Sports Medicine Article and Info

First of all, the treatment of sports related injury in Chinese medicine has a very long and extensive history in treating injuries related to war and martial arts. To this day it is one of the most complete methods to treat, rehabilitate and prevent injuries, there is outside of Western Medicines surgical techniques.

Now Let’s Begin

A word about Muscles, Tendons, Ligaments, Cartilage and Bones.
Muscles heal fast because they are filled with blood vessels and have good blood flow. Pulled muscles are really micro-tears in the muscle and surrounding tissue. The small blood vessels that run through the muscle tissue are also torn. This is why muscle pulls are often accompanied by a black-and-blue discoloration at the site of the injury (except in the case of deep muscle strains which may not show any discoloration at the skin surface). Pulled muscles usually take about two to three weeks to heal. Healing time will depend on the degree of tearing, the health and age of the person, and if the muscle is re-injured before it is fully healed.

Bones also heal relatively quickly because they have a large blood supply. In a healthy person, a simple fracture will usually heal in five to six weeks.

Ligaments and Tendons are composed of thicker fibrous tissue, which compared to muscles, do not have a large direct supply of blood. When damaged, they heal more slowly than bones or muscles, often taking 5-6 weeks for tendons and 7-8 weeks or longer for ligaments. If tendons or ligaments are severely torn or overstretched, they can take considerably longer to heal or may never heal completely without Acupuncture, Prolotherapy, PRP (Platelet Rich Plasma) Therapy or surgical intervention.

Cartilage and Discs take considerably longer to heal. Three to six months is a realistic estimate.
If treated properly at the onset, they have a greater chance of healing properly and quickly.

Repeated damage to these structures will make them harder to heal. In cases where there is extensive damage to cartilage and disc, surgery may be required. In these cases, Chinese Medicine can be used to speed the recovery and post-surgical healing process.

Treatment for Sprains, Strains and Contusions.
First lets define a strain, sprain and contusions.

Strains: pulls or tears of muscles or tendons. This usually occurs at the junctions of the tendons and muscles because this tends to be the weakest area. Pain and swelling that may be gradual along with discoloration from the bleeding tissue if severe enough trauma.

Sprains: tears to the ligaments that join the ends of bones together. The ankles, knees, and wrists are commonly affected by sprains. Besides pain, rapid swelling can occurs from the pooling of blood and fluids of the tear, along with limited local mobility.

Contusions: a blunt force injury to the soft tissue causing bleeding inside and around that tissue. Black and Blue discoloration of the skin, usually painful to some degree and may also swell or you may feel a lump at the injury site.

Now the types of treatment.
Cupping: immediately pulls the stagnant blood and fluids away from the damaged tissue, thus increasing the flow of fresh blood and fluids.

Acupuncture with needles, magnets, lasers, and micro-current: normalizes the circulation and thus removes stagnant blood and fluids which promotes healing of the damaged tissue. The laser and micro-current directly and immediately promotes tissue repair but their affect is not as lasting as electro-acupuncture.

Moxa and TDP: these are both multi-frequency healing methods. The body directly absorbs these frequencies and promotes circulation and tissue healing.

Poultices such as San Huang San, especially if there is heat.
Trauma Liniments like Die Da Jiu.
Trauma pills like Die Da Wan or Yun Nan Bai Yao.

Movement Exercises: Simple range-of-motion exercises and massage that does not aggravate the injury, then range of motion exercises with resistance and finally weight bearing exercises with more vigorous massage.

It helps stimulate circulation and reduce swelling while reducing the brain-injury guarding and protecting process that can inhibit complete healing.

Acupuncture is one of the best modalities to reduce this, especially if the brain-injury guarding/protecting is excessive or prolonged.

Old Injuries that don’t go away!
Why did this old injury come back or why hasn’t it gone away?

The main reason is it wasn’t completely healed physically and mentally, and sometimes emotionally, before you started using it again for the specific activity which stresses it.

The physical aspect is easy to understand for most people because we tend to go back too early with a injury in general. We take Advil, Motrin, or just “work through it” until it’s better. But it’s not really better but just tolerable enough that we can get back to the activity we love, and in doing this we usually re-injure ourselves or make an acute injury a chronic one.

The mental/emotional aspect is our tendency to protect the injured site by restricting motion or certain movements that we use to do so easily without thought, and now we have to think about it and make it happen.

This causes muscle imbalance issues and injuries due to the extra strain/stretch on the supporting musculature whether it is at the injured site, or another part of the body that is compensating for the original injury.

The simple way of looking at this is if the injured site has a decrease in blood/nourishment flow to the area and a decreased flow of waste products away from the area, it will not heal completely and “age”, or break down overall, instead of repair. If you are over 30 and in poor general health, this aging process is accelerated even more.

Ice should not be used for chronic injuries; it will only prolong the injury repair process and could make it a long standing “Cold” or “Cold Damp” injury in Chinese Medical Terms.

A very common example: if you sit on a cold metal or concrete bench in regular pants, the cold will penetrate into your hip/pelvic area and make them temporarily stiff as most of us know, especially if you have had an injury in that area before. Now if you continued to do this daily, that cold stiff feeling will stay with us longer and longer until we feel stiff and achy in that area most of the time, and it will feel worse in cold weather (or cold application) and better in warm weather (or heat application). In this case the “cold” has caused damage to the joints by decreasing the circulation of nourishment going into the hip joint, decrease the elimination of waste products leaving the hip and consume the energy in the muscles and surrounding tissue trying to warm the area up.

In general, you have just aged your joints faster than they would have normally aged.

This aging of the body, especially joints, occurs more rapidly every time we re-injure ourselves and when we make an acute injury into a chronic injury it’s even worse.

Many of us can remember when we were young we would bounce back from a injury easily, or if you stayed up 24 to 36 hours you could recover in a day or two. But as we get older our injuries became harder and harder to heal, or they never really did heal and we just live with it, and forget about staying up for 24 or especially 36 hours and recovering in a day or two, more likely than not our ability to function during that time would be greatly decreased.

A note to the YOUNG: all those injuries that occurred and we really didn’t allow them to heal properly or especially the big injury that never really went away, these will become those chronic nagging aches and pains you always hear older athletes complain about, “my old football injury is acting up” or I got tennis elbow so many times in my 20’s and now I get a shooting pain in my forearm when I open the door or try to open a jar with that hand.

I have heard many of these complaints in my years of practice, and I always question them about their past injuries and they almost always relate to the chronic condition.

Simply stated if there is enough qi and blood and it can travel freely throughout the body/mind, there will be health.

If there is any prolonged decrease in qi or blood our health will be compromised. If something is preventing this qi and blood from its normal free flow, there will be ill health, even if there is sufficient qi and blood. This is a form of blockage in Chinese Medicine and a major cause of disease/illness.

Chinese Medicine has been treating these conditions for thousands of years with Acupuncture, Chinese Massage, and Herbal Medicine.

Externally we can use Acupuncture, Microcurrent, Laser therapy, Moxa and the TDP lamp to treat these conditions.

Internally we use Herbal Medicine, nutritional supplements, along with dietary and lifestyle changes.

As for the mental side of this, the more restricted or unnatural the movement the greater the stress on the area or balancing musculature there is, this is where acupuncture shines.

Acupuncture with needles or microcurrent is a great way to address the brain/muscle miss-communication, along with proprioceptive training and visualization.

Why should you warm up for a specific activity?
There is a reason you warm up before strenuous activity! Your muscles need to “warm up” and your muscle-brain connection also needs to “warm up” to the specific activity you are going to do. This warm up increases blood flow, puts the muscle through their normal range of motion for that activity, while mentally preparing us for the activity we are going to do, without this, our chances of injury greatly increase.

For example a baseball player isn’t going to run around the field dribbling and kicking a soccer ball with quick changes of directions to warm up or the soccer player swinging a bat to warm up.

Even the stretching for these two sports is different.

Of course this is over-simplified because many activities would benefit from running around the field, jumping, sprinting, actively stretching the calves, hamstrings and thighs, but each sport or activity will have their own specific exercises and stretches. You would think this is just what a soccer player and a sprinter would need, that is true but this isn’t enough for a soccer player, sprinters don’t run shoulder to shoulder trying to stick their foot in and get the soccer ball while sprinting down the field and leaning on the other player to “push” them off the ball!

The pressure on the ankles and knees are far greater, due to the multiple directions of force on these joints, which the sprinter does not have because the running is in a straight line without physical interference albeit with greater intensity.

Football, Rugby, Lacrosse, etc., all have similar change of direction demands on the ankles and knees plus their own specific demands (such as tackles in football and rugby) of their sport and thus need a more encompassing warm-up then the sprinter.

The muscle patterning with the brain is so important, and that is why after an injury the chances of re-injuring the same area or the compensating areas are so great. If the brain thinks there is still a problem with, say the ankle, then the normal function of that joint will be restricted in some way, but the athlete will try to do the things they did before the injury. Besides the injury not being healed, (even this has many different criteria) this conflict, which causes whole body compensation, is one of the greatest reasons for re-injury. That is why proprioceptive training and visualization is so important after an injury. Without doing these your chances of a full recovery is greatly decreased.

Acupuncture has been used successfully to speed this brain/muscle connection up.

The Pros and Cons of Ice and Heat Therapy.
Both heat and cold therapies have been used to help alleviate pain resulting from sports injuries, and both have their role in treatment and rehabilitation.

In general, application of Cold Packs or Ice has the following effects:

*Reduces swelling following a traumatic injury, especially if used immediately before the swelling actually occurs, but if used too often or too long it will inhibit the healing process. Ice is a extreme therapy that tends to be used to casually without much thought of what it’s doing to the local tissue.
Too many people put cold packs directly on the skin, this is actually traumatic to the local tissue due to its extreme cold temperature and besides inhibit the healing process can damage the local tissue.
*Reduces the inflammation response. This inflammatory response tells the brain and surrounding tissue to start the healing process, and if it is blocked locally or systemically it will actually inhibit the healing process.
*Produces a numbing effect that can reduce pain.
*Decreases blood flow to an area.
*Decreases muscle spasms.

For a sports injury ice should be used minimally and never directly on the skin. You should have a cloth or several layers of paper towels, minimum, between the ice and the skin! Never ice an area after an injury and then go back to that activity; you will greatly increase the chance of injuring the area even more; or another area because of the compensation required from the original injury.

Why? You just tightened the muscle fibers, decreased blood flow, and numbed the area of pain. This is exactly the opposite of what we do to prepare for an activity, which is to increase blood flow, increase the range of motion of the muscles and have a correct sense of what they are doing.
See above “Why we warm up”

The effects of Heat Therapy include:

*Increased blood flow to an area. Should not be used if there is a lot of swelling and especially HEAT, then only used above the injury, while gently massaging around the injured area, to promote movement of the stagnant fluids at the injured site.
*Relief from tension or tightness in muscles.
*Can reduce joint stiffness.
*Optimizes the healing/repair process in tissues through the increased blood supply. This works in two ways: Increase the flow of nutrients and specific cells to break down the damaged tissue and promote tissue repair, and the blood flow away from the injury to remove the excessive waste products.
*In Chinese Medicine if you don’t reduce the stagnant blood and fluids it will slow down the healing process or promote an area that is prone to re-injury, and with time, the development of chronic aches and pains in that area or another area that relates to it.
*Increase in flexibility.
Note: Certain types of heat therapy can be used at the injury site, but you must be trained in these methods, otherwise you can temporarily make it worse.

Methods of Treatment.
Physical Medicine: Acupuncture, Cupping, Moxa, Magnets, Microcurrent, TDP (Far Infrared), and Massage.

All these modalities are used to break up or remove accumulations of stagnant fluids and blood that can greatly slow the healing process and lead to chronic pain and dysfunction.

External Herb Therapy: Liniments, Oils, Poultices, Plasters, and Soaks.

These herbal formulas are based on the ancient Chinese martial arts formulas that stimulate local circulation, reduce pain and promote tissue regeneration by cooling or warming, and eliminating dampness and blood stagnation.

Poultices: Are composed of finely powdered herbs that are mixed with an aqueous or viscous medium. This combination produces a thick, mud like paste that molds to the injured area and penetrates into the tissue. This paste is then covered with cloth and an elastic bandage to hold the mixture firmly against the skin. Different mediums are used to enhance or modify the effect of the herbal powder. Common mediums for sports injuries are Bee’s wax, Alcohol, Castor Oil, Olive Oil, Jojoba, Green Tea and Egg Whites. Poultices tend to have a stronger effect than medicated plasters, and are custom made to the condition that is being treated.

Ice is still the most common Poultice in Western Medicine, which unfortunately has its drawbacks.

Plasters: Are made of herbs impregnated into an adhesive sheet or roll that is applied like a bandage over a wound. You simply peel off the plastic backing and cover the injured area. These are set herbal formulas which cannot be customized, and therefore reduce the effectiveness in some cases. However they are extremely convenient to have around for quick use.

Internal Herb Therapy: These can be Herbal Teas, Capsules, Tablets, and Tinctures.

Again many of these formulas came from the Martial Arts. The herbs work systemically to nourish the muscles, tendons and ligaments and promote tissue repair.

Sleep: I include this here because of its general neglect in sports recovery.

This is one of the least utilized recovery therapies used by most athletes, especially teenage athletes.
Athletes need more sleep than the average person due to the stresses on the endocrine system let alone the muscular skeletal system.

For example: When we do intense exercise this will increase production of growth hormone which will promote the rebuilding and repair process when we sleep, but if we are sleep deprived this reduces the production of growth hormone and we have less rebuilding and repair; speeding up the aging process as well as decrease our ability to heal.

In general, sleep deprivation causes: Decrease in growth hormone production.
Decreases glycogen synthesis, which is our stored form of glucose and main fuel for muscle cells during activity.
Increases cortisol production, which is a catabolic (breaking down) hormone, that interferes with tissue repair and growth. It can also decrease our resistance because of its immune suppressant function.

Note: Very strenuous exercise will also increase cortisol production as a response to the stress put on the body and is generally a protective mechanism. So when athletes do an intense fitness or training period it should be followed with rest and light to moderate exercise the next day or two.

A positive note: as stated above, strenuous exercise will also increase growth hormone production you just need to give yourself the time to recuperate.

Attempting to play with a serious injury (or even a not so serious injury).

All injuries produce some loss of function and strength, and cause some degree of compensation.
If you play with the injury you could increase the degree of the original injury, and cause an injury in the muscles, tendons, and/or ligaments that are compensating for the original injury.

IT’S NOT WORTH IT!!!.

I see way too many kids end their athletic futures because a coach or parent told their kid to “walk it off” because they wanted to win the “game” or their kid was too important to be out of the “game”. Well now they are out of the game for sure and may never be able to play the game at their previous level.

I will repeat this again, IT’S NOT WORTH IT! It is still just a game, and not worth the lifelong debilitation that goes along with this sacrifice.

If it’s preventable to stop the advancement of the degree of injury by simply getting off the field of play, then do it.

Note: If this is your job it’s not as cut and dry and you already know this.

The professional athlete should be far more in-touch with themselves and their sport (job) then the average athlete and know the pros and cons of each injury that can occur in their sport and thus the repercussions of increasing the damage of that injury in the long and short run.

Note: A sprained ligament will always cause at least a strain to the surrounding tendons and tissue, but a strained muscle is usually just a strained muscle as long as there are no joints underneath it.

A tendon strain doesn’t cause injury to the surrounding ligaments but may affect the muscle attached to it, not by injury but by the natural guarding or tension that the mind places on that muscle/tendon pair to guard or protect it. In this case the muscle and tendon both need treatment to heal the original tendon injury.

Let’s define this a little more for tendon injuries: Depending on the degree of injury you have different possibilities.

1st Degree: a partial tear(s) or micro tear(s): If treated correctly they may be able to continue to play the same day. Elevation with gentle circular massage of trauma liniment and taping the joint, the athlete may be able to go back into play but will have limited range of motion to that joint and thus effect the level of play. The athlete must understand this and not try to over compensate for this or they will create another injury. After this they will need to treat the area every day to speed the healing process or else it has a greater chance to become a 2nd degree tear next time they play or practice.

2nd Degree: This is a tear that is part way through the tendon(s): With this degree of injury there is no possibility to continue play until it is healed, and this may take from 1- 3 weeks. Then the area has to be strengthened again along with proprioceptive training until there is a high degree of confidence mentally and physically of the injury area. Only then should you attempt to play to your previous degree of athleticism.

3rd Degree: This is a full or complete tear: A complete tear will require surgery and a lengthy rehab both physically and mentally. There are many treatments to speed this process up post-surgery. One of the biggest mistakes people make is to concentrate on the physical aspect of recovery and not the mental aspect. In a prolonged injury the mental recovery is usually the hardest one to overcome.

Again there are thousands upon thousands of athletes who wake up with chronic pain and debility because they didn’t stop playing when they should have or didn’t complete the rehabilitation process that they should have.

This debility and pain will only get worse as the years go on and will cause other areas of the body that weren’t originally injured to have excessive wear and tear due to compensation from the original injury(s).