Matthew: It’s a really interesting question, in terms of having to look back historically to the reasons why I do use collagen quite frequently, and a lot. It’s part of the daily protocol, in terms of, like, when a lot of patients are coming in, it’s so easy to talk about, for me. But I remember, must have been around 10 years ago. So, I’ve been a physio for just over 20 years. Let’s call it 23, 24 years. And you’re seeing patients, like, chronic pain, you’re seeing acute pain, you’re seeing shoulders, you’re seeing toes, broken toes. You’re seeing everything. Seeing people post-cancer treatments. There’s a lot involved in private practice that we see. And I just remember my sister, who’s a geneticist over in Switzerland, and she’s a smart cookie. She’s a molecular biologist, and she’s got patents, and she was in the cancer research field for many years, and big researcher. Like, anything she says, I sort of just go, “yes, it must be true.”

And then, 10 years ago, she actually did a big backflip, and she created a collagen product. And I was talking to her, just on, probably, very primitive FaceTime 10 years ago. I wonder what that was. Was it FaceTime? Who knows? It could have been Skype or something exciting. And I said, I remember saying to her, “You’re making collagen. What’s collagen? Isn’t that tendons? Isn’t that bone broth? Isn’t that something that the hippies sort of stir up on the stove and take?” And, yeah. So, that’s where I started learning. She essentially said, “Look, Matt, you’re a physio. You’re dealing with people every single day that have orthopedic issues, inflammatory problems, like, muscle strengthening issues, etc., etc., degenerative, etc.” And I thought, “Oh. So, does that mean I could use that?  I could talk to my patients about this? Like, is this…like, am I allowed?” I immediately thought maybe I’m not allowed, as a physio. Like, what’s my governing body thinking of this? Is this a drug? Like, what is it? And, yeah. Like, to my patients’ benefit, over the last, at least 10 years, it’s been amazing to use as an adjunct, in the background of what I can do or what I’ve been able to provide my patients. So, it’s really, yeah, it’s nice to be able to talk to you about it today, in terms of how I would utilize it, on a daily basis.

Andrew: So, Matt, can I then ask, when do you approach this along the patient’s therapeutic journey, if you like? When do you start to talk about collagen? Do you say, “Hey, listen, early on, let’s get into it?” Or do you say, “Look, let’s do my physio. We’ll see how that works. And if we’re having some struggles, we might then instigate some collagen therapy?” Which…where do you sort of approach it?

Matthew: It’s, I probably have, like, thinking about it, I probably have two approaches. There’s the approach where someone’s really busy. I work in the city, in Sydney, so it’s a very busy clinic. So, sometimes people aren’t… I guess they’re just, they want some really quick relief, manual therapy, out they go, back to their Pilates classes or their normal routine. Yep.

I am pretty firm when someone comes into the clinic with certain conditions that I know take the human body quite a lengthy period of time to improve, whether it’s the natural history of the particular connective tissue that’s injured. An example would be, like, a meniscal tear of the knee. A disc-related bulge, a protrusion, an extrusion. And when you put those two together, those particular issues, if you’re looking at, say, a knee and a lower back, or a neck, that is a lot of what a physiotherapist would see each day, in the clinic. So, I’m pretty tough on those people, in terms of outlining how poor the perfusion of blood flow is to those tissues. And the best thing they can do… Because everyone wants to get better quicker, right? They don’t actually wanna come and see me in my clinic, pay my rate, and know that they could or could not get better quickly. So, it’s in their best interest to know straight away about it. So, yeah, scenario two is often the case, but there is also that scenario one, where someone just wants to get in, they got a headache, they just want their neck manipulated, and they just wanna get back into a lot of their busy meetings. But if it’s a journey, I talk about it straight away. I don’t wait three months and say, “Look, we could be getting better if we also take some supplementation in your diet.”

Andrew: And, I mean, you mentioned a few conditions here, but what other conditions do you tend to employ collagen in? You said you’re a cancer specialist physio. Take us through that. That’s really interesting.

Matthew: Yeah, it’s really interesting, particularly knowing your background, too, and your career in nursing and medicine. So, there is a PINC, for women, and a STEEL rehab physiotherapy accreditation that’s out there. And it was, essentially, I guess the founder, you could say the founder of the particular cancer rehab foundation is a New Zealand physiotherapist. And she works with a lot of pain management specialists, cancer, oncology doctors, etc. So, I, I guess, just naturally, with my history of treating chronic pain, and also sports injuries, as you’re getting a bit older, you see…you just wanna delve a bit more and a bit more into the complexity of treatment, and helping people in need. So therefore, yeah, I went down that pathway, and just learned a lot more about, I guess, cancer, inflammation, mechanical issues as a result of different treatment types, whether it’s, like, chemotherapy, radiotherapy, hormone therapy. Yeah. Physio, exercise. It’s a big world. And I think the best

Andrew: Oh, yeah.

Matthew: …is a multidisciplinary approach, yeah. So…

Andrew: Can I ask you about cording? We commonly refer to cording as this sort of tight muscles, that mainly women experience when they’ve had breast cancer, radiotherapy. And so, the muscles under the armpit get really tight and corded, bunched up. But do you see cording anywhere else in the body? You know, let’s say, for men experiencing prostate cancer, and they’re getting, you know, they’d be lucky enough to get the cyber knife, but if they had other radiotherapy in the genital area, do they get cording, like, of the groin or anything like that?

Matthew: They do. Coming back to the, I guess, more of the breast surgery, the cording is amazing. If you haven’t seen cording, it would be hard to try and explain… Well, it is, I’m explaining it now. It’s very hard to explain that someone’s armpit can look like they’ve got guitar strings poking outside the skin. It’s really interesting, right? You’ve seen it. And to think that, I guess, it’s generally pretty conservative in medicine, in the oncology clinics and that world, like, everyone’s just sort of getting information and advice just to be happy that you’re alive. But there’s functional impacts on things like cording. And cording will basically present like, particularly a female, having breast surgery, or a mastectomy, their glands try and find a new pathway within their own lymphatic system. And then suddenly, you do. You get this, like, guitar string effect through the armpit. And now in the armpit, every single nerve that goes to your fingertips, from your neck down, goes through your armpit. So it’s an absolute nightmare if you were just to follow general practice advice, and just see how it goes. So, that, I have seen, definitely, on the male side, like, through different areas of the adductors. Probably not as common, in terms of the presentation to a private practice, because I think, also, men tend to not seek therapy, or they probably just, I don’t know, hide it away or… I don’t know. They just don’t tend to probably talk much about it, or it’s not really potentially painful, or irritating their function. But I have definitely seen it through that, sort of that adductor area, but also through the calves. Yeah.

Andrew: Oh.

Matthew: And it can… Yep. So, if someone is actually…generally, a male might tell me their history after the fact that they’ve introduced themselves to me or one of my physios in the clinic, as someone with sciatica or back pain. So, then we start looking at the body. We start, like, testing, you know, length of muscles and, you know, their range of motion through the hips, the knees, the ankles. And then suddenly, you can just see, it’s quite an interesting twitching response that the medial gastroc, or the calf muscle, can actually portray. And straight away, I know that this person has probably had something else other than just back pain. Like, something’s hypersensitizing, you know, the neural connectivity.

Andrew: Right.

Matthew: Which is really, yeah, it’s a bit of a pick a path. Like, how much time do we have to find out what’s actually going on? And majority of the time, like, because people come back very frequently, and finish off their treatment because they want to, we can get to the bottom line of it. Yep.

Andrew: And of course, you mentioned early on your backs and your knees and things like that. Obviously, there’s degenerative changes that we get as we age. But there’s also the sports injuries as well. So, how do you pick and choose, well, which type of collagen, if you like, or…? Now, we can’t mention brand names here. Can’t mention product names.

Matthew: Yeah, yeah. Yeah.

Andrew: I don’t know how you feel about ingredient names, but that’s, I don’t have a problem with that. But…

Andrew: …yeah, how do you sort of wend your way and introduce that topic to somebody, say, “Hey, listen. We should, apart from me, you know, massaging you and working on range of motion, things like that, we should also be looking at collagen.” How do you approach that conversation?

Matthew: Yeah. So, I would, I see a lot of, a lot of arthritis, and a lot of perimenopause, menopause, bone density issues coming through. There’s so much excellent research. I will definitely be chatting to most people that enter the clinic to, like, take that pathway, and understand more about how they got to where they are, or potentially prevent where they could be heading, when it comes to certain conditions like that. We often laugh, like when you come into our particular clinic, where, I guess we’re rare in the sense that we do have, like, quite a big retail space as you enter. So, it’s, we kind of laugh and call it our physio open locker room. So, you’ve got your bands, you got your supplements, you’ve got your products that we trust, right? And we know we’re gonna use them, so they don’t stay on the shelf for very long before we then replenish them. So, there is very good trademarked brands of collagen out there. You’ve got some very bad collagen, and you’ve got some very good collagen. Okay? It’s like anything out there that you’ve probably been talking about for years and years and years, like, a lot of years, right? Like, and we’re talking about…we’re talking about trying to supplement someone’s, or be an adjunct to a treatment, but then also give someone the best outcome. So, generally, you kinda do get what you pay for, in a sense, when it comes to collagen. It has to be a small enough amino acid peptide to be able to be absorbed. So therefore, when you’re looking at what you’re treating, let’s say it’s a tendon, versus a bone, there’s a certain collagen that’s better for that tendon. But then there’s also one that’s better for the bone. It’s been researched. So, there’s a lot of really cool microbiology and macrobiology out there, to allow us to know, okay, go down that path. But essentially, a lot of it’s patented from, like, Germany and some of these really forward-thinking countries. Yeah. In that  and hydrolyzed…

Andrew: Yeah, yeah. I was very… Yeah, I know one of the products you’re talking about, and one of them, I remember looking at the research, and I think it was a Zed score that they were looking at, and the improvement was dramatic. Like, it was dramatic for… Oh.

Matthew: Yeah.  Yeah. And, look, honestly, like, the nice thing is, like, I guess a lot of people have heard of collagen, and it’s been sort of a bit exciting in the beauty market. Yeah? So, a lot of it, like, a lot of the hype and the knowledge of collagen has come from a good place in the beauty market, but then it’s in very low doses, and sort of poorly absorbed, and it’s led to a lot of big companies wanting to achieve better outcomes for chronic conditions that actually don’t have good treatments for. There’s no cure for arthritis. Like, there’s no cure. There’s symptomatic relief. There’s different drugs you can take. Exercise is, like, obviously excellent, as in to try and somewhat modify the disease. But we’re seeing right now, like, we’re, I reckon in the last five, like, in the next five years, there’s going to be a lot of really fine-tuned research, if not already, it’s beginning, in terms of how and which collagen we can use for that particular case, or that individual. And there’s literally no side effects. I’ve had a couple of patients say, “Oh, I don’t wanna take my collagen now, because it upsets my tummy.” I’m like, “Well, just get used to it.” It’s, you know, if that’s the side effect of not having, you know, less bone density, it’s not that bad.

Andrew: That’s the big thing. It’s usually really well-tolerated, isn’t it? I, too, have had a couple of patients, and wind has been the issue, but it’s normally been with combination products. As soon as I take the… It’s not the combination. It’s when they’re combining it with collagen and other things. As soon as I keep it to collagen, the side effects tend to abate.

Matthew: It’s really interesting too, because people, like, when I sort of, I am pretty forceful with my treatment plans. Like, after being a physio for many, many years, you sort of think, well, you called me, you made the effort to, like, book in online or call me. Like, I didn’t call you. So, you want the best outcome possible, in the shortest amount of time, and to not have a recurrent issue. So, I can be quite forceful, and just say, “And now you’re taking this twice a day,” which we’ll talk about, no doubt, in terms of the dose for different conditions, but it’s like basically being the pharmacist or the doctor just going, “[vocalization 00:18:56] this is what you need to do.”

Matthew: We understand a lot, in terms of, like, those in the researches know how to get the molecule into the tissue, to best help your condition, yeah.

Andrew: Take us through post-surgery, because that’s another area that you’re expert in. This is huge. Like, this is a big area.

Matthew: So, what do we…should we start with the incision?

Andrew: Yeah. Look, take us through, like, when do you start to employ it? Pre-surgery, or let’s say a week or two post-surgery?

Matthew: Look, it’s really dependent on when the person’s booked in to come and see us. Like, I might have a patient where, for example, I’ll say Wendy, and Wendy is a real patient. And if Wendy ever sees this, she’ll laugh and go, “Yep, that was actually, yeah, that’s what we did.” So, Wendy, known her for many years, so many years, and I think we both just got sick of treating her knee. We just got sick of it. Just going, “It’s bone on bone. You need a total knee replacement.” We’ve got no…we’ve run out of jokes. Our bedside conversation is, like, you know, getting boring. So, essentially, Wendy needed to have surgery a long time ago, I think. So, if someone is already a patient, we’ve tried a little bit of collagen, a little bit of this, little bit of that, but now we’re too far gone… So, a lot of patients come in, freshly post-surgically. I’ve got a lot of orthopedic surgeons that refer directly to us, neurosurgeons, oncologists, where there’s incisions in the skin, and a lot of the connective tissue have been modified, you could call it. So there’s gonna be scar tissue involvement. There’s gonna be bleeding, inflammation. Oh, mate, it’s like a cocktail of chemicals that your body is pretty clever at releasing, mediating, and trying to somewhat turn those chemicals into a physical structure. So, I would definitely get my post-surgical patients, as soon as possible, onto taking collagen. We know there’s a huge amount of research that shows how great it is at stimulating fibroblasts in the skin, the dermis. Like, scar tissue itself lays down its own, like, venous structures and nerve structures, essentially, hence why we feel it when it gets tight. And the fascia, which we generally cut through. So, not only the bones that we might be cutting into and putting metal into, to make a new surface, we’re also gotta be thinking about how much pain is presenting within the skin, and the upper layers of the tissues that then allow us to move, which is the muscle, the connective tissue, the padding, the bursas, the fat pads and the like, of those structures. They’re all innervated by nerves. There’s a lot of swelling post-surgically. I make my patients take it.

Andrew: How long after surgery? Are we talking, like, five to seven days, or a couple of weeks, once they can walk and make an appointment to see you?

Matthew: It’s generally one to two weeks after. Yeah. And it’s only because they’re usually stuck in a institution, a hospital, or they’ve potentially chosen to do rehab in a external facility for two to three weeks, maximum. So, I guess the largest delay would be within a month of having a surgical procedure. Yeah.

Andrew: Gotcha. And can you give us an idea of dose that you use in those instances?

Matthew: Yeah. I would generally, if I know there’s inflammation, or it’s very acute, in terms of, like, someone’s body’s trying to really heal, as opposed to, say, just, like, a garden-variety tennis elbow, for example, someone’s had it for months, months, months, months, months, they can stick to a standard dose, which I would say these days, the standard dose is about 10 grams of collagen per day.

Andrew: Yep.

Matthew: However, someone that’s in that, I call it, like, a critical window. Like, that critical window of the body’s really trying to heal, so you need to power that factory, and all the mitochondria and everything in your system, to do its job at its best, in terms of the immune system. So, I’m always telling people to take the daily dose twice a day. So, up to 20 grams of collagen a day. And a lot of the literature says 15 is great. So, we just go a little bit extra, knowing that it’s actually quite a cost-effective… It’s not expensive. It’s not that expensive, when you think about how much you’re paying otherwise for Lyrica, for pain. Or Mobic. Or, you know, there’s a lot of other more-expensive things that are just more symptomatic relief, as opposed to, yeah, good for you into the future, long-term.

Andrew: We usually think, you mentioned this quite early on, we usually think about collagen, as you said, about tendons and, you know, soft tissue and fascia or blah, blah, blah. But you mentioned bones. Have you got any case histories? Can you pull out, obviously not mentioning names, but can you pull out any case histories of, especially women, I’m gonna say here, that might be suffering from osteoporosis or osteopenia, and you’ve seen the results that they can gather, that they can get when taking collagen?

Matthew: Yeah. A lot. Yeah, it’s nice to say, a lot. Like, many, many. Because we’ve been in our community where we’re based for 20 years, coming in January. We have seen a lot of people. And they’re growing, we’re all growing old together. We’re all growing old together. Andrew, it’s great. And they laugh, going, “Yeah, but, like, you’re doing really well out of this.” But, yes. A lot of… I tell you what. Endocrinologists, I mean, they’re starting to, like, get it. They’re really starting to get it. They don’t just go, “Boom, you’ve gotta take the HRT,” or, “There’s only one way for you to go.” They’ll talk about, some that I know, they’ll talk about, with my patients, collagen. They’ll talk about exercise, and how, together, they are the best methods for you moving forward. So, there’s research for premenopause, there’s research, really good research for menopause, postmenopause, and it’s amazing. Like, it’s all in the last three, four years, this research, and a lot of it’s from Germany. So, it definitely indicates that the bone density improves. Like, who would have thought, like, when I went through physio school, 20 years ago, or more, I was told the best you can do is lose 1% to 2% per year bone density as a female that’s hit menopause. That’s a lot. But now, like, people are seeing, like, the extracellular matrix improving. Like, not like that. But they’re not…

Andrew: No,  Yeah.

Matthew: It’s, like, a very shallow change.

Andrew: Yeah, yeah.

Matthew: And then it goes up a little bit. Which is quite nice. And that’s important, because

Andrew: That’s a big difference, when you consider, as you said, their trajectory, their normal trajectory. That little uptick is a massive difference. In a Zed score, you’re talking long-term. If you think about nerve impingement, you know, collapsed vertebrae, all of the extremely painful conditions, that are disabling for, especially older women, but there are men who suffer from osteoporosis as well. That slight uptick is dramatic.

Matthew: And I think one of the things we need to talk about is to say, you don’t even know your bone density, like, most of the time, you wouldn’t even know what your bone density is unless you actually had a fracture. You fell over, you tripped over the tree root, you’re walking down the main street, going to a meeting, suddenly you’ve gone straight in an ambulance to hospital, you’ve had a pin and plate put in your wrist, and then your GP goes, “Maybe we should do a bone density scan.” And then suddenly, oh,  you’re, like, you’re up at the top end of osteopenia, or, like, you’re on your way. Who would have thought? You otherwise exercise.

Andrew: Do you know, I was speaking with an endocrinologist who specializes in osteoporosis. And this was some years ago now, but he was mentioning this study he was involved in, where they were looking at N-telopeptides. And N-telopeptides were, back in my day, they were a functional pathology, that was poo-pooed by the orthodoxy. And yet here they are… Now, this is probably 10 years ago, but it was 10 years after the fact, using it as a standard sort of check to see, to look at bone turnover over time, if you like. Wouldn’t it be great if we were allowed, I’m just thinking, I’m trying to think about the public purse here. I’m trying to think about public health expenditure. And wouldn’t it be great if we had enough knowledge of the trajectory, if we checked something like N-telopeptides of women and men, say, age 40, 30, and then did another one at 50, and said, “Ooh, you’re headed on this trajectory.” I’ve got my pen slanted at a 45-degree angle downwards. Or, “You’re at this trajectory. Don’t worry about it. Go on merrily on your way.” Wouldn’t that be a lovely thing for the Australian healthcare system to look at?

Matthew: Amazing. Like, how many people die within two years of having a hip fracture?

Andrew: Yeah. Yeah.

Matthew: Like, it’s just…like, we know this. There’s so much information there. It would be interesting, though, with your concept, to really fine-tune it, kind of like, I guess, the bowel cancer kits that get sent out by the government.

Andrew: Yes. Exactly.

Matthew: Like, is there a way you could easily, or more easily, have access to checking your bone density? Because with bone density, I guess that’s also, not that osteoporosis or osteopenia, you have to have arthritis, but a lot of the time, they go hand in hand, from a bone health point of view. And they’re hugely impacting our socio-economic outcomes. Huge.

Andrew: Oh, yeah.

Matthew: Like, our hospitals are full of… Like, knee replacements, oh, my gosh. It’s number one. It’s the number one thing that we see longer-term in our clinic, the rehab of an osteoporotic knee, that sort of has had a probably, like, a medical practitioner say, “Don’t do anything until you actually can’t walk anymore.” And by that stage, you’ve got diabetes, you’ve put on so much weight. Like, this is such a big…

Andrew: An anesthetic risk.

Matthew: Exactly. Like, it’s harder to then rehab. Oh, my gosh. Yeah.

Andrew: And it’s harder to recover, for elderly people. So, hence the collagen.

Matthew: Right.  trademark that. Whatever you come up with. I was here.

Andrew: I’ll work on it with you.

Andrew: Let’s go to the other end of the spectrum, Matt, and that is the younger people.

Matthew: Yes.

Andrew: I shouldn’t be so careful to pigeonhole people. So, but let’s say, the more younger set, the athletic injuries. So, what do you treat? What do you see in clinic? Obviously, you’ve got your common ones, your netballers. But what else do you see, and how do you treat it with collagen? And can we throw in maybe a few other therapies you might use?

Matthew: Can I do this? Can I just show you a very recent review?

Andrew: Yeah. “24-Week study on the use of collagen hydrolysate.” What? Keep going. Sorry. Hold that up

Matthew: Essentially, for athletes with activity-related joint pain.

Andrew: Right.

Matthew: So, no arthritis, none of the co-morbidities that we were talking about before. Not old people. Like, young people, in their prime, that exercising hard, and having to recover. That particular study is one…that one was back in 2008, but that same set of researchers have just continued along that pathway, in terms of making sure that it has had very good outcomes for people, from a joint pain point of view, from a recovery point of view, so they can actually train more again the next day or the day after that. They recover well. They don’t get to that point where they tear tissues, or, I guess, live in too much discomfort. So, their functional strength is definitely improved with collagen. There’s a huge, huge… I love it, actually. I love… Google “YouTube collagen,” and you will see, it’s a very interesting world. Because collagen is a protein that it’s for a particular purpose, yeah? It’s not just the whole protein that you should be taking. And the only people saying collagen isn’t very effective is the ones that are really bro-science. Because they want the best outcome for their muscles.

So, collagen is a good protein. It’s sort of known as, like, a lower-growth protein, when it comes to muscle. But everything else, connective tissue, the best. The little amino acids in it, the peptides in it, is amazing. Glycine, proline, all that sort of stuff is great. But when it comes to muscle, the belly of muscle, so,  you know, the bulk…

Andrew: The guns.

Matthew:  you can take whey protein, or soy protein. You can take something else.

Andrew: Yes.

Matthew: So, a lot of my patients, I will say, take a higher dose. For example, if you’re a dragon boater. We see a lot of dragon boaters. We’re in Pyrmont, so we’re near the Anzac Bridge. Younger, older. Like, you’re in high school, you’re competing at the Olympic Games, you should be taking collagen, essentially. It helps that recovery phase. It also helps to mediate a lot of the inflammatory cells that you develop post-exercise. So, it actually helps to dampen down the lactic acid effect and feeling. And, guess what? Hey, it’s really good for your hair, skin, and nails.

Andrew: Yeah.

Matthew: That’s what I tend…I tend to get a really good laugh from my athletes when I say that. That’s the side effect.

Andrew: So, can I ask about delayed onset muscle soreness? Are you saying that because of that anti-inflammatory action, it could dampen some of that DOMS syndrome?

Matthew: Yeah. And that’s coming back to that, one of the first questions you asked about the types of collagen. That is sort of important to know. Like, why…which one are we giving someone, based on why are you presenting, and what’s your lifestyle like? What do you need to be able to do, compete with? Yeah. So, if I know that someone needs to be able to back up, and they’re very intense with their training, I will actually think, okay, you need a collagen that targets type one or type two or type three collagen. In that sort of particular instance, it’s more like type two. There’s so many different collagens. Yeah. So, we need to try and target that, because that mediates the inflammatory phase. Whereas the other one might be good at really rebuilding your tendon length, or your tendon, your skin, etc. So, yeah. It’s a little bit complicated, and they’re just fine-tuning it. They’re gonna keep fine-tuning it every year, no doubt, for the next five years or more.

Andrew: Matt, it’s absolutely so interesting talking to you and your history. You know, sort of, I can see that you’ve got, like, files floating around your head, of so many patients that you’ve used collagen on, and gained so many benefits. But thank you so much for taking us through just some of the ways in which you use collagen for a therapeutic benefit today. I’ve really enjoyed it. Really interesting to talk to you today. Thanks so much.

Matthew: Yeah, no problem. Thanks for having me. I’ve had a great time.

Andrew: And we’ll put up in the show notes as much information as we can, so that you can explore the different actions and usages of collagen. And of course, there’s the other podcast that you can listen to, on the Designs for Health website. I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”