Summary

IA-HA is an important component of a multimodal approach to OA management [10]. When selecting a product for IA injection, it is crucial to recognize the differences among available products. Further development and optimization of treatment algorithms incorporating orthobiological therapy options (such as PRP, collagen, ACS) are necessary to ensure safe and efficient patient treatment. The following goals should be focused on to advance treatment algorithms in sports medicine:

• Improvement of clinical outcomes.
• Improvement of clinical efficacy through innovative combinations of DMOADs active ingredients – product developments.
• Optimization of the indication-­specific use of HA preparations (differences in active ingredient combinations…) in orthobiological treatment algorithms.
• Review of the necessity for research to address current study limitations and to avoid “research waste”.

Literature

1. Allied Market Research. Viscosupplementation market research, 2031. Verfügbar unter: https://www.alliedmarketresearch.com/viscosupplementation-market.
2. Ferkel E, Manjoo A, Martins D, Bhandari M, Sethi P, Nicholls M. Intra-articular Hyaluronic Acid Treatments for Knee Osteoarthritis: A Systematic Review of Product Properties. Cartilage. Dezember 2023;14(4):424–32.
3. Steinmetz JD, Culbreth GT, Haile LM, Rafferty Q, Lo J, Fukutaki KG, u. a. Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 1. September 2023;5(9):e508–22.
4. Fuchs J, Kuhnert R, Scheidt-Nave C. 12-Monats-Prävalenz von Arthrose in Deutschland. 2. Aufl. 2017; Verfügbar unter: DOI 10.17886/RKI-GBE-2017-054
5. Migliorini F, Tingart M, Niewiera M, Rath B, Eschweiler J. Unicompartmental versus total knee arthroplasty for knee osteoarthritis. Eur J Orthop Surg Traumatol Orthop Traumatol. Mai 2019;29(4):947–55.
6. D’Ambrosi R, Mangiavini L, Loucas R, Loucas M, Brivio A, Mariani I, u. a. Similar rate of return to sports activity between posterior-stabilised and cruciate-retaining primary total knee arthroplasty in young and active patient. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. Februar 2023;31(2):551–8.
7. Zhao Y, Ou Q, Cai Y, Ruan G, Zhang Y, Ding C. Shedding light on experimental intra-articular drugs for treating knee osteoarthritis. Expert Opin Investig Drugs. Juni 2023;32(6):509–24.
8. Overton C, Nelson AE, Neogi T. Osteoarthritis Treatment Guidelines from Six Professional Societies: Similarities and Differences. Rheum Dis Clin North Am. August 2022;48(3):637–57.
9. Phillips M, Bhandari M, Grant J, Bedi A, Trojian T, Johnson A, u. a. A Systematic Review of Current Clinical Practice Guidelines on Intra-articular Hyaluronic Acid, Corticosteroid, and Platelet-Rich Plasma Injection for Knee Osteoarthritis: An International Perspective. Orthop J Sports Med. 1. August 2021;9(8):23259671211030272.
10. Conrozier T, Raman R, Diraçoglu D, Montfort J, Bard H, Baron D, u. a. EUROVISCO Consensus Guidelines for the Use of Hyaluronic Acid Viscosupplementation in Knee Osteoarthritis Based on Patient Characteristics. Cartilage. 20. November 2024;19476035241271970.
11. Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 6. Januar 2015;162(1):46–54.
12. Pereira TV, Jüni P, Saadat P, Xing D, Yao L, Bobos P, u. a. Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis. BMJ. 6. Juli 2022;378:e069722.
13. Migliorini F, Maffulli N, Schäfer L, Kubach J, Betsch M, Pasurka M. Less Pain with Intra-Articular Hyaluronic Acid Injections for Knee Osteoarthritis Compared to Placebo: A Systematic Review and Meta-Analysis of RandomisedControlled Trials. Pharm Basel Switz. 20. November 2024;17(11).
14. Büchter R, Pieper D. Hyaluronsäure bei Kniearthrose – Sinvolle IGeL oder Placebo? Netzw Evidenzbasierte Med. 2024;(06).
15. Passi A, Vigetti D. Hyaluronan as tunable drug delivery system. Adv Drug Deliv Rev. Juni 2019;146:83–96.

We make far too little use of the possibilities offered by physical therapy in sports medicine. This statement was not made by us but by our scientific advisor, Robert Percy Marshall, MD, team physician for RB Leipzig. He made this statement during a presentation at DKOU 2024, and we at sportärztezeitung wholeheartedly agree. For this reason, we would like to introduce you to this exciting field in the following issues and also show you in a very concrete and practical way the potential and advantages of the various therapy methods, such as extracorporeal shock wave therapy.

The range of treatments includes cryotherapy (radial and focussed), neuro-­reflective cryotherapy and heat therapy, laser therapy, electrotherapy, magnetic field applications, and magnetic resonance therapy. Peter Stiller gives a differentiated insight into the topic of cryo­therapy on page 30 and in this context presentes the application of neuro-reflector hyperbaric CO2 cryotherapy paired with his experiences (www.sportaerztezeitung.com/rubriken/therpie/18072/cryotherapie/). Here you find an article by PD Anna Schreiner, MD on magnetic resonance therapy. What exactly is it, how does it relate to MRI, and how does it differ from magnetic field therapy? Supplemented by practical and application-­oriented insights from the world of professional sport by Prof. Götz Welsch, MD (HSV). sportärztezeitung

Magnetic resonance therapy

Sports medicine and comprehensive conservative therapy should be broadly based, sensibly multimodal, ideally customised to the individual patient and open to new additions to the range of therapies. We sports physicians /doctors are on the right track, but we are nevertheless often confronted with a certain treatment gap, the desire for a more cause-orientated rather than purely symptom-orientated therapy and specialist training that does not always  justice to this.

For historical reasons, physical therapy methods have been underestimated or only used to a limited extent in practice. In German-speaking countries, for example, magnetic resonance therapy (MBST®) or tNMR (therapeutic nuclear magnetic resonance) is little known despite many years of experience and (inter)national use. In addition to the often heterogeneous evidence-based medicine situation, the experience of the indivi­dual physician often plays a decisive role in determining therapeutic action, which for historical reasons – in addition to surgical methods – is predominantly characte­rised by interventions in chemi­cal processes and less by the application of physical principles. Naturally, these in turn could only be investigated after re­cognising the scientific correlations at a molecular and cellular level and corresponding disorders could only be addressed after discovering the electrical processes in the living body. Most recen­tly, the interdisciplinary field of quantum biology has developed from this [10]. 

This article sheds light on this therapeutic principle, which starts at the level of causal cell health, has a symptomatic effect, has enormous potential and positively modulates Nobel Prize-winning cell processes. In addition, previous areas of application – including professional sports – are shown and this is differen­tiated from other methods for orie­ntation purposes.

Discovery, development & clinical use

In the early days of MRI (magnetic resonance imaging), test subjects and patients often had to be examined repe­atedly and with long examination times. It was discovered by chance that some patients reported health improvements afterwards, such as better mobility, more energy or less joint pain. The developers of the later MBST® technology became aware of these results and dis­covered that the positive effect at the cellular level was triggered by the energy transfer to protons in resonance [1]. However, years of interdisciplinary research and development work were required to be able to utilise magnetic resonance technology therapeutically, i. e. to achieve this effect without the complexity of MRI and to develop a widely usable therapy system. Relevant tissue parameters such as proton density, repetition and relaxation times were determined for different tissues (bone, cartilage, etc.), taking into account the corresponding Larmor frequency. This therapy is based on the same physical principles as MRI but operates at a much lower magnetic field strength and uses significantly lower radio (pulse) frequencies (RF) (see Fig. 1).

Magnetic resonance therapy has been in clinical use since 1998 and is a non-invasive, drug-free, and pain-free therapy option, either as an alternative or supplement. It is used by medical professionals to treat various indications and tissue types in the case of complaints, injuries and painful, degenerative and/or pathological changes to the musculoskeletal system. With regard to contraindications, MRI should be used as a guide. The devices (MBST®) are Class IIa medical devices and approved in accordance with EU 2017/745 Medical Device Regulation (MDR) and require therapy cards containing the tissue-specific software.

The physics behind it: Low magnetic fields and radiofrequency as efficient partners and differentiation from similar physical therapy methods

In nuclear magnetic resonance therapy (tNMR), the human body is not exposed to any harmful radiation. Instead, both MRI and tNMR devices use magnets and radio signals that measurably influence hydrogen protons in the body, which consists of approximately 70 % water, in the short term and – in contrast to the geomagnetic field – align them in a targeted manner for a limited period of time. The respective tNMR power parameters to establish nuclear magnetic resonance conditions with the target tissue, successive radio frequency impulses and to repeat the treatment parameters tissue-specifically depending on the phase are:

• Radio frequency power: max. 1 W at resonance
• Radio frequency range: 13.5 – 18 kHz
• Magnetic field strength: max. 1 mT

To generate nuclear magnetic resonance in tNMR, three coordinated fields of different properties are required: A static main magnetic field, a variable, long-modulated „sweep“ magnetic field parallel to the main magnetic field and an alternating electromagnetic field that satisfies the Larmor frequency condition (for hydrogen atoms) and must be perpendicular to the other fields. The output signals each contain a modu­lated, rectified magnetic field with a static component and a modulated alternating field.

The relevant effect for the treatment is the so-called Adiabatic Fast Passage (AFP). Put simply, energy is only transferred if the transmitter (MBST®) and receiver (tissue) have the same parameters, i. e. resonance conditions exist. This physical principle has been confirmed by scientific reports [1, 2].

The most common risk of confusion to date is with (so-called non-invasive) magnetic field therapies (MFT). Here, devices generate static or pulsating fields of various kinds. The frequency, the periodic change of direction and the intensity of the magnetic field can be individually adjusted. In contrast to tNMR, this is not a therapy that produces nuclear magnetic resonance based on the parameters, but rather a wide range of different magnetic fields with heterogeneous evidence. tNMR is a non-comparable and much more complex method compared to conventional MFT. In contrast to the ionic functional principle of MFT, in tNMR the energy transfer is carried out at the proton level of the hydrogen atoms in resonance. As the human body consists of almost 80 % water, energy can be optimally transferred into the tissue almost without loss via this route. tNMR is an independent, innovative and unique therapeutic procedure in terms of bio-physics. It is the only non-invasive method in the world that works directly at the hydrogen proton and therefore cell level.

Commercially available MFT devices mostly use the PEMF method (pulsed electromagnetic fields). These are fields that build up and break down. The magnetic field is located inside a thin-walled air coil, is strongest at the edge of the coil and decreases towards the centre. However, it does not have a core spin field or its properties. The devices are usually adjustable in terms of frequency, waveform and power and can be freely selected by the doctor or patient for home use. This PEMF technology, which is scientifically controversial in some quarters, is based on the transfer of energy into the organism through ion transport (ion level) via an air coil system with simple pulsing, i.e. switched on and off, magnetic fields (PEMF). This is intended to stimulate metabolic processes in the cell structures and support regeneration. However, only a small amount of energy is transferred to the organism in this way, as the form of energy transfer does not have a biological signal form and such air coil systems tend to have higher losses, which limits their effectiveness. These systems cannot cause resonance effects because they do not operate under Larmor conditions, which is a basic prerequisite for inducing resonance effects in cells and thus a demonstrable therapeutic effect. Only with tNMR, i.e. a combination of a static magnetic field, a sweep field and a radio frequency applied orthogonally to it, can proton spins be specifically stimulated.

In repetitive peripheral magnetic stimulation (rPMS), the nerves that control the muscles are stimulated and activated by magnetic pulses to relieve pain. Strong, rapidly pulsing magnetic fields are used to stimulate nerve cells and muscle fibres using the principle of induction. The rPMS device generates pulses at frequencies similar to those used by the body itself for neuromuscular control and regulation (5-50 Hz). In high-energy induction therapy, for example, a magnetic field is generated that is about 600 times stronger than a normal magnetic rod and can vary between 1-150 Hz. The pulses are noticeable to the patient and the clicking of the magnetic coil stimulation is audible.

In the field of alternative medicine, the use of mats is also known, whose mode of action consists of an electromagnetic field that is intended to address the functionality of capillaries by specifically intervening in the body’s bioelectrical processes. The devices sold by manufacturers such as BEMER Int. AG generate a very weak magnetic field of 50 to 100 µT, which corresponds approximately to the strength of the Earth’s magnetic field at the Earth’s surface.

Overall, static magnetic fields are well described in nature, whereas the heterogeneous study situation on pulsating magnetic fields using a wide range of frequencies cannot be generalised. The range of indications for MFT is broad and also includes orthopaedic and sports medicine.

Transcranial magnetic stimulation (TMS) is based on the law of electromagnetic induction. This states that an electric current is induced in a conductor when the magnetic flux changes, which in turn changes when the electric current in the magnetic coil generating the magnetic field changes. Technically, this is achieved by quickly switching the current in a magnetic coil on and off with the aid of a thyristor switch. This electrical current, which changes over time, induces a magnetic flux that also changes, which in turn induces an electrical current in the ‘conductor’ brain. In order to induce a magnetic flux change that reaches the cerebral cortex through the skin and bones, voltages of up to 2000 V and currents of up to 10,000 A are required. Accordingly, the devices place high demands on safety.

This must be distinguished from invasive MFT (electro-osteo-stimulation (EOS)). Here, the magnetic field is used to transmit electrical energy, while the effect is based on electrical stimulation, whereas in the non-invasive method, the magnetic field as such exerts its effect in the body.

Radio frequency therapy, on the other hand, is an invasive procedure used in the spinal area, e.g. for denervation. Here, heat is generated via radio waves (250 kHz to 1 MHz) (75–90 °C for 60–90 seconds). In pulsed radio frequency therapy, radio waves with a base frequency of approx. 500 kHz are used.

In the field of electrotherapy, a distinction is made between direct current therapy (galvanisation), low-frequency therapy (up to 1000 Hertz), medium-frequency therapy (1 to 100 kilohertz) and high-frequency therapy (over 100 kilohertz). Ultrasound therapy and TENS also belong to this group of therapeutic methods and are primarily used for symptomatic pain relief.

In summary, tNMR is a biophysically independent, innovative and unique therapeutic method. It is the only non-invasive method in the world that acts directly on hydrogen protons and thus at the cellular level.

Understanding the cellular level – Circadian cell clock and co.

In order to understand why tNMR  referred to as healing at the cellular level,  is necessary to take a closer look at relationships that have so far been little known in everyday clinical practice. Living organisms are a highly complex biological system with numerous molecular, biochemical and bio-physical processes. Biological homeostasis is self-­regulating and requires healthy cells. The body consists of cells and almost 80 % water (in tissue, cytoplasm, etc.). tNMR utilises the ubiquitous water protons in a tissue-specific manner and modulates various cell processes in the sense of homeostasis. An important aspect of cellular processes is the so-called circadian cell clock. This is an endogenous oscillation of metabolic activities with a periodicity of approx. 24 hours. All our cells in the body have such an internal clock, which consists of clock genes or proteins. The internal clock of the cells controls cellular signalling pathways such as the basal (sugar) metabolism, the mitochondrial respiration, immune and stress response or cell division. An „adjustment of the clock“ is associated with a variety of diseases [3 – 9]. tNRM has been shown to influence the cell clock [3, 10, 11]. In basic science tNMR studies, for example, it was shown that the combination of weak magnetic fields in combination with radio waves has a clear influence on the signalling pathways of the cell – such as the internal clock, the basic cell metabolism or the oxygen signalling pathway [11 – 13]. This means that tNMR also has a positive influence on the balance of free oxygen radicals [12]. These so-called ROS (reactive oxygen species) not only have a harmful effect if too much of them are formed, but are also necessary for the fine control of cellular signalling pathways. High ROS concentrations ultimately lead to irreparable damage to macromolecules and DNA and can trigger cell apoptosis. The findings on hypoxia-controlled signalling pathways were awarded the Nobel Prize in 2019 („When cells get out of breath“ – Kaelin, Ratcliffe, Semenza [14]) and are also described in connection with osteoarthritis and bone meta­bolism, for example [15, 16].

In addition to other in vitro studies showing that tNMR reduces inflammatory and catabolic mechanisms and stimulates anabolic effects (see also the arthrosis model) [17, 18], the Innsbruck research group has repeatedly demonstrated the connection between the circadian cell clock and the hypoxic signalling as described above [3, 11 – 13, 19, 20]. Ultimately, tNMR can be used as a kind of switch for the cellular clocks and thus the metabolism of both human and veterinary cells. In another study it was shown that tNMR accelerated the regeneration of dorsal root ganglia in vitro [21, 22]. In summary, tNMR can activate the body’s own natural repair mechanisms,

Musculoskeletal applications and clinical evidence

MBST® is widely used to treat osteo­arthritis, osteoporosis, and both acute and chronic sports injuries. It is also applied postoperatively for optimised wound healing, back pain, and pain management (both analgesic and anti-inflammatory) [1]. In terms of tissue types and treatment areas, cartilage (cartilage damage, arthrosis), bones (bone oedema, osteoporosis), intervertebral discs (herniated discs, back pain), nerves (nerve damage, pain) and muscles / tendons / ligaments (sports injuries, overuse reactions) can be addressed. tNMR can be used both as a standalone therapy and, more importantly, as part of a modern multimodal treatment approach. There are numerous studies, including nearly 30 relevant publica­tions on MBST®, covering both clinical and scientific research. This includes collaborations with universities, research institutions, clinics, and medical practices worldwide. No side effects or complications have been reported so far in in any of the applica­tions and procedures to date. In addition to various other specialist publications, the relevant publications (in addition to the basic scientific data presented above) are retrospective, but also prospective, controlled clinical studies of varying quality. The following main statements, among others, were shown in various studies [1, 23]:

• Pain reduction in osteoporosis, fewer osteoporosis-related complaints, i.e. improved quality of life, increased bone density (qCT), increased bone formation markers, fracture risk reduction [1, 24 – 32]
• Significant medium to long-term pain reduction in osteoarthritis, improvement in quality of life and joint function, optimisation of degenerated cartilage structures (according to the Eckstein procedure) [1, 33 – 40] ; additive in-vitro: modulation of cartilage metabolism (see HIF1α, reduction of lactase level), modulation of IL-1β-induced inflammatory reactions, positive influence on chondrocytes / osteoblasts [41, 42]
• Long-term improvement of Back pain, longer-lasting rehabi­litation effect, reduction in sick days [43 – 48]
• Part of the successful multimodal treatment of muscle injuries (see article in sportärztezeitung) [49].

Case reports and application data also cover the area of neuralgia (PNP, CRPS, fibromyalgia, etc.), wound healing disorders, osteo-necrosis and numerous applications for acute and chronic sports injuries (see also articles in the sportärztezeitung). The various device types are certified in accordance with the EU standard for medical devices (EU 2017/745 MDR), including a regular evaluation report on safety and efficacy, and MBST® has now been tried and tested in more than 2 million hours of therapy. There is also a mobile device version for the sports medicine sector. Sports physicians and team doctors from Bundesliga teams, top international teams and Olympic athletes are already using it successfully – currently in Germany, for example, at HSV (Prof. Götz Welsch, MD) and Basketball Löwen Braunschweig (Nico Fiedler, MD).

Outlook and summary

To summarise, it can be said that tNMR is a long-established and successful procedure that is increasingly emerging as a relevant partner for modern multimodal therapy in a patient-individu­alised multimodal setting, not least due to the latest basic scientific data and increasing national and international clinical experience in the professional sports sector and orthopaedics as a whole. The experiences of many colle­agues and patients often describe magnetic resonance therapy as „the missing piece“ that can help to close a treatment gap. Further studies are underway to optimise the evidence base. Particularly in the case of chronic common diseases such as osteoporosis and arthrosis, this therapy may a be a meaningful option in view of the socio-economic situation. Basic research is also constantly being carried out to explore further mechanisms of action, optimise treatment approaches and further therapy. This is what sport is all about, „to get all the horsepower back on the road“, i. e. to enable a successful and efficient return-to-sports etc. or to generally help patients to recover, or at least to reduce symptoms and improve their quality of life. If we continue with the car analogy, MBST® can help optimise cellular function, much like fine-tuning an engine. However, the whole thing also needs the right fuel, i. e. nutrients, vitamins, trace elements etc. in the form of food, food supplements, supplements etc. The vehicle also needs to be moved, i.e. training in whatever form. If a targeted repair is required due to ageing, an accident or similar, further physical therapies, orthobiologics and, if necessary, interventional procedures are used.

Insights from professional sport

from  Prof. Götz Welsch, MD

The time factor also plays an important role. How can I get a footballer back on the pitch as quickly and safely as possible? In addition to medical, physiotherapeutic or osteopathic treatment, we use a wide range of physical therapies for chronic or acute injuries in professional sport, as mentioned at the beginning of the article. These forms of therapy must complement each other sensibly with the aim of accelerating tissue regeneration. After 12 months of experience with magnetic resonance therapy (MBST) in the context of supporting a professional football team, this form of therapy has proven to be an extremely useful addition to a multimodal treatment spectrum. As part of the therapy concept for typical injuries and overuse injuries in professional football, the team doctors manage the rehabilitation processes together with the physiotherapists and rehab/athletic trainers. Physical forms of therapy play a key role here and are applied differently depending on the injury. MBST has now become a very important component. We use the „ARTHRO•SPIN•FLEX 2“ magnetic resonance therapy treatment device for the following indications:

• Chronic cartilage damage in the knee and hip joint
• Bone bruises / bone marrow oedema (acute or chronic)
• Muscle injuries (both contusions and overloads / DOMS, strains, fibre and bundle injuries)
• Acute joint injuries (ankle, knee, shoulder, etc.)
• Back pain, intervertebral disc pathologies, spondylolysis
• Post-operative

It can be seen that these indications include the majority of all sports injuries and overuse injuries that occur in a professional football team. Depending on the affected structure, the specific MBST tissue types (e.g. cards for cartilage / osteoarthritis, bones, tendons, muscles, ligaments, intervertebral discs) are used.

The aim of multimodal combination therapy is to initiate various regenerative processes and utilise them alongside or with each other. In this way, the self-healing process should be supported and, if necessary, accelerated. Among other things, the aim is to achieve a modulation and resolution of the inflammatory processes that take place as part of this healing process. At the cellular level, as described above, homeostasis should be established, cell permeability and mitochondrial activity should be increased (increased energy supply) and cell metabolism and protein synthesis should be activated. The aim is to improve microcirculation and stimulate the secretion of nutrients, growth hormones and stem cells are activated in the healing process.

Individual physical measures have an impact on different, complementary processes in this cascade and often enable faster and more intensive treatment, while at the same time accelerating regenerative processes. Depending on the pathology, MBST is used together with microcurrent, shockwave, deep heat, laser, but sometimes also together with pulsating magnetic field therapy. A major advantage of MBST is certainly its tissue specificity and the possibility of treating even very deeply localised or intra-osseous pathologies in a targeted manner.

While magnetic resonance therapy can achieve a time advantage in the healing process for acute injuries, it is a very effective addition to the therapeutic procedure for chronic processes (cartilage damage / osteoarthritis, inflammation of the pubic bone / tendon attachment tendinopathies) and bone marrow oedema, which is often difficult to treat.

The aforementioned device has been accepted extremely well as part of team care. The 60-minute therapy time is very well tolerated by the athletes and we also use this for parallel treatments, e.g. micro­current or ionising oxygen therapy. This therapy is planned and scheduled by the physiotherapists in consultation with the team doctors.

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