Collingwood coach Nathan Buckley said it best when he told SEN radio “…that’s the industry we’re in. There’s probably some blokes in country Victoria saying, ‘why are you sending the bloke to Germany, I can fix him’ ”. Buckley was of course referring to star forward Jordan De Goey’s recent hamstring troubles and his subsequent plight to be fit for Collingwood’s intended run into the depths of September. De Goey is currently in Germany being treated by renowned specialist Dr. Hans-Wilhelm Müller-Wohlfahrt, having re-injured his hamstring in last Friday night's qualifying final win against Geelong – a move which has sparked conjecture from a consortium of pundits.
According to the internet, Dr. Müller-Wohlfahrt and his methods are enigmatic - a narrative perpetuated by aloof accounts from former patients. A qualified orthopaedic and sports practitioner, Dr. Müller-Wohlfahrt is the current physician for Bayern Munich and the German national football team, and a quick look through his patient list breeds a deep sense of authority. Despite his track-record of success, including a relationship with Usain Bolt spanning over a decade, Dr. Müller-Wohlfahrt and his methods are controversial, mainly due his reliance on injectable treatments. Speaking on De Goey’s journey to München, former Hawthorn premiership doctor Dr. Adam Castricum suggested that a major drawcard of Dr. Müller-Wohlfahrt’s treatment was the placebo effect due to an extensive client list and a rich history of success (a valid construct which is nicely explored in Ben Goldacre’s Bad Science). Self-appointed leader of the private strength industry in Australia, Christian Woodford, went one step further in describing the treatment techniques of Dr. Müller-Wohlfahrt as “witchcraft”, suggesting that De Goey would benefit more from an approach which simply and gradually increases training load. These comments add to a strong chorus of conjecture sung by the AFL community, casual and professional alike. But the average physical literacy of this eclectic community, journalists included, is poor, and the decision to cart De Goey off to Deutschland warrants deeper insight.
Is there merit to the methods? Precise details of Dr. Müller-Wohlfahrt’s methods are thinly available to the public, but it is understood that he uses a cocktail of both homeopathy and real science which, according to his track-record, is potent. Dr. Müller-Wohlfahrt’s treatment protocol is hallmarked by his pioneering use of calf blood extract known as Actovegin. Far from a simple matter of taking calf blood and injecting it into the human system, the blood goes through a multi-stage filtering process which leaves an amino-rich substance. However, the active ingredients of Actovegin, and the subsequent influence on athletic performance, are somewhat of an enigma. Although the substance was briefly prohibited in 2000 following its prominence during the Sydney Olympics and the Tour de France, the ban was promptly lifted two months later pending further research, and the substance remains permitted by WADA in 2019. Despite recent preliminary evidence, the true potential of the substance is not in performance enhancement, but is rather in the regeneration capabilities which have been demonstrated to accelerate return to play (RTP) timeframes.
The first peer-reviewed evidence for the use of Actovegin in treating tissue injuries arrived in 1990, several years after Dr. Müller-Wohlfahrt first jabbed a hamstring with the substance. In a partially-blind study of 103 patients across a number of sports, those who received Actovegin injections returned from muscle tear injuries 2.2 weeks faster than those who did not receive the injections. Although this study has clear discrepancies, including a mix of amateur and professional athletes and non-standardised physiotherapy regimes, more recent (and more robust) evidence echoes these original findings. This includes the finding that professional football players with comparable fitness levels and standardised physiotherapy protocols return to play 8 days earlier if given intramuscular Actovegin injections.
But the administration of Actovegin is no longer a point of difference between the RTP protocols of Dr. Müller-Wohlfahrt and Australian sporting teams. AFL clubs have been self-administering the substance to recover from soft tissue injuries since at least 2009 when Geelong, spurred by Max Rooke’s successful visit to Dr. Müller-Wohlfahrt in 2007, included the injections in their RTP protocols. Interestingly, Australia is actually well positioned as a world leader in hamstring injury research and practice, with an internationally renowned research focus group publishing high impact papers, and a progressive professional sport science environment spurring the development of practical solutions for injury prevention and rehabilitation. The unique requirements of AFL provide a broad canvas to work with too, as hamstring tissue injuries are the most common ailment league-wide, with an average of 6.3 new hamstring injuries per club in 2018.
Given Australia’s prominence as a hamstring hub, the German guru must have a secret weapon that validates De Goey sitting on a plane for over 20 hours to the other side of the world, right? His arsenal of treatments includes the injection of homeopathic packages alongside Actovegin, which rely primarily on Traumeel as a natural anti-inflammatory. But homeopathy is no magic bullet, and its efficacy is perhaps best discussed on another platform. Acupuncture is another cornerstone of the treatment protocol, but graduate physiotherapists country-wide are eagerly jabbing needles into tissue at rapid rates (even the ones who work at Back in Motion). This leaves three possible scenarios. The least likely is that Dr. Müller-Wohlfahrt has discovered a unique combination of substances for superior tissue regeneration that only he knows how to employ, and that these remain undiscovered by experts worldwide despite significant developments in sports biochemistry since his ascension decades ago. The second possibility involves a steep journey down the rabbit hole of doping in sports that is best left untouched in this article, although Dr. Müller-Wohlfahrt has never been implicated in a doping scandal across his 40 years in the industry. The third, and perhaps most likely, scenario is simply that there is no secret. Instead, Dr. Müller-Wohlfahrt has developed a world-leading integrated approach to diagnosing and treating soft tissue injuries that goes far beyond injections and is instead systematic, comprehensive and multi-modal.
The ‘no secret’ hypothesis is lost in the media’s infatuation with mystery, theatre and needles. The Herald Sun devoted more words to articulately describing Dr. Müller-Wohlfahrt’s aesthetic than they did to outlining his treatments. Nowhere within the articles written by the usual suspects will you find information regarding his commitment to diagnosing, assessing and loading his clients long before and after any injections are given – a system that has been developed and refined over decades.
The multi-modal approach to hamstring rehabilitation is well documented in a peer-reviewed case-study of a Liverpool FC player (Darren Burgess, recently appointed as head of performance for Melbourne, appears as a co-author). The paper details seven integrated modes of treatment that contributed to successful RTP, including biomechanical assessment, neurodynamics, neuromuscular control training, an increase in hamstring strength via eccentric-biased training, an overload running program, injection therapies (including Actovegin and Traumeel) and stretching/yoga/relaxation. The inclusion of injection therapies in the protocol is based on the work of Dr. Müller-Wohlfahrt, and variations of this RTP protocol are used around the world at dozens of professional sporting organisations, including in Dr. Müller-Wohlfahrt’s clinic in München. The success of these protocols is entirely dependent on the accurate diagnosis of the injury - something which Dr. Müller-Wohlfahrt specialises in, alongside his obvious affinity for Actovegin.
The experts and social media nuffs calling for Collingwood to simply increase De Goey’s training load progressively until the tissue is ready for action blatantly ignore two things: 1) that the injections do not replace a progressively loaded physical training program – they simply accompany it, and 2) that this was precisely the strategy used by Collingwood following the initial injury to no avail. De Goey had 42 days between his round 19 tear, which was publicly broadcasted as a ‘low-grade’, and his return in the qualifying final. Despite gradually increasing training load according to best practice and passing all the necessary simulations in training with full intensity, it took just 48 seconds for De Goey to experience discomfort in his hamstring against Geelong. Such an event indicates a failure in initial diagnosis, a failure of the RTP protocol, or the failure of De Goey to be transparent about the status of his hamstring. Given that De Goey played a further 18 minutes on Friday night after recurrence of the injury, a failure at all three levels is conceivable. But with only 23 days between the Geelong game and the grand final, combined with the likelihood of substantial tendon involvement in the injury, Collingwood cannot afford a guessing game. Who can blame them for going straight to the source?
So what’s the verdict? If Collingwood can get past the winner of the semi-final between Greater Western Sydney and Brisbane, they’ll have a brutal decision to make. 23 days to recover from the recurrence of an injury that did not appropriately heal within 42 days does not add up. But if everything goes to plan in München, and provided Buckley didn’t watch Kevin Durant succumb to severe injury in the NBA finals following one of the best RTP protocols in the world, I can see the Pies risking De Goey on September 28th, even if he isn’t at 100%. For now, with the Actovegin authority, the world’s most revered hamstring rehabilitation program and a generous hint of placebo, De Goey is in the best available Hans.