Enzyme therapy in sports injuries

Authors

  • Mohit R. Shete Department of Orthopaedics, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane, Maharashtra, India
  • James John Department of Medical Services, SIRO Clinpharm Ltd., Thane, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2454-2156.IntJSciRep20222638

Keywords:

Proteolytic enzymes, Sprains, Ankle injury, Inflammation

Abstract

Sports and exercise activities are helpful to increase overall health and physical fitness. But also, there is risk of different types of injuries such as sprains, strains, dislocations and fractures collectively known as sports injuries. Sports injuries, if not treated promptly and properly, may lead to lifelong disabilities or may affect athlete’s ability to participate in sports. Most of the sports injuries are affecting bones and soft tissues manifesting pain, inflammation and restricted mobility. The common treatment modalities are the use of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids for pain and inflammation management in sports injuries. But these drugs may lead to severe side effects in long term use. Also, NSAIDs and corticosteroids, do not promote crucial process of remodeling and repair of injury. Hence, there is a need for treatment modalities facilitating fast recovery with less side effects hastening the return to competition by injured athletes. Systemic enzyme therapy (SET) is the enzyme flavonoid combination administered orally and has been recommended since many years for the treatment of pain and inflammation. SET including bromelain, trypsin, rutoside combination has been evaluated and proven effective treatment option for faster recovery with reduced inflammation. These enzymes either in combination or individually show effect on injuries. This review explains types, pathophysiology, current treatment modalities, use of SET and its clinical evidences in sports injury.

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References

Maffulli N, Longo U, Gougoulias N, Caine D, Denaro V. Sport injuries: a review of outcomes. Br Med Bull. 2011;97(1):47-80.

Bhardwaj S. Common sports injuries and their management. Int J Inform Futuristic Res. 2013;1(3):46-55.

Abou Elmagd M. Common sports injuries. Int J Physical Educ Sports Health. 2016;3(5):142-8.

Paradis M, Couture P, Gigleux I, Marin J, Vohl M, Lamarche B. Impact of systemic enzyme supplementation on low-grade inflammation in humans. Pharma Nutri. 2015;3(3):83-8.

Stone W, Basit H, Burns B. Pathology, Inflammation. StatPearls. StatPearls Publishing. 2019.

Scott A, Khan K, Roberts C, Cook J, Duronio V. What do we mean by the term “inflammation”? A contemporary basic science update for sports medicine. Br J Sports Med. 2004;38(3):372-80.

Hertel J. The role of nonsteroidal anti-inflammatory drugs in the treatment of acute soft tissue injuries. J Athletic Training. 1997;32(4):350-58.

Paoloni JA, Milne C, Orchard J, Hamilton B. Non-steroidal anti-inflammatory drugs in sports medicine: guidelines for practical but sensible use. Br J Sports Med. 2009;43(11):863-5.

Solomon L. Drug-induced arthropathy and necrosis of the femoral head. J Bone Joint Surg Br. 1973;55(2):246-61.

Lotz-Winter H. On the pharmacology of bromelain: an update with special regard to animal studies on dose-dependent effects. Planta Med. 1990;56(03):249-53.

Sarmento D, Moura D, Lopes S, Silva S. Bromelain monograph. Altern Med Rev. 2010;15:361-8.

Metzig C, Grabowska E, Eckert K, Rehse K, Maurer H. Bromelain proteases reduce human platelet aggregation in vitro, adhesion to bovine endothelial cells and thrombus formation in rat vessels in vivo. in vivo. 1999;13(1):7-12

Sahbaz A, Aynioglu O, Isik H, Ozmen U, Cengil O, Gun B, et al. Bromelain: a natural proteolytic for intra-abdominal adhesion prevention. Int J Surg. 2015;14:7-11.

Pavan R, Jain S, Kumar A. Properties and therapeutic application of bromelain: a review. Biotechnol Res Int. 2012;2012:1-6.

Mynott T, Ladhams A, Scarmato P, Engwerda C. Bromelain, from pineapple stems, proteolytically blocks activation of extracellular regulated kinase-2 in T cells. J Immunol. 1999;163(5):2568-75.

Lorkowski G. Gastrointestinal absorption and biological activities of serine and cysteine proteases of animal and plant origin: review on absorption of serine and cysteine proteases. Int J Physiol Pathophysiol Pharmacol. 2012;4(1):10-27.

Walad M, Honzikova M, Lysikova M. Systemic enzyme support: an overview. Nutrition News. 2008;4:2-5.

Targoni O, Lehmann P. Modulation of the activation threshold for autoreactive T cells via systemic enzyme therapy with phlogenzym®. J Neuroimmunol. 1995;56:66.

Julovi S, Xue M, Dervish S, Sambrook P, March L, Jackson C. Protease activated receptor-2 mediates activated protein C–induced cutaneous wound healing via inhibition of p38. Am J Pathol. 2011;179(5):2233-42.

White M, Gomer R. Trypsin, tryptase, and thrombin polarize macrophages towards a pro-fibrotic M2a phenotype. PLoS One. 2015;10(9):e0138748.

Akhtar N, Naseer R, Farooqi A. Oral enzyme combination versus diclofenac in the treatment of osteoarthritis of the knee-a double-blind prospective randomized study. Clin Rheumatol. 2004;23:410-5.

Fitzhugh D, Shan S, Dewhirst M, Hale L. Bromelain treatment decreases neutrophil migration to sites of inflammation. Clin Immunol. 2008;128(1):66-74.

Shoham Y, Krieger Y, Tamir E, Silberstein E, Bogdanov‐Berezovsky A, Haik J, et al. Bromelain‐based enzymatic debridement of chronic wounds: A preliminary report. Int Wound J. 2018;15(5):769-75.

Kauss T, Moynet D, Rambert J, Al-Kharrat A, Brajot S, Thiolat D, et al. Rutoside decreases human macrophage-derived inflammatory mediators and improves clinical signs in adjuvant-induced arthritis. Arthritis Res Ther. 2008;10(1):R19.

Adefegha S, Leal D, de Oliveira J, Manzoni A, Bremm J. Modulation of reactive oxygen species production, apoptosis and cell cycle in pleural exudate cells of carrageenan-induced acute inflammation in rats by rutin. Food Funct. 2017;8(12):4459-68.

Ganeshpurkar A, Saluja A. The pharmacological potential of rutin. Saudi pharmaceut J. 2017;25(2):149-64.

Afanas' ev I, Dcrozhko A, Brodskii A, Kostyuk V, Potapovitch A. Chelating and free radical scavenging mechanisms of inhibitory action of rutin and quercetin in lipid peroxidation. Biochem Pharmacol. 1989;38(11):1763-9.

Gerdin B, Svensjö E. Inhibitory effect of the flavonoid O-(beta-hydroxyethyl)-rutoside on increased microvascular permeability induced by various agents in rat skin. Int J Microcirculation Clin Exp. 1983;2(1):39-46.

Wadworth A, Faulds D. Hydroxyethylrutosides. A review of its pharmacology, and therapeutic efficacy in venous insufficiency and related disorders. Drugs. 1992;44(6):1013-32.

Sheu JR, Hsiao G, Chou PH, Shen MY, Chou DS. Mechanisms involved in the antiplatelet activity of rutin, a glycoside of the flavonol quercetin, in human platelets. J Agric Food Chem. 2004;52(14):4414-8.

Muller-Hepburn W. "Anwendung von enzymen in der sportmedizin." Forum d. Prakt. Arztes, 1970;18.

Worschhauser S. "Konservative therapie der sportverletungen. Enzympraparate fur therapie undprophylaxe." Aligemeinmedizin. 1990;19:173.

Zollner N. Innere Medizin. Verlag, Heidelberg, adopted literature. 1991.

Loes M, Steinman D. Healing Sports Injuries Naturally. Freedom Press: Topanga CA. 1999.

Rathgeber W. The use of proteolyric enzymes (chymoral) in sporting injuries. S Afri Med J. 1971;45(7):181-3.

Masson M. Bromelain in blunt injuries of the locomotor system. A study of observed applications in general practice. Fortschr Med. 1995;13(1):303-6.

Baumuller M. The application of hydrolytic enzymes in blunt wounds to the soft tissue and distortion of the ankle joint: a double blind clinic al trial (Translated from German). Allgemeinmedizin. 1990;19:178-82.

Lichtman A. Traumatic Injury in Athletes, International Rec. Medicine. 1957;170:322-5.

Shaw PC. The use of a trypsin-chymotrypsin formulation in fractures of the hand. Br J Clin Pract. 1969;23:25-6.

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Published

2022-10-26

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Review Articles