More supplements can improve knee pain than just about any other condition. Here, I’ve focused on the best supplements for knee pain that I’ve found most effective as a doctor, medical nutritionist and ex-sufferer of knee pain.
The best supplements for knee pain
Whether your knee pain is due to a sports injury or knee arthritis, the following supplements can reduce knee pain, knee stiffness and improve how your knees function – in other words how well you can carry out every day activities like going up-and-down stairs, walking, getting in and out of the bath and even putting on your socks.
- Glucosamine plus chondroitin
- Vitamin C
- Krill oil
I know these supplements can reduce knee pain from personal experience, from reviewing the published research, and from seeing an X-ray of my right knee taken after a ski fall. Apart from some laxity from damaged ligaments (now cured!) my joint space looks great with no obvious signs of osteoarthritis, which I attribute to long-term use of glucosamine and chondroitin, krill oil, and vitamin C.
For treating the knee pain due to damaged ligaments, I added in turmeric, collagen and ginger with excellent results.
Different supplements work for different people, however, depending on the genes you have inherited. Some respond to glucosamine alone, but in my clinical experience most people benefit from taking both glucosamine plus chondroitin.
Combination supplements that blend ingredients for a synergistic effect can tackle knee pain through different mechanisms.
If you are not getting the degree of pain relief you hoped for after 6 weeks, you can either swap to a different treatment or add in another supplement.
It’s not always easy to spot small gradual improvements in knee pain, so you might like to complete a WOMAC Osteoarthritis Index joint symptom questionnaire before and after taking a supplement for a few weeks to assess if there is any meaningful benefit.
How supplements reduce knee pain
Nutritional supplements can improve painful knees in a number of ways, by:
- Providing building blocks for the repair of cartilage, ligaments and tendons
- Stimulating the repair of damaged tissues and the production of cushioning synovial fluid
- Regulating the enzymes involved in breaking down or building new cartilage
- Reducing inflammation
- Reducing pain through analgesic effects.
Some supplements, especially plant extracts, contain a wide variety of compounds that each work in different ways to provide more benefits than any single prescribed painkiller ever could.
In fact, supplements are set to play an increasing role in treating painful knees as the long-term use of paracetamol is no longer recommended. Paracetamol is not as safe as previously thought and is linked with an increased risk of heart attack and stroke. This follows similar findings that long-term use of non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen can also increase the risk of heart attack and stroke.
Glucosamine and chondroitin for knee pain
Glucosamine and chondroitin are produced naturally in the body as building blocks needed to make cartilage, tendons, ligaments and synovial fluid. Their production declines with age, and it is often in short supply, especially when active joint repair is needed.
Glucosamine and chondroitin regulate the levels of at least 31 different proteins in cartilage cells which are involved in cartilage health, antioxidant stress responses, and the synthesis of new proteins such as collagen. Glucosamine and chondroitin act as biological signals to switch on the repair of damaged joint tissues, and suppress the inflammation and breakdown of cartilage that is a feature of osteoarthritis.
As you get older, your cartilage cells secrete less and less glucosamine and chondroitin. As a result, cartilage becomes more brittle and prone to the degenerative changes seen in ageing joints.
How effective are glucosamine and chondroitin supplements for knee pain?
Prevention: Taking glucosamine supplements (at doses of 1.5g to 3g daily) can preserve joint health by reducing cartilage breakdown, and maintaining the production of collagen in athletes involved in various sports, including soccer and bicycle racing.
Sports injuries: Research involving 106 athletes with an acute knee injury found that taking glucosamine (1500 mg daily), significantly improve knee bending (flexion and extension) compared with placebo. These improvements in mobility took 28 days to develop, as it takes time for damaged tissues to use these building blocks, and for them to enhance repair processes, so don’t expect immediate results.
Osteoarthritis: Data from 54 studies, involving 16,427 people with knee pain due to osteoarthritis, found that glucosamine and chondroitin were more effective than placebo in pain relief and improving joint function. Both glucosamine and chondroitin reduced joint space narrowing, as seen on X-rays, to indicate that the progression of osteoarthritis was significantly slowed.
Collagen Supplements for knee pain
While glucosamine and chondroitin give cartilage its flexibility and resilience, it gets its strength from a strong, fibrous protein known as type II collagen. Collagen is a protein composed of long chains of amino acids. Every third amino acid is glycine, with proline, hydroxyproline and hydroxylysine appearing in between. These last two amino acids are not found in any other human proteins.
Long chains of collagen come together in threes. Hydroxyproline, which needs vitamin C for its synthesis, has a unique shape which allows collagen fibres to twist around each other and form long triple strands for extra strength
How effective are collagen supplements for knee pain?
Collagen supplements stimulate the synthesis of collagen, to help maintain the structure of the joint and reduce joint discomfort. Collagen supplements also increase blood levels of the amino acids needed to make collagen, and when collagen hydrolysate is ‘labelled’ to show up on x-ray, it is seen to preferentially accumulate in cartilage and to build it up (anabolic effect).
Those with the greatest joint degeneration and with the lowest intake of dietary meat protein benefited the most.
Sports injury knee pain: In athletes and weekend warriors who experience knee pain on exercise, taking either 40mg undenatured collagen type 2 supplements per day, or a liquid collagen hydrolysate supplement (10g per day) for 4 to 6 months, provides significant improvements compared with placebo.
Those taking the collagen supplements experienced significantly increased joint mobility, less joint pain at rest, when walking, standing, running, lifting or carrying weights. They were also able to exercise for longer with a speedier recovery afterwards. Some of those taking collagen supplements experienced a complete resolution of pain on exercise. The researchers concluded that collagen hydrolysate can support joint health and possibly reduce the risk of joint deterioration in athletes, who are at high-risk of developing joint problems.
Rheumatoid arthritis knee pain: Type II collagen is the main protein in joint cartilage and may be one of the targets for antibody attack in people with rheumatoid arthritis. Taking small doses of undenatured collagen supplements (eg chicken type II collagen, 0.1mg per day for one month then 1mg per day) may help the immune system become more ‘tolerant’ of the body’s own collagen to suppress joint inflammation. In one study involving 60 people with severe, active rheumatoid arthritis, this collagen immunotherapy significantly reduced the number of swollen and tender joints within 3 months, compared with no change in those taking placebo. Four of those taking collagen even had a complete remission of their symptoms even though they were initially classed as severe. NB If you have rheumatoid arthritis, don’t take collagen supplements except under medical advice and supervision – very low doses are needed for this form of immunotherapy, and it is possible that taking higher doses may make your symptoms worse.
Hydrolysed and unhydrolysed collagen supplements
The form of collagen found in joints (type 2 collagen) is found in the diet, particularly in meat. The collagen used in supplements is either derived from marine sources (eg from shark or other fish cartilage), or from animals cartilage (typically chicken, but also from beef or pork sources). Marine collagen peptides have a higher concentration of the amino acids needed for the production and repair of human cartilage (glycine, proline and hydroxyproline).
Supplements can contain collagen in its original state (known as unhydrolysed or undenatured collagen), or in a hydrolysed or solubilised form.
- Unhydrolysed collagen contains large collagen molecules (polypeptides) which must first be digested before they can be absorbed and used in the body.
- Hydrolysed collagen is in a ‘body-ready’ form as it is pre-digested by protease enzymes to release small fragments (peptides) that are more easily absorbed and used.
When you take a hydrolysed collagen supplement, it is rapidly absorbed into the circulation from which it is extracted by cells that need these building blocks (eg fibroblasts in the skin, chondrocytes in cartilage) and cartilage where it acts as a signal to trigger the synthesis of new collagen fibres.
As well as supporting joint health, collagen supplements have benefits on skin suppleness, elasticity and hydration to reduce the formation of skin wrinkles. Collagen also offers benefits for people with thinning bones (osteoporosis) as it is a bone scaffold protein on which calcium salts are laid down.
Vitamin C supplements for knee pain
Vitamin C is a water-soluble vitamin found mainly in fruit and vegetables. As vitamin C is water-soluble, it cannot be stored in the body so a regular intake is essential.
How vitamin C reduces knee pain
Vitamin C is essential for collagen synthesis (to convert the amino acid, proline, to hydroxyproline so strands can coil around each other) and for the metabolism of joint cartilage. Vitamin C is also a powerful antioxidant, especially in joint fluid.
Poor intakes of vitamin C can lead to reduced collagen formation and slow joint healing. In contrast, good intakes of vitamin C can reduce cartilage loss and disease progression in osteoarthritis, while its antioxidant action reduces joint inflammation.
Vitamin C stimulates bone-building cells (osteoblasts) to improve bone mineral density and support the overlying joint cartilage. Vitamin C may even help to prevent damage, cartilage loss and the development of osteoarthritis.
How effective are vitamin C supplements for knee pain?
In the Framingham Osteoarthritis Cohort Study, who underwent regular knee x-rays, people with the highest vitamin C intakes (including supplements) were three times less likely to see their knee osteoarthritis progress than those with the lowest vitamin C intake. This protection was mostly related to a reduced risk of cartilage loss. Those with high vitamin C intake also had a 70% reduced risk of developing knee pain.
In the similar Clearwater Osteoarthritis Study, those who took vitamin C supplements were 11% less likely to develop knee osteoarthritis than those who did not take vitamin C supplements.
Vitamin C may also enhance the effects of glucosamine and chondroitin. A small trial involving 34 males from the U.S. Navy who had degenerative joint disease of the knee or lower back found good results from combing glucosamine HCl (1,500 mg/day), chondroitin sulfate (1,200 mg/day) and vitamin C in the form of manganese ascorbate (228 mg/day). After 16 weeks, knee pain in those with osteoarthritis was reduced by 26.6% using a pain scale recorded during clinic visits, while their physical examination score improved by 43.3%. The researchers concluded that this combination was effective in relieving symptoms of knee osteoarthritis.
Turmeric supplements for knee pain
Turmeric is a familiar, yellow spice widely used to enhance the flavour and colour of curries. It is also a traditional Ayurvedic medicine used to treat inflammation and reduce pain.
The active ingredient in turmeric is a golden-yellow pigment, curcumin, which has powerful anti-inflammatory actions.
Turmeric supplements can be concentrated and standardised to contain as much as 95% curcumin, the active ingredient, per dose.
Several studies suggest that turmeric is as effective as non-steroidal anti-inflammatory drugs (NSAIDs) for alleviating knee pain – but without the side effects.
The absorption of turmeric and curcumin from the digestive system is notoriously poor. Even so, turmeric still produces significant anti-inflammatory effects elsewhere in the body, such as reducing knee pain, even though no measurable levels are present.
The most likely explanation is that turmeric is able to interact with immune cells within the gut lining to ‘reprogram’ how they respond to inflammation. Water soluble turmeric supplements with boosted absorption are now available for a more powerful dual action.
How turmeric reduces knee pain
Turmeric blocks the production of a variety of inflammatory substances, including the enzyme COX-2, interleukins, and TNF-alpha – a powerful cell signalling protein involved in triggering acute inflammation.
Curcumin is recognised as one of the few orally available substances that can block TNF-alpha, which is the target for many new and expensive antibody treatments given by intravenous infusion or subcutaneous injection to treat severe inflammatory diseases including some forms of arthritis.
How effective are turmeric supplements for knee pain?
A study involving 367 people with moderate to severe knee osteoarthritis found that taking turmeric curcumin extracts (1,500 mg per day, in divided doses) for 4 weeks was as effective in reducing knee pain, knee stiffness and improving knee joint function as ibuprofen (1,200 mg per day) but with fewer gastrointestinal side effects.
Turmeric can be combined with glucosamine and chondroitin to produce a faster onset of action and improved results.
I recommend selecting a turmeric supplement that provides solubilised turmeric, as this is 185 times better absorbed than normal turmeric powder, for a more rapid onset of action.
Krill Oil supplements for knee pain
Krill are a tiny, shrimp-like crustaceans found in all the oceans of the world. They feed on microalgae from which they obtain omega-3 fatty acids and two antioxidant pigments, astaxanthin and canthaxanthin. These pigments are produced by algae to protect them from ultraviolet light and, when these algae and shrimps are eaten by wild flamingos, give them their attractive pink plumage. Without them flamingos would be grey. These carotenoid pigments, which also cause shrimps, prawns and lobsters to turn red when cooked, are the reason why krill oil has such a vibrant, crimson colour.
How krill oil reduces knee pain
While ‘plain’ omega-3 fish oils and cod liver oil are popular for preventing and treating knee pain, krill oil has the advantage of supplying long-chain, omega-3 fatty acids plus antioxidant pigments for an enhanced anti-inflammatory effect.
The long-chain omega-3s, EPA and DHA, are processed in the body to reduce formation of inflammatory substances known as leukotrienes. These omega-3s reduce inflammation, stiffness, swelling and, in people with different types of arthritis can reduce the number of painful joints, and the long-term need for pain killers.
Both the omega 3s and the antioxidants found in krill oil have an anti-inflammatory action which help to reduce joint pain, stiffness and swelling in people with rheumatoid or osteoarthritis. In a trial involving 90 people with inflammatory conditions such as rheumatoid or osteoarthritis, levels of inflammation were reduced by 19% within 7 days, in those taking 300mg krill oil a day, and by 30% within 2 weeks. In those taking placebo, levels of inflammation increased.
As well as helping your knee pain, krill oil is beneficial for the heart and circulation, too.
How effective are krill oil supplements for knee pain?
Krill oil supplements can produce a significant improvement in knee pain and knee stiffness within a week. Krill oil supplements have also been shown to reduce the amount of pain-killing ‘rescue’ medication such as paracetamol and ibuprofen needed.
A study involving 50 people with knee joint pain compared the effects of taking either 2g krill oil per day, or an identical placebo, for one month. Those taking krill oil showed more improvements in knee pain and stiffness than those taking placebo and, when other factors such as age, weight and lifestyle were taking into account, krill oil also significantly reduced the effects of knee pain on sleeping, standing and the range of movement in both knees compared to placebo.
As krill are an important food source for marine animals such as baleen whales, Antarctic Fur Seals and Adelie penguins, it’s important to select a supplement derived from sustainable sources that do not impact on these feeding grounds. Sustainably derived krill oil will have an on-pack endorsement from an organisation such as the Marine Stewardship Council is an international, non-profit organisation that works to safeguard seafood supplies for the future.
Rosehip Extracts for knee pain
The fruits of the wild dog rose are an excellent source of vitamin C, and scientists have now found that rosehips contain additional anti-inflammatory substances that can greatly reduce joint aches and pains.
How rosehip supplements reduce knee pain
Rosehips contain a pain-killing complex of galactolipids which have an aspirin-like ability to inhibit two enzymes (COX-1 and COX-2) involved in the generation of pain and inflammation. They do this through a different mechanism to aspirin so rosehips do not cause the same intestinal side effects.
Galactolipids isolated from rosehips also inhibit the activity of inflammatory white blood cells, and lower levels of inflammatory markers in the blood. Reducing the movement of inflammatory cells into joints can reduce both pain and stiffness.
How effective are rosehip supplements for knee pain?
The results from three studies, involving 287 people with osteoarthritis found that taking rosehip extracts for an average of 3 months significantly reduced joint pain. Those taking rose hip extracts were twice as likely to respond to treatment than those taking placebo.
Significant improvements in morning pain and stiffness, sleep quality, mood, energy and well-being were also seen, as well as a reduced need for rescue medications such as tramadol, codeine and paracetamol.
Over eighty per cent of people taking rosehip extracts report noticeable benefits in pain and stiffness within three weeks, and the level of pain relief in clinical trials is equivalent to that achieved with non-steroidal anti-inflammatory drugs, paracetamol and aspirin (but with fewer side effects).
Ginger supplements for knee pain
Ginger is one of the oldest medicinal spices, whose rhizomes contain unique substances known as gingerols and shogaols, as well as therapeutic terpene essential oils. Although well-known for their anti-nausea action, ginger root extracts are also able to reduce knee pain.
How ginger supplements reduce knee pain
Ginger has a warming, analgesic, anti-inflammatory action, increasing blood flow to the peripheries to boost the delivery of oxygen and nutrients.
The anti-inflammatory action of ginger results from an ability to block the COX-2 enzyme involved in triggering inflammation in a similar way to aspirin (but without the side effects).
Ginger also reduces the production of an inflammatory substance, TNF-alpha, in joint lining cells – a substance that is also targetted by many powerful drugs prescribed to treat inflammatory arthritis. Ginger is growing in popularity to relieve muscle aches and joint pains.
How effective are ginger supplements for knee pain?
Analysis of data from five trials, involving 593 people, showed that taking ginger significantly reduced pain by 30% compared with placebo, and reduced disability by 22%.
Ginger is also effective in treating knee pain in people who have not responded well to non-steroidal anti-inflammatory drugs (NSAIDS).
Boswellia supplements for knee pain
Boswellia is a resin obtained from a large tree, Boswellia serrata, that is native to India, North Africa and the Middle East. The resin is obtained by peeling away strips of bark and then harvesting the gum that oozes out and hardens to protect the tree. Boswellia resin is highly fragrant and is also known as frankincense and olibanum.
How Boswellia supplements reduce knee pain
Boswellia contains several anti-inflammatory substances, including boswellic acids, which are as effective in reducing pain as some non-steroidal, anti-inflammatory drugs (NSAIDs). Boswellia is particularly effective for reducing knee pain, and is often combined with other joint supplements such as turmeric and glucosamine to boost their effects.
When Boswellia extracts were added to cartilage cultures grown from people underoing knee replacement surgery, Boswellia was found to stabilise the cartilage, reduce loss of structural substances, and had a protective, anti-inflammatory effect that was predicted to reduce cartilage degeneration.
How effective are Boswellia supplements for knee pain?
Boswellia improvess pain, stiffnees, flexion, swelling, and increases walking distance in people with osteoarthritis of the knee. Research shows that Boswellia is at least as effective as the prescribed NSAID, valdecoxib for treating osteoarthritis. Improvements in knee pain are usually seen within 7 days, and continue to improve over several months. Benefits can also last for one month after stopping Boswellia. Boswellia and turmeric together have a synergistic effect that is more successful in treating knee pain than the prescribed pain killer, celecoxib.
Cherry supplements for knee pain
Sour cherries are best known for their ability to promote sleep, but they can also reduce muscle and joint pain after exercise.
How cherry supplements reduce knee pain
Cherries are a rich source of antioxidants, including vitamin C, carotenoids, and rich purple-red anthocyanin polyphenols. Together, these have an anti-inflammatory, pain-killing action that mimics that of non-steroidal anti-inflammatory drugs – but without the same side effects.
Drinking sour cherry juice can reduce muscle and joint pain and inflammation in people with osteoarthritis, and in athletes with injuries.
How effective are cherry supplements for knee pain?
A group of 58 people with osteoarthritis of the knee were asked to drink either tart cherry juice or placebo juice for 6 weeks. Then, after a week of no treatment, they swapped over to take the other juice for another 6 weeks so acted as their own controls.
Their knee pain, knee stiffness and knee joint function were assessed before and after each treatment, and scores decreased significantly after the cherry juice treatment but not after the placebo treatment.
Which supplements are best for your knee pain?
I have taken glucosamine plus chondroitin for general knee health for at least ten years. Recently I added turmeric to my joint regime and was able to jog comfortably for the first time in several years.
Following a recent fall while skiing, which twisted my right knee, I added in a collagen supplement and my stretched ligaments have now almost healed two weeks later.
Which supplements do you find most helpful for your knee pain?