Hyaluronic Acid for Athletes: What Does the Evidence Say?
Hyaluronic acid is best known from skincare adverts, but it is also sold as an oral "joint supplement" and injected into knees in some private clinics. Athletes with sore joints understandably want to know whether it is worth trying. Our editorial team examined the evidence for both oral and injected forms and what it means for people who train.
What hyaluronic acid does in joints
Hyaluronic acid, or hyaluronan, is a long-chain sugar molecule (a glycosaminoglycan) produced naturally in the body. It is a major component of synovial fluid, the slippery liquid that lubricates joints, and of cartilage, skin and the vitreous humour of the eye.
In synovial fluid, hyaluronan gives viscosity and elasticity, helping the joint absorb shocks and glide smoothly. In osteoarthritis, both the concentration and molecular size of hyaluronan fall, which is thought to contribute to stiffness and pain.
This observation led to two lines of treatment: injecting hyaluronan directly into the joint (viscosupplementation) and, more recently, taking it by mouth as a supplement, typically extracted from rooster combs or produced by bacterial fermentation.
The key question for oral products is absorption. Hyaluronan is a large molecule that is broken down in the gut. Animal studies suggest that fragments can be absorbed and may reach tissues, but whether that translates into meaningful effects in human joints is still being investigated.
Oral supplements: the research
Most trials of oral hyaluronic acid have studied adults with knee osteoarthritis or knee pain, not athletes. The results have been modestly positive but come from relatively small studies, frequently funded by manufacturers.
A pilot trial by Kalman and colleagues (2008) found improvements in pain and quality-of-life scores with a chicken-comb extract rich in hyaluronan. Tashiro and co-workers (2012) reported symptom improvement over 12 months in Japanese adults with knee osteoarthritis, particularly in those under 70 who also performed quadriceps exercises.
A review by Oe and colleagues (2016) concluded that oral hyaluronan may relieve knee pain, while acknowledging the limited number and size of trials. Typical studied amounts were in the range of about 80–240 mg per day over 8 weeks to 12 months.
The overall picture is of a supplement with a plausible mechanism and some encouraging small trials in people with existing joint problems — but without the large, independent studies needed for firm conclusions.
Injections: a different story
Intra-articular hyaluronan injections have been studied far more extensively, yet the conclusions are more cautious than many patients expect.
A large systematic review by Rutjes and colleagues (2012) found that viscosupplementation produced only a small, clinically irrelevant benefit on pain compared with placebo injections, alongside an increased risk of serious adverse events. A network meta-analysis by Bannuru and colleagues (2015) noted that placebo injections themselves produce a notable improvement, which complicates interpretation.
In England, NICE guidance on osteoarthritis (NG226, 2022) advises against offering hyaluronan injections for osteoarthritis. As a result, they are rarely available on the NHS, though some private clinics continue to offer them.
| Form | Main evidence base | Status in UK practice |
|---|---|---|
| Oral supplement | Small trials in knee pain and skin | Sold as a food supplement; no authorised health claim |
| Joint injection | Many trials; small effect versus placebo | Not recommended by NICE for osteoarthritis |
| Topical (skin) | Cosmetic hydration | Cosmetic product, not a joint treatment |
Injections are medical procedures and carry risks, including infection and post-injection flare. Any decision about them should be made with an orthopaedic or sports medicine specialist.
Relevance for healthy athletes
Here the honest answer is that there is very little direct evidence. Healthy young athletes with normal joints have not been the focus of meaningful oral hyaluronan trials, so claims about "protecting cartilage" or "preventing injuries" are speculative.
Joint pain in active people often has specific causes: tendon overload, patellofemoral pain, meniscal or ligament injury, or early osteoarthritis following an old injury. Each has its own management, typically centred on load modification and structured strengthening.
- Possible candidates: masters athletes with early knee osteoarthritis who want to try a low-risk adjunct.
- Unlikely to benefit: young athletes with no joint symptoms.
- Not a substitute: for diagnosis of a new injury or for physiotherapy.
Some combination products pair hyaluronan with glucosamine, chondroitin or collagen. This makes it difficult to attribute any effect to a single ingredient and often increases cost considerably.
Practical use and safety
If you choose to try an oral hyaluronic acid product, it is sensible to follow the amounts used in studies — roughly 80–240 mg per day — and to commit to at least two to three months before judging the effect.
Keeping a simple log of pain during key activities, such as stairs, running or squatting, provides a more objective way to assess change than relying on memory.
Oral hyaluronan appears well tolerated in trials, with few reported side effects. People with allergies to poultry or eggs should check whether a product is derived from rooster combs. Data in pregnancy and breastfeeding are limited, so it is best avoided in those situations unless a doctor advises otherwise.
Hyaluronic acid is not on the WADA prohibited list. As with any supplement, tested athletes should choose products certified by an independent batch-testing programme to reduce the risk of contamination.
Conclusions of the editorial team
Hyaluronic acid plays a central role in joint lubrication, but evidence that supplements improve joint health in healthy athletes is lacking.
Oral products show modest, preliminary benefits in people with knee pain or osteoarthritis, while injections have been found to offer little over placebo and are not recommended by NICE.
For most athletes, joint health depends far more on sensible loading, strength training, body weight and timely assessment of injuries than on any supplement.
Readers may also be interested in our articles on how to take collagen, on glucosamine and chondroitin, and on returning to running after knee pain.
References
- Kalman DS, Heimer M, Valdeon A, Schwartz H, Sheldon E. Effect of a natural extract of chicken combs with a high content of hyaluronic acid (Hyal-Joint) on pain relief and quality of life in subjects with knee osteoarthritis: a pilot randomized double-blind placebo-controlled trial. Nutr J. 2008;7:3.
- Tashiro T, Seino S, Sato T, Matsuoka R, Masuda Y, Fukui N. Oral administration of polymer hyaluronic acid alleviates symptoms of knee osteoarthritis: a double-blind, placebo-controlled study over a 12-month period. ScientificWorldJournal. 2012;2012:167928.
- Oe M, Tashiro T, Yoshida H, et al. Oral hyaluronan relieves knee pain: a review. Nutr J. 2016;15:11.
- Rutjes AW, Jüni P, da Costa BR, Trelle S, Nüesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med. 2012;157(3):180–191.
- Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015;162(1):46–54.
- National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226). London: NICE; 2022.
