Everything you always wanted to know about Diego Costa's "horse placenta" treatment

What is this story about a placenta and Diego Costa?

From the Daily Mail:

Diego Costa has flown to Belgrade to see 'miracle doctor' Marijana Kovacevic in a desperate attempt to be fit for the biggest match of his career.

The Serb uses placenta to help players recover quickly from muscle injuries and on Saturday Costa wants to play for Atletico Madrid against Real Madrid in the Champions League final.

The striker has been diagnosed with a grade one hamstring tear, sustained against Barcelona last weekend in La Liga.

Who is Marijana Kovacevic?

She is a controversial Belgrade-based pharmacologist who came to notoriety in 2009 when an injured Robin van Persie flew to Belgrade for a treatment which apparently involved massage with a special rejuvenative fluid made from placenta (whether human or horse is still unknown).  Kovacevic had reportedly worked with several footballers already, and was recommended to Van Persie by his former teammates Orlando Engelaar and Serb striker Danko Lazovic.  

Van Persie was pretty open-minded at the time:

"She is vague about her methods but I know she massages you using fluid from a placenta. I am going to try. It cannot hurt and, if it helps, it helps. I have been in contact with Arsenal physiotherapists and they have let me do it."

Several other prominent footballers visited Kovacevic too, including Frank Lampard, Nigel de Jong and Glen Johnson. Liverpool player Yossi Benayoun also visited her, and gave some details surrounding her treatment:

"She explained everything to me beforehand and told me she would be using fluid from a placenta that had come from a woman. Nothing went into the muscle itself. It was just a case of massaging the liquid on to the skin around the affected area."

Kovacevic has a website in which she describes her approach—it involves a topical massage (no injections) with “different naturally active substances” and stimulation of “electro-magnetic fields”, and promises that within one to seven days, the “patients muscle tissue is completely regenerated’.  It also guarantees that “results on doping tests are negative to presence of illegal substances in blood and urine.”

Tax evasion and clinic ‘shut down’

Shortly after the Van Persie story broke, authorities shut down her clinic in November according to reports from Belgrade. A website Blic Online reported in November 2009 that Serbian health authorities had to that point “no knowledge” of her and her treatment, and that she did not run a registered private medical practice. Yet in December of that same year the Mail found her operation in a “tiny first floor clinic above a stairwell” in New Belgrade.

The Daily Mail also reported in 2009 she was being investigated by Serbian authorities for possible tax evasion, charging players up to €3,000 for the treatment without reporting income. She also allegedly changed her appearance often to avoid detection, and went to great lengths to shield the players visiting her.

Is there any scientific basis for this treatment?

Using the nutrient rich placenta for pharmacological application isn’t necessarily a novel idea. Placentas are a source of human chorionic gonadotropin (hCG), which was a developed as a “homeopathic” diet drug (and subsequently banned in 2011 by the FDA). hCG has also been associated with steroid use, as an “adjunct” to counter the negative effects of testosterone shut down. Major League Baseball banned Manny Ramirez for fifty games for a positive urine test for hCG.

As for the topical massage of placenta gel healing muscle and ligament injuries, when asked by the BBC on the subject in 2009, Bristol University’s Sports Medicine Clinic manager Abbie Turner said this:

"If it is a low grade ligament tear, treatment would include deep tissue massage and rehabilitation to restore balance and strength to the affected joint, ultrasound, joint mobilisations and strengthening exercises to strengthen weakened muscles around the joint. If a tear is very serious then surgical repair can sometimes be required. More alternative treatments are sometimes used with success and these can include acupuncture and joint injections. But I have never heard of this - and I won't be rushing out to use it on my patients."

I wasn’t able to find any peer-reviewed studies on the procedure.

“Modern” Football

Nevertheless, some players, including Yossi Benayoun, have sworn by the treatment. “I never envisaged being on the pitch again so soon, and it shows what can be done with this treatment.” he claimed.

Some clubs, including Liverpool and Manchester City, were, as recently as five years ago, rumoured to be working to sign on Kovacevic full-time. Napoli coach Rafa Benitez once claimed “She is a doctor with a degree in pharmacology and is really good with muscle injuries.”

This is, depending on your point of view, either incredibly alarming considering the lack of any and all scientific evidence supporting the healing claims by both Kovacevic and her patients, or a testament to the power of the placebo effect and the desperate lengths players and managers are willing to go to overcome debilitating and expensive injuries.

With all the talk of injury analytics and advanced research, that players are still visiting a horse/human placenta administering doctor in Belgrade to make the impossible possible is a reminder that football isn’t perhaps as “modern” as we often make it out to be.