**6. Mesotherapy**

any injection carries the risk of introducing infection. Experiments on animal models have been promising. Anaccelerated recovery of contractile tension after a single dose injection of corticosteroids provided soon after a muscle strain, was proven effective in rats, with‐

Unfortunately, evidence is lacking on human subjects. To our knowledge, only two stud‐ ies have been performed on athletes, both of which show promising results. However, neither has been confirmed by other researchers. The first research study [23] retrospec‐ tively reviewed American football players treated with corticosteroid intralesional injec‐ tions for acute hamstring strain. The results demonstrated that the return to play time was reduced and that there were no adverse effects. In the second study [24], baseball pitchers were treated with corticosteroid injection for abdominal strains. This treatment resulted in a quicker recovery and return to play, without any reinjuries. Unfortunately, these studies contained many limitations which warrant further research studies before

A frequently used preparation for the symptoms associated with acute musculoskeletal injuries, is Traumeel® (Biologische Heilmittel Heel GmbH, Baden-Baden, Germany). This is an antiinflammatory and analgesic homeopathic remedy combination that contains small amounts of belladonna, arnica montana radix, Aconitum napellus, chamomilla, Symphytum officinale, Calendula officinalis, Hamamelis virginina, millefolium, hepar sulphuris calcar‐ eum, and mercurius solubilis,plus a fixed combination of biological and mineral extracts. Its use in sport medicine is based on its effect on pain (Atropa belladonna), inflammation (Echinacea), bruising (Arnica montana), wound healing (Matricaria recutita, Calendula officinalis), bleeding (Achillea millefolium), edema (Mercurius solubilis), and infection (Hepar sulfuris). All these effects may have a positive effect on muscle strain healing, however, its ability to accelerate healing has not yet been demonstrated [25]. Traumeel is described to be well tolerated and without adverse effects, which are important characteristics for a product

Actovegin® is a deproteinised haemodialysate produced by Nycomed Austria GmbH. It enhances aerobic oxidation in mammals, which improves absorption of glucose and oxy‐ gen uptake in tissue. It does not contain growth factors or hormone-like substances, how‐ ever, since ithas been thought to be aperformance enhancing agent, Actovegin has been banned for a period by WADA. This is despite the fact that there is evidence in the litera‐ ture,that oral Actovegin does not have any anabolic or ergogenic activity in terms of mus‐ cle development [26]. There is also some scientific evidence that Actovegin may facilitate healing and reduce time of return to play following soft tissue injury [27] However, its use in mainly based on expert opinion, which are reporting good results on the use of

out any major adverse effects recorded [22].

considering an implementation of such treatment.

**5.2. Traumheel®**

160 Muscle Injuries in Sport Medicine

to be utilized on athletes.

Actovegin in athletes.

**5.3. Actovegin**

Mesotherapy is a term that derives from Greek mesos (middle) and therapeia (therapy). It employs multiple injections of pharmaceutical and homeopathic medications, plant extracts, vitamins, and other ingredients into subcutaneous fat. This technique has been purposed and implemented by Michel Pistor (1924–2003), a French physician which performed the first clinical research on this treatment. Mesotherapy is quite a diffusely used treatment method, especially in the sport medicine field. However there are concerns over its efficacy due to the lack of strong scientific evidence supporting its use.

In particular, there is no scientific research on the use of mesotherapy for muscle strains. However, international guidelines purpose weekly sessions to be started as soon as possible after the lesion. Common substances proposed are an anesthetic, a vasodilator and an antiinflammatory with deep injection techniques and a miorelaxant with superficial injection techniques in the region of the lesions.
