Proteolytic enzymes are also of interest because of their ability to support, enhance, and regulate the circulatory and immune systems - factors that help to optimise performance during sports.

Nevertheless, for years, enzyme use fell out of popularity, due in part to the fact that many are natural substances that pharmaceutical companies cannot patent and, therefore, profit from. However, new formulations now involve patented combinations of several types of enzymes that deliver standardised levels of activity (see box, page 2) so, once again, this kind of treatment has become fashionable.

Over the years, several trials have reported faster recovery from athletic injuries, including sprains and strains, and an earlier return to activity using trypsin/chymotrypsin (Penn Med J, 1965; Oct: 35-7; Br J Clin Pract, 1970; 24: 375-7; S Afr Med J, 1971; 45: 181-3), papain (Curr Ther Res, 1969; 11: 621-4) and bromelain (Practitioner, 1967; 198: 547), or a combination of these enzymes.

Even better, enzymes compare very favourably to NSAIDs - often besting them in clinical trials. One double-blind study compared an oral preparation containing bromelain, trypsin and rutin with an NSAID (diclofenac) in 73 patients suffering from osteoarthritis of the knee (Clin Drug Invest, 2000; 19: 15-23). After three weeks, it was found that the enzyme mixture was as effective as the NSAID in significantly reducing pain - by around 80 per cent. This decrease in pain was sustained for four weeks after the treatment had ended. Enzyme therapy also produced fewer adverse effects.

Another study comparing the same combination of enzymes with various NSAIDs found similarly positive results (J Assoc Phys Ind, 2001; 49: 617-21).

Finger on the trigger Other alternative measures have plenty to offer active men and women who sustain musculoskeletal injuries during sports or exercise. Chiropractic, hyperbaric oxygen and massage, among others, can help get athletes off the NSAID treadmill and back into action (see box, page 3). Acupuncture, however, appears to work most closely with natural body processes to relieve pain and encourage healing.

Acupuncture, a traditional Chinese healing practice, involves inserting hair-thin needles into specific anatomical points to redirect the body’s flow of energy, or qi (pronounced ‘chee’). Since 1997, acupuncture has been recognised by the US NIH (National Institutes of Health) as a valid treatment for a range of painful conditions, including tennis elbow, fibromyalgia, low-back pain and carpal tunnel syndrome (JAMA, 1998; 280: 1518-24). The technique appears to activate the body’s natural painkillers by causing the release of the morphine-like endorphins (Life Sci, 1979; 25: 1957-62).

The good news is that acupuncture doesn’t just cover up pain. Numerous studies have documented its effects on circulating hormones such as ACTH, cortisol and growth hormone (Lancet, 1979; 2: 535-6; Int J Neurosci, 1980; 10: 95-7; Life Sci, 1983; 32: 1705-9), thereby affecting inflammation and tissue healing.

Acupuncture now encompasses the Western discipline ‘trigger-point therapy’, commonly used in sports medicine.

Trigger points are irritated points in muscles that often refer pain to other parts of the body. In some ways, trigger points are the muscle equivalent of a stress fracture in bone.

A good example is tennis elbow, where trigger points in the forearm muscles cause the problem. Chronic spasm of these muscles puts tension on the elbow tendons, leading to pain and inflammation. If these particular trigger points are not treated, the tennis elbow will not get better, or will return as soon as the patient returns to regular activity.