The gut-joint and gut-muscle axis is an unexplored frontier in injury prevention and management. With the gut-brain axis gaining increasing awareness, clinicians must know the possible interactions between the gut and musculoskeletal system. Silvia Barbaresi explores this interaction.
Tennis - WTA 1000 - Italy’s Jasmine Paolini in action during the final against Russia’s Anna Kalinskaya REUTERS/Rula Rouhana
More than 2000 years ago, Hippocrates said, “All disease begins in the gut.” Today, clinicians are close to understanding the importance of gut health. However, they struggle to apply genomics, proteomics, and metabolomics disciplines in daily clinical practice. As the center of health, the gut goes beyond its important physiological functions, such as food digestion, nutrient absorption, neurotransmitter release, and immune system regulation. The gastrointestinal (GI) tract has a complex ecosystem known as the gut microbiota. It includes bacteria, fungi, protozoa, and viruses, accounting for over 38 trillion microorganisms and 1000 species. The gut defends the delicate homeostasis balance between the microbiota and the host, and it is the largest immunity organ.
A balanced gut microbiota contributes to the host’s health by strengthening the intestinal barrier and ensuring a low inflammatory state. It works on the immune system and hormonal signaling and secretes several bioactive metabolites. Pathological conditions cause dysbiosis and result in an imbalanced microbiota, negatively affecting microbial species’ abundance and metabolite release. Moreover, multiple external factors cause dysbiosis, but the most relevant include an unhealthy diet, excessive physical activity, drug intake, environmental toxins, and psychological distress.
Researchers are close to unraveling the connections between the gut, muscles, and joints. Therefore, it opens up new avenues and treatment possibilities for injury prevention and management in athletes. The challenge is translating the research into clinical practice.
Acute and chronic sports injuries affect the musculoskeletal system. Training type and intensity, athlete gender and age, inadequate diet, bad sleeping habits, and insufficient recovery increase injury risk. For example, elite youth football has high injury rates, possibly due to the intense schedules without adequate nutrition and recovery. Furthermore, in professional football, injuries affect player availability, impacting team performance and the club economically (approximately €6 million per club per season). Muscle injuries usually account for 20-37% of all injuries in professional football players, followed by ligament–joint injuries. However, the economic loss for ligament–joint injuries is nearly six times higher than for muscle injuries due to the longer recovery time(1).
Studying the gut-joint and gut-muscle axis opens the possibility of redirecting communication between the musculoskeletal system and the intestine toward gut microbiota-based therapies. Physical activity and dietary habits significantly influence an athlete’s performance. Selecting functional foods and pre-probiotics optimizes brain, bone, muscle, and cardiovascular health. Improved overall health reduces GI discomfort and inflammation and lowers the risk of injury(2).
Gut microbiota releases active microbial metabolites that influence muscle physiology (see figure 1)(3). Crossing the intestinal barrier, they impact muscle metabolism, eliciting different effects (positive and negative):
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