***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Extracorporeal shockwave therapy ( ESWT ) produces good results in the treatment of insertional Achilles tendinopathy . The efficacy of combined administration of dietary supplements with ESWT has not yet been studied . Methods In this prospect i ve , r and omized clinical trial , Shock Waves therapy and Arginine for Achilles Tendinopathy ( SWAAT ) , subjects affected by insertional Achilles tendinopathy were enrolled . Between January and October 2011 , all participants underwent three sessions of ESWT .  In addition , the patients in the experimental group received a daily dietary supplement containing arginine , Vinitrox ( Bio Serae Laboratories SAS , Bram , France ) , collagen , methyl-sulfonyl-methane , vitamin C , and bromelain , while the control group patients received placebo . Results There was no statistically significant difference in the visual analog scale ( VAS ) score between the two groups at 2 months ( 3.9 vs. 5.1 ; P = 0.07 ) , whereas at 6 months the value was significantly lower in the experimental group ( 2.0 vs. 2.9 ; P = 0.04 ) . The difference in the Ankle-Hindfoot Scale score at 2 and 6 months of follow-up ( FU ) was significantly in favor of the experimental group ( 2 months : 85.4 vs. 72.1 ; P = 0.0035 ; 6 months : 92.4 vs. 76.5 ; P = 0.0002 ) . The Roles and Maudsley score also showed a statistically significant difference between the two groups in favor of the experimental arm as regards patient satisfaction ( at 2 months : 1.7 vs. 2.8 ; P < 0.0001 ; at 6 months : 1.5 vs. 2.3 ; P < 0.001 ) . There was a statistically significant reduction in tissue oximetry values compared to baseline in both treatment groups at 2 and 6 months of FU . Comparing the groups , only at the last FU , at 6 months , was a significantly lower oximetry value observed in the experimental group versus controls ( 60.2 vs. 66.0 ; P = 0.007 ) . Conclusion On the basis of the results obtained in this study , the authors conclude that in the treatment of insertional Achilles tendinopathy , ESWT induces a hemodynamic re-equilibrium with an in tendon trophism . The addition of specific dietary supplements could improve the therapeutic response Methylsulfonylmethane ( MSM ) is a sulfur-containing compound commonly found in diet and known to reduce oxidative stress . This trial was conducted to determine whether single dose supplementation with MSM attenuates post-exercise oxidative stress in healthy untrained young men . Sixteen untrained men volunteered for this study . Participants were r and omized in a double-blind placebo-controlled fashion into 2 groups : Methylsulfonylmethane ( MSM ) ( n = 8) and placebo ( n = 8) . The participants took supplementation or placebo before running on treadmill for 45 min at 75 % VO2max . The MSM supplementation was prepared in water as 100 mg/ kg body weight . The placebo group received water . Serum Malondealdehyde ( MDA ) , uric acid , bilirubin , protein carbonyl ( PC ) and plasma vitamin E levels were determined as the markers of oxidative stress . Plasma GSH ( reduced Glutathione ) and total antioxidant capacity ( TAC ) were measured as markers of plasma antioxidant system . MSM supplementation successfully lowered serum PC 2 and 24 h after exercise . Plasma TAC in MSM group was higher at 24 h after exercise . Serum level of uric acid and bilirubin were significantly low immediately after exercise in MSM supplemented group . There was no significant difference between groups in terms of plasma GSH level . These results complement earlier studies showing anti-oxidant effect of MSM and suggest that single dose oral supplementation with MSM lowers exercise induced oxidative stress in healthy untrained young men , but is not adequate to significantly affect plasma GSH level 1 . Endogenous nitric oxide plays an important physiological role and is synthesized by several isoforms of nitric oxide synthase from the semiessential amino acid L-arginine . Nitric oxide is detectable in the exhaled air of normal individuals and may be used to monitor the formation of nitric oxide in the respiratory tract . 2 . We have investigated the effect of orally administered L-arginine ( 0.05 , 0.1 , 0.2 g/kg ) compared with matched placebo on the concentration of nitric oxide in the exhaled air in 23 normal individuals . 3 . L-Arginine caused significant increases in the concentration of nitric oxide in exhaled air at doses of 0.1 and 0.2 mg/kg , which was maximal 2 h after administration . This was associated with an increase in the concentration of L-arginine and nitrate in plasma . There were no significant changes in heart rate , blood pressure or forced expiratory volume in 1 s. 4 . These results suggest that an increase in the amount of substrate for nitric oxide synthase can increase the formation of endogenous nitric oxide . This may have therapeutic relevance in diseases in which there is defective production of nitric oxide OBJECTIVES We evaluated the effects of glucosamine chondroitine sulphate ( glcN-CS ) on rat Achilles tendons in this experimental animal study . MATERIAL S AND METHODS Thirty Wistar albino type rats weighing 300 - 350 g were r and omly grouped into two . Group A : Achilles tendons were tenotomized , repaired and , glcN-CS given orally . Group B : Achilles tendons were tenotomized and repaired . All the rats were fed with pellet chow . Five rats in each group were sacrificed at 4 , 8 , and 12 weeks interval . Tensile strength of three tendon specimen from each group were tested biomechanically and two specimen were analysed histopathologically via immunohistochemical staining and hematoxylin and eosin staining . Contralateral side Achilles tendons were also grouped and analyzed as controls ( group C and D ) . RESULTS Histological results showed well organized collagen formation and less inflammation in group A. Biomechanical testing showed higher tendon strength in group A at eight weeks which is not statisticaly significant ( 55.3±4.84N , p=0.078 ) . Rats which were were given glcN-CS had greater tendon strength which is statisticaly significant ( 50.01±5.62 , p=0.014 ) . CONCLUSION Glucoseamine chondroitine sulphate improved results of Achilles tendon healing in rats . This result might be due to decreased inflammation and stimulation of collagen synthesis . Although glcN-CS is recommended only in osteoarthritic patients to relieve symptoms and signs it can also be prefered in treatment of soft tissue injuries formed during sports activities BACKGROUND The Pineapple plant contains the enzyme bromelain which has been accl aim ed to reduce pain and swellings following acute muscle injuries as well as carotenoids and polyphenols which are powerful antioxidants . It is yet to be determined if these constituents are distributed throughout the plant and what effect they have on the healing of acute tendon injuries . OBJECTIVE This study therefore investigated the effects of the aqueous extract of different parts of the pineapple plant on tenoblast proliferation and the tendon Malondialdehyde ( MDA ) level in the early stage of healing in a crush injury to the achilles tendon of Sprague-Dawley rats . METHODS Forty male rats were divided r and omly into five groups ; all had induced crush injury to the left Achilles tendon . Group 1 ; injury and nil treatment , Group 2 ; leaves extract , Group 3 ; fruit flesh extract , Group 4 ; bark extract , Group 5 ; core extract . The extract was given at a dosage of 30 mg/kg body weight daily over the first 14 days post-injury . On the 15th day post injury , the animals were sacrificed and the tendons excised and processed for histological study and MDA assay . RESULTS The flesh and bark extract induced a proliferation of tenoblasts which however was not significantly different from that of the untreated tendon while the leaves and core extracts reduced the population of the tenocytes . The flesh extract significantly ( p < 0.05 ) reduced the MDA level while the leaves and core extract significantly ( p < 0.001 ) increased it . The bark extract had no significant impact on the MDA level compared with the untreated tendon . CONCLUSION This study suggests that the anti-oxidant constituents of the pineapple plant are concentrated in the flesh while the bark and flesh extracts have the potential to promote healing by stimulating tenoblast proliferation Abstract Objective : Glucosamine , classified as a slow-acting drug in osteoarthritis ( SADOA ) , is an efficacious chondroprotective agent . Methylsulfonylmethane ( MSM ) , the isoxidised form of dimethyl-sulfoxide ( DSMO ) , is an effective natural analgesic and anti-inflammatory agent . The aim of this study was to compare the efficacy and safety of oral glucosamine ( Glu ) , methylsulfonylmethane ( MSM ) , their combination and placebo in osteoarthritis of the knee . Patients and design : A total of 118 patients of either sex with mild to moderate osteoarthritis were included in the study and r and omised to receive either Glu 500 mg , MSM 500 mg , Glu and MSM or placebo capsules three times daily for 12 weeks . Patients were evaluated at 0 ( before drug administration ) , 2 , 4 , 8 and 12 weeks post-treatment for efficacy and safety . The efficacy parameters studied were the pain index , the swelling index , visual analogue scale pain intensity , 15 m walking time , the Lequesne index , and consumption of rescue medicine . Results : Glu , MSM and their combination significantly improved signs and symptoms of osteoarthritis compared with placebo . There was a statistically significant decrease in mean ( ± SD ) pain index from 1.74 ± 0.47 at baseline to 0.65 ± 0.71 at week 12 with Glu ( p < 0.001 ) . MSM significantly decreased the mean pain index from 1.53 ± 0.51 to 0.74 ± 0.65 , and combination treatment result ed in a more significant decrease in the mean pain index ( 1.7 ± 0.47 to 0.36 ± 0.33 ; p < 0.001 ) . After 12 weeks , the mean swelling index significantly decreased with Glu and MSM , while the decrease in swelling index with combination therapy was greater ( 1.43 ± 0.63 to 0.14 ± 0.35 ; p < 0.05 ) after 12 weeks . The combination produced a statistically significant decrease in the Lequesne index . All treatments were well tolerated . Conclusion : Glu , MSM and their combination produced an analgesic and anti-inflammatory effect in osteoarthritis . Combination therapy showed better efficacy in reducing pain and swelling and in improving the functional ability of joints than the individual agents . All the treatments were well tolerated . The onset of analgesic and anti-inflammatory activity was found to be more rapid with the combination than with Glu . It can be concluded that the combination of MSM with Glu provides better and more rapid improvement in patients with osteoarthritis Introduction This experimental study was performed to assess , whether or not , vitamin C , required during the collagen synthesis , would influence the Achilles tendon healing in a healthy rat model . Material s and methods The right Achilles tendons of 42 healthy female Wistar Albino rats were completely ruptured . The rats were r and omly divided into the vitamin C and control groups and both groups included third , tenth and twenty-first day subgroups . One hundred and fifty milligrams ( 1.5 cc ) of vitamin C and 1.5 cc % 0.9 NaCl were injected once for every 2 days for the vitamin C and control groups , respectively . Qualitative and quantitative microscopic comparisons of the repair tissues of both groups were made on the mentioned days . Results Angiogenesis was more evident on the third day in the vitamin C group . There was a significant difference between the control and vitamin C groups regarding the type I collagen production on the tenth day . The structure of the repair tissue was almost in the form of regular dense connective tissue at the end of twenty-first day in the vitamin C group . Mean collagen fiber diameter was considerably higher , and the number of active fibroblasts in the repair tissue was slightly elevated in the vitamin C group during the entire healing process . Conclusion High-dose vitamin C supplementation once for every 2 days has stimulating effects on the Achilles tendon healing because of early angiogenesis and increased collagen synthesis in a healthy rat model . Further studies are needed to make clear the mentioned encouraging effects of the vitamin C on the Achilles tendon healing Nitric oxide is a small free radical generated by a family of enzymes , the nitric oxide synthases ( NOSs ) . In a series of experiments performed over the last 15 years , we showed that nitric oxide is induced by all 3 isoforms of NOS during tendon healing and that it plays a crucial beneficial role in restoring tendon function . In normal tendons , very little NOS activity was found , whereas in injured rat and human tendons , NOS activity was expressed in healing fibroblasts in a temporal fashion . In healing rat Achilles tendon fibroblasts 
    Output:
    
All these nutraceuticals demonstrated several effects on normal and pathological tendons .
Pre clinical and clinical studies showed a possible role on collagen synthesis , inflammation , mechanical properties , and maturation of collagen bundles , antioxidant effect , edema , and analgesia .
pre clinical results are very encouraging , however they are not fully confirmed by clinical studies .
For these reasons , it is not possible to draw any definitive raccomendations on the use of nutraceutical supplementation in tendinopathies