Caught in a spat between a multi million pound footballer and a multi billion pound football club. Bet they didn’t warn him about that in medical school. Owen Hargreaves said he felt like a “guinea pig” while his injury was treated at Manchester United – and the club doctor, Steve McNally, was named in the media. We don’t know the details and can only interpret what is written, but in the Guardian report Hargeaves said his problems stemmed from his treatment with prolotherapy. Sir Alex Ferguson defended the reputation of the medical staff, and the club said they had some of the very best medical staff in world sport.
Prolotherapy is based on injecting irritants to stimulate healing. There is not a lot of good quality evidence to support practice. Being interested in tendon injury I went to hear David Robago, one of the pioneers of this treatment, speak about some of his early work at various international sports medicine and general practice meetings- and he is currently undertaking a trial in tennis elbow. In his systematic review, published in the British Journal of Sports Medicine, which captured nine studies of which three addressed prolotherapy, he concluded that there was strong “pilot-level” evidence. Hardly convincing but enough to suggest the need for future good quality randomised controlled trials. It is difficult to know at what stage these treatments should be integrated into current practice. Innovative treatments tend to be ahead of the evidence but, in recent discussions in the literature, some sports medicine specialists argue that there is a case for trying such innovative and potentially exciting new treatments in elite sports men and women- who are very different from normal patients. Elite athletes are at the outer margins of sports performance. What about their medical care – should doctors be pushing out the boundaries too? For most of us this is an academic question. But, most doctors don’t deal with such high profile footballers, nor do they expect to find themselves featured in the headlines of national newspapers. The stakes are very high.
Other sports doctors in the news this week…James Robson, Scottish (and former Lions) team doctor hit out at the schedule for the Rugby World Cup in New Zealand, saying that a four day turnaround between international matches was too short. Scotland were undone on Sunday, however, by the skill of another doctor – the Argentine star and Dublin medical graduate, Felipe Contepomi.
Domhnall MacAuley is primary care editor, BMJ