Diet & Fitness

Several preliminary trials have reported reduced pain and swelling, and/or faster healing in people with a variety of conditions using either bromelain,¹ papain from papaya, ^2,3 or a combination of trypsin and chymotrypsin.⁴ Double-blind trials have reported faster recovery from athletic injuries, including sprains and strains, and earlier return to activity using eight tablets daily of trypsin/chymotrypsin,^5,6,7,8 four to eight tablets daily of papain,⁹ eight tablets of bromelain (single-blind only),¹⁰ or a combination of these enzymes.¹¹ However, one double-blind trial using eight tablets per day of trypsin/chymotrypsin to treat sprained ankles found no significant effect on swelling, bruising, or overall function.¹²

Bromelain is measured in MCUs (milk clotting units) or GDUs (gelatin dissolving units). One GDU equals 1.5 MCU. Strong products contain at least 2,000 MCU (1,333 GDU) per gram (1,000 mg). A supplement containing 500 mg labeled “2,000 MCU per gram” would have 1,000 MCU of activity, because 500 mg is half a gram. Some doctors recommend 3,000 MCU taken three times per day for several days, followed by 2,000 MCU three times per day. Some of the research, however, uses smaller amounts, such as 2,000 MCU taken in divided amounts in the course of a day (500 MCU taken four times per day).

Several preliminary trials have reported reduced pain and swelling, and/or faster healing in people with a variety of conditions using either bromelain,¹³ papain from papaya, ^14,15 or a combination of trypsin and chymotrypsin.¹⁶ Double-blind trials have reported faster recovery from athletic injuries, including sprains and strains, and earlier return to activity using eight tablets daily of trypsin/chymotrypsin,^17,18,19,20 four to eight tablets daily of papain,²¹ eight tablets of bromelain (single-blind only),²² or a combination of these enzymes.²³ However, one double-blind trial using eight tablets per day of trypsin/chymotrypsin to treat sprained ankles found no significant effect on swelling, bruising, or overall function.²⁴

Bromelain is measured in MCUs (milk clotting units) or GDUs (gelatin dissolving units). One GDU equals 1.5 MCU. Strong products contain at least 2,000 MCU (1,333 GDU) per gram (1,000 mg). A supplement containing 500 mg labeled “2,000 MCU per gram” would have 1,000 MCU of activity, because 500 mg is half a gram. Some doctors recommend 3,000 MCU taken three times per day for several days, followed by 2,000 MCU three times per day. Some of the research, however, uses smaller amounts, such as 2,000 MCU taken in divided amounts in the course of a day (500 MCU taken four times per day). Other enzyme preparations, such as trypsin/chymotrypsin, have different measuring units. Recommended use is typically two tablets four times per day on an empty stomach, but as with bromelain, the strength of trypsin/chymotrypsin tablets can vary significantly from product to product.

Comfrey is also widely used in traditional medicine as a topical application to help heal wounds.²⁵ In a study of people with acute ankle sprains, topical application of an ointment four times a day containing a comfrey extract was at least as effective as, and possibly more effective than, a topically applied anti-inflammatory drug (diclofenac). The comfrey ointment was a proprietary product that contained 35% comfrey extract.²⁶

Horse chestnut contains a compound called aescin that acts as an anti-inflammatory and reduces edema (swelling with fluid) following trauma, particularly sports injuries, surgery, and head injury.²⁷ A topical gel containing 2% of the compound aescin found in horse chestnut is widely used in Germany to treat minor sports injuries, including sprains and strains.²⁸ The gel is typically applied to affected area every two hours until swelling begins to subside.

Antioxidant supplements, including vitamin C and vitamin E, may help prevent exercise-related muscle injuries by neutralizing free radicals produced during strenuous activities.²⁹ Controlled research, some of it double-blind, has shown that 400–3,000 mg per day of vitamin C may reduce pain and speed up muscle strength recovery after intense exercise.^30,31 Reductions in blood indicators of muscle damage and free radical activity have also been reported for supplementation with 400–1,200 IU per day of vitamin E in most studies,^32,33,34 but no measurable benefits in exercise recovery have been reported.³⁵ A combination of 90 mg per day of coenzyme Q10 and a very small amount of vitamin E did not produce any protective effects in one double-blind trial.³⁶

Vitamin C is needed to make collagen, the “glue” that strengthens connective tissue. Injury, at least when severe, appears to increase vitamin C requirements,³⁷ and vitamin C deficiency causes delayed healing from injury.³⁸ Preliminary human studies have suggested that vitamin C supplementation in non-deficient people can speed healing of various types of trauma, including musculoskeletal injuries,^38,40 but double-blind research has not confirmed these effects for athletic injuries, which included sprains and strains.⁴¹

Zinc is a component of many enzymes, including some that are needed to repair wounds. Even a mild deficiency of zinc can interfere with optimal recovery from everyday tissue damage as well as from more serious trauma.⁴¹ Trace minerals, such as manganese, copper, and silicon are also known to be important in the biochemistry of tissue healing.^42,43,44,45 However, there have been no controlled studies of people with sprains or strains to explore the effect of deficiency of these minerals, or of oral supplementation, on the rate of healing.

Arnica is considered by some practitioners to be among the most effective wound-healing herbs available.⁴⁶ As a homeopathic remedy, arnica is often recommended as both an internal and topical mean to treat minor injuries. Some healthcare practitioners recommend mixing 1 tablespoon of arnica tincture in 500 ml water, then soaking thin cloth or gauze in the liquid and applying it to the injured area for at least 15 minutes four to five times per day.

Glucosamine sulfate and chondroitin sulfate may both play a role in wound healing by providing the raw material needed by the body to manufacture molecules called glycosaminoglycans found in skin, tendons, ligaments, and joints.⁴⁷ Test tube and animal studies have found that these substances, and others like them, can promote improved tissue healing.^48,49,50,51 Injectable forms of chondroitin sulfate have been used in Europe for various types of sports-related injuries to tendons and joints,^52,53,54,55 and one preliminary trial reported reduced pain and good healing in young athletes with chondromalacia patella (cartilage softening in the knee) who were given 750–1,500 mg per day of oral glucosamine sulfate.⁵⁶ However, specific human trials of glucosamine and chondroitin sulfate for healing sprains and strains are lacking.

Zinc is a component of many enzymes, including some that are needed to repair wounds. Even a mild deficiency of zinc can interfere with optimal recovery from everyday tissue damage as well as from more serious trauma.⁵⁷ Trace minerals, such as manganese, copper, and silicon are also known to be important in the biochemistry of tissue healing.^58,59,60,61 However, there have been no controlled studies of people with sprains or strains to explore the effect of deficiency of these minerals, or of oral supplementation, on the rate of healing.

The use of DMSO, a colorless, oily liquid primarily used as an industrial solvent, for therapeutic applications is controversial. However, some evidence indicates that dilutions, when applied directly to the skin, have anti-inflammatory properties and inhibit the transmission of pain messages by nerves, and in this way might ease the pain of minor injuries such as sprains and strains.^62,63,64 However no controlled research exists to confirm these effects in sprains and strains. DMSO comes in different strengths and different degrees of purity. In addition, certain precautions must be taken when applying DMSO. For those reasons, DMSO should be used only with the supervision of a doctor.

Glucosamine sulfate and chondroitin sulfate may both play a role in wound healing by providing the raw material needed by the body to manufacture molecules called glycosaminoglycans found in skin, tendons, ligaments, and joints.⁶⁵ Test tube and animal studies have found that these substances, and others like them, can promote improved tissue healing.^66,67,68,69 Injectable forms of chondroitin sulfate have been used in Europe for various types of sports-related injuries to tendons and joints,^70,71,72,73 and one preliminary trial reported reduced pain and good healing in young athletes with chondromalacia patella (cartilage softening in the knee) who were given 750–1,500 mg per day of oral glucosamine sulfate.⁷⁴ However, specific human trials of glucosamine and chondroitin sulfate for healing sprains and strains are lacking.

Zinc is a component of many enzymes, including some that are needed to repair wounds. Even a mild deficiency of zinc can interfere with optimal recovery from everyday tissue damage as well as from more serious trauma.⁷⁵ Trace minerals, such as manganese, copper, and silicon are also known to be important in the biochemistry of tissue healing.^76,77,78,79 However, there have been no controlled studies of people with sprains or strains to explore the effect of deficiency of these minerals, or of oral supplementation, on the rate of healing.

Many vitamins and minerals have essential roles in tissue repair, and deficiencies of one or more of these nutrients have been demonstrated in animal studies to impair the healing process.⁸⁰ This could argue for the use of multiple vitamin-mineral supplements by people with minor injuries who might have deficiencies due to poor diets or other problems, but controlled human research is lacking to support this.

Zinc is a component of many enzymes, including some that are needed to repair wounds. Even a mild deficiency of zinc can interfere with optimal recovery from everyday tissue damage as well as from more serious trauma.⁸¹ Trace minerals, such as manganese, copper, and silicon are also known to be important in the biochemistry of tissue healing.^82,83,84,85 However, there have been no controlled studies of people with sprains or strains to explore the effect of deficiency of these minerals, or of oral supplementation, on the rate of healing.