Homeopathy In Sport : Can less really be more when it comes to treating sports injuries?

Homeopathy is a form of medicine that has become increasingly popular in recent years, with more than 30 million users in Europe and many millions more across the globe. Sportsmen and women are particularly likely to favour homeopathic preparations and with good reason, writes Jim Rogers. [MAM] In simple terms, homeopathy is a complete system of medicine that has been in use around the world for more than 200 years. Although it is often lumped together and confused with herbal medicine, aromatherapy and other so-called complementary therapies, homeopathy is a unique system, with defining features that distinguish it from any other method. The word homeopathy is derived from the Greek words homoios, meaning similar, and pathy, meaning suffering. It is based on the principle of treating like with like, known to homeopaths as the law of similars. This idea was known to the ancient Greeks and suggested by Hippocrates, but it wasnt until the early nineteenth century that it was developed into a system by the German doctor Samuel Hahnemann. The second defining feature of homeopathy is that the medicines are used in ultra-molecular, or very extreme, dilutions. This practice developed through systematic experimentation, which indicated that a process of repeated dilution of a substance, together with a vigorous shaking of the mixture at each stage of dilution, produced, paradoxically, a more potent or effective medicine. Many scientists find this idea completely illogical because it defies the known laws of chemistry and physics. However, others have found that it makes a lot of sense in practice. In recent years, many attempts have been made to develop new theories that can explain its mechanism of action, which remains mysterious. Bear in mind, though, that there are a number of conventional medicines, including aspirin and certain antibiotics, whose mechanism of action remains unknown but are still prescribed with confidence by doctors.

A sceptical approach
Many researchers approach the subject of homeopathy with scepticism and are then persuaded to change their minds by the evidence. For example, pharmacologist Madeleine Ennis and colleagues from Belfast recently embarked on a study to prove that homeopathy was impossible (1) . They repeated earlier controversial research into the effects of dilutions of histamine on human white blood cells involved in inflammation. The study, replicated in four different laboratories, found that homeopathic dilutions so small that they theoretically contained not a single histamine molecule acted just like histamine. Ennis conclusion was that we are unable to explain our findings and are reporting them to encourage others to investigate this phenomenon. Before looking at further evidence for and against homeopathy it is worth considering for a moment the central idea of homeopathy and asking if it makes any sense. Why should the idea

of curing like with like hold any validity? Consider for a moment what it means when the body produces a symptom, whether it be pain, swelling, inflammation, fever or anything else. A symptom is a sign that something is going wrong, but it is also part of the healing process. As Andrew Hamilton demonstrated in a recent issue of Peak Performance (PP 214, page 1), the process of inflammation is a necessary response to injury which, through a range of complex processes, allows the renewal and healing of damaged tissue. If symptoms are part of the healing process, what is the best way to treat them? The strategy employed by conventional medicine is to remove or suppress them and, indeed, antiinflammatory medications do this very well. However, as Hamilton pointed out, suppressing symptoms may also suppress the healing process, and it is now clear that this is exactly what happens with the commonly-used non-steroidal anti-inflammatory drugs (NSAIDs).

Treatment mimics symptoms

Homeopathy takes the opposite approach by prescribing a treatment that, far from suppressing the symptoms, actually mimics them for a short time and therefore encourages the healing process. Thus a homeopath might prescribe to a person with a fever a preparation of belladonna (deadly nightshade), an obvious poison which can cause a very high fever along with many other symptoms. Because the amounts used in homeopathic preparations are diluted to an extreme degree and in a series of stages, all homeopathic preparations are very safe. Indeed, homeopathy is probably the safest of all medical systems. A very thorough review of the worldwide literature found that, while there can be adverse effects, these are always mild and transient (2). Herbal medicines can be toxic and even acupuncture carries some risks, such as contaminated needles. By contrast, homeopathy offers the ideal risk:benefit ratio.

Does homeopathy really work?

Contrary to popular perception, a wide range of trials have been carried out on homeopathy, and in the last 20 years a number of attempts have been made to summarise and assess these trials. A standard technique is meta-analysis, which pools and assesses the data from a range of trials and includes issues of quality and reliability. For example, a 1991 meta-analysis by Linde et al, which considered the evidence from 107 trials, was published in the respected medical journal The Lancet. The authors were surprised by the amount of favourable evidence they found 81 of the trials had positive results and concluded: it is wrong to say that homeopathy has not been evaluated according to the modern method of controlled trials (3). In 1996 the European Parliament requested a similar study. Data from trials comparing homeopathy either to placebo or to no treatment were examined and the authors, nonhomeopathic scientific researchers, concluded that the number of significant results was clearly not down to chance (4). An important point to bear in mind is that homeopathic medicines are usually matched to individual symptoms rather than to diagnostic categories. A 1997 meta-analysis of 89 trials,

which took account of this individualised treatment, concluded that: it is impossible that the clinical effects of homeopathy were exclusively caused by a placebo effect(5). As Dr David Taylor Reilly, of the Glasgow Homeopathic Hospital, noted after the third in a series of trials of homeopathy in allergy treatment showed positive results: Either homeopathy works or the clinical trial does not(6). A systematic review of results from 93 randomised controlled trials (RCTs) carried out in 2003 concluded that, of 35 different medical conditions covered by these trials, the evidence favoured a positive treatment effect in eight, as follows: childhood diarrhoea, fibrositosis, hay fever, influenza, pain (miscellaneous), side effects of chemotherapy or radiotherapy, sprains and upper respiratory tract infections (7).

Homeopathy in sport
Several trials of homeopathy have considered the effects on sports injuries, such as ankle sprains, muscle strains and muscle soreness after exercise, while others have homed in on the kinds of health problems many athletes are prone to, including upper respiratory tract infections, influenza, hay fever and cramps. Homeopathic medicines are used in a range of different strengths, which are indicated by a number after the name of the medicine. Thus a study which mentions arnica 6x refers to a preparation of arnica that has been prepared using six stages of dilution and succusion (vigorous shaking) of the crude substance, with each stage involving a 1-in-10 dilution of the original substance. When the letter c appears after the number, this denotes a centesimal dilution ie one part in 100.

Table 1: ten reasons for athletes to choose homeopathic medicines

There are no harmful side effects They are safe to use in all cases, and equally effective in babies, old people and pregnant women Because of the degree of dilution, they will not show up in any drug testing procedures, so there is no need to check whether any of the ingredients are on a banned list They cost less than NHS prescription medicines Unlike conventional medicines, they can be kept for later use, with often only a few tablets from a bottle being needed for each episode of treatment They are NOT tested on animals all homeopathic medicines are tested through systematic trials with healthy human volunteers They work with rather than against the bodys own repair mechanisms They have been used effectively, in all parts of the world, for over 200 years They appear to speed up the healing process and get you back to training and performing more quickly An increasing amount of high-quality scientific research demonstrates that homeopathic medicines really do work

Table 2: common homeopathic remedies used by athletes

Arnica montana ( made from the plant also known as leopards bane) This is the first remedy that users of homeopathy think of for any kind of injury. The list of symptoms which have been successfully treated by arnica include:

Bruising Shock (dazed, cold, fainting, confusion)

Ruta graveolens (made from the plant also known as rue)

Injuries to the periosteum, eg bruised shins Sprained ankles, bursitis Stiffness in the joints that improves with movement and warmth but is worse if too much activity is undertaken and in cold, damp conditions

Rhus tox (made from the poison ivy plant)

Plantar fasciitis, tendinitis Stiffness which is worse on first movement and in the cold but improves with continued movement and with warmth

Hypericum (the homeopathic use of the St Johns wort plant)

Injuries to parts that are rich in nerves and hence tend to be very painful, eg coccyx, fingers and toes

Ledum (made from the marsh tea plant)

Bruises that do not respond to arnica Black eyes Injuries that feel cold to the touch but are also better for application of cold packs

Calendula (made from the marigold plant)

Used externally to aid healing of wounds, cuts and abrasions. Has antiseptic properties

Symphytum (made from the plant also known to herbalists as knitbone)

To aid and speed the healing of fractures

Traumeel (a combination of 14 homeopathic remedies in low strengths 3x-6x which can be used internally or externally, as a cream)

Traumas such as sprains and bruises with their resulting pain, inflammation and swelling

Arnica and muscle soreness

Arnica is one of the most popular homeopathic remedies for musculoskeletal problems, and many endurance athletes use it in the belief that it can reduce muscular soreness after exercise.

There have been a number of studies of this remedy. For example, a 1998 study of arnica for treating muscle soreness after long-distance running found it no more effective than placebo a finding that has been widely reported (8). [MAM] However, a similar study carried out in Norway in 2003 found that arnica did reduce muscle soreness after marathon running (9). This study pooled results from two trials conducted around the Oslo Marathon in 1990 and 1995. The treatment, tablets of arnica 30, was started on the night before the race and continued for four days. Runners assessed muscular soreness on a visual analogue scale, while muscle enzymes, electrolytes and creatinine were measured before and after the marathon. The results suggested that, while arnica did not have any effect on cell damage as measured by enzymes, it did reduce muscle soreness. As far as arnica is concerned, one further study is worthy of mention. Arnica 5c was given to patients subjected to prolonged venous perfusion (a condition which easily leads to phlebitis) (10) . The researchers found that arnica not only reduced pain and inflammation by comparison with placebo but also inhibited the formation of haematomas. Furthermore, the arnica-treated group also experienced improved blood flow and clotting ability. In other research, a trial comparing two homeopathic drugs against placebo for muscular cramps found the homeopathic preparations to be therapeutically superior (11). A placebo-controlled trial of a topically applied homeopathic remedy to treat tibiotarsal (ankle) sprain also found that the homeopathic treatment was superior (12). In this trial, patients who used the homeopathic combination remedy Traumeel were significantly more likely to be painfree on day 10 of treatment than those in the placebo group. Another trial of Traumeel for a range of sports injuries again found it superior to placebo on measures of maximum muscle force, time to resumption of training, pain severity and overall evaluation by patients and doctors (13). It is well established that sports performers are particularly prone to infection when training at high intensity. For example, a study after the Los Angeles Marathon found that one in seven runners came down with an upper respiratory infection after taking part in the race, compared with just two out of 100 runners who didnt compete (14). Take part in an ultra event, such as a 100-mile race, and your chances of getting sick are more like one in four (15)! Homeopathy is widely used to treat infections and homeopathic medicines have been shown not just to reduce the occurrence of upper respiratory tract infections and influenza but to treat them effectively when they do arise. Several studies have suggested that the homeopathic remedy oscillococcinum (which is prepared from a duck liver) is a very effective treatment for influenza. One study found that the remedy significantly increased the rate of cure within two days of diagnosis (16). This was a high- quality trial, published in an important, non- homeopathic journal and involving large numbers of patients (237 treated and 241 on placebo).

A recent literature review of this treatment found that it did reduce the duration of illness in patients presenting with influenza symptoms. However, the researchers concluded that, while promising, the evidence was not strong enough to recommend the use of oscillococcinum as a first- line treatment (17).

Homeopathy a sports doctors testimonial

Dr Jean Marcel Ferret, doctor to the French soccer team from 19932004, the period which included their World Cup win, became an advocate of homeopathy. Heres why: I am open to all techniques. As a sports doctor I quickly discovered that, except for antiinflammatories and muscle relaxants, I was very limited in the care of athletes. I began to use homeopathy, first occasionally, and then more and more. At first the athletes were surprised and even wary. So I explained how and why homeopathy acts. The greatest value in sports? Its speed of action. I can use it directly on the soccer field, within seconds of the trauma, and note the results almost immediately. The players are highly trained, a population at risk, with slightly defective immune systems. We have to protect their health this involves an emphasis on prevention, taking into account the personality of each player. I now know that this approach is that of homeopathy (21) Dr Ferrets experience mirrors that of many doctors and coaches who add homeopathy to their repertoire of techniques for assisting athletes at all levels. They find homeopathy offers treatments that:

work very fast in acute and traumatic situations; support the immune system and help to prevent and treat infection; are tailored to each individual and his/her unique physical and psychological make-up.

Cough treatment
A further example in the field of respiratory tract infections relates to the treatment of cough. A French study looked at the treatment of dry cough with a syrup mixture based on the homeopathic remedy drosera and nine other homeopathic remedies. After one week the cough had improved or disappeared altogether in 20 out of 30 patients in the treatment group, compared with only eight out of 30 in the placebo group (18). Interestingly, it seems that sportsmen and women are particularly motivated to use complementary therapies like homeopathy. A study of 436 patients attending German hospitals found that 42% used some form of alternative medicine, with homeopathy by far the most popular. While there was no statistical link between use of these therapies and age, gender, education or duration of the problem, there was a strong correlation with regular sports participation (19). It has been said that extraordinary claims require extraordinary evidence. And many members of the orthodox scientific community have argued that homeopathy is too extraordinary to

credit. However, there is a growing body of high- quality evidence that homeopathic treatment is superior to placebo for a range of conditions. While the evidence remains weak and contradictory in some areas, it is worth pointing out that homeopathy is both low cost and low risk. As well as proving superior to placebo it has been shown for a range of conditions to be as good as the equivalent conventional medicine, yet with no side effects and lower cost (20). We can only hope that the current increase in the number of high quality research studies into homeopathy continues, and that researchers in fields related to sports science can add to this body of knowledge and help to answer some of the many questions which remain in relation to this popular form of medicine. In the meantime, sportsmen and women who use homeopathy can do so safe in the knowledge that, while the body of scientific evidence behind it remains relatively small, the evidence is growing rapidly and it is undoubtedly a very safe and inexpensive method of treatment. Jim Rogers B Hons, RMN, RS Hom is a registered homeopath practising in Hull and East Yorkshire and also lecturing on complementary medicine at the University of Lincoln. He is also an ultra runner (currently the fastest in the UK over 24 hours) and has a keen interest in the use of complementary medicine in sport

References
1. Inflammation Research 2005; 53:181 2. British Homeopathic Journal 2000; 89(1):S35 3. The Lancet 1997; 350:834-43 4. Report to European Commission Directorate XII, 1996; 16-7 5. Homeopathic Medical Research Advisory Group 1997, EC 6. British Medical Journal 321:471 7. Homeopathy 2003; 92(2):84-91 8. Clinical Journal of Pain 1998; Sep 14 (3): 227231 9. Homeopathy 2003; 92(4):187-189 10. Cahiers Biotherapie 1988; 98.77 11. Allgemeine Homeopathische Zeitung 1976; 221: 26-31 12. Forts der Med 1988; 96:62-100 13. Biol Ther 1992; 10(41):290-300 14. Journal of Sports Medicine and Physical Fitness 1990; 30(3):316-28 15. International Journal of Sports Medicine 2003; 24:541-47 16. British Journal of Clinical Pharmacology 1989; 27:329 17. Cochrane Database Systematic Review 2000; CD001957 18. Cahiers dOtorhinolaryngologie 21.731 19. Schweiz Med Wochenschr 1998; 128:616-22 20. Homeopathy Scientific Proofs of Efficacy 2002, GUNA, Milan 21. www.boiron.com/en/htm/03_homeo_medecine/homeo_med_sport.htm