Kelley Mondesire', DA, AP, L.Ac.

Improve Your Golf Game!

The Treatment of Soft Tissue Damage

with Traditional Chinese Medicine (TCM)

Golf is a sport of repetitive motion, concentration and precision.  Pain or limited range of motion can be detrimental to one’s game.  The golfers I treat in my practice typically present with  muscle strains, spasms, limited range of motion in the upper torso and lower back, and usually experience chronic pain.  Lateral and medial malleolus tendonitis (golfer’s elbow), rotator cuff tears, iliopsoas pain, tight IT bands, and wrist pain are just a few of the most common ailments.  Traditional Chinese Medicine can be quite effective to prevent injury while training and resolve acute and chronic conditions. 

What is Acupuncture and How Does It Work?

Acupuncture is the gentle insertion of hair-fine needles into specific body points to treat health at the level of Qi. The Qi (pronounced 'chee') is the life force or the subtle vital energy that motivates all living things.  The invisible Qi is believed to circulate via a system of conduits; the principle ones being the meridian or channels, as well as through the blood (Xue).  The conduits resemble those of the vascular or nervous system.  Each has a network of main channels and minor capillaries. When the Qi flows well, there is harmony and balance. If it is blocked or stagnates, then disease results. Needles are inserted along these meridians in an attempt to influence the flow to the internal organs. This can have a profound effect on the structure and function of these organs.

Often, immediate relief is obtained. This is because acupuncture stimulates the release of endorphins. These are the body's own morphine-like substances. They are natural pain killers. These substances are responsible for the 'high' the runner feels after the effort.

Safety

These needles are ultra fine, unlike hypodermic needles. Some ten to fifteen acupuncture needles can fit into a normal hypodermic needle.  The process is generally painless. Disposable and sterile needles are used; there is no risk of infection.

The utilization of acupuncture, external herbal applications, internal herbal prescriptions, Shang Ke Xue (known here in the United States as ‘Hit Medicine’ and associated with the Martial Arts),  Tui Na (soft tissue manipulation), Active Release Techniques (ART),  and rehabilitation exercises can exponentially speed up the recovery process of acute and chronic injuries and get you back into the game. 

How Can This Improve Your Golf Game?

By increasing the blood flow throughout the body increases cellular nutrition.  What this means in plain English:  new muscle fibres can grow, lymphatic drainage can function properly and the synovial fluid can flow freely through the joint capsules.  This will increase range of motion, resolve tightness and strain, eliminate pain and scar tissue.

The bottom line…your stroke will be freer, faster, stronger and much more precise.

The Bottom Line

If your par isn’t what it should be, or you’d like to improve that swing…come in for an orthopedic evaluation and we can develop a program to improve your game!!

So many sports-related injuries, particularly muscle strains and tears, can be avoided if some simple preventative measures are worked into a fitness routine. But once the damage is done, the use of Active Release Techniques, Acupuncture combined with Chinese herbal internal and external formulaes can do wonders for the healing process. Let’s explore how the damage is done, what we can do to prevent these injuries, and what you can expect during the recovery process:

Muscles move bones. At either end of a muscle, the tissue becomes much more solid. This is called a tendon. The tendon is what attaches to the bone. Now…when a muscle shortens, it pulls on the tendon, which, in turn, pulls on the bone. Easy, right? So what happens when the muscle ‘strains’?

A Muscle ‘Strain’ (commonly known as a ‘pulled’ or ‘torn’ muscle) is when the softer portion of the muscle (the fibres) stretch and/or tear. This typically occurs at the muscule-tendon junction (where the muscle transforms into the tendon).

The Cause: The troublemaking culprit better known as ‘the muscle’, is more frequently one who is weak, fatigued, rigid, inflexible or ‘cold’ (hasn’t been warmed up prior to the exercise or sports activity). This also occurs when the muscle is stretched too quickly. This results in pain and inability to repeat the activity currently at hand.

When it tears, there’s acute pain, sometimes accompanied by a popping or ripping/tearing sensation, and commonly, a burning sensation…as if you were hit by a baseball thrown at 90mph.

1^ST Degree: this is mild; this is categorized by limited tearing and overstretching of the muscle. A ‘knotty’ and ‘wound up like a ball of wool’ sensation is accompanied by pain and discomfort when attempting to use the muscle. There is a minor loss of strength and the activity can be continued but with some limitations.

2^nd Degree: this is considered to be moderate. In this case, a ‘pull’ is felt accompanied by fatigue, weakness, swelling, bruising, tenderness and inability to continue the activity at hand. In this case, we apply external poultices to reduce swelling and increase the circulation of red blood cells. This aids in a quicker recovery time.

3rd Degree: This is a severe strain. There is a total rupture of the muscle. Here’s where we get the sound effects of ‘pop’, and ‘snap’. Forget completing the activity. There is acute and significant pain; the affected area may become swollen and bruised. This is because the muscle may be bleeding on the inside. After the swelling dissipates, a noticeable gap between the muscle and where it connects to the bone can be seen and/or felt. My suggestion to anyone who has a 3^rd degree injury is this: go see your primary care physician and see exactly what the damage is…then proceed with a sensible treatment plan.

Clinical trials have proven that strong and supple muscles are key to preventing most sports related injuries. A warm muscle is a happy muscle. Heated muscles are much less likely to be strained. Warm up before you exercise. Jump rope, jog in place, do jumping jacks. Stretch AFTER you’ve warmed up. If you are a beginner, go slowly.

If possible, work with your personal trainer or physical therapist to ensure that the muscle groups are sufficiently warmed up before attempting resumption of exercise. Warm up the muscle BEFORE and AFTER you stretch and exercise.

Initially, icing the affected area during the first 24 hours of initial injury is a good idea. Treatment will be predicated by the degree of the strain. For 1^st and 2^nd degree strains, proceeding the first 24 hours, apply heat and start moving the affected area. Move the joints and the muscle as soon as you can. This prevents stiffness, fatigue and atrophy of the muscle. Once you can extend and flex the muscle without pain, begin light stretching.

TRADITIONAL CHINESE MEDICINE FOR TREATMENT

Traditional Chinese Medicine can be quite effective to prevent injury while training, as well as resolve acute and chronic conditions.

This is not a ‘tear’ of the muscle but a fatigued muscle. Cramps occur when the muscle ‘cramps’ or ‘knots’. This usually occurs during the first few weeks of football, basketball and soccer season. The best treatment for a cramp is to alternately rest and stretch and drink plenty of water. If you are experiencing muscle cramps while sleeping and this happens frequently, discuss this health concern with your health care provider. The use of Acupuncture combined with internal/external Chinese formulaes may provide relief from these nocturnal occurrences.

Diet is very important when we speak about muscle cramps. If you are on a restricted diet, consult with your dietician about ways in which you can improve your diet. Red meat is the only true protein source that can rebuild striate muscles after they’ve been torn - both microscopic from exercise (weight lifters in particular) or a major tear via trauma. Fatty fish such as salmon or any other fish that contains fatty omega 3’s are great not only for the tendons and muscles, but also the skin, hair and joints. If you are a vegetarian…think red! Red kidney beans, lentils and beets are great sources of lean protein and important vitamins.

The most effective way to avoid muscle cramps is to HYDRATE!!! Hydration is so very important for overall health. We are over 80% water in our bodily composition. Cells need water for homeostasis and bodily functions. If you are an endurance athlete, you must take care that you are fuelling your body with enough carbohydrates, proteins and electrolytes while running that marathon or doing those triathlons.

Impact-loading" activity, such as jogging or high-impact aerobics, is not recommended, but more gentle exercise, such as swimming or water aerobics, is.

Acupuncture and Chinese Herbology is a therapy that has been studied extensively. It can be quite effective in managing pain and reducing stress associated with living with the chronic arthritis and extremely successful in the prevention of osteoarthritis if therapy is sought early enough.

That as early as in 1980, the World Health Organization endorsed acupuncture for the treatment of some 40 ailments, including both osteoarthritis and rheumatoid arthritis.

In 1997, an National Institute of Health panel also concluded that acupuncture was not only helpful for postoperative pain and nausea, but also could help in the treatment of fibromyalgia and other musculoskeletal conditions, and without the side effects of anti-inflammatory drugs.

The University of Maryland School of Medicine recently completed a four-year National Institute of Health-funded study, the largest ever undertaken, to determine how well acupuncture works. The results, published in December 2004 in the Annals of Internal Medicine, found that traditional Chinese acupuncture significantly reduces pain and improves function for patients with knee osteoarthritis who have moderate or more severe pain despite taking pain medication. But let’s not forget Chinese Herbal treatments - both internal and external.

Begin with treatments such as exercise and weight loss. Try the simplest and cheapest regimen first. That should be your first line of defense.

Let’s not point fingers, but how many of you are 15lbs or more over your recommended weight? Did you know that for every pound you are overweight, 3 pounds of additional pressure is placed on each knee. So, do the math. 10lbs of stupid fat equals 60 pounds of pressure!!!! This means that if you have issues with hips, knees and/or ankles and you are 10 pounds overweight, you are walking around everyday as if you have 30 pound weights strapped to each knee!!

Because the quality of herbs and supplements can vary, even some of these treatments might not work.

Fortunately, most products contain what they claim Choose supplements wisely and with the consent and supervision of your primary healthcare provider. And buyer beware: If a product is not working, it may be the product itself that is flawed, and not the approach.

Better Bones on a Budget!  For Men and Women Alike

Since we’re all living a lot longer than our ancestors, perhaps it’s time we learned how to stay healthy and active during those golden years.

The 2004 Surgeon General's Report on Bone Health stated that many patients who have experienced fractures have had no discussions about osteoporosis with their healthcare provider. In fact, a 2004 Sanford study revealed that more than 50% of all persons having osteoporosis continue to suffer undiagnosed! The study also concluded that post-surgical patients very often do not consume enough calcium and vitamin D in their daily diets to support their bones.

What a pity for those who experience the degeneration of quality of life when it is fairly easy and inexpensive to take care of your ‘bag o bones’. The tragedy: the fractures and bone degeneration occurs at a fairly rapid pace when no care is taken for the skeleton.

Did You Know?

Osteoporosis causes more than 1.5 million fractures every year. Women who are older than 50 years have a 50% chance of having an osteoporosis-related fracture. For men, the statistic is currently 1 in 4!

So What Can You Do?

It’s not very difficult or expensive to take some simple steps and adjustments to your daily life to decrease the odds of becoming a victim to osteoporosis-related fractures.

Here are some helpful hints that, in general, can only help improve the quality of daily life:

Intake of the daily recommended amount of calcium and vitamin D is very important. The National Osteoporosis Foundation recommends 400 to 800 IU of vitamin D every day. Vitamin D and calcium can be found in various foods such as: dairy products, egg yolks, fish, and liver. For women who are postmenopausal, the recommended daily intake is 1,200 milligrams of calcium, and 1,000 milligrams daily if for pre-menopausal women.

Bone Density Demystified

Many of my patients who are beginning their early stages of menopause frequently ask me about bone density testing. First and foremost, let’s remember that no two ‘bag o bones’ are the same. Bone Density test results can be deceiving because some patients have smaller or larger bones than the mean standard. This means that when these persons have their bone density tested, the results can be misleading. Very petite women can have very low results according to the scales where, this level can be quite normal for their small frames and bone size. This can result in bone mass treatment, where no treatment is necessary!

Diagnostic testing is important, but other factors equally in the frontline are past histories of fractures, age, history of smoking, high level of alcohol consumption, little exercise, bone rebuilding rates, and familial history of fractures. Did you know that 85% of your bone mass is genetically determined? That being said, let’s move on to a brief primer on what these tests are really all about!

DXA (dual-energy x-ray absorptiometry) - this is a low dose x-ray that measures the level of calcium in the bones and how tightly the calcium is massed in the hip and spine. The average (or mean) is the average peak bone mass of a healthy young white woman at age 30. The difference in any given woman’s score and the mean is known as a T-score. A score between +1 and -1 is considered within the mean. A score between -1 and -2.5 is considered Osteopenia. Osteoporosis is considered to be a score of -2.5 or lower. This means that these bones have 32% less mass than the average 30 yr old woman.

DXA is typically used to make a baseline score, diagnosis and treatment by western medical standards. It is also used as a diagnostic tool over the long term to monitor bone density for patients who might or might not be on medication.

Urine Calcium Level - this is a test that involves collecting the urine over a 24 hour period. This diagnostic tests whether you are losing too much calcium from the body than the average person.

Vitamin D Levels - This test measures the level of vitamin D in your body. Usually, lower than normal levels of vitamin D are treated with dietary modifications and/or vitamin supplements.

Bone Turnover Markers - this is a urine test which scores the rate at which bone ‘remakes’ itself. This test is used in conjunction with DXA to better monitor the progress of medications and other treatment strategies being used to slow down the overall loss of bone mass.

Parathyroid Hormone Measurement - this hormone is responsible for the maintenance of the levels of calcium in the blood. A marker of excessive levels can point to bone loss. Elevated levels of calcium in the blood are indicators that something could be amiss in the parathyroid gland. Sometimes a benign tumor can be the culprit; this is usually resolved with surgery.

O.K…..now that you’ve got the primer, print out this page and keep it tucked away for future reference. The more information you have about bone density, the less intimidating the experience will be for you when it comes time to have the initial baseline test performed. And as always, ask questions! Take your time and sit down with your healthcare provider and discuss your baseline results. If your test results are out of the mean, test again. If medications are recommended, get a second opinion. The more educated you are about your own body, the more active and productive role you take to ensure optimal health.

Traditional Chinese Medicine and Your Bone Health

The Sea of Marrow Courses Through the Bones….bone health is nothing new to us practitioners of Traditional Chinese Medicine. I’ll try to keep this as simple as possible:

The bones are considered a miscellaneous or curious organ because they resemble Yang organs in their form but function like Yin organs. The ancient Chinese believed that the Kidneys ruled the Bones. According to the theorems of Traditional Chinese Medicine, the Kidneys store Essence which is responsible in turn for the production of marrow, which creates and nourishes and courses the bones. The Kidney Essence is also responsible for birth, development and maturation. Therefore, the health of the Bones is dependent upon the maintenance of the Kidney Essence. For example, children with soft bones or fontanels that do not close usually are deficient of Kidney Essence. For adults, a deficiency of Kidney Essence can manifest as weak and sore knees and legs, brittle bones, stiffness of the spine, leading to multiple fractures. The Chinese believe that the teeth are byproducts of the bones, which are also ruled by Kidney Essence. Children who have poorly developed teeth or adults who suffer with chronic tooth problems can be diagnosed as suffering from a deficiency of Kidney Essence.

All this might seem quite confusing and quite illogical to some, but the proof of the pudding is this: Traditional Chinese Medicine (the use of both acupuncture and herbal formulaes) can be quite effective in the treatment of the Bones. We treat the root cause by tonifying and nourishing Kidney Essence. Your practitioner of Traditional Chinese Medicine will partner with you and your western medical practitioner to devise a treatment plan that will specifically address YOUR needs to help slow the process of bone degeneration. For information about how Traditional Chinese Medicine can help you maintain healthy bones, telephone my office to arrange a consultation. We can go over your health history and together develop a productive strategy for your total well-being.

Source: The Web Has no Weaver, Kaptchuk, 2000, Contemporary Books.