The history of engaging in sport and leisure activity is as old as mankind. The oldest known cave paintings predating 15000 years depict wrestling matches and swimming competitions. 3000 yr old murals in Egyptian burial chambers represent wrestling matches. The first formal games are recorded in Greece some 3000 years ago which included racing, swimming, spear throwing, wrestling, chariot racing etc. Sports not only involved leisure activity but also practising and preparing for wartime. Wrestling and other activities prepared soldiers through mock combat while at the same time keeping them fit. In Greece, sports were considered noble as it was practised by the elite class. Dwandhayudh described in Mahabharata are dated 3000-4000yrs. However, earlier these activities were enacted between competitors without rules and proper supervision, which often led to grievous injuries. Galen, the great Greek physician writes in his ‘Protreptic about medicine’, referring to great athletes of boxing- when athletes grow old, they creep, wrinkle and squint due to severe blows; their eyes filled with catarrhal liquids, their teeth fall and their bones become porotic and break easily. Sports today has become much more regulated and less dangerous than in antiquity, nevertheless, it remains a source of injury affliction. The treatment of such afflictions nonetheless especially concussion has not much advanced despite an increase in the understanding of their dynamics, kinetics and pathology.
Homoeopathy has much to offer when it comes to the treatment of concussions/ head injuries, especially during sports. It is a highly unexplored area and I wish to lay the path to a completely new field and apprise readers with a homoeopathic perspective to sports injury. Let’s start by understanding the monster (aph 3 knowledge of disease).
Concussion is a trauma-induced change in mental status, with confusion and amnesia and other presentations, with or without a brief loss of consciousness.
In contrast, a subconcussive injury shakes the brain violently and has no apparent immediate effect on the functioning of the person.
Sub concussive trauma are more frequent and more often than not go unnoticed and are not remembered and easily recalled later on.
A concussion can happen in any sport that will involve running, sudden change of direction, those that involve speed (a whiplash injury in car racing), nevertheless, it is more common in contact sports such as boxing, rugby, American football, soccer, ice hockey, bull riding etc. Other frequent causes include blast injuries in army personnel, domestic violence etc., which are however out of the scope of the present discussion.
The conditions that can arise as a result of trauma, in this discussion- concussion, depends on many factors which include:
- the sports played,
- the age at which the sport was started,
- particular position of player in team plays and
- the length of time (career span) for which the sports was engaged in.
The younger players, those who are at offensive positions and whose style of play involves headers and those with a longer career are at higher risk of sustaining an injury and its complications.
The injury sustained during a sporting activity can vary from severe trauma to a mild injury with no apparent consequence. At one end of the spectrum, there is acute haemorrhage in the brain which can be life-threatening while at the other end there is chronic traumatic encephalopathy (CTE).
The haemorrhages in the brain can be either epidural, subdural haemorrhages or subarachnoid haemorrhages and they are usually a result of a severe sudden blow to the head (except in those persons who have aneurysms or any condition that requires antiplatelet medication, in which case even mild trauma can induce these beddings.). They may follow injury immediately or may have a lucid interval before neurological deterioration happens. Some may be fatal if not immediately identified and treated, while others may not be fatal but may present as chronic headaches, personality changes and other neurological signs days to a week after the trauma. Depending on the presentation the location of the haemorrhage can be pointed.
In contrast, in an injury of a less severe nature, the treatment is rarely sought. It has been found that those with a history of untreated head injury (traumatic brain injury- TBI) are at higher risk of depression, Alzheimer etc. than the general population.
We may sometimes discard the minor jerking of the head and subconcussive injuries as unfounded fears, it has been however found out in a study done on players during a practice session that pre and post subconcussive functional MRI showed functional changes in the connectivity of the brain in just one session, though there were no changes structurally.
The middle spectrum of the injury holds concussions as well as post-concussive traumas which are defined by headaches, confusion, tinnitus, sleep disturbances etc for a prolonged period. Many of these cases may resolve spontaneously over a period of time, there is still a percentage that continues to suffer despite conventional treatment and fails to resolve.
As against the acute haemorrhages in sports, the other end characterizes recurrent, multiple, prolonged trauma to head over a period of few years most of which goes unnoticed and without treatment. Slowly the recurrent brain injury (recurrent mild traumatic brain injury- MTIB)- responds by recurrent inflammation and healing, leading to deposition of tau protein in the brain and manifesting years later as chronic traumatic encephalopathy (CTE). As we have seen the chronic effects of boxing were even described by Galen 1500 years ago. In modern times, however, it was first described in the 1920s by Dr Martland as dementia pugilistica. In recent times Dr Omalu has described it in detail. CTE is a diagnosis confirmed only on autopsy and presently there is a lack of any test in a living to diagnose it. This neurodegenerative disease manifests as confusion, disorientation, headache in the first stage; memory loss, impulsive/ explosive behaviour, paranoia, jealousy etc in the second stage and speech impairment, dementia, movement disorders, lack of coordination, and imbalance of gait etc in the final stage. The mean duration of onset is between 14-16 yrs after the start of a career. Suicide rates are high among those afflicted as is violent behaviour. Motor symptoms are more common in boxers while behavioural troubles find themselves manifesting in football players and other sports. Maybe these differences could be attributed to differences in the direction and type of injury that the players are prone to during play.
The only treatment of promise in a case of concussion, post-concussion syndrome (PCS) and recurrent subconcussive attacks in conventional medicine is the use of hyperbaric oxygen chambers which reduce the symptoms and help in faster recovery, however, to what extent it will help to prevent CTE is unknown.
In 1999 a study of the effect of homoeopathy as against placebo in MTIB showed statistically significant improvement in the persons who used homoeopathy to treat symptoms. This was later published in the Journal of head trauma rehabilitation (1999).
Moving forward with how to approach such cases, it is imperative to take guidance from Organon of medicine.
Understanding our patients before we start treating them is very important. In aph 7, aph 94 etc master Hahnemann urges us to take the circumstances of the patient into consideration. What the patient looks like, how he/she lives, what are their habits, hobbies, occupation etc. This gives us a sneak peek into the problems that the patient is facing or may face in the future. A complaint from a wrong habit does not need any medication and can be simply corrected by a change in lifestyle. Such maintaining causes should be readily identified and patients should be instructed appropriately in regards to changes that are required. In sports, the surest removal of maintaining cause would be a complete cessation of the sports activity that disposes the sportsperson to injury which may sometimes be possible and other times not.
Severe injuries demand sudden medical attention and the person afflicted seeks immediate assistance, as in those presenting with symptoms of haemorrhage following head trauma, concussion or PCS. In such cases, the history of injury would be clear cut (aph- 93- obvious cause). Such injuries should be evaluated clinically and with the help of modern diagnostic techniques and if required surgical removal of haematoma that has occurred should be done. This is clearly instructed in aph 186. However, despite this, the patient requires dynamic help which is most certainly found in our armamentarium, the queen of injury remedies- ‘Arnica’. The suddenness and severe nature of such injury may preclude any detailed case taking in these cases and one would have to rely on the time tested and proven specifics for such cases. For players in remote areas with no access to medical care, this could be the only hope. In others from urban areas and in elite sportspersons homoeopathy will not only reduce symptoms till the emergency is averted but also will improve the outcome of the injured athlete. In MMP and in the preface to organon 5th edition master Hahnemann clearly enunciate that the unvarying character of blows, concussions etc finds their similimum in ‘arnica’.
When the injury is of more chronic nature, the presentation however is diversified due to the modifying factors, such as environment, personality and personal disposition (aph 81FN) and the character of the disease changes as it manifests itself in different persons. Here TIB and PCS can be treated by taking the manifestation and the causation into account. This will provide us with the totality of symptoms and guide us to the right remedy. Medicines such as arnica (yes, arnica could still be indicated) hypericum, cicuta v etc will come in handy provided the causation of head trauma manifests as a peculiarity, suggestive of these remedies. (cause and effect).
Depression of nat sulph with the tendency to suicide by shooting, irritability and convulsions after trauma suggestive of cicuta, depression after trauma pointing to nat mur are some of such examples.
The last end of the spectrum is to be treated with guidance from aph 7 and 153 where after removing all the exciting and maintaining causes what remains is the pure totality which finds its remedy based on the most peculiar and characteristic symptoms.
Here rubrics like depression, impulsive, suicidal etc comes in handy and after appropriate case taking and individualization will reveal the remedy specific to the case.
There are times when we find that after such injuries what is presented to us by the patient consists of very few symptoms and those that do not particularly point to any remedy. Such cases fall under the classification of one-sided diseases and need a selection of remedies according to the directions mentioned in aph 173- 184.
The need to remove the maintaining cannot be overemphasized, as, as long as the trauma happens, though our medicines would help the majority of cases, there would still be cases that we would only be able to palliate.
It is needless to say that all homoeopaths have treated such cases in their individual capacities with successful outcomes, whether it was labelled a sports injury or not. It is high time that homoeopathy is recognized officially in the treatment of sports injury after it has proven its mettle in other fields. One cannot turn a blind eye to the efficacy, acceptability and accessibility of homoeopathy. The time is not far when homoeopathic medicines would find their way into the first aid boxes serving sportspersons, whether amateurs or professionals officially (homoeopathy has been used by a lot of elite athletes and sportspeople around the world, who vouch for its efficacy in enhancing performance and treating injuries.)
Aude Sapre