R.M. Lawrence, M.D, Ph.D
D. Sanchez, D.C., C.C.S.P
Mark Grosman, D.C.
Twenty-four subjects (both male and female) were seen
in a clinical office setting. The subjects suffered from
acute injuries (under 30 days) sustained during the course
of athletic endeavor. The patient's were selected on a
random basis to receive either a placebo or Lignisul MSM
(methylsulfonylmethane) in addition to routine chiropractic
manipulation, ultrasound and muscle stimulation at each
visit. All patients were treated with similar therapy
and all patients received unmarked capsules of either
a placebo or Lignisul MSM. Patients were discharged from
care once all their symptoms were resolved. Of the twelve
patients who received placebo four of the twelve graded
their results as excellent or good, while of the twelve
patients on Lignisul MSM seven of the twelve graded their
symptom reduction as excellent or good. This represented
a 58.3% of symptom reduction on Lignisul MSM, versus 33.3%
on placebo. Of greater significance, however, was the
fact that patients on Lignisul MSM had 3.25 visits on
an average, while those on placebo had 5.25 visits. This
means that patients on Lignisul MSM had 40% fewer visits
to the office before reaching a recovery phase. This represents
sizable economic advantage.
This paper discusses the chemical nature
of MSM, the possible mechanisms involved in treatment
of such sports injuries and the implications for future
usage of this phytonutrient for the treatment of short
term athletic injuries.
Methylsulfonylmethane (MSM) was first discovered in the
late 1970's by researchers at Oregon Health Sciences University
in Portland. It is a metabolite of DMSO (Dimethyl sulfoxide).
By 1965, more than one thousand five hundred studies had
been conducted on DMSO involving about one hundred thousand
patients. DMSO is used for a host of problems, primarily
musculoskeletal. inflammatory conditions. However, by
1978, the FDA approved DMSO only as a prescriptive treatment
for interstitial cystitis. When DMSO enters the body,
approximately 15% of it is converted to MSM, its major
breakdown component. MSM is in reality DMSO 2 (dimethyl
sulfone). MSM has had widespread use since the late 1970's
in veterinary medicine where it has been used to treat
inflammatory conditions, including muscle and bone disorders.
(1, 2, 3, 4, 5)
In 1998, one of the authors of this
paper, Ronald M. Lawrence, performed a doubleblind study
using patients with degenerative arthritis. This study
showed an 82% decrease in symptomatology after six weeks
of usage on a three-times-a-day dosage. (6) It has been
postulated that MSM takes anywhere from three to six weeks
to produce significant changes in regard to the treatment
of arthritic disorders, but to date there has been no
study that has evaluated it for acute short-term injuries.
R. D. Moore and J. I. Morton
studied the effect of MSM in inflammatory joint disease
in MRL/1pr mice. (7) In addition, R.D. Moore and Morton
studied the effect of 3% water solutions of dimethyl sulfone
(DMSO 2) in P/w mice and found a diminishment in death
due to lupus nephritis. (9) B. V. Siegel and J. Morton
studied the effects of dimethyl sulfone on murine autoimmune
lymphoproliferative disease and explained the benefits
of this compound. (9) Since one-third of the DMSO 2 molecule
is composed of sulfur, a relationship to sulfur metabolism
has been postulated. Several papers have been written
about sulfur and it's roles in such disorders of the musculoskeletal
type. (10, 11) For this reason, and because of the 3 I
effective results noted in the treatment of degenerative
arthritis, this study was undertaken to evaluate the potential
effects of DMSO 2 (MSM) in athletic injuries involving
muscles, tendons, and ligaments.
Twenty-four subjects were examined in a clinical practice
setting (the practice of Daniel Sanchez and Mark Grosman).
This practice deals with a large number of athletic
injuries on a daily basis. The first twenty-four subjects
who came in with complaints of acute injury were admitted
into the study and the subjects were divided in a random
fashion into two groups (A and B). The twelve subjects
in group A received a container labeled "A" which had a thirty-day
supply of capsules, while the twelve in group B received
a contained labeled "B". The doctors and patients involved
were not privy as to whether they received placebo or
actual Lignisul MSM. The code, which defined whether
bottle A or bottle B contained placebo or active substance,
was no broken until after the completion of the study.
Nine of the twelve patients taking
bottle A had diagnoses of sprain/strain injuries, one
had an acute episode of bilateral chondromalacia patellae,
one patient had a right lateral epicondylitis (right elbow),
and one patient had a radicular syndrome (bilaterally)
in addition to a lumbar strain syndrome. In the group
taking bottle B, ten subjects had a sprain/strain diagnoses,
while one subject had a radiculopathy involving the left
lower extremity along with a lumbar sprain syndrome and
one patient exhibited a lateral epicondylitis involving
the right elbow.
Each patient received chiropractic
manipulation in a standard fashion, ultrasound (five watts
for ten minutes) and muscle stimulation (applied in a
standard fashion for five minutes). Each subject took
the material in either bottle A of bottle B three times
a day with meals. The only differential between treatment
given to each group was the administration of either the
placebo or the phytonutrient Lignisul MSM.
All patients were examined in
a similar fashion for angle of motion of the part or parts
involved and this was duly recorded. Patients were also
quizzed as to subjective complaints at the time of each
visit. In addition, palpatory findings in regard to the
musculature in the involved area was recorded on the basis
of zero to four plus, with zero being the absence of any
type of muscle spasm beyond that of a normal resting state,
while four-plus represented extreme muscle spasm based
on the rigidity of the muscle involved. This information
was recorded at each visit as well. In those injuries
involving the upper extremities a Jamar Hand Dynamometer
evaluation of grip strength was recorded at each visit.
In those exhibiting lower extremity or low back injuries,
straight-leg raising testing was performed at each visit
and the degrees of elevation from the horizontal were
noted and recorded.
Those patients in the aliquot which consumed the Lignisul
MSM, on average, reported a faster reduction of symptomatology
than those on the placebo. Four of the subjects taking
the MSM reported the "Disappearance" of symptoms after
taking the capsules for a very short period of time.
(We shall discuss this below). Symptom resolution and
evaluation also consisted of the objective findings
noted by the examining doctors at each visit. Response
of the patients in regard to their symptoms were graded
on a scale of zero to ten with ten being the severest
pain and zero representing an absence of pain. This
evaluation of the symptom level of pain was performed
at each of the visits. Therefore the patients were
evaluated objectively by the doctor at each visit and
there was a subjective evaluation in regard to the
patient's own perception level of pain.
Since we were dealing with very
small study groups the excellent and good categories were
combined in arithmetic fashion and the satisfactory category
and poor category were grouped together, again for purposes
of statistical evaluation in using this small group of
subjects. Seven out of twelve in the A category showed
excellent to good results (58.3%). Those in the B category
showed four out of twelve having excellent to good results
(33.3%). In the satisfactory to poor categories, the total
for the A group was five of twelve (41.66%) versus eight
of twelve in the B category (66.66%).
Since economic considerations
are very important, we determined the number of visits
for each group. The number of visits, on average, for
group A was 3.25 versus group B which was 5.25 visits.
This represents a 40% reduction in visits. The economic
advantages of reduced number of office visits was clearly
noted with patients on Lignisul MSM. This is also reflected
in reduced disability time.
One patient in group A (who
had an acute flare-up of bilateral chondromalacia patellae)
noted complete resolution of her pain within two visits.
Past episodes of this problem had usually taken up to
four visits to resolve and up to two weeks to clear.
This patient had resolution of her problem in less than
one week. One patient who had a diagnosis of left ankle
sprain/strain of a severe type noted a complete resolution
of her problems within three visits over a period of
one week, with a reduction of plus-four swelling of the
ankle joint, resolving within two days after beginning
the test substance ("A").
One patient in group A with a diagnosis of moderate cervical
strain with associated radical syndrome of the right
upper extremity noted complete relief of her discomfort
within one week. Another patient with an episodic flare-up
of lumbar radicular syndrome involving the left lower
extremity noted a 70% improvement in five days (category
A) where typical flare-ups in the past required approximately
ten to fourteen days to resolve. One patient with left
elbow medial collateral ligament sprain (grade 0 needed
only two visits and five days of taking bottle A to resolve
her symptomatology. One patient with a lumbar strain
diagnosis eventually was diagnosed with a herniated nucleus
pulposus (ruptured disc) and substance A did not produce
a resolution of his symptornatology within thirty days.
A male, age sixteen, who fell while playing softball
and injured his right elbow (diagnosed with right elbow
strain, medial collateral ligament grade I strain) noted
a disappearance of symptoms within two days and the examining
doctor found full range of motion (which had been impaired
by 25%) after two days on bottle A. One patient with
lumbar sprain syndrome and associated pyriformis syndrome
went from severe to slight within two days after starting
CONCLUSIONS AND DISCUSSION:
In this small study using Lignisul MSM versus a placebo
(both administered in a similar capsule form and both
capsules appearing exactly the same to the examiners and
the patients) it was discovered that those taking substance
Lignisul MSM had a level of significant recovery from
short-term injuries or flare-ups of previously induced
athletic injuries. From the economic point of view, we
were particularly gratified to see a marked reduction
(40%) in the number of visits usually required to treat
these injuries. It is postulated that MSM has an anti-inflammatory
action based upon increased blood flow to the injured
part (dilation of blood vessels and enhanced blood supply),
reduction in muscle spasm and change in cellular membrane
potentials involving sodium-potassium transfer. (12)
Since MSM, a phytonutrient, has
been shown to have a very low level of toxicity (comparable
to water) and since the substance has also been widely
used in veterinary medicine without showing any toxic
results as well, the use of Lignisul MSM to treat human
sprains, strains and athletic injuries appears to be very
beneficial based on this small but intensive study. A
larger study involving several hundred subjects is being
planned and these subjects will be taken from a sports
It is felt by the authors that
Lignisul MSM, in view of it's low toxicity, inexpensive
costs, and ease of administration, should be considered
as an invaluable addition for treatment of short-term
athletic injuries of the type that were involved in this
study. It was previously shown in a double blind study
that Lignisul MSM had a high rate of effectively in a
chronic painful condition involving osteoarthritis, the
physiologic actions of MSM are apparently similar in producing
an alleviation of symptoms in both chronic and acute conditions.
The present study demonstrated the effectiveness of a
natural substance Lignisul MSM on acute athletic injuries,
such as muscle sprains and strains, with a negligible
level of toxicity and, of even greater importance, a significant
reduction in visits necessary to the doctor's office or
1. Jacob, S. W., E.E. Rosenbaum, and D. C. Wood. Dimetbyl
Sulfate (Basic Concepts), New York; Marcel Dekker, Inc.
2. Jacob, S. W., ed. Biological Actions of Dimethyl Sulfoxide,
Volume 243. New York New York Academy of Sciences, 1975.
3. Jacob, S. W., R. J. Herschler, and H. Schmellenkamp.
The Use of DMSO in Medicine, Munich: Springer Verlag,
4. Jacob, S.W., and J. G. Kappel. DMSO, Munich: Springer
5. Tarshis, Barry. DMSO - The True Story of a Remarkable
Pain-Killing Drug. New York: Morrow, 1981.
6. Lawrence, R.M. "Methylsulfonylmethane (MSM): A double-blind
study of its use in Degenerative arthritis." International
Journal of Anti-Aging Medicine, Summer 1998, I(I)50.
7. Moore, R.D., and J. L. Morton. "Dimished inflammatory
joint disease in MRL/1pr mice ingesting dimethyl sulfoxide
(DMSO) or methylsulfonylmethane (MSM)." Federation of
American Societies for Experimental Biology, 69th annual
meeting. April 1985, p.692.
8. Morton, Jane I., and R. D. Moore. "Lupus nephritis
and deaths are dimished in B/W mice drinking 3% water
solutions of dimethyl sulfoxide (DMSP) and dimethyl sulfone
(DMSO (2). "Journal of Leukocyte Biology, 1986, 40 (3);
9. Morton, Jane I. And Benjamin V. Siegel. "Effects of
oral dimethyl sulfoxide and dimethyl sulfone on murine
autoimmune lymphoprolifefative disease." Proceedings
of the Society for Experimental Biology and Medicine,
10. Moss, Jeffrey. "A perspective on sulfur - Is it the
most ignored, misunderstood essential trace element. "
The Moss Nutrition Report, August 1997, Hadley, M.A.
11. Osterberg, E. E., et al. "Absorption of sulfur components
during treatment by sulfur baths." Archives Dermatol.
Syphitol, 1929, 20:156-66
12. Jacob, Stanley, and Robert Herschler. Pharmacology
of DMSO: Crybiology, 1986, 23.