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Sports
medicine
Bringing Oriental Medicine into the sports
medicine arena is going to be challenging at best. Oriental Medicine
within the western academia and medical community is new and not widely
understood, although there is more curiosity about what defines Oriental
Medicine’s physiological function. Oriental medicine research is
transposed to fit within the traditional academic single - variable
research methodologies. Although research is needed, - until
multi-variable research methodologies are adopted, can we truly explore
the ramifications of provingoriental medicine. The sports medicine arena
is no different. If one wants to specialize in sports medicine then one
must have depth within the sports medicine profession as well as Oriental
medicine, and vice versa. This means one must understand both the western
and eastern approach to treatment singularly before one can integrate them
with ease. This article will discuss injury mechanism from both
perspectives, as it relates to sports injuriesof the extremities. Actually
understanding the injury mechanism within the sports medicine arena is the
basis for comprehending how to treat athletes from both perspectives. The
injury mechanism identifies the difference between acute and chronic
conditions. I have found in many sports medicine, physical therapy,
chiropractic, and athletic training environments that protocol treatments
tend to be used across the board. These protocol treatments tend to focus
on symptoms rather problem origins. Again, the basis reverts to
recognizing the appropriate injury mechanism. Oriental Medicine can also
employ protocol treatments. However, the patient results are marginal at
best, and if patients do not see results quickly they go back to the
“politically correct” health care provider. Understanding how to use
knowledge that is gained, one can see the importance of recognizing
equally the value of both professions. The western health care
professionals who try to learn Oriental medicine in weekend seminars, and
then try to practice protocol treatments, are representing our profession
as well. This presents a very delicate problem. Therefore, it is
imperative for both professions to recognize and equally respect each
other’s profession. As an acupuncturist, if you identify with the sports
medicine profession and its treatment methodologies, then your acceptance
within the field will be easier than one with no sports medicine
background in the west. Conversely, if we are to accept a sports medicine
professional within the acupuncture community, the same also applies.
Understanding and equally respecting each other as health care providers
enables greater diagnostic precision in differentiating acute and chronic
injury mechanisms for more effective patient results. Injury Mechanism -
Western Perspective Acute injuries are injuries that happen suddenly , and
correlate to direct or indirect trauma. For example, falling on an
outstretched arm, represents the wrist joint as direct trauma, and the
elbow and shoulder as indirect trauma. These injuries include fractures,
strains, sprains, dislocations, subluxations, bursitis, nerve
impingements, and growth plate problems in children.
The initial treatment focuses on managing the edema with RICE (rest, ice,
compression and elevation). Once this is achieved, range of motion is
increased and then progressed into exercises that gradually increase
strength. The idea within a clinical setting is to return the patient to
normal daily activity, whereas with an athlete, the goal is to return that
athlete back to his/her sport -specific activity. Chronic injuries are
injuries that happen over time where muscles are either used that are not
used regularly engaged or overused. This is the area within sports
medicine that tends to be forgotten. It becomes very easy to implement
protocol treatments. However, the problem arises with patients not getting
results. Why? Usually symptoms are being treated as inflammation rather
than the root of the problem, which is based within the injurymechanism.
Treating them simultaneously is preferred but rarely practiced, except by
those who think through the patient’s condition. However, few sports
medicine training centers or university training rooms I have supervised
or participated practice this method. This is especially true with overuse
injuries like tendonitis. Injury Mechanism – Eastern PerspectiveAcute
injuries in Eastern methodologies are also injuries that happen suddenly.
These injuries involved the Qi, Blood, Body Fluids, Channels and Zang/Fu
organs. The most common is Blood and Qi stagnation that represents an
excess condition. In both instances, the Qi and Blood flow become
disrupted and cause stagnation to occur, meaning the Qi and Blood diminish
and/or are completely obstructed. Pain is a good indicator. To
differentiate Qi verses Blood stagnation an easy rule applies: pain
followed by swelling - Qi stagnation is predominant; swelling followed
bypain -Blood stagnation is more predominant. Usually they occur together.
Chronic injuries in Eastern methodologies can happen over a period of
time. Within the Eastern perspective, TCM’s focus is on pre-existing
conditions that predispose an individual to a particular condition/s. The
majority of these cases involve are pre-existing conditions within the
Zang/Fu organs such as Qi deficiency, Qi stagnation, Blood deficiency,
Blood stagnation, Damp-Phlegm accumulation, Yin and/or Yang deficiency,
all of which give rise to Wind, Cold, Damp Bi invasion, exacerbating the
condition and invasion of the collaterals. By understanding the injury
mechanism, we can identify the pre-existing condition to counterbalance
it. By being able to identify the organ/s affected, we can be more
specific and preventative in our treatments. Most acupuncturists,
(including formally trained medical doctors, chiropractors, physical
therapists and athletic trainers), tend to still use protocol treatments
within the clinical setting, and do not identify the pre-existing
conditions. This lack of depth is extremely apparent among Eastern and
Western health care providers. That is why knowledge in both professions
needs to be equally appreciated. The organs as related to sports medicine
within the eastern philosophy are broken down accordingly by each Zang/Fu
organ’s basic function. (There are other functions for each of these
organs, but for the sake of simplicity, I have addressed issues specific
to sports injuries of the extremities). Tendons are related to the liver
according to the Five Element correspondence, and as the athlete’s
intensity increases with their training the function of the liver,
according to TCM is impaired. One of the functions of the liver is to
supply blood to all parts of the body. If bloodflow decreases or becomes
obstructed, then the liver’s responsibility is to regulate the blood
(because of its function to regulate and store blood). Thus, if the liver
becomes impaired or obstructed, the sign and symptoms correlate with many
sports injuries involving tendons. Muscles are related to the spleen
according to the Five Element correspondence. The spleen’sbasic functions
are transporting and transforming nutrients, and producing blood. Another
aspect unique to the spleen is that it “rules” the extremities. Therefore,
the spleen and stomach are extremely important to sports injuries because
they nourish all the other Zang/Fu organs. Thus, if the spleen becomes
impaired or obstructed, the signs and symptoms correlate with any injuries
associated with the extremities, and their transporting and transforming
of nutrients to support the other Zang/Fu organ functions. Although, bones
are related to the kidney, I want to address the kidney’s relationship
with the tendons. The kidney supports the liver and the liver directly
supports the tendons. However, if the kidney yin becomes deficient, this
affects the liver yin, which affects the tendons. The kidneyalso stores
the essence/Jing. This information is valuable in chronic conditions.
Thus, if the kidney becomes impaired or obstructed, the signs and symptoms
correlate with any injuries associated with lower extremity functions and
low back functions. Therefore, having depth through understanding includes
why we are treating and what we are treating -- a step that tends to be
overlooked in both professions. These are very important steps since they
directly relate to the quality of care of our sports medicine
athletes/patients. Conclusion Oriental Medicine is very valuable within
the sports medicine arena. The traditional academic sports medicine
perspective will place credibility upon the acupuncturist with his/her
individual knowledge within the sports medicine profession. I caution
those who do want to pursue a sports medicine specialty either from the
western or eastern perspective; you must have formal training in each
respectively. The knowledge an acupuncturist lacks within the sports
medicine arena will, unfortunately, represent western viewpoints of the
Oriental Medicine profession as a whole as being incompetent. This would
not be the case in reverse. Oriental Medicine can contribute a wealth of
knowledge and result-oriented outcomes that canbenefit the sports medicine
arena greatly. Again, the key goes back to the basics and comprehending
the how’s and why’s of both professions. The ultimate goal for the
Oriental Medical community is to gain credible acceptance within the
already existing sports medicine community by establishing open
communications within both academic arenas. Hopefully, this will promote
joint research collaborations that will ultimately benefit both academic
professions. Additionally, by promoting integrated injury prevention
education and treatments, athletes will benefit directly with results,
encompassing greater depth and refining the quality of care in the sports
medicine arena.
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