Boswellia

Boswellia has plausible anti-inflammatory mechanisms and decent human data for joint pain (especially osteoarthritis). Direct, high-quality trials for tendonitis are scarce; one large observational study and a small randomized post-surgical shoulder trial used Boswellia in combination with curcumin and reported benefits. Treat it as an adjunct to a proper tendon-loading rehab program—not a stand-alone cure.

Shuts down leukotriene-driven inflammation (5-LOX): The boswellic acid AKBA inhibits the 5-lipoxygenase enzyme (5-LOX), reducing leukotrienes that can fuel inflammatory pain in musculoskeletal tissue. This has been demonstrated in pharmacology work on AKBA’s non-competitive 5-LOX inhibition. Bournemouth University

Broader anti-inflammatory signaling effects: Reviews describe down-regulation of NF-κB/TNF-α and matrix-degrading enzymes—mechanisms relevant to painful tendon and peritendinous tissue irritation. ScienceDirect

Human pain data (indirect for tendons): Multiple randomized trials in knee osteoarthritis show clinically meaningful pain and function improvements with standardized Boswellia extracts within 1–2 weeks, supporting its analgesic/anti-inflammatory potential in load-bearing tissues. Frontiers

Oral standardized extracts (most studied):

• Look for products standardized to boswellic acids (often 30–65%) and/or AKBA (~20–30%).
• Typical trial-based regimens:
• Boswellia serrata extract (AKBA 30%): 150–300 mg twice daily for 90 days in knee OA RCT; improvements seen by day 5. Link includes full dose details. Frontiers
• 5-Loxin® or Aflapin® (AKBA-enriched): 100 mg once daily for 90 days in knee OA RCTs. PubMed
• How long to try: Evaluate at 4–8 weeks; many OA trials ran 8–12 weeks. If no benefit by ~8 weeks, reconsider. (Duration derived from RCT timelines above.) Frontiers+1
• With food: Helps minimize GI upset (general herbal guidance; also reflected in consumer-facing monographs). WebMD

Topical use (less data, but may help local pain):

• An RCT in knee OA used a frankincense (Boswellia) oily solution applied 3× daily for 4 weeks and improved pain/function vs placebo. Extrapolation to tendons is reasonable for superficial sites (e.g., lateral elbow, patellar), but evidence is indirect. BioMed Central

Combinations sometimes used in tendon care:

• Boswellia + Curcumin:
• Tendinopathy (observational): 670-patient, 1-month open-label study (2 tablets twice daily of a curcumin+Boswellia product) reported ~50% reductions in pain and functional limitation across tendon sites; authors call for RCTs. ProCare Health
• Post-op supraspinatus repair (randomized, placebo-controlled): Boswellia+curcumin supplement started 3 weeks pre-op and continued post-op reduced pain vs placebo. This is peri-operative pain, not classic overuse tendinopathy, but supports an analgesic role. ResearchGate

Mechanism

• AKBA’s selective, non-redox 5-LOX inhibition (leukotriene pathway). (British Journal of Pharmacology mechanistic work.) Bournemouth University
• Reviews on anti-inflammatory signaling and joint protection with Boswellia. ScienceDirect

Musculoskeletal pain & joints (indirect but higher-quality)

• Frontiers in Pharmacology (2024): RCT, 105 pts, Boswellia 150–300 mg BID (30% AKBA) for knee OA → significant pain/function gains by day 5; biomarkers (TNF-α, IL-6, hs-CRP) fell; no major adverse events. Frontiers
• Int J Med Sci (2010): RCT, 5-Loxin® or Aflapin® 100 mg daily vs placebo for knee OA → significant pain/function improvement, some within 7 days. PubMed
• Additional OA RCTs/meta-analyses referenced within the above papers corroborate benefits (e.g., Kimmatkar 2003; Majeed 2019). BioMed Central

Tendons specifically

• Open-label, post-observational (2020): 670 patients with tendinopathy given curcumin + Boswellia for 1 month reported ~50% pain and function reduction; non-randomized; industry-funded → low certainty, but promising. ProCare Health
• Randomized, placebo-controlled, post-op shoulder study (2015): Curcumin+Boswellia as co-analgesic around arthroscopic supraspinatus repair reduced pain vs placebo. Not classic overuse tendinopathy but relevant to tendon pain modulation. ResearchGate

Bottom line on evidence strength for tendonitis: We have plausible mechanisms and good RCTs for joint pain, plus limited, lower-quality or combination-product data in tendon conditions. Use as an adjunct while prioritizing progressive loading rehab.