By Shihan Mary Bolz
Master of Science Oriental Medicine
Doctoral Fellow, FBU
Master Martial Arts Instructor
Sports enthusiasts and all people who are into exercise can be happy to hear that acupuncture and Oriental medicine works great for all types of injuries and even enhances athletic performance. This can improve a person’s game, their competitive edge and even their overall health even if they are not into competition. All without the use of drugs! Let us look at injuries and general principles of medical treatment, both allopathic (conventional Western) and Eastern.
The treatment, both in allopathic (conventional Western) and Traditional Chinese Medicine (TCM) depends on the stage of the injury. In general, there are three stages of injury: 1) Acute stage: 1 – 4 days after the occurrence of the injury (inflammatory stage). 2) Post-acute: 3-6 days 3) Chronic: more than 7 days after the injury. The general objectives of treatment are to: 1) Decrease the inflammation 2) Increase fluid drainage throughout blood and lymph systems (i.e. reduce the swelling). 3) Improve physiological function: regain strength, flexibility, mobility of the injured part. Allopathic medicine’s therapeutic modalities include: 1) Thermotherapy (heat) 2) cryotherapy (cold) 3. electrotherapy (e.g. TENS units) four. manual therapy (manipulation of the injured part by self or another party, such as a physical therapist 5) Medication therapy with the use of non-steroidal anti-inflammatory drugs (NSAIDS). These include, but are not limited to aspirin, ibuprofen (e.g. Motrin), and indocin. Tylenol is not considered an anti-inflammatory agent. However, is used to reduce pain. The mechanism of action of the NSAIDS are to decrease pain by increasing analgesic sensation, decrease the inflammation by acting on prostaglandin’s and other chemicals produced in the “inflammatory soup,” and decrease inflammation via antipyretic action (reducing fever).
At the acute stage, the modalities used in allopathic treatment are either heat or cold compresses and in these recent years, cold is most often used, with the idea that heat will just increase the inflammation and not abate it. The recipe for cold application is: R.I.C.E. (Rest: to prevent further insult, Ice: to reduce rate of blood flow to the injury site (causes vasoconstriction), Compression: to decrease fluid concentration and Elevation: to reduce blood pressure for the first 48-72 hours. Cold is used for the acute stage of injury (first 48-72 hours). For the post-acute stage, the contrast method of heat and cold is used to reduce the swelling and improve ecchymosis (bruising, which is not always evident and is a sign that blood is breaking down). The contrast method will often be used for up to 10 days. In the chronic stage of injury, allopathic medicine will use heat or heat and cold before activity and then use cold therapy after activity to prevent further inflammation. Some recognized unexpected outcomes with cryotherapy could be: 1) nerve palsy 2) hives, joint pain, swelling 3) Reynaud’s phenomenon, which is a vasospasm of the arteries, and could cause death. It appears as a cyanotic condition, where the person actually looks blue in complexion and skin tone. These resulting conditions are all on the rare side of occurrence. Sensations of thermotherapy by the injured person will be warmth and relaxation and with cryotherapy, there may be burning, stinging, aching, or a numbing sensation. The recommended time to keep an ice pack on the injured area is 20-30 minutes each time, this is also true for ice immersion, cold whirlpool, cold hydro collator pack, cold gel pack. An ice massage is generally 8 – 15 minutes. Sometimes a vapocoolant spray is used which will give an instant numbing sensation but the effect lasts only a few minutes.
Twenty minutes is the usual time for thermotherapy each time, this includes moist heat packs, warm whirlpool, and contrast bath (alternating heat and cold). Topical analgesics with superficial heat have a short-lived effect, just like cold topical analgesics. For pain reduction, the theory behind TENS units, thermo and cryotherapyis the Gate Control Theory. Heat works also via the endorphin theory and cold slows the nervous conduction velocity by freezing the tissues involved. What is the gate control theory? In short, what essentially occurs is that the spinal cord experiences pain and other sensation and these sensations are transmitted to the brain. The dorsal horn of the spinal cord is the place where inhibition of pain may occur. This area (the dorsal horn), contains T-cells and substantia gelatinosa. The T-cells take the information up to the brain and the substantia gelatinosa acts as a control over the transmission–acts as a “gate.” The mechanism of action that is proposed is that it is the small, slow nerve fibers that carry pain sensations. The large, fast nerve fibers carry other sensations such as cold, heat, and pressure. The large, fast fibers get through the substantia gelatinosa gate, and close it on the small fibers; therefore, the pain sensations do not get through to the brain.
The endorphin theory of pain is that when the body is exposed to physical stress, endorphins may be released into the circulation. These endorphins seem to release opiate-like substances, which act to decrease pain. The idea behind all of these methods is to control the pain, reduce inflammation and allow the body to heal. Now, let us look at the Eastern tradition to treat injuries. As it seems in other areas, the Eastern outlook it exactly opposite of the Western outlook. The West likes to use ice. The East traditionally never uses ice, but uses heat. Also oppositely, the East does not look at inflammation as the enemy, but as the body’s own method of healing and achieving balance. The West wants to fight inflammation. The East accepts inflammation as the first stage in the process of healing.
Traditional Chinese Medicine also recognizes the same general stages of injury. For the acute stage, it is important to: 1) reduce swelling 2) control inflammation 3) reduce the pain and one more: 4) promote further healing. Cryotherapy (use of ice) can help with the first three factors, but it does nothing for the fourth factor: promote further healing. In fact, it actually will inhibit the healing process by doing exactly what it is intended to do (reduce swelling, controlling inflammation and reducing pain). Why is that? Because the inflammatory process is part of the healing process. Nature is made so perfect; it makes that process so that certain chemicals will be released into the area that aid in rebuilding and repairing. The application of cold will stop that process. In addition, ice will slow down the movement of blood, Qi (life-force energy), fluid (which carries the natural chemicals released by the body to repair and heal), and virtually freezes the entire process. That means it is halting the healing process. Once that happens, it is difficult to have it continue as it should, in spite of movement and exercise. Application of ice/ cold can temporarily reduce the pain sensation because it slows down nerve conduction, another halting process, but when the ice is removed, the pain is again felt.
Without the use of ice, how does Eastern medicine promote the healing of injuries? External application of herbal formulas, internal consumption of herbal formulas, manual acupuncture, electro acupuncture, and application of tofu. Let us break this down into those same stages: The acute stage. Instead of using ice, which was never used in traditional Oriental medicine, traditional Japanese doctors and orthopedists use tofu. Yes, tofu. It has some unique properties. Looking at tofu in the traditional way of the yin-yang theory of medicine, tofu is predominately yin in character if compared with the hot, inflamed situation of an acute injury. Some yin properties are cool, soft, dark, female, etc. While some yang properties are hot, hard, bright, male, etc. The yin tofu is cooling in nature and it is “alive” compared to a pack of ice.
That means the cool tofu will attract the heat in the area of the body. The overly hot sensations in the inflamed area will be attracted to the cool, yin tofu when it is applied to the skin directly. It is also permeable, which the skin is also. The excess heat and unwanted poisons will actually be pulled through the skin and into the tofu when it is applied as a plaster. This similar idea of mudpacks, which have been applied, to injuries in the American Indian culture and other cultures, applies the same principle. However, tofu is not so cold that it will freeze the blood, the Qi, the fluid, the nutrients and chemicals that the body needs to heal. Therefore, at the acute stage we have achieved our goal of reducing pain and inflammation, to put it in Western terms. Secondly, special external herbal formulas of the proper mixture and dosages are made and applied directly to the area. Herbs are “smart” so to speak. (Only “smart” so far as the doctor knows how to use them, knowing the properties of each of the herbs, the particular type of injury or pain for the individual and match it correctly.) Some herbs are cooling in nature, can reduce swelling and reduce inflammation, while others move the Qi and the blood, some stop bleeding as well. Each of the herbs chosen in a formula has their own particular duties and functions, and the formula is put together like a very well organized army. When the herbs work together, they make a great team. Different formulas will be needed at the different stages of the injury and are mixed according to what the purpose at that stage is. Tofu is meant for use only immediately after the injury and within the acute stage. After that, the correct external herbal formula should be used.
You may have heard about many types of external formulas coming from the Shaolin temple in China. It was run by monks and martial artists who devised special formulas for treating their martial arts injuries and beyond that, for enhancing their vigor and power for martial skills. The most important modality of healing at all stages of the injury from acute to chronic is acupuncture. Acupuncture can prevent much of the swelling at the early stage, encourage healing and reduce the pain considerably, thereby speeding up the healing process many times over that of conventional medicine or doing nothing to it. It is also more effective, with quicker pain relief than using herbs alone. Both herbs and acupuncture are used simultaneously by many traditional doctors of Oriental medicine.
Acupuncture works as an analgesic via the endorphin theory, and by promoting the flow of blood and Qi, the most important function needed for the body to heal. When the blood and “Qi” are flowing smoothly, the muscles start to relax and when the muscles relax, the pain goes away. Thus, by virtue of healing in the process, the pain starts to lessen and will be gone when the healing is complete and the area normalized. Even in areas of little or no blood supply, the “Qi,” fluid, chemicals and nutrients need to be flowing freely. Acupuncture will do this in the case of joints, spine, pinched nerves, bones and vertebrae, as well.
Electro acupuncture works by the same principles as manual acupuncture as for the result or purpose of the treatment. It does not use the Gate Control Theory, where the sensation of pain is only blocked from going to the brain. The needles go into the tissue and will have the effect of actually getting the body to heal itself faster and permanently. How acupuncture and electro acupuncture works through a scientific theory and through traditional Oriental medicine theory will be the subject of a future article.
“Blocked” flow of qi and blood, known as “blood stasis” among Oriental medicine doctors is the main culprit causing the pain in all forms of neuromusculoskeletal injuries and disorders and even diseases. Being able to open up the pathways and meridians along which the energy flows and let the blood and/or fluids nourish all the parts as it should is probably the main “magic” of acupuncture. Nature does the rest.
Athletic training departments in Japan will bring out the acupuncturist as well as the athletic trainers and other paraprofessionals. However, in the United States, acupuncture is still little known or recognized as immediate treatment among the Athletic Training Departments in the colleges and among the public. It is about time that the United States “gets with it,” too! Professional, amateur, and weekend athletes could benefit greatly!