On one level this article is speculation combined with exaggeration, optimism and good old fashioned hope.
It’s simply going to weave tendon pain together with current research on nitric oxide, glyceryl trinitrate (GTN) patches and beetroot.
Wish me luck!
Fun fact one. Nitric oxide has shown an ability to enhance tendon healing The body can fix tendons, but, with nitric oxide, they heal better and stronger than they were.
Murrell (2007 Using nitric oxide to treat tendinopathy. British Journal of Sports Medicine 41, 227-231.) demonstrated a beneficial effect of Nitric oxide on patient assessed pain, function, and loss of symptoms of Achilles tendinopathy, chronic supraspinatus tendinopathy and tennis elbow
Some studies have shown that Nitric Oxide delivered by a skin patch enhances the subjective and objective recovery of patients with tennis elbow, Achilles tendinosis and supraspinatus tendinosis.
These trials involved the application of a commercially available Nitric Oxide delivery system (glyceryl trinitrate (GTN) patches) The participants received their dose through 1.25 mg/24 h GTN. However, “Topical glyceryl trinitrate and noninsertional Achilles tendinopathy: a clinical and cellular investigation” by Tim Cane failed to show the same reaction
So, if we can put nitric oxide patches on the painful tendon and sometimes get good results, is it worthwhile factoring in some of the observations of Clifford T, Howatson G, West DJ, Stevenson EJ. The potential benefits of red beetroot supplementation in health and disease. Nutrients. 2015;7(4):2801-22. doi:10.3390/nu7042801 and eating beetroot?
for fun fact two
Eating beetroot provides a natural means of increasing nitric oxide availability and has emerged as a potential strategy to prevent and manage pathologies associated with diminished Nitric oxide bioavailability, notably hypertension and function. Beetroot is also being considered as a promising therapeutic treatment in a range of clinical pathologies associated with oxidative stress and inflammation. Its constituents, most notably the betalain pigments, display potent antioxidant, anti-inflammatory and chemo-preventive activity
Dubious conclusion( or fun fact 3). Whilst, some evidence points towards the role that Nitric oxide has in promoting tendon recovery, there is a big gap between applying a targeted GTN patch directly to the point of pain, and eating a bit of beetroot. The famous quote is “Let food be thy medicine” . However, it’s still unlikely that someone will stagger into casualty screaming “Im in agony, get me a beetroot salad”.
Still, if steering your diet towards better stuff that could promote healing, is a cheap, no harm option, why wouldn’t you?
I’m pretty thrilled to find this blog entry today as I’ve been thinking along these lines. I’m 40, and I’ve been dealing with tendon pain in the tarsal tunnel for 8 years, which started as a running overuse injury. I’ve been constantly in physio since; I’ve had PRP in my posterior tib, FHL, and FDL tendons; and I had an os trigonum (accessory bone that can rub against FHL) surgically removed, but no improvements (and I don’t think I’ve fully recovered from the surgery yet from over a year ago). I’ve focused on swimming during this time since I haven’t been able run comfortably.
A couple months ago, I tried taking beetroot powder capsules for the NO vasodilation effect to help with swimming. Within a day or two of starting, my ankle started hurting worse than normal, and it felt stiff and inflamed. I took the beetroot for a few more days, and the ankle effects continued. I then stopped the beetroot, and the ankle pain went back down to baseline in a day or two. I thought that the ankle inflammation could be (1) a direct effect of NO on the tendon healing process and/or (2) the vasodilation increased bloodflow to the area (and I have Reynaud’s syndrome with poor bloodflow to my hands and feet, which could have been inhibiting healing of my ankle tendons all along). Of course it could be placebo, although I was never expecting this effect from the beetroot, and it could also have just been coincidence.
About 2 weeks ago, I stopped swimming because my swimming was the biggest COVID risk my family was taking (and the case rates are now very high where I live), so I decided to start taking beetroot again. As predicted the pain and inflammation increased again (lowering the chance of it being a coincidence), as well as pain in my right SI joint, where I have had issues in the past (I think I have too much laxity in the ligament). I’m hoping that over 1-2 months, these injuries may ultimately heal better than they had in the past. Fingers crossed.
Regarding your “dubious conclusion”, there is some addition evidence that sits in between GTN patches helping tendon healing and increasing NO generally via oral supplementation helping tendon healing. This study (https://link.springer.com/article/10.1007/s000110050027) showed that suppressing NO synthase in rats (via an oral supplementation) hurt tendon healing. Hence, this result somewhat supports that increasing NO production via oral supplementation could improve tendon healing.