UltraInflamX Plus 360˚ provides therapeutic nutritional factors in higher concentrations than found in food:

• Protein — threonine and lysine fortified, low-allergenic, rice protein concentrate

• Carbohydrate— rice syrup solids, rice bran

• Healthy fat — olive oil, medium chain triglycerides

• Micronutrients — complete vitamins, minerals & herbs

4. Repair/RegenerateLow-Allergen Potential Macronutrients Reduce Immune Reactions

• Ginger Promotes healthy eicosanoid metabolism

• Rosemary & Turmeric Modulates NFKB, scavenge nitric oxide

• D-Limonene May reduce mast cell degranulation and affect arachidonic acid release

Plummer SM, et al. Inhibition of cyclo-oxygenase 2 expression in colon cells by the chemoprotective agent cucumin involves inhibition of NF-KappaB activation via NIK/IKK signaling complex. Oncogene 1999 Oct 28;18(44):6013-20

Specific Nutrients Calm Inflammation in Local Tissues

• RIAA Modulates NFKB and active kinase signals

Antioxidants in UltraInflamX Plus 360˚ Support Against Oxidative Stress

Tissue-damaging free radical production increases in the presence of inflammation

UltraInflamX Plus 360 medical food provides comprehensive antioxidant support:

• Comprehensive vitamin

profile A,C, E, D, B vitamins,

and Zinc

Nutrients in UltraInflamX Plus 360˚ Support Healthy GI Function

• L-glutamine

• Rice bran

• Vitamin B5

• Zinc

• Medium chain triglycerides

UltraInflamX Plus 360˚ medical food calms GI inflammation and provides a nutritional blend designed to make the GI barrier healthy:

Glutamine

• Skeletal muscles are the primary sites of glutamine concentration

• Glutamine protects muscle tissue and supports immune function during periods of immune and muscular stress

• Glutamine supports protein synthesis

• Glutamine supports integrity of intestinal mucosal cell

Glutamine (cont’d)

“Potential mechanisms of glutamine effects include

maintenance of mucosal integrity, improved immune competence,

inhibition of cell proliferation, increased apoptosis rate, increased synthesis of glutathione, induction

of heat shock protein synthesis, and increased synthesis of glucagons-like peptides”.

Eur J Nutr. 2009 Nov 21

Glutamine supplementation attenuates ethanol-induced disruption of apical

junctional complexes in colonic epithelium and ameliorates gut barrier

dysfunction and fatty liver in mice

Kamaljit K Chaudhry, et al. J of Nutr Biochem July 23, 2015

Dr. Rob’s GI Restoration Protocols Remove & Replace – 30 Days

Ingredients Dosage

Berberine HCL, Oregon grape, Coptis root, Chinese herbs, ginger, licorice, skullcap

3 TID

Thyme oil, oregano oil, sage leaf, lemon balm leaf (If pt. has respiratory symptoms)

1 sg TID

Betaine HCL, pepsinTitrate up to a warming dose

Protease, amylase, lipase 1 tab w. each meal

Modified elimination food plan

EPA/DHA 4 g.

Dr. Rob’s GI Restoration Protocols Reinoculate & Regenerate – Next 30 Days

Ingredients Dosage

A formulation for maintenance of good GI health 2 scp. BID

Glutamine, aloe vera, licorice 2 tsp Bid

D3 5000 (check 25-OH D3 levels)

L. Acidophilus NCFM/b. Lacti Bi-07 (60 billion) 1 ca. daily

Modified elimination food plan 30-60 days

Include digestive enzymes if score indicatesIf autoimmune disease – may take up to 90 days

Retest

The 5R GI Restoration Program

• Remove pathogens

• Replace digestive enzymes and stomach acid

• Reinoculate with probiotics

• Regenerate damaged intestinal mucosa

• Retain to create GI supportive lifestyle

Dr. Rob’s GI Restoration Protocols Retain

Ingredients Dosage

A formulation of antioxidants for maintenance of good health2 scp. once daily

Modified elimination diet plus foods added through 3 day testing

50:50 blend 15 billion L. acidophilus NCFM, B. Lactis Bi-07

A low-allergy blend of soluble and insoluble fiber 1 scp. daily

Dr. Rob’s Super 5

If autoimmune continue w. medical food for inflammation and GI support

Alpha-linoleic acid (ALA) is an anti-inflammatory agent in inflammatory bowel disease

• ALA supplementation shown to be effective in inhibiting inflammation induced by IL-1β by down-regulating mRNA levels of pro-inflammatory genes including IL-8, COX2, and inducible nitric oxide synthase

• Results suggest that plant derived oil, rich in ALA could ameliorate inflammatory damage in colitis

J of Nutr Biochem, March 2, 2015

Study Links IBS with Vitamin D Deficiency

“Vitamin D receptor is expressed in the gut and regulates epithelial barrier function and bowel inflammation suggesting that a vitamin D

deficiency may directly impact bowel function and hence IBS symptomology”.

BMJ, Jan. 5, 2016

Join The Conversation

@YourSportsDoc @NYChiroCarefacebook.com/DrRobertSilverman

“You can’t medicate your patients out of a problem.

They behaved their way into it.”Dr. Dane Donohue

Study shows 70 percent of Americans take prescription drugs

• CBS Atlanta: Nearly 70% of Americans on at least 1 prescription drug

• 55% take 2 prescription drugs

• 20% take 5 or more prescriptions

• Mayo Clinic: Antibiotics, antidepressants and pain killer opioids are most common

The U.S. accounts for 4.4% of the world’s population and consumes 52% of the world’s pharmaceuticals

(medications)

Patients are like…

….we can take it to the next level

Key Nutritional Protocols for

Musculoskeletal System

Shock. 2009 Oct;32(4):374-8

We demonstrated a correlation between the degreeof systemic inflammation and an increase in

intestinal permeability

World J Gastro 2009 March 14; 15(10): 1209-1218

Lipopolysaccharide (LPS) has many deleterious effectsand plays a significant role in a number of disease

processes by increasing inflammatory cytokine release

1

“low-grade systemic inflammation (‘metaflammation’) associated with obesity, insulin resistance and chronic disease

British Journal of Nutrition (2009), 102, 1238–1242

META-FLAMMATION“(f) it appears to

perpetuate, rather than resolve, a

disease”British Journal of Nutrition (2009), 102, 1238–

1242

METAFLAMMATION(d) it has its

effects systemically

British Journal of Nutrition (2009), 102, 1238–1242

Watch for Axial Back Pain in Psoriatic Pts

• National Health and Nutrition Examination Survey (NHANES) 2009-2010 data:

• Patients with psoriasis – higher prevalence of lower axial back pain than general population

• Inflammatory back pain (IBP), spondyloarthritis (SpA), and alternating buttock pain also more likely to occur

Inflammation — Key Component of Myofascial Pain Syndrome

Inflammation is associated with virtually every chronic disease

Inflammation is responsible for the pain and tissue destruction in patients

Nutritional Approaches for

Joint Pain

A Powerful Combination• New and improved, enriched form of a Hops extract

• Designed to provide powerful joint relief without GI

side effects

• Modulates kinase activity in favor of good joint health including biomarkers such as PGE2

• Un-denatured Collagen Type – (UC-II)

• Twice as effective as glucosamine/chondroitin

• Positively influenced knee extension in patients who experienced joint discomfort

• Able to exercise longer before experiencing joint discomfort

• Recover from joint discomfort faster

• A key protein that supports structure and integrity

Lugo JP et al. Undenatured type II collagen (UC-II®) for joint support: a randomized, double-blind, placebo-controlled study in healthy volunteers. J of the Int’l Soc of Sports Nutr 2013;10:48.Crowley DC et al. Safety and efficacy of undenatured type II collagen in the treatment of osteoarthritis of the knee: a clinical trial. Int’l J of Med Sci 2009;6(6):312-321.

Research on a Hops Extract

• Targets the inflammatory signal transduction pathway without affecting constitutive COX-2 enzyme in vitroa

• Inhibits markers of inflammation such as PGE2, MMP-3, IL-6 and IL-8 in vitrob

• Reduces swelling in a model of acute inflammation and inhibits bone and cartilage degradation in an animal model of chronic inflammationb

a. Desai A et al. META060 inhibits multiple kinases in the NF-κB pathway and suppressed LPS-mediated inflammation in vitro and ex vivo. Inflammation Research 2009;58(5):229-34.

b. Konda VR et al. META060 inhibits osteoclastogenesis and matrix metalloproteinases in vitro and reduces bone and cartilage degradation in a mouse model of rheumatoid arthritis. Arthritis & Rheumatism 2010;62(6):1683-92.

Hop’s proposed anti-inflammatory MoA

The presence of THIAA is associated with decreased levels of substances associated with joint discomfort in a dose-dependent fashion

0

20

40

60

80

100

120

PG

E 2(%

inh

ibit

ion

)

THIAA (µg/ml) - - 1 5 10 20LPS (1 µg/ml) - + + + + +

Column 1:Negative control

Column 2:Positive control (to show LPS induces PGE2)

Column 3 – 6:THIAA reduces LPS-induced PGE2 production in a dose dependent fashion

Desai A et al. Inflammation Research 2009;58(5):229-234

EndotoxemiaContributes to Inflammation and Disease Development

Endotoxemia: LPS

Immune cells HepatocytesAdipocytes Endothelial cells

PI3K/AKT pathway

IKK – NF-KB

Pro-inflammatory mediators

Low-grade inflammation, insulin resistance, etc.

O/A joint pain

Sports Health: A Multidisciplinary Approach. Jan 2014, 6:18-30

EndotoxemiaContributes to Inflammation and Disease Development

SKRMSHOPS

Endotoxemia: LPS

Immune cells HepatocytesAdipocytes Endothelial cells

PI3K/AKT pathway

IKK – NF-KB

Pro-inflammatory mediators

Low-grade inflammation, insulin resistance, etc.

O/A joint pain

Sports Health: A Multidisciplinary Approach. Jan 2014, 6:18-30

R

ArachidonicAcid

COX-2

PGE2

R

R

R

IKK

HOPS

Selective Kinase Response Modulators affect target kinases implicated in inflammation

Selective kinase response modulators affect genetic expression of inflammatory mediators

External Signals

Manage Pain & Inflammation

R

ArachidonicAcid

COX-2

PGE2

R

R

R

IKK

HOPS

Key nutrients support a balanced response to inflammation

Modulate the cellular signals that trigger inflammation through kinase signaling

Cytokines

Omega-3 EFAs

Curcumin and ginger reduce COX-2

UC-II + n-enriched HOPS = Improved Joint Function

UC-II

HOPS

Section V: Gastrointestinal Assessment

Middle-aged Executive with Chronic Musculoskeletal Pains

The NMS Detonation SequencePain DynamicTight muscle

Inhibited muscle

Strain point

PAIN

Complaint

Sherrington’s law of reciprocal

inhibition

Head = 10 lbs 1” = 2x weight

Tight muscle Inhibited muscles1. Pecs 1. Mid-lower trap2. Suboccipitals 2. Deep neck flexors3. Erector spinae 3. Abdominals4. Psoas 4. Gluteus maximus

Suboccipitals

Medial scapula stabilizers

C7 – T1TMJ

Deep neck flexorsGH jtPec major

Abs

Psoas

Hip

T/L jct

Erector spinaeL/S jct

Gluteus maximus

Strain points Symptoms1. TMJ neck & shoulder2. C7-T1 jct stiffness & pain3. GH joint4. T/L junction SI, L/S & hip5. L/S junction stiffness & pain6. Hip

1 2 34

Hypertonicity

Weakness

Pathogenesis of the cumulative trauma disorder

RecoveryCycle

Injury Cycle

Frequency of Insult

Am

ou

nt

of

Tiss

ue

Insu

lt

SymptomaticInjury Threshold

Pathogenesis of the cumulative trauma disorder

Injury Cycle

Frequency of Insult

Am

ou

nt

of

Tiss

ue

Insu

lt

Insufficient Tissue Recovery Between Injury Cycles

Tissue Damage Accumulates

Copyright Jerome M. True, DC

Dr. Rob’s Magnificent 7

• Posture/pain

Functional Movement Assessment

• Push-up

• Overhead squat

• 1-legged squat

• Trunk stability push-up

• Valgus jump test

• Upper/lower muscle firing patterns

Functional Movement Assessment

“Our response to injury is like hearing the smoke detector go off and running to pull out the battery.”

UltraPrevention by Hyman & Liponis

Kinetic Chain = Functional Anatomy

Muscles act in synergy not in

isolation” Movement, not muscles

Movement becomes habit, which becomes posture, which becomes

structure

FORM = FUNCTION =

PERFORMANCE

Correct Altered Motor Control

• Specific nutrients and oxygen are requiredto sustain a heavily used muscle

• Overuse soft tissue injuries result when supply of nutrients are unable to match demands of muscle/tendon region

• Healthy nutrient supply through diet and supplementation assists the body with natural function and repair processes

Dr. Rob’s Nutritional Take

Nutritional Protocols for the Management of Soft Tissue Injuries

As a rule of thumb, the earlier a musculoskeletal injury is treated, the sooner healing can begin. An untreated injury can

easily slide from “acute” into “sub-acute,” and even into “chronic.”

Symptoms

Basic Physiology of the Injury

• Cytokines and chemokinesmobilize immune cells

• PLA2 liberates arachidonic acid

• Prostaglandins and thromboxanes are created, which signal pain and induce inflammation

• Injury tears open cells

3 Phases of Care

PHASE 1

Acute Phase (first 3-5 days)

Protective Phase

PHASE 2

Sub-Acute Phase (day 4-8 weeks)

Repair & Remodeling Phase

PHASE 3

Wellness/On-going

Care

CHRONIC PHASE

Beyond 3 monthsOn-going Repair & Remodeling

Scar-tissueAdhesions

Fibrosis

INJURY

Nutrients to Address Swelling (within the first 72 hours)

Tricket P. Proteolytic enzymes in treatment of athletic injury. Appl Ther. 1964;30:647-652.

Trypsin & Chymotrypsin (Proteolytic Enzymes)

Some studies suggest that patients who received proteolytic enzymes showed reduced swelling, pain, and inflammation—and experienced faster recovery rates.

Use Bromelain and Proteolytic Enzymes to Address Swelling and Pain

Fortschr Med. 1995;113(19):303-306.

[Bromelain in blunt injuries of the locomotorsystem. A study of observed applications in general practice]

[Article in German]

Masson M.

METHOD: In an open case observation study involving patients with blunt injuries to the musculoskeletal system, the efficacy and tolerability of high-dose Bromelain POS, a plant-derived enzyme preparation, were investigated. The investigating physician was an orthopedic surgeon who, in addition to the usual therapeutic measures, treated 59 of his patients with the bromelaine preparation. The duration of the application was determined by the nature and severity of the lesion, and varied between one and three weeks. The test criteria were swelling, pain at rest and during movement, and tenderness. These parameters were evaluated on the day of the injury and on five subsequent dates.

“Treatment with bromelain resulted in a clear reduction in all four parameters tested. Both swelling and the symptoms of pain had improved appreciably.”

Fortschr Med. 1995;113(19):303-306.

Proteolytic Enzymes

• Proteolytic enzymes—various enzymes that digest proteins and fibrin

• Work systemically when taken orally without food

• Without food, they are absorbed with enzymes intact in the small intestines

• Turmeric:

1) Inhibit inflammation by blocking cyclooxygenase and lipoxygenase

2) Stimulates tissue repair, mainly the regeneration of muscle tissue

3) NF-KB inhibitor

• Ginger:

• Anti-inflammatory, antioxidant

• Boswelia serrata: inhibits 5-lipoxygenase

• Quercetin, cayenne: anti-inflammatory properties

Nutrients to Address Pain and Inflammation (within the first 72 hours)

Prostagladins Leukotr Med 1986;24:195-98Int J Clin Pharmacol Ther Toxicol 1986;24(12):651-54Journal of Biological Chemistry – August 2011. “Curcumin modulates nuclear factor-KB”

Boswellia, Turmeric, and Ginger lower the volume on pain & inflammation without side effects

Conclusion

Iseri LT, French JH. Magnesium: nature’s physiologic calcium blocker. Am Heart J. 1984;108(1):188-194.

Calcium and magnesium• Calcium may work to relieve spasms by

acting via presynaptic inhibition at neuromuscular junction

• Magnesium promotes muscle relaxation

• A balance of these minerals reduces spasms and cramping

Lemon balm, passion flower, and valerian root

These herbs have been traditionally used to promote relaxation and are considered to be safe and effective.

Nutrients to Address Muscle Tissue

Nutritional Approaches for the First 72 Hours of a Sports Injury

Proteolytic Enzymes• Trypsin, chymotrypsin, and bromelain

Natural Anti-inflammatory• Boswellia, turmeric, ginger, quercetin, and cayenne

pepper

Nutrients to Relax Muscle Tissue• Calcium, magnesium, lemon balm, and valerian

Nutritional Approaches to Support Acute Phase (first 72 hours of injury)

• Presents continued joint or muscle pain

• Palpable inflammation surrounding injury may still be present

• Range of motion may be compromised

• Tissue repair and remodeling has begun

Sub-acute Healing and Tissue Remodeling: 4 days to 8 weeks

Phase II of Soft Tissue Injury

Your connective tissues are your extracellular matrix

http://images.google.com/imgres?imgurl=http://www.pride.hofstra.edu/~akroto1/img009.jpg&imgrefurl=http://www.pride.hofstra.edu/~akroto1/bioengg.html&h=450&w=600&sz=75&hl=en&start=3&tbnid=9BMB7hzszEIkUM:&tbnh=101&tbnw=135&prev=/images%3Fq%3Dextracellular%26gbv%3D2%26hl%3Den

TendonsLigaments

CartilageFascia

What is Extracellular Matrix (ECM)?

The Extracellular Matrix: the Network that Binds Us Together

“The ECM is a conglomerate of substances in which biochemicals and biophysical properties allow for the construction of a flexible network that integrates information from loading and converts it into mechanical capacities…It serves as a scaffold for adhesion of cells mediated by integrins, dystroglycan, and proteoglycans at the cell surface and of tyrosine kinase receptors. The interaction between the ECM and the adhesion molecules leads to activation of intracellular signaling pathways and cytoskeletal rearrangement.”

Kjaer, M. Physiol. Rev. 84:649-698, 2004.

The Extracellular Matrix is Composed of Tissues that Serve Multiple Purposes

A complex web that of connective tissues that

• Provide adhesion to cells

• Act as a structural scaffold

• Actively participate in intracellular signaling

• Translates mechanical loading into cellular response

EFFECT

FASCIA

Key

Extracellular matrix—the fascial system is the largest system in the body and is the only system that touches every other system.

IT’S ALL CONNECTED

Tendinopathy: Pathophysiology and Nonoperative Treatment

• Tendon heals in 3 overlapping phases:1) Inflammation

2) Repair

3) Remodeling

• Injured site never achieves the original histologic or mechanical features of a healthy uninjured tendon

• MMPs are collagen digesting enzymes naturally produced by the chondrocyte during time of injury

• Poor diet, lifestyle, injury, and tissue damage can trigger cell signals, which can lead to the over-activated release of MMPs

• Excessive release of MMPs can damage healthy tendon and cartilage tissue

Litherland, et al. JBC. Papers in press, March 10, 2008.

Matrix Metalloproteinase (MMPs) Enzymes Damage Collagen and Connective Tissue

Matrix Metalloproteinases Digest Collagen and Connective Tissue

Collagen Triple Helix

Chondrocyte

MMPs are released from the chondrocyte in response to injury or inflammation

MMP-9

MMP- 2

MMP-1

MMP-13

MMP-13

MMP-13

MMPs further degrade collagen tissue during injury or inflammation

Modulate expression of MMPs to support healthy remodeling of connective tissue

Failed Healing of Rotator Cuff Repair

• Found that gene expression related to tissue remodeling, particularly MMP-1 and MMP-9, differs between rotator cuffs that healed and those that failed to heal after orthoscopic repair

• MMP-1 and MMP-9 are highly effective in degrading type-1 and 3 collagen

• Their expression contributes to poor cuff healing

• MMP-1 and MMP-9 expression reflect a highly degenerated tendon or diminished ability to heal

American Journal of Sports Medicine. 2012;40(9):1993-2000.

The Mature Adult: Aging Tendons and Ligaments

• Several published reports shown increased levels of matrix metalloproteinases (MMPS) lead to degenerative tendon disease

• MMP inhibitors associated with a decrease in tendon dysfunction

Sports Health, Jan/Feb. 2014, p.41-48

Disc Injuries

Flexion movement

Flexing the spine

Strains layers of collagen in spinal discs

MMPS, cytokines

Inflammation

Flexion moment

Flexing moment or torque

Ab muscle stiffening

No movement

Stuart McGill website

vs.

Interleukin-1β in intervertebral disk degeneration

• Interleukin-1 (IL-1) β has strong pro-inflammatory activity by stimulating the secretion of multiple pro-inflammatory mediators

• IL-1β is highly expressed in degenerative intervertebral disk (IVD) tissues and cells

• Inhibition of IL-1β found to promote extracellular matrix (ECM) repair and protect against disk degeneration

Yang W, et al. Clin Chim Acta 2015

New approach to diagnosing low back pain

• Findings determined serum levels of IL-6 significantly higher in subjects with low back pain compared with control participants

• Participants with low back pain due to spinal stenosis or degenerative disc disease also had higher levels than those with intervertebral disc herniation and controls

• Findings suggest that patients with low back pain have low-grade systemic inflammation

• Biochemical profiling or circulating cytokines can assist in diagnosing those with low back pain

North Shore-Long Island Jweish (LIJ) Health System-Jan-7-2016

Failed healing of rotator cuff repair

• Found that gene expression related to tissue remodeling, particularly MMP-1 and MMP-9, differs between rotator cuffs that healed and those that failed to heal after orthoscopic repair

• MMP-1 and MMP-9 are highly effective in degrading type-1 and 3 collagen

• Their expression contributes to poor cuff healing

• MMP-1 and MMP-9 expression reflect a highly degenerated tendon or diminished ability to heal

American Journal of Sports Medicine, 2012, vol. 40 (9):1993-2000

Key Takeaway

• Inflammation/MMPs cause cartilage loss, not “wear-and-tear”

• This is the same process that causes disc nuclear degradation and herniation

A Comprehensive Strategy to Support the Health and Integrity of Extracellular Matrix Tissues

• THIAA & berberine synergistically modulate MMP-13

• Selenium to address MMP-1 & MMP-2

• Folic acid to impact MMP-9

• Niacinamide to address tissue-damaging PARS

• Zinc to reduce cytokine release

• Biotin to reduce NF-Kappa production

Nutrients that impact matrix metalloproteinases:

Nutrients that affect the lifespan and health of connective tissues:

Additional nutrients:

Phase II Collagen Synthesis

• Formulation providing targeted nutritional components involved in the biochemical processes that support growth and construction of connective tissue:

• Amino acids — Research shows that providing specific amino acids (predominately glycine, proline, and lysine) supports healthy collagen fiber formation

• Micronutrients — Vitamin C, B6, B5, L-taurine, silica, zinc, iron, copper, and alpha-ketoglutarate are examples of the micronutrients required for healthy collagen formation

Powerful Nutrients for Building Cartilage

Glucosamine Sulfate Chondroitin Sulfate Methyl-Sulfonyl-Methane (MSM)

SOD Induction

Complex

Antioxidant Promotion

Nutrients to Support Connective Tissue and Joint Stability

Glucosamine & Chondroitin Sulfates

These well-researched nutrients help to form the “shock-absorbing” components of cartilage (proteoglycans and glycosaminoglycans) and to heal articular surfaces.

Furthermore, glucosamine and chrondroitin sulfate have been shown to reduce pain and inflammation and slow cartilage loss.

Hardington, T. Chondroitin Sulfate and Joint Disease. Osteo Cart 1998;6 (suppl A):3-5

Chondroprotection and the Prevention of Osteoarthritis Progression of the Knee

Conclusion: For patients with or at risk for osteoarthritis, the use of glucosamine and chondroitin sulfate may serve as a non-operative means to protect joint cartilage and delay osteoarthritis progression.

Gallagher B, Fotios P, et al. The Am J of Sports Med. 2015;43(3):539-541.

Glucosamine and chondroitin sulfate slow deterioration in knee arthritis• GC effectively delayed progression of the disease while improving

functional capacity and decreasing pain

• GC reduced cartilage loss and effective for long-term management of arthritis progress

Arthritis Care and Research online. Feb 16, 2016

Chondroitin outperforms celecoxib in knee osteoarthritis study

• Chondroitin sulfate more successful than celecoxib in reducing long-term progression of knee osteoarthritis (OA)

• Research documented at initial visit and 1 and 2 years later

• MRI was used to detect loss of cartilage

American College of Rheumatology (ACR) Annual Meeting. Nov. 7, 2015

Methyl-Sulfonyl-Methane (MSM),an Effective Synergist/Sulfur Donor

Chondroitin SulfateGlucosamine Sulfate

Methyl-Sulfonyl-Methane (MSM)

Nutritional Approaches to Support Sub-acute Recovery and HealingDay 4 8 weeks

1) Nutritionally modulate Matrix Metalloproteinases:3 Tablets BID- THIAA, berberine, B vitamins & minerals

2) Collagen synthesis: 2 tablets BID

3) Nutrients to support connective tissue and joint stability: 3 tablets BID

Phase III—Soft-tissue Injury Wellness & On-Going Care

Objectives:1) Achieve optimal

tissue remodeling2) Support

wellness/prevention care:a) Maintain

foundation nutrition

b) Reduce risk of re-injury and degeneration

ReCap• Phase 1: Acute

• Tissue swelling• Tissue congestion• Pain modulation

• Phase 2: Sub-acute• Reducing scar tissue formation• Aid in connective tissue remodeling• Support joint health• Reduce risk of re-injury and degeneration

• Phase 3: • Continued connective tissue remodeling• Support wellness care:

• Maintaining foundation nutrition• Reducing risk of re-injury