Stop pain, prevent injury and extend workouts

Supporting your athletes’ active lifestyle requires a well-rounded approach to chiropractic care, integrating regular adjustments, balanced nutrition and restorative sleep. Incorporating certain supplemental nutrients can further enhance long-term fitness, mobility and prevent injury.

Many of your patients have active lives and come to your practice, in part, to stay in top shape. And I’m just as certain you frequently have other patients who come to you because they would like to get back into shape. Aside from regular adjustments and smart practices, such as proper nutrition, pre-workout stretches and getting restorative sleep, adding the right supplemental nutrients can greatly assist their exercise regimens and even prevent injury.

While every patient’s needs vary, in my own practice, I have seen excellent results with a core of nutrients that address inflammation, prevent injury, enhance physical workouts and speed recovery.

Palmitoylethanolamide (PEA): Found in some food sources, including egg yolks, and can be synthesized in the body from palmitic acid found in meats, cheeses and butter. It has endocannabinoid-like actions in the body, and as a result, is an effective anti-inflammatory with a wide range of applications.¹

Since PEA is naturally synthesized in the body from food sources, we have this superhero molecule naturally circulating in our systems. It’s not a first responder like other anti-inflammatories; instead, it kicks into action after the body’s first wave of immune defenses, cytokines and other responses have arrived on the scene. But our naturally circulating levels of PEA can be rapidly exhausted during times of physical and mental stress, so recommending a supplemental form can help your patients address any chronic conditions that may be holding them back from being as active as they’d like.^1,2

Clinical studies with PEA show impressive results for chronic and acute pain. For example, in cases of chronic idiopathic axonal polyneuropathy (CIAP), a form of neuropathy that causes painful “pins and needles” feelings and greatly affects mobility, PEA is an effective intervention. One clinic reported, in some cases, PEA reduced pain by 50% in just one week. They also found PEA could be recommended alongside standard pain relievers or as a stand-alone medicine.³

In a clinical study of individuals with sciatic nerve compression, a cause of chronic lower back pain, a 600-mg daily dose of PEA reduced pain on the visual analog scale by five points, from 7.1 to 2.1, while the placebo group noted a drop of only two points, from 6.6 to 4.6. PEA is a solid recommendation for patients dealing with nerve pain or dysfunction of any type.⁴

While PEA isn’t quite classified as an endocannabinoid when synthesized in the body, it does help preserve levels of anandamide, one of the key endocannabinoids responsible for positive mood—a definite factor in how well a patient overcomes pain and remains motivated to stay active.^1,4

And of course, since we’re talking about athletic patients, other clinical work shows that while it reduces pain, PEA may also help preserve lean muscle mass and promote protein synthesis. This is especially important for active people as they get older. And, unlike prescription or over-the-counter drugs, it doesn’t interfere with muscle maintenance or injure the liver or stomach.^1,5

Serratiopeptidase: This proteolytic enzyme is an excellent partner nutrient to PEA. Serratiopeptidase binds to COX-2 and suppresses the release of inflammatory prostaglandins and interleukins, so its effect is much like a non-steroidal anti-inflammatory drug (NSAID), but like PEA, it doesn’t cause liver or stomach damage.^6,7,8

Serratiopeptidase has the ability to reduce swelling at the sites of injury, so it can speed recovery time, too. In fact, in patients recovering from ankle ligament surgery, researchers noted a 50% reduction in swelling in just three days, thanks to the assistance of the enzyme.^9,10

This nutrient is a perfect choice for anyone with an active lifestyle or physically demanding job because in addition to reducing inflammation it helps injuries heal faster. The enzyme travels to the site of wounds and because of its proteolytic activity, dissolves dead tissue around the wound (without harming healthy tissue), improves circulation that feeds new tissue growth, and, ultimately, speeds up the repair process.^6,8

Both PEA and serratiopeptidase can be challenging for the body to absorb, so combining them with gamma cyclodextrin can help. Gamma cyclodextrin is a plant-based ingredient that carries difficult-to-absorb nutrients within a bucket-like structure that has water-soluble outer walls. Since the outer shell is easily absorbed through the intestinal walls, the benefits of this supplement are much more reliable and consistent.¹¹

Curcumin, boswellia and black sesame oil: For acute pain—those times when your active patients overdo it a bit—a combination of curcumin, boswellia and black sesame oil is an ideal recommendation.

Curcumin fights COX-2 inflammation and modulates virtually every other inflammatory pathway as well. It has been used for reducing delayed-onset muscle soreness, relieving rheumatoid arthritis symptoms and, alongside boswellia, has shown excellent effects for individuals with osteoarthritis. Boswellia works primarily through the 5-LOX inflammatory pathway, making it a good partner to curcumin for pain relief.^12,13

Emulsifying these two herbs in black sesame oil has been shown to speed relief and improve patients’ states of mind. The botanical’s compounds reduce the activity of TNF-a, an inflammatory cytokine recognized as a prime culprit behind the joint damage of rheumatoid arthritis (RA). Other scientific studies show sesame seed compounds can help increase type II collagen and prostaglandins and prevent the breakdown of joint-supporting fatty acids.^15,16,17

In clinical research, sesame supplementation alone reduced inflammatory markers, decreased pain scores and relieved symptoms for patients with knee osteoarthritis.^18,19

But aside from its anti-inflammatory power, sesame oil also helps other nutrients, including vitamin E tocopherols, vitamin C and vitamin K, absorb more effectively.^20,21

Of course, curcumin from turmeric and boswellia are two well-established pain fighters, so it’s no surprise researchers wanted to include them in a formulation to battle acute pain along with black sesame oil. A clinical trial showed some fascinating results.²²

First, the combination was just as effective, and essentially just as fast, as acetaminophen, reducing pain in about an hour. In fact, the results regarding the relief of pain intensity and magnitude were so close as to being negligible in their differences.²²

But what’s also interesting about this study was the combination of curcumin, boswellia and black sesame oil reduced the negative emotional aspects of pain 8.5 times better than acetaminophen, an extremely important aspect of pain relief.^22,23,24

So, when your patients need safe, fast and effective pain relief, curcumin, boswellia and black sesame oil show great promise. As I mentioned with PEA and serratiopeptidase, absorption is key to results. In the case of curcumin, it is even more efficacious when blended with turmeric essential oil for enhanced absorption, and when the boswellia is standardized for higher levels of acetyl-11-keto-beta-boswellic acid (AKBA), one of the herb’s compounds most recognized for fighting 5-LOX inflammation.

Final thoughts: Prevention of injury and recovery keep your patients active

An active lifestyle is a healthy one, but it needs to be supported properly. In my own practice, I’ve seen great results with the supplemental options I’ve mentioned here. As part of a regimen of regular adjustments, balanced nutrition and restorative sleep, I think PEA with serratiopeptidase for daily use, and curcumin, boswellia and black sesame oil for acute pain, can help your patients remain fit for years to come.

Jacob Teitelbaum, MD, is one of the most frequently quoted integrative medical authorities in the world. He is the author of the best-selling From Fatigued to Fantastic, Diabetes Is Optional, Pain Free, 1,2,3, the Beat Sugar Addiction Now series, Real Cause Real Cure, the Fatigue and Fibromyalgia Solution and a popular free smartphone app, Cures A-Z. He is the lead author and researcher on effective treatment for fibromyalgia and chronic fatigue syndrome, and a study on treatment of autism using NAET. Teitelbaum appears often as a guest on news and talk shows nationwide, including Good Morning America, The Dr. Oz Show, Oprah and Friends, CNN and Fox News Health. Learn more at endfatigue.com.

References

Clayton P, et al. Palmitoylethanolamide: A natural compound for health management. Int J Mol Sci. 2021;22(10):5305. https://pubmed.ncbi.nlm.nih.gov/34069940/ . Accessed June 6, 2025.
D’Aloia A, et al. Palmitoylethanolamide modulation of microglia activation: Characterization of mechanisms of action and implication for its neuroprotective effects. Int J Mol Sci. 2021;22(6):3054. https://pubmed.ncbi.nlm.nih.gov/33802689/ . Accessed June 6, 2025.
Hesselink JM. Chronic idiopathic axonal neuropathy and pain, treated with the endogenous lipid mediator palmitoylethanolamide: A case collection. Int Med Case Rep J.2013;6:49-53. https://pubmed.ncbi.nlm.nih.gov/24049461/. Accessed June 6, 2025.
Keppel Hesselink JM, Kopsky DJ. Palmitoylethanolamide, a neutraceutical, in nerve compression syndromes: Efficacy and safety in sciatic pain and carpal tunnel syndrome. J Pain Res. 2015;8:729-734. https://pubmed.ncbi.nlm.nih.gov/26604814/. Accessed June 6, 2025.
Huschtscha Z, et al. The effect of palmitoylethanolamide (PEA) on skeletal muscle hypertrophy, strength, and power in response to resistance training in healthy active adults: A double-blind randomized control trial. Sports Med Open. 2024;10(1):66. https://pubmed.ncbi.nlm.nih.gov/38844675/ . Accessed June 6, 2025.
Nair SR, C SD. Serratiopeptidase: An integrated view of multifaceted therapeutic enzyme. Biomolecules. 2022;12(10):1468. https://pubmed.ncbi.nlm.nih.gov/36291677/ . Accessed June 6, 2025.
Jadhav SB, et al. Serratiopeptidase: Insights into the therapeutic applications. Biotechnol Rep (Amst). 2020;28:e00544. https://pubmed.ncbi.nlm.nih.gov/33134103/ . Accessed June 6, 2025.
Tiwari M. The role of serratiopeptidase in the resolution of inflammation. Asian J Pharm Sci. 2017;12(3):209-215. https://pubmed.ncbi.nlm.nih.gov/32104332/ . Accessed June 6, 2025.
Panagariya A, Sharma AK. A preliminary trial of serratiopeptidase in patients with carpal tunnel syndrome. J Assoc Physicians India. 1999;47(12):1170-1172. https://pubmed.ncbi.nlm.nih.gov/11225219/ . Accessed June 6, 2025.
Esch PM, et al. Reduction of postoperative swelling. Objective measurement of swelling of the upper ankle joint in treatment with serrapeptase: A prospective study. Fortschr Med [German]. 1989;107(4):67-68 71-72. https://pubmed.ncbi.nlm.nih.gov/2647603/ . Accessed June 6, 2025.
Bhagavan HN, et al. Assessment of coenzyme Q10 absorption using an in vitro digestion-Caco-2 cell model. Int J Pharm. 2007;333(1-2):112-117. https://pubmed.ncbi.nlm.nih.gov/17092667/ . Accessed June 6, 2025.
Chandran B, Goel A. A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res. 2012;26(11):1719-1725. https://pubmed.ncbi.nlm.nih.gov/22407780/ . Accessed June 6, 2025.
Antony B, et al. Clinical evaluation of a herbal product (Rhulief™) in the management of knee osteoarthritis. Abstract 316. Osteoarthr Cartil. 2011;19(S1):S145-S146. https://rootdownnaturals.com/wp-content/uploads/2010/10/OARSI_abstract.pdf. Accessed June 6, 2025.
Khansai M, et al. Effects of sesamin on primary human synovial fibroblasts and SW982 cell line induced by tumor necrosis factor-alpha as a synovitis-like model. BMC Complement Altern Med. 2017;17(1):532. https://pubmed.ncbi.nlm.nih.gov/29237438/ . Accessed June 6, 2025.
Phitak T, et al. Chondroprotective and anti-inflammatory effects of sesamin. Phytochemistry. 2012;80:77-88. https://pubmed.ncbi.nlm.nih.gov/22704650/ . Accessed June 6, 2025.
Khansai M, et al. Ex vivo model exhibits protective effects of sesamin against destruction of cartilage induced with a combination of tumor necrosis factor-alpha and oncostatin M. BMC Complement Altern Med. 2016;16:205. https://pubmed.ncbi.nlm.nih.gov/27400672/ . Accessed June 6, 2025.
Srisuthtayanont W, et al. Effects of sesamin on chondroitin sulfate proteoglycan synthesis induced by interleukin-1beta in human chondrocytes. BMC Complement Altern Med. 2017;17(1):286. https://pubmed.ncbi.nlm.nih.gov/28569157/ . Accessed June 6, 2025.
Eftekhar Sadat B, et al. Effects of sesame seed supplementation on clinical signs and symptoms in patients with knee osteoarthritis. Int J Rheum Dis. 2013;16(5):578-582. https://pubmed.ncbi.nlm.nih.gov/24164846/ . Accessed June 6, 2025.
Khadem Haghighian M, et al. Effects of sesame seed supplementation on inflammatory factors and oxidative stress biomarkers in patients with knee osteoarthritis. Acta Med Iran. 2015;53(4):207-213. https://pubmed.ncbi.nlm.nih.gov/25871017/ . Accessed June 6, 2025.
Hanzawa F, et al. Dietary sesame seed and its lignan, sesamin, increase tocopherol and phylloquinone concentrations in male rats. J Nutr. 2013;143(7):1067–1073. https://pubmed.ncbi.nlm.nih.gov/23700348/ . Accessed June 6, 2025.
Ikeda S, et al. Dietary sesame seed and its lignan increase both ascorbic acid concentration in some tissues and urinary excretion by stimulating biosynthesis in rats. J Nutr Sci Vitaminol (Tokyo). 2007;53(5):383–392. https://pubmed.ncbi.nlm.nih.gov/18079604/ . Accessed June 6, 2025.
Rudrappa GH, et al. Efficacy of high-dissolution turmeric-sesame formulation for pain relief in adult subjects with acute musculoskeletal pain compared to acetaminophen: A randomized controlled study. Medicine (Baltimore). 2020;99(28):e20373. https://pubmed.ncbi.nlm.nih.gov/32664057/ . Accessed June 6, 2025.
Vallath N, et al. Unpleasant subjective emotional experiencing of pain. Indian J Palliat Care. 2013;19(1):12-19. https://pubmed.ncbi.nlm.nih.gov/23766590/ . Accessed June 6, 2025.
Löffler M, et al. Impact of controllability on pain and suffering. Pain Rep. 2018;3(6):e694. https://pubmed.ncbi.nlm.nih.gov/30706037/ . Accessed June 6, 2025.