Collagen Supplements Help Reduce Joint Pain

By Heba Ghazal

Collagen supplements have become one of the bestselling products in the wellness industry, promising everything from smoother skin to stronger joints. But do they actually work?

A major new review of the evidence – pulling together data from 113 clinical trials – suggests that, for some health outcomes, the answer is probably yes. But as ever with nutrition science, the full picture is more complicated.

Collagen is a protein the body makes naturally. It gives skin its structure and elasticity, supports bones and muscles, helps wounds heal and plays a role in protecting organs. The problem is that production slows as we age, which is why so many people turn to supplements to top it up.

Not all collagen is the same, though. The collagen found naturally in food may be less well absorbed than the smaller forms used in most supplements. These hydrolysed forms – where the protein has been broken down into shorter chains called peptides – are thought to pass more readily into the bloodstream and making it easier for the body to transport these fragments to tissues where they may have biological effects, potentially supporting skin, joint and muscle health.

The new review examined research published up to March 2025, drawing on 16 systematic reviews that between them included nearly 8,000 participants. The overall picture was cautiously positive.

Collagen supplementation was linked to moderate improvements in muscle health and reduced pain in people with osteoarthritis. There were also improvements in skin elasticity and hydration – though these benefits built up gradually, suggesting that taking collagen consistently over a longer period matters more than a short-term burst.

Some of the findings were less clearcut. Results for skin elasticity and hydration shifted depending on when the studies were conducted, with newer research showing lower improvements in elasticity but greater improvements in hydration. That inconsistency is worth noting – it suggests the science is still settling.

The quality of the research itself is also worth scrutinising. The studies used a wide variety of methods, doses and ways of measuring outcomes, which makes direct comparisons difficult.

Fifteen out of the 16 reviews included were rated as low or critically low quality – not necessarily because the supplements don’t work, but because of methodological problems such as studies not being registered in advance and poor reporting on potential biases. Many trials were also short and included few participants, which limits what we can reliably conclude about long-term effects.

Not All Collagen Is Equal

Part of the problem is that collagen supplements vary enormously. Some are derived from animals, such as cows, pigs and chickens, and others come from marine sources, including fish, jellyfish and shellfish. There are even so-called “vegan” collagen alternatives. Some studies used oral supplements, while others tested collagen dressings applied to the skin.

The way collagen is processed also affects the size and composition of the peptides in the final product, which in turn influences how it behaves and is absorbed in the body. Lumping all these different products together in a single analysis risks obscuring as much as it reveals.

Individual differences matter too. Factors such as sun exposure, smoking, sleep quality, environment and hormone levels all affect how skin ages and how it might respond to supplementation. If studies fail to account for these variables, it becomes very difficult to know whether any observed changes are genuinely due to the collagen or simply reflect differences in participants’ lifestyles.

This review adds to a growing body of evidence suggesting collagen supplements are not simply expensive placebos. There appear to be real, if modest, benefits – particularly for skin hydration, joint pain and muscle health.

The research base still has significant gaps. Without more rigorous, standardised studies, it remains genuinely difficult to say what is driving those benefits, or who is most likely to see them. Studies need to clearly specify the type of collagen used, the dose, how it was delivered and the characteristics of the people taking it.

Heba Ghazal, PhD, is a Senior Lecturer in Pharmacy at Kingston University in London.

This article originally appeared in The Conversation and is republished with permission.

The Link Between Collagen Deficiency and Arachnoiditis

By Dr. Forest Tennant

A major finding in our studies of adhesive arachnoiditis (AA) is that most AA patients also have hypermobile Ehlers-Danlos syndrome (hEDS) or a related disorder now called hypermobile spectrum disorder (HSD).

AA is a chronic inflammatory condition that causes nerves in the spinal canal to form adhesions that “glue” them together, while hEDS and HSD cause deficiencies in collagen and the immune system.

How are these conditions connected?

Normal collagen is in thick strands that hold connective tissues together and helps resist infections, tearing, and autoimmune degeneration. When collagen is deficient, the strands may be thin, broken, shortened or non-existent. This allows viruses and bacteria to invade, infiltrating tissues and causing more infections than in individuals with healthy immune systems.

Spinal tissue normally contains considerable amounts of collagen, but in patients with hEDS or HSD they are weak and susceptible to deterioration, inflammation, adhesions and scarring. These spinal tissues include intervertebral discs, vertebrae, spinal canal cover (dura and arachnoid layers), ligaments, and cauda equina nerves.

Weaknesses in spinal tissue make persons with hEDS and HSD more susceptible to AA. It’s also not uncommon for them to develop one or more of these conditions before AA:   

• Tavlov cyst

• Spinal fluid leaks

• Chiari

• Tethered spinal cord

• Herniated disc

• Back pain

• Neck pain

• Spinal arthritis

We have found that persons with hEDS and HSD are also susceptible to Lyme disease, cytomegalovirus, herpes 6 virus, and especially the Epstein-Barr virus (EBV). Almost everyone has EBV, which is typically dormant, but the virus may reactivate from its parasitic life in throat membranes or lymphocytes to infiltrate the brain and spinal tissues.

Persons with hEDS or HSD who have back or neck pain for over 90 days should be screened with the new EBV 4 panel test and take measures to hopefully prevent AA. We highly recommended that they take collagen supplements.

In our studies of patients with MRI-documented AA, essentially 100% have EBV autoimmunity and about 70% show EBV reactivation. About half of those that we review do not know they have hEDS or HSD.

For more details on the link between AA, hEDS and HSD, our new book "The Ehlers-Danlos / Arachnoiditis Connection" is recommended.

Forest Tennant, MD, DrPH, is retired from clinical practice but continues his research on the treatment of intractable pain and arachnoiditis.

Readers interested in learning more about this research should visit the Tennant Foundation’s website, Arachnoiditis Hope. You can also subscribe to its bulletins here.  

The Tennant Foundation gives financial support to Pain News Network and sponsors PNN’s Patient Resources section.   

Fascia: An Overlooked Cause of Chronic Pain

By Dr. Adam Taylor, Lancaster University

We are constantly reminded about how exercise benefits our bone and muscle health or reduces fat. However, there is also a growing interest in one element of our anatomy that is often overlooked: our fascia.

Fascia is a thin casing of connective tissue, mainly made of collagen – a rope-like structure that provides strength and protection to many areas of the body. It surrounds and holds every organ, blood vessel, bone, nerve fibre and muscle in place. And scientists increasingly recognise its importance in muscle and bone health.

It is hard to see fascia in the body, but you can get a sense of what it looks like if you look at a steak. It is the thin white streaks on the surface or between layers of the meat.

Fascia provides general and special functions in the body, and is arranged in several ways. The closest to the surface is the superficial fascia, which is underneath the skin between layers of fat. Then we have the deep fascia that covers the muscles, bones and blood vessels.

The link between fascia, muscle and bone health and function is reinforced by recent studies that show the important role fascia has in helping the muscles work, by assisting the contraction of the muscle cells to generate force and affecting muscle stiffness.

Each muscle is wrapped in fascia. These layers are important as they enable muscles that sit next to, or on top of, each other to move freely without affecting each other’s functions.

Fascia also assists in the transition of force through the musculoskeletal system. An example of this is our ankle, where the achilles tendon transfers force into the plantar fascia. This sees forces moving vertically down through the achilles and then transferred horizontally into the bottom of the foot - the plantar fascia – when moving.

Similar force transition is seen from muscles in the chest running down through to groups of muscles in the forearm. There are similar fascia connective chains through other areas of the body.

When Fascia Gets Damaged

When fascia doesn’t function properly, such as after injury, the layers become less able to facilitate movement over each other or help transfer force. Injury to fascia takes a long time to repair, probably because it possesses similar cells to tendons (fibroblasts), and has a limited blood supply.

Recently, fascia, particularly the layers close to the surface, have been shown to have the second-highest number of nerves after the skin. The fascial linings of muscles have also been linked to pain from surgery to musculoskeletal injuries from sports, exercise and ageing. Up to 30% of people with musculoskeletal pain may have fascial involvement or fascia may be the cause.

A type of massage called fascial manipulation, developed by Italian physiotherapist Luigi Stecco in the 1980s, has been shown to improve the pain from patellar tendinopathy (pain in the tendon below the kneecap), both in the short and long term.

Fascial manipulation has also shown positive results in treating chronic shoulder pain.

One of the growing trends for helping with musculoskeletal injuries is Kinesio tape, which is often used in professional sports, although evidence for its effectiveness is mixed. It is also being used to complement the function of the fascia, and is used to treat chronic lower back pain where fascial involvement is a factor.

Fascia in Disease

Aside from getting damaged, fascia can also provide paths that infections can travel along, within muscles.

The spaces between fascial layers are usually closed (think of cling film being folded over), but when an infection occurs, germs can spread between these layers. This is a particular problem in the neck, where there are several layers of fascia for infections to travel along. In severe cases, surgery is often needed to remove the dead tissue and save the healthy remaining tissue.

One of the primary examples of fascia functioning in health, and the challenges its dysfunction can bring, is seen in the common complaint plantar fasciitis, which causes pain on around the heel and arch of the foot.

This incredibly common ailment affects 5-7% of people, rising to 22% in athletes. It is recognised as an overuse injury, causing the thickening of the fascial bands on the soles of the feet that help give the arch support.

Fascia can also be implicated in more serious health conditions, such as necrotising fasciitis. This is a rare but serious bacterial condition that can spread through the body quickly and cause death.

The condition is almost always caused by bacteria, specifically group A Streptococcus or Staphylococcus aureus. The initial infection comes from a cut or scratch, and then the bacteria travel along the fascia to other areas away from the initial site of access and multiply in the ideal environment afforded by the warm recesses of the body.

One reason fascia has been overlooked in health and disease is because it was difficult to see using current imaging technology. More recently, though, MRI and ultrasound imaging have been shown to be beneficial in visualising fascia, particularly in musculoskeletal conditions such as plantar fasciitis, and pathological changes in the fascia of the shoulder and neck.

With the growing interest in fascia and the growing understanding of its contribution to musculoskeletal health, it’s sensible to suggest that we look after it in the same way we do with the rest of the musculoskeletal system - by using it. Simple techniques like foam rollers and stretching are beneficial in increasing mobility, but there is still much to learn about our fascia and the role it plays in our day-to-day health.

Adam Taylor, PhD, is a Professor and Director of the Clinical Anatomy Learning Centre at Lancaster University. His research interests lie within the field of osteoarthritis and the degeneration of cartilage and bone.

This article originally appeared in The Conversation and is republished with permission.