Is collagen a secret weapon for reducing injury?

Here's a scary stat...

40% of distance runners are injured at any point in time 😬. Most injuries are chronic, involving tendon, muscle and/or ligaments. So, why do so many runners get injured?

Running injuries are complex and likely caused by a combination of factors. Known reasons for running injury include:

• history of previous injury (hands up runners!)
• training errors - large mileage increases, acute changes in training load ("I need to make up training...I'll just add an extra long run this week")
• poor sleep quality (often difficult to manage in our busy, modern lives)
• abnormal or absent menstruation (pre-menopausal ladies this is not ok!)

Can diet prevent & treat running injury?

Whether diet plays a role in running injury prevention and management remains unclear. Within sport generally, chronic underfueling increases risk for bone injuries, such as the dreaded stress fracture. Avoiding nutrient deficiencies is important for bone, muscle, tendon and ligament health. A high protein diet may be beneficial in healing and avoiding loss of muscle after injury. Supplementation with creatine monohydrate can also minimise muscle loss and support muscle gain. There is some research regarding calcium, vitamin D, omega 3 fatty acids and antioxidants but results are mixed, with poor quality studies, different methods and many studies being limited to female collegiate athletes only, preventing consensus. Collagen support is a nutritional strategy for preventing and treating injury with promising research.

What is collagen?

Collagen, a type of protein, is present in skin, bone, ligaments, and tendons. It makes up about one-third of the body's total protein, with type I collagen comprising 90% of this amount. Its role is to provide structural support to these tissues, which enables them to remain robust, flexible, and durable. Unfortunately, as we age, our production of collagen decreases, leading to an increased risk of chronic degenerative tendinopathy, a condition that involves changes to the structure of tendons and impaired healing. These types of injuries are notoriously challenging to repair. However, taking collagen supplements can help ensure that the body has access to the necessary amino acids required for collagen synthesis. Studies suggest that this increased availability of amino acids can improve tissue repair, boost physical function, and alleviate pain, although the precise mechanisms of action are not yet fully understood. As a result, collagen supplementation has become increasingly popular in recent years, with claims of benefits ranging from improved skin health to better joint health, faster injury recovery, and enhanced mental wellbeing and cognition.

What does research say about collagen supplementation and injury?

Interest in collagen supplements took off in 2017 through a randomised controlled trial* of vitamin C-enriched gelatin vs placebo in 8 healthy males. One hour after taking gelatin, the participants completed 6 minutes of rope skipping to stimulate collagen synthesis. This was repeated 3 times per day with 6+ hrs between rope skipping sessions for 3 days. Blood taken from the participants was used to bathe artificial ligaments to assess effects at the tissue level. Ligaments exposed to collagen had 2 times higher collagen synthesis, collagen content and mechanical function. Jumping rope for 6 minutes with gelatin resulted in 2 times greater increase in collagen synthesis than jumping alone.

Further studies have found that collagen seems to be beneficial for reducing pain and promoting faster recovery for some tendinopathies (including patellar and achilles tendinopathy). Some of these studies have combined supplementation with other treatments, e.g. strengthening programs and Shockwave Therapy, making it difficult to understand which treatment contributed to outcomes. Collagen supplementation has also been shown to improve strength and body composition when paired with resistance training. The overall quality of studies is poor, with risk of bias due to self-reported outcomes and variation in the dosage, timing, duration and type of collagen supplement used.

Gelatin and hydrolysed collagen (derived from collagen) is made from the skin, bones, tendon and ligaments of cattle, pigs and fish. It can be found in gelatin and specifically-designed sports nutrition supplements. A third party batch-tested product comes with the lowest risk of contamination with banned substances. Being of animal origin, collagen is not suitable for vegan or vegetarian diets. There are companies working to genetically modify yeast and bacteria to create animal-free "vegan" collagen or bio-engineer it. But more research is needed to demonstrate whether it works similarly to animal-based collagen.

So, what's the bottom line? Should I take collagen supplements or not?

It's still early days but overall research suggests that collagen supplementation may assist in the prevention and/or treatment of muscle, tendon, bone and ligament injury.

It is important to ensure collagen supplementation does not take place of strategies with stronger evidence of benefit. Seek a proper injury diagnosis and treatment plan from your sports physician or physiotherapist. Do your rehab exercises to support your body to heal and gain strength.

If you're struggling to heal your injuries with traditional methods like strength exercises and modified training, it may be time to consider collagen supplementation. As an Accredited Sports Dietitian, I'm well-versed in the most appropriate protocols and forms of collagen supplementation for your unique needs. I can show you how to maximise your chances of success with collagen supplementation and get you back to your peak performance.

*A randomised controlled trial is an intervention study given the highest evidence level because it is designed to be unbiased and have less risk of systematic errors.

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References

https://www.ais.gov.au/nutrition/supplements/group_b#collagen_support

Capatano, MC et al 2021, 'The Aging Athlete', American Academy of Physical Medicine and Rehabilitation, vol. 14, pp. 643-651.

Close et al 2019, 'Nutrition for the Prevention and Treatment of Injuries in Track and Field Athletes', International Journal of Sport Nutrition and Exercise Metabolism, vol. 29, pp. 189-197.

Francis, P, Whatman, C, Sheerin, K, Hume, P & Johnson, MI 2019, 'The proportion of lower limb running injuries by gender, anatomical location and specific pathology: a systematic review', Journal of Sports Science & Medicine, vol. 18, no. 1, p. 21.

Hilkema et al 2022, The impact of nutrition on tendon health and tendinopathy: a systematic review, Journal of the International Society of Sports Nutrition, vol. 19, iss. 1, pp. 474-504.

Koizumi S, et al 2020, ‘Effects of collagen hydrolysates on human brain structure and cognitive function: a pilot clinical study’ Nutrients, iss. 12, pp. 50.

Kviatkovsky SA et al 2021 ‘Collagen peptide supplementation improves measures of activities of daily living and pain in active adults’, Proceedings of the Eighteenth International Society of Sports Nutrition (ISSN) Conference and Expo.

Kviatkovsky SA et al 2022, ‘Collagen peptide supplementation improves measures mental component scores of the VR-12 inactive adults’ Proceedings of the Nineteenth International Society of Sports Nutrition (ISSN) Conference and Expo, In press.

Shaw et al 2017, Vitamin C enriched gelatin supplementation before intermittent exercise augments collagen synthesis, The American Journal of Clinical Nutrition, vol. 105, pp. 136-143.