Sports injury treatment-a functional approach
Author(s): Dalius Barkauskas | Keyword(s): treatment
Understanding sports and sports medicine-not so simple as you may think
Today our life is very demanding. If you want to stay on top you need to be hand in hand with the latest news in your professional field, you need to meet the highest standarts in what you are doing-in other words pressures and demands are high. The top level sports world is very very demanding. Here every small detail is important, that’s the reason why a team approach is widely accepted in professional sports, when together with athlete and coach, in their way to perfection, we see not only a sports doctor or physio, but as well specialists in nutrition, psychology, sports physiology and other related fields as well.
Usually if one begins the talk about sports medicine the first thought is sports injury. However sports medicine covers much wider scope of interrelated problems-let say athlete in state of overtraining or even overreaching is already on his/her way of being injuried. In such a situation it is possible even to predict the injury. The treatment strategy of such an athlete will be very complex, with the main emphasis on the immune system (or to be modern I may say on neuroimmunoendocrinology), but not on the injuried area which would be just as a consequence of the general state of the body. So we have to define sports medicine as ‘the medicine of exercises’-that’s a perfect remark from tablebook of every sports doctor Clinical sports medicine by Brukner/Khan. For me sports medicine is very dynamic speciality, which incorporates the most effective methods and techniques in approaching human body, speciality with great demand for practitioner to understand not only pathology, but the complexity of being healthy, to understand functional language of human body and the last, but not the least, to understand the phenomenon of sports. My personal opinion is that those people in sports needs special approach and care and so special doctor, for me sports medicine is a full time speciality. And I’d like to stress that sports is about result, so this does not mean health, but You must be in a state of maximal health to have an ability to reach for a limits and beyond. It is about motivation, intensity, willpower. When talking about health let’s talk about physical activity or exercises, about positive stress for our bodies, humans are designed for activity and movement. Search for a limits it is already another story. So I would like to define sports as the need for the maximum from mind, soul and body, need for perfect health and let’s do not forget about an impact of politics and money.
Not only professional athletes suffer from injuries and other sports related problems-of the millions who participate in sports, thousands deal with injuries, ranging from minor bruises to major trauma, overexertion and etc. So we have very specific groups of individuals (look below) with different needs and expectations. And so those interested in sports medicine and already in the field have to fulfill such expectations.
- Olympic team member-that’s a group of very motivated individuals and often under great pressure physiological plus psychological.
- Businessman crazy about running-for those individuals running is stress resolving method, so injury may has devastating consequences.
- Woman with a need to loose x-teen kilos-very, very, very motivated group on unhealthy, sometimes stupid diet.
- Tennis player – weekend warrior-a perfect patient for Monday morning
- Many others
When dealing with sports people the medical profession faces a lot of problems These injuries and related pathology can cause permanent health problems, as well serious professional and financial consequences. First aid given within the first few minutes and correct diagnosis often determines the gravity and duration of injury. Those who participate in sports usually are very active in social and business life as well, and here we are in trickysituation because:
- First – no time for full treatment and little or no place for treatment strategy known in medical profession as ex juvantibus, if you fail in your treatment, such individuals will never approach you again
- Second – sensitivity to hypodynamics and so need for aggressive treatment strategy, and so possibility of iatrogenic factor
- Third – often muscular imbalance, microinjuries, chronic problems
- Fourth – psychological problems: is it possible to continue?
- Fifth – changes of movement pattern
- Most important – the doctor or other medical professional must understand what sports mean
So again we see the pressures the medical man/lady is under. Plus during in-season (competitions) there is now time for a second try and there is a need to use human body friendly methods and substances. In other words there is a need for “soft” techniques. But again sports doctor needs result in quickest time possible and predictability of intervention.
Homotoxicology in sports medicine: why and how?
It must be stressed that biological medicine offers some really unique approaches and treatment modalities for doctor or other professional in the field, such as:
- Drainage therapy
- Stimulation of enzymatic systems
- Treatment of acute and chronic injuries
- Immunomodulation when dealing with immunodeficiency
- Treatment of viral infections
- Revitalization and recovery optimization therapy plus suis organ preparations
The main feature of such approach is safety and of course a possibility to combine different techniques. Antihomotoxic medicine is a regulatory therapy. It is very common for a sports doctor to deal with dysbacteriosis, syndromes of overreaching and overtraining. Biological medicine and homotoxicology especially is very effective in such cases. Latent acidosis is another factor which should be considered. In sports it is very important not only because of anaerobic activity, but also because of the unlimited use of sports supplements, many for which the long term safety have not been established. Even such a widespread and well known supplement as glucosamine may cause skin allergic reactions, gastrointestinal disturbances, it is not advisable to use during pregnancy and so on.
So it is very clear advantages of such approach and a good possibility to be very effective yet minimally invasive.
In my experience and opinion both the doctor and athlete are winners when the treatment stimulates natural physiological reactions of healing in our bodies. So as I have mentioned already we need to have control on what we are doing, predictability of intervention, minimal or no side effects and yet be aggressive. So total suppression of pain reaction is not our target, because pain is the only criterion, which allows controlled aggression.
It is interesting to mention that by choosing right homotoxicological preparations it is possible to predict the level of intervention.
- Catalysts – cell
- Suis-organ preparations– organ
- Nosodes – tissues
- Complex preparations – whole body
And for maximum effectiveness of course knowledge of Reckewegs antihomotoxic medicine philosophy and basis of treatment-the disease evolution table-will be of paramount importance. But that’s the topics beyond the scope of this article. Simplified scheme of action mode of biotherapeutics is seen below
As we see mechanism of action is modulated by immune system so understanding an immunological bystander reaction will be an advantage, the same applies to general knowledge of matrix physiology and pathophysiology.
Treatment strategy of sports injuries
First of all I would like to stress that acute injury treatment usually is rather clear and straightforward. Well known acronym RICE applies as well other treatment techniques. It is important to follow general principles-diagnosis, treatment, reevaluation. As I have mentioned earlier. We ought to remember that inflammation means healing as was stressed by Bruno van Brant (personal communication). If we analyze inflammatory response phases (acute, repair, maturation) it is clear that there is a need to control inflammation but not to suppress it. Plus during treatment we are dealing with reflex action of nervous system (any nociceptive stimulus will cause nervous system to react ) and again it is important to have adequate reaction. Thus indiscriminative use of inflammation suppression drugs (NSAID, steroids) may have not only direct side effects but as well remote ones. From the point of view of antihomotoxic medicine, the preparation of choice here is Traumeel. Below you see the simplified scheme of action. Preparation is very complex and all parts have synergistic mode of action on inflammatory reaction.
- Aconitum, Hamamelis, Millefolium, Bellis perrenis, Belladona, Arnica-stabilise the vascular permeability, prevent venous stasis
- Aconitum, Arnica, Chamomilla, Hypericum perforatum-analgesic action
- Echinacea purpurea and angustifolia, Mercurius solubilis, Hepar sulfuris-anti-suppurative action
- Calendula, Arnica montana, Symphytum officinalis, Echinacea purpurea-promote healing and callus formation.
The best preparation to combine with Spascupreel (muscle strain injuries), Lymphomyosot (swelling of tissues) in acute injury cases.
Some doctors sometimes try to show that they are open minded and add Traumeel into injection cocktail with antiinflammantory steroid drugs. If we look into the scheme below it is clear that there will be no advantage in such approach, because the steroid drug is blocking all the inflammatory reaction pathways. Plus the corticosteroids side effects on connective tissue are well known and their use in treatment of sporting injuries is a very controversial issue.
When dealing with sports injuries it is advisable to check other components of successful performance: sound nutrition, wise use of the supplementation (theory and scientific data sometimes do not fit), flexibility, the main aid of recovery: SLEEP (growth hormone physiological peaking is about 10pm-1am). Before making a final statement on the diagnostic conclusion it is important to stress that
- Often the site of the lesion is not where the pain is-so to treat site of pain maybe a mistake, therefore careful functional evaluation is needed
- Usually no objective signs-to make final statements only on the basis of instrumental data is misleading. It is not rare to see ‘awful’ changes on X-ray’s and no clinical symptoms or vice versa.
So doctor needs to answer following questions before deciding on treatment strategy:
- Local lesion or referred pain?
- Inert or contractile structure?
- Capsular or non-capsular pattern?
- Palpation? Or diagnosis is made on base of functional tests.
When dealingwith microinjuries and chronic problems in locomotor system it is important to realize that any disturbance of function in a single motor segment will have its repercussions throughout the body axis and must be compensated-in other words we will see chain reactions in locomotor system. Therefore local treatment is impossible or even nonsense. It is the nervous system that determines whether disturbed function will manifest clinically. Control by the nervous system has several aspects: it subserves normal function by the maintenance of correct motor patterns and compensates for disturbed function. On the other hand a chronic nociceptive stimulus may disrupt normal function and cause pathological motor patterns to become fixed (Lewit 1999). So more locomotor system problems we will see in psychologically labile athletes. The main changes may be grouped into three categories:
- Movement stereotype changes
- Cross-syndromes (upper and lower)
- Myofascial trigger points
When injecting trigger points it always important to state that there are silent trigger points (usually main ones-core of the problem) and active (usually satellite) ones. Therefore there is a need for skillful palpation and ability to incorporate into the clinical picture muscular chain reactions and relations (it maybe inevitable to inject peroneus tertius to solve the problem of biceps femoris). Preparations of choice Traumeel and Spascupreel. For very persistent problem Coenzym comp, because this preparation stimulates aerobic metabolism in the tissues. For long term result preventative measures such as matrix detoxification (Thyreoidea comp, Galium Heel, Detox kit as best known preparations maybe prescribed) and corrective exercises is a must.
Example of infiltration in the area of lig., talofibulare anterius after acute ankle sprain, in basketball player. Needles 27G-3/4 inch. 2 ampoules of Traumeel and 3 ampoules of Lymphomyosot where used. Dramatic improvement in the ability of locomotion next day.
Epilogue
For sports physician antihomotoxic medicine offers very safe and yet very powerful way in approach for human body. For sports and those in the field it is a unique way and the possibility to be aggressive and gentle in selection of treatment strategy. From point of view of functional medicine the predictability of the intervention is a paramount requirement. As a final statement I would like to stress few topics:
- Not all techniques from professional body building are suitable for health club clients-and that’s a main problem in modern fitness. We need control of our body, but not mountains of flesh.
- Do not forget about genetics
- Use food supplements with brain
- Be prepared for intensive training
- The main body parts are the brain, the will and the knowledge
- Do not compare yourself with others
- Remember your passport data
