Complementary and Integrative Medicine and Sports Injuries

Introduction
How does CAM Therapies assist in the healing and overall health of athletes, and even the
hobbyist? During this three-week class, I will go over how certain CAM therapies can help in the
health and healing of sports injuries. I’ll focus on Chiropractic Care, Acupuncture Therapy, and
Ayuervedic Medicine. Not only will I go over what each therapy is, I will cover how each
therapy helps the body heal, and how it helps the body stay healthy. Each discipline has ethical
codes and training that need to be followed, and that will also be covered in this class. Finally,
I’ll go over what is available locally for you, if you want to try one of these CAM therapies for
yourself.

Day 1: Chiropractic Care

First question you probably have is, what is Chiropractic Care? Many people have probably seen
the viral videos of people’s back cracking and snapping, but there is a lot more to Chiropractic
care than cracking people. Chiropractic is a licensed health care profession that emphasizes the
body’s ability to heal itself. Treatment typically involves manual therapy, often including spinal
manipulation, which is where the viral videos come from. Other forms of treatment, such as
exercise and nutritional counseling, may be used as well. This exercise and nutritional
counseling is the main part of chiropractic care that many people don’t realize how much this can
benefit them. Chiropractors approach patient care in a way that is similarly used in conventional
medicine. They interview the patient, obtain a detailed health history, perform an examination,
do tests, and develop a working diagnosis. They then develop a management plan, start
treatment, and monitor the patient’s progress. Chiropractors often treat problems related to the
musculoskeletal system. The manual treatment methods used by chiropractors range from
stretching and sustained pressure to specific joint manipulations, which are usually delivered by
hand and involve a quick and gentle thrust. The purpose of the manipulations is to improve joint
motion and function. Manipulations are most commonly done on the spine, but other parts of the
body may also be treated in this way. This manipulation is what everybody thinks of when we
talk about going to the chiropractor. To practice in the United States, chiropractors must earn a
Doctor of Chiropractic (D.C.) degree, pass the National Board of Chiropractic Examiners exam,
and have a state license. Many states also require chiropractors to pass an exam about state-
specific laws, and all states require practicing chiropractors to take continuing education classes.
To enroll in a D.C. program in the United States, which typically takes 4 years to complete,
students must have had at least 3 years of undergraduate education. Institutions that award the
D.C. degree are accredited by the Council on Chiropractic Education. Chiropractic education
includes classes in basic sciences, such as anatomy and physiology, and supervised clinical
experience in which students learn skills such as spinal assessment, adjustment techniques, and
making diagnoses. Some chiropractors complete postgraduate education in specialized fields,
such as orthopedics or pediatrics. The scope of chiropractors’ practice varies from state to state.
Health insurance plans may cover chiropractic, but coverage may be partial rather than complete.

Ethics: Code of Ethics has been disseminated by the American Chiropractic Association (ACA).
Doctors of chiropractic should maintain the highest standards of professional and personal
conduct, and should comply with all governmental jurisdictional rules and regulations. Doctors
of chiropractic have an obligation to the profession to endeavor to assure that their behavior does
not give the appearance of professional impropriety. Any actions which may benefit the
practitioner to the detriment of the profession must be avoided so as to not erode the public trust.
This runs pretty well in line with most codes of ethics within the medical community.

How does Chiropractic Care Help with Injuries?

Athletes of all skill levels can suffer from varying degrees of sports injuries during practice or
gameplay. The constant stress from punishing training and games can lead to overuse injuries,
pains, aches, and stiffness, which can worsen if not treated properly. Athletes don’t have to give
up playing their favorite sport or sacrifice performance due to injuries. Visiting a local
chiropractor can help relieve pain, improve range of motion, and give athletes a competitive edge
with regular spine adjustments and other specialized techniques.

How does chiropractic help with injury prevention? Misalignment in the spine and pelvis can
create asymmetry in a person’s body. This asymmetry in the spine means certain muscles have to
compensate for the unequal distribution of pressure throughout the body. Pinched nerves and
out-of-place vertebrae can lead to tension and a decreased range of motion. Chiropractic
adjustments can restore the body’s natural spinal alignment and even perform soft tissue massage
to reduce pain and tension. Spinal manipulations can remove tension, spasms, and cramps that
lead to strains and missed practices and games. A properly aligned body can improve an athlete’s
form during training, reduce the chance of injury, and enhance performance.

How does this effect your pain management? Athletes can suffer a wide range of sports injuries
including muscle, tendon, and ligament strains, tears, aches, and, pains. These injuries often lead
to soft tissue damage that can take weeks or months to heal. Soft tissue damage can be more
painful than bone injury. As the body heals itself, it creates scar tissue over the muscle tear. The
scar tissue can reduce flexibility and strength, as well as muscle pain and joint stiffness.
Chiropractic adjustments and soft tissue manipulation can help athletes manage pain during a
sports injury recovery by improving muscle balance and removing nerve interference. Sports
injuries often result in misaligned vertebrae that pinches nerves and causes pain. Soft tissue
inflammation can intensify pain and prevent proper nerve signaling. Athletes looking for a drug
and surgery-free way to manage sports injury pain should consider chiropractic care.

So, what about recovery time? When the body is healing itself from a sports injury, athletes may
experience spasms and inflammation which can increase the time it take for the injury to heal.
Chiropractic care doesn’t just reduce the pain associated with injury recovery, but enables the
body to recover faster. Adjustments and soft tissue manipulation can help break up scar tissue to
increase flexibility, elasticity, and strength throughout recovery. Chiropractors restore joint
movement by preventing the shortening of muscles and ligaments that inevitably comes after
immobility from an injury. Chiropractic care can alleviate and prevent sports injury by restoring
optimal joint mobility, aligning the spine, and removing nerve interference. Proper spinal health
can reduce inflammation, improve blood circulation, reduce pain and tension in muscles, all of
which improve the body’s ability to heal itself. Don’t wait to visit a chiropractor until it’s too
late. Chiropractors offer a low-risk and budget-friendly option to enhance flexibility, endurance,
and performance athletes of all ages.

Refer to Handout: Talk about the 5 books mentioned in the handout. Where to find the books,
and how they can help you at home. Next, if the books aren’t enough, talk about the closest
offices available. Top 3 offices are listed on the handout.

DAY 2: Acupuncture
When talking about Acupuncture, a lot of you will think that it is needles sticking into your
body. At its most basic level, it is, but there is so much more than that to acupuncture.
Acupuncture is a technique in which practitioners stimulate specific points on the body—most
often by inserting thin needles through the skin. It is one of the practices used in traditional
Chinese medicine. What does the science say about the effectiveness of Acupuncture? Results
from a number of studies suggest that acupuncture may help ease types of pain that are often
chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. It also may help reduce
the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture
appears to be a reasonable option for people with chronic pain to consider. For those of us that
are physically active on a daily basis, we all know about that chronic pain. Different joints,
different muscles, and overall fatigue are some of the most common complaints that I find with
those people. A lot of people have concerns about the safety of acupuncture. Well, the good
news is, it is a very safe practice when done with a licensed professional. Relatively few
complications from using acupuncture have been reported. Still, complications have resulted
from use of nonsterile needles and improper delivery of treatments. When not delivered properly,
acupuncture can cause serious adverse effects, including infections, punctured organs, collapsed
lungs, and injury to the central nervous system. Don’t use acupuncture to postpone seeing a
health care provider about a health problem. If you decide to visit an acupuncturist, check his or
her credentials. Most states require a license, certification, or registration to practice
acupuncture; however, education and training standards and requirements for obtaining these
vary from state to state. Although a license does not ensure quality of care, it does indicate that
the practitioner meets certain standards regarding the knowledge and use of acupuncture. Most
states require a diploma from the National Certification Commission for Acupuncture and
Oriental Medicine for licensing. Some conventional medical practitioners—including physicians
and dentists—practice acupuncture. In addition, national acupuncture organizations (which can
be found through libraries or by searching the Internet) may provide referrals to acupuncturists.
When considering practitioners, ask about their training and experience. Ask the practitioner
about the estimated number of treatments needed and how much each treatment will cost. Some
insurance companies may cover the costs of acupuncture, while others may not. For more
information, see NCCIH’s fact sheet Paying for Complementary Health Approaches.

Ethics: Given the unique practice of medical acupuncture, we are often the only providers of
nontraditional medications and devices. To that end it is incumbent upon us to respect the laws
of the states in which we practice and the ethics of the professional societies to which we belong
regarding the sale of products and services: As Physician Acupuncturists, we shall be dedicated
to providing the best of acupuncture and Western medicine to all patients. As Physician
Acupuncturists, we shall promote a healing relationship with respect and compassion for the
rights and needs or our patients. As Physician Acupuncturists, we shall promote education and
awareness of acupuncture among our colleagues, other health professionals and patients. As
Physician Acupuncturists, we shall promote continuing education, research and the advancement
of the scientific foundation of acupuncture. As Physician Acupuncturists, we will honor and
respect the code of ethics of other professional organizations to which we belong and the laws of
the state(s) and country in which we practice.

How does Acupuncture help with Injuries?

In recent years, I have noticed that more and more athletes are adding acupuncture therapy to
their recovery routine. Why? When conventional rehabilitation methods are just not enough,
what else can facilitate return to sport? Acupuncture can provide a number of benefits,
including:

Pain relief – Acupuncture needles can be placed where the injury occurred in the muscle or
tissue, and also the surrounding areas. Their insertion provides a minor trauma to the skin, which
stimulates the production of pain-relieving chemicals both locally at the trauma site, and at the
brain and spinal cord level. Chemicals such as endorphins and opioids are released and pain
feedback channels from the pain source to the brain are blocked so that the level of pain
perceived by the brain is reduced.

Inflammation reduction – The microtrauma of needle insertion also stimulates an natural anti-
inflammatory response by releasing chemicals that cause vasodilation (blood vessel dilation) and
vascular permeability (this allows greater flow of chemicals through the vessels). These
physiological responses allow the removal of inflammatory mediators from the injury site, and
the enhancement of healing mediators to the area.

Trigger point release – In addition to promoting anti-inflammatory and pain-relieving

mechanisms, acupuncture can also be used to resolve regions of tightened muscle called trigger
points. Trigger points (also known as muscle knots) occur when there is the over-contraction of a
small number of muscle fibers in one region. Needling directly in to the trigger points simply
causes mechanical disruption of the contracted muscle fibers to encourage relaxation. It also
stimulates blood flow and the delivery of oxygen and nutrients through vasodilation, and reduces
the elevated electrical activity in the muscle, allowing them to relax.

Given the potential benefits, acupuncture treatment may help accelerate the return to
rehabilitation and training for athletes. With pain modulating and inflammatory reduction effects
the athlete is then better placed to begin loading their body and the injury safely. An example is
trigger point release. Trigger points can often develop after repetitive activity, eccentric and
concentric exercises, and in association with pain5. The acute onset of pain from a muscle
contraction or spasm is usually the result of overloading the muscle, over stretching it, or
increased activity without adequate warm up or preparation. The trigger point development will
produce nociceptive pain, reduce the range of movement, and may alter gait patterns, giving an
overall loss of function.

Refer to Handout: Talk about the Acupuncture Therapy practices in the area. Talk about the
literature that is available to learn more about Acupuncture. The books listed will help
understand the pressure points used in different therapies, and how Acupuncture helps with
injury relief and injury healing.

DAY 3: AYURVEDIC MEDICINE

The last topic in this mini series is about Ayurveda, or Ayurvedic Medicine. The ancient Indian
medical system, also known as Ayurveda, is based on ancient writings that rely on a “natural”
and holistic approach to physical and mental health. Ayurvedic medicine is one of the world’s
oldest medical systems and remains one of India’s traditional health care systems. Ayurvedic
treatment combines products (mainly derived from plants, but may also include animal, metal,
and mineral), diet, exercise, and lifestyle. When you ready metal and minerals, you tend to ask
yourself, how safe is this? The U.S. Food and Drug Administration warns that the presence of
metals in some Ayurvedic products makes them potentially harmful. A 2015 published survey of
people who use Ayurvedic preparations showed that 40 percent had elevated blood levels of lead
and some had elevated blood levels of mercury. About one in four of the supplements tested had
high levels of lead and almost half of them had high levels of mercury. A 2015 case report
published in the Center for Disease Control’s Morbidity and Mortality Weekly Report linked
elevated blood lead levels in a 64-year-old woman with Ayurvedic preparations purchased on the
Internet. Although rare, Ayurvedic products may cause arsenic poisoning. Ayurvedic Medicine
is not something that should be done at home without training. This is something that you
should be going to a professional for.

Ethics: Ayurvedic ethics are more oriented toward the principle of beneficence, non-maleficence
than the principle of autonomy. Hence, Ayurveda should be recognized as a pioneer in
foundation of four basic tenets of bioethics and can help to fulfill the needs of pluralism.

How does Ayurveda help with sports injuries?

One of the eight limbs of Ayurveda is exercise. Yoga is a type of exercise often used as a method
of rehabilitating and calming the mind. Yoga is mentioned as central to the Ayurvedic daily
routine known as dinacharya. Also, and more poignantly we might add, yoga is used for the
rehabilitation of the body. Specifically, we are seeing a rise in the use of yoga to tackle sports
injuries. Sports medicine often uses yoga as a means increasing vascularity, blood flow,
flexibility and strength. It’s also used in cohort with several other treatments to ensure the
healthiest recovery of bone, nerve and muscle tissue. Knowledge from Ayurveda can be used in
essence as a form of Ayurvedic sports medicine, for all types of injuries. Ayurveda is based on
the foundation of balance. An injury would be the crux upon which an external and internal
balance has to be created. Finding the balance of applied rehabilitation is crucial here with a
caveat. As with any form of conventional Western-style sports medicine, exertion here is not
what is aimed for. So much so that Ayurvedic text comments that when we begin to feel so much
exertion that we stop breathing through the nose we must stop. This is that caveat. Overexertion
in Ayurveda for recovery of injuries is not recommended. We must not push our body beyond
50% load. Diets, workout plans, and Ayurveda itself will never prove to be fruitful without the
discipline of consistency. Ayurvedic Sports Medicine additionally has a few extra snippets that
facilitate you.

Here are a few general guidelines:

People under the age of 25 should engage in effective sports.

People between the ages of 25 to 40 should engage in moderate exercise

People above the age of 40 should consider even more moderate exercise.

Aim to work out between 6 and 10 am.

Refer to Handout: Talk about the importance of finding a professional to consult with before
starting any Ayurvedic routine. Make sure the class understands the importance of safety when
it comes to an Ayurvedic diet. Talk about the professionals in the area. If there are people who
wants to learn more on their own time, talk about the books available to them. There are many
different options for books, but the 4 that I listed are the best for beginners that are just learning
about Ayurvedic medicine.