Discussion By Dr. Carrie Cooper

As a physical therapist, my practice has always been burdened by the ”why.” Why did this injury occur? Why does this treatment work here but not there? Why is this injury so prevalent? Why?! 

Being able to answer the “why” is what drove me to understand and publish a classification system for pulley injuries in climbers. It’s what made me look into the prevalence of acute knee injuries in climbers three years ago, co-publishing with a group of international climbing medicine doctors in 2020.

When the clock struck 2020, I found myself not in the doctor role but in the patient role having just had ACL reconstructive surgery with a meniscal root repair.  My post-op restrictions were significant, so I tried to negotiate my way out of needing the restrictions that my surgeon imposed. I called on my entire knowledge community to find out what they knew and how I could get a “leg up.” I was also reading everything I could. Everything I read had to do with load intensity, cross-sectional area of muscle, range of motion and typical time to return to sport. Again, I wasn’t looking for typical. I was looking for a leg up!

I read a case report that Keith Baar, et al did with some post-op ACL-R Rugby Players that was mostly geared toward what they were eating. This was different. Could I bolster my treatments just by consuming certain nutrients? This article, and many others I found, indicated that yes, you can bolster musculo-tendonous stiffness by consuming collagen before you exercise. They even wrote out an entire menu that had protein requirements as well as collagen requirements. Could this be true?!

First let’s answer: What is a healthy musculo-tendonous unit? The tendon transmits the force from the muscle to the bone. In order for this to occur you need appropriate stiffness in both the extracellular matrix of the muscle as well as the tendon.  In my normal vernacular, “stiffness” in the musculoskeletal system refers to an area being less mobile or flexible than the contralateral limb or the adjacent muscles, which is not ideal. But in this case, “stiffness” is directly related to the amount of collagen in the extracellular matrix. 

Muscles are vascularized while tendons are avascular (no blood supply) matrix of fibers that actually consume their nutrients from the fluid in the surrounding extracellular matrix. So rule number one should actually be, stay hydrated because that is the only way your tendons are getting nutrients. Additionally, and interestingly, you can actually target your collagen supplements directly to the tendon. (This is where Keith Baar’s research gets really cool.)

It sounds like voodoo but it’s been proven to actually work, and work often. Even with just light activity following ingestion of well-sourced specific collagen (you should ask Gnarly Nutrition for the details because I’m no expert), you can improve tendon and muscle stiffness. 

Starting at post-op day six, I was consuming the recommended collagen, vitamin c, and protein that the research indicated would in fact give me a leg up. Combine that with my diligence and ingenuity with my own quarantine rehab, and at six weeks post-op my surgeon thought I was 12 weeks. And I was doing single leg pistol squats at five months and cleared for full return to sport. 

Don’t ask me for recipes though, I sprinkle the stuff on just about everything: morning granola, middle eastern leftovers … you name it. As long as I am getting all the necessary elements, I could care less how pretty it is. Just as long as it is giving me that “leg up.”