This article addresses injuries such as bruises, minor fractures, and sprains. Other forms of minor injury such as minor burns, minor wounds, back pain, and more chronic soft tissue injuries are discussed in their own articles.
Unless you never leave your couch, you are likely to injure yourself sometime. Although minor injuries such as bruises and sprains will heal without treatment, they can be quite unpleasant.
Conventional treatment for minor sprains and strains involves anti-inflammatory drugs, icing, and, in some cases, physical therapy. Bruises are sometimes treated with ultrasound, although there is no meaningful evidence that it really helps.
Proteolytic enzymes help you digest the proteins in food. Your pancreas produces the proteolytic enzymes trypsin and chymotrypsin, and others, such as papain and bromelain, are found in foods. Proteolytic enzymes are primarily used as digestive aids for people who have trouble digesting proteins. When taken by mouth, proteolytic enzymes appear to be absorbed internally to a certain extent, and they might reduce inflammation and swelling. Several small studies have found proteolytic enzyme combinations helpful for the treatment of minor injuries. However, the best and largest trial failed to find benefit.
Most studies involved proteolytic enzymes combined with citrus bioflavonoids, which are also thought to decrease swelling.
A double-blind, placebo-controlled study of 44 individuals with sports-related ankle injuries found that treatment with a proteolytic enzyme and bioflavonoid combination resulted in faster healing and reduced the time away from training by about 50%.1 Based on these and other results, a very large (721-participant) double-blind, placebo-controlled trial of people with an ankle sprain was undertaken.19 It compared placebo against bromelain, trypsin, or rutin (a bioflavonoid), separately or in combination. None of the treatments alone or together proved more effective than placebo.
Three other small, double-blind studies, involving a total of about 80 athletes, found that treatment with proteolytic enzymes significantly speeded healing of bruises and other mild athletic injuries as compared to placebo.2,3,4 In another double-blind trial, 100 people were given an injection of their own blood under the skin to simulate bruising following an injury. Researchers found that treatment with a proteolytic enzyme combination significantly speeded recovery.5 However, most of these studies were performed decades ago and fall beneath modern standards in design and reporting.
Oligomeric proanthocyanidins (OPCs), substances found in grape seed and pine bark, have shown promise for the treatment of minor injuries. A 10-day, double-blind, placebo-controlled study enrolling 50 participants found that OPCs improved the rate at which edema disappeared following sports injuries.8 It is also relevant that a double-blind, placebo-controlled study of 63 women with breast cancer found that 600 mg of OPCs daily for 6 months reduced postoperative edema and pain.9 Similarly, in a double-blind, placebo-controlled study of 32 people who had cosmetic surgery on the face, swelling disappeared much faster in the treated group.10
Preliminary evidence from a somewhat poorly reported double-blind trial of 40 college football players suggests that a combination of vitamin C and citrus bioflavonoids taken before practice can reduce the severity of athletic injuries.12
Another small placebo-controlled study suggests that an oral combination product containing vitamin C, calcium, potassium, proteolytic enzymes, rutin, and OPCs can slightly accelerate healing of skin wounds.20
The herb horse chestnut is thought to have properties similar to those of citrus bioflavonoids. The active ingredient in horse chestnut is a substance called aescin. One double-blind study of 70 people found that about 10 g of 2% aescin gel, applied externally to bruises in a single dose 5 minutes after the bruises were induced, reduced their tenderness.11
The herb comfrey is unsafe for internal use due to the presence of liver-toxic pyrrolizidine alkaloids. However, topical use is believed to be safe. In a double-blind, placebo-controlled study of 142 people suffering from an ankle sprain, use of comfrey gel resulted in more rapid recovery than placebo gel, according to measurements of pain, swelling, and mobility.21
The supplement creatine has shown some promise for preventing the muscle weakness that commonly occurs when a limb is immobilized following injury or surgery.14,15 However, one study failed to find creatine helpful for restoring strength following arthroscopic knee surgery.22
The supplement glucosamine might be helpful for people who experience knee pain due to cartilage injury.17 In addition, one study found somewhat inconsistent evidence hinting that glucosamine might aid recovery from acute knee injuries experienced by competitive athletes.28
One study failed to find that onion extract can help reduce scarring in the skin.27
Acupuncture is a treatment method aimed at eliciting a response (such as pain relief) through insertion of very fine needles in the body surface at sites called acupuncture points. Although it is a popular alternative way to help relieve pain, it is difficult to properly ascertain the its effectiveness. In a review of 20 randomized or quasi-randomized trials, acupuncture was evaluated in 2,012 people with a sprained ankle. Acupuncture was associated with an improved cure rate or function when compared to no treatment, other nonsurgical treatments, or in combination with other nonsurgical treatments such as topical gels, far-infrared lamp radiation, electrophysical therapy, and Chinese herbal medications. There were no differences when acupuncture was compared to Chinese herbal patches, ice packs, or elastic bandage and immobilization. The trials evaluated were unblinded, meaning people were aware of their treatment. This bias can affect the results of the trials, making it appear the treatment is more effective than it really is.29
Homeopathic forms of the herb arnica are popular as a treatment for injuries, but studies suggest they are no more effective than placebo.16,24-26 Other homeopathic treatments are discussed in the homeopathy section of this database, under the titles Bruises and Sports-related Injuries.
1. Baumuller M. The application of hydrolytic enzymes in blunt wounds to the soft tissue and distortion of the ankle joint—a double-blind clinical trial [in German]. Allgemeinmedizin. 1990;19:178-182.
2. Zuschlag JM. Double-blind clinical study using certain proteolytic enzyme mixtures in karate fighters [working paper]. In: Mucos Pharma GmbH(Germany). 1988;1-5.
3. Rathgeber WF. The use of proteolytic enzymes (chymoral) in sporting injuries. S Afr Med J. 1971;45:181-183.
4. Deitrick RE. Oral proteolytic enzymes in the treatment of athletic injuries: a double-blind study. Pa Med. 1965;68:35-37.
5. Kleine MW and Pabst H. The effect of an oral enzyme therapy on experimentally produced hematomas [translated from German]. Forum des Prakt und Allgemeinarztes. 1988;27:42, 45-46,48.
6. Shaw PC. The use of a trypsin-chymotrypsin formulation in fractures of the hand. Br J Clin Pract. 1969;23:25-26.
7. Blonstein JL. Control of swelling in boxing injuries. Practitioner. 1969;203:206.
8. Parienti J-J, Parienti-Amsellem J. Post-traumatic edemas in sports: a controlled test of Endotelon [translated from French] . Gaz Med Fr. 1983;90:231-236.
9. Pecking A, Desprez-Curely JP, Megret G. Oligomeric grape flavanols (Endotelon) in the treatment of secondary upper limb lymphedemas [translated from French]. [Source unknown]. 1989:69-73.
10. Baruch J. Effect of Endotelon in postoperative edema. Results of a double-blind study versus placebo in 32 female patients [in French]. Ann Chir Plast Esthet. 1984;29:393-395.
11. Calabrese C, Preston P. Report of the results of a double-blind, randomized, single-dose trial of a topical 2% escin gel versus placebo in the acute treatment of experimentally-induced hematoma in volunteers. Planta Med. 1993;59:394-397.
12. Miller MJ. Evaluation of ascorbic acid and water soluble citrus bioflavonoids in the prophylaxis of injuries in athletes. Med Times. 1960;88:313-316.
13. Fassina A, Rubinacci A. Post-traumatic edema: a controlled study into the activity of hydroxyethyl rutoside [translated from Italian]. Gazz Med Ital Arch Sci. 1987;146:103-109.
14. Hespel P, Eijnde BO, Van Leemputte M, et al. Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans. J Physiol. 2001;536:625-633.
15. Op 't Eijnde B, Urso B, Richter EA, et al. Effect of oral creatine supplementation on human muscle GLUT4 protein content after immobilization. Diabetes. 2001;50:18-23
16. Alonso D, Lazarus MC, Baumann L. Effects of topical arnica gel on post-laser treatment bruises. Dermatol Surg. 2002;28:686-688.
17. Braham R, Dawson B, Goodman C. The effect of glucosamine supplementation on people experiencing regular knee pain. Br J Sports Med. 2003;37:45-49.
18. Perna FM, Antoni MH, Baum A, et al. Cognitive behavioral stress management effects on injury and illness among competitive athletes: a randomized clinical trial. Ann Behav Med. 2003;25:66-73.
19. Kerkhoffs GM, Struijs PA, De Wit C, et al. A double blind, randomised, parallel group study on the efficacy and safety of treating acute lateral ankle sprain with oral hydrolytic enzymes. Br J Sports Med. 2004;38:431-435.
20. Brown SA, Coimbra M, Coberly DM, et al. Oral nutritional supplementation accelerates skin wound healing: a randomized, placebo-controlled, double-arm, crossover study. Plast Reconstr Surg. 2004;114:237-244.
21. Koll R, Buhr M, Dieter R, et al. Efficacy and tolerance of a comfrey root extract (Extr. Rad. Symphyti) in the treatment of ankle distorsions: results of a multicenter, randomized, placebo-controlled, double-blind study. Phytomedicine. 2004;11:470-477.
22. Tyler TF, Nicholas SJ, Hershman EB, et al. The effect of creatine supplementation on strength recovery after anterior cruciate ligament (ACL) reconstruction: a randomized, placebo-controlled, double-blind trial. Am JSports Med. 2004;32:383-388.
23. Doetsch AM, Faber J, Lynnerup N, et al. The effect of calcium and vitamin D(3) supplementation on the healing of the proximal humerus fracture: a randomized placebo-controlled study. Calcif Tissue Int. 2004 May 27. [Epub ahead of print]
24. Ramelet AA, Buchheim G, Lorenz P, et al. Homoeopathic arnica in postoperative haematomas: a double-blind study. Dermatology. 2000;201:347-348.
25. Campbell A. Two pilot controlled trials of Arnica montana. Br Homeopath J. 1976;65:154-158.
26. Stevinson C, Devaraj VS, Fountain-Barber A, et al. Homeopathic arnica for prevention of pain and bruising: randomized placebo-controlled trial in hand surgery. J R Soc Med. 2003;96:60-65.
27. Chung VQ, Kelley L, Marra D, et al. Onion Extract Gel versus Petrolatum Emollient on New Surgical Scars: Prospective Double-Blinded Study. Dermatol Surg. 2006;32:193-198.
28. Ostojic SM, Arsic M, Prodanovic S, et al. Glucosamine administration in athletes: effects on recovery of acute knee injury. Res Sports Med. 2007;15:113-124.
29. Kim TH, Lee MS, et al. Acupuncture for treating acute ankle sprains. Cochrane Database Syst Rev. 2014;6:CD009065.
Last reviewed September 2014 by EBSCO CAM Review Board
Last Updated: 9/18/2014
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