RICE (rest, ice, compression and elevation) is a mainstay treatment of sports injury. It is not uncommon to see a professional or college athlete on the sidelines with a bulky bandage holding an ice pack in place and an elevated limb following an injury on the field. Participating in sports is becoming more popular, and so are sports injuries. Whether you are a competitive athlete or a weekend warrior, you can consider yourself among the very lucky if you have not yet experienced a sports-related injury or condition requiring specialized treatment.
Some sports injuries unequivocally require surgery to repair/stabilize the structure of the bone or function of the joint. But what about injuries not requiring surgery, or those old injuries developing arthritis and years later ache after each game? Are there alternatives or complements to surgery to assist the body’s return to optimal function? It turns out that there are a number of alternatives and many are available locally.
This article is not meant to replace a discussion with your physician about need for surgery following an injury, but rather to inform you and provide an overview of a variety of available treatment options.
Acupuncture, an ancient healing art that originated in China, began to gain popularity in the United States following President Nixon’s China visit in 1972. Johnny Howell, of All Mountain Sports and Acupuncture, specializes in the use of acupuncture for sports injuries. “Biochemically acupuncture can work in a couple of ways… [by] stimulating natural opiate production in parts of the brain, aiding in pain relief… and by releasing a natural anti-inflammatory compound adenosine, which acts as a powerful natural pain killer,” Howell said. In addition, acupuncture needling “facilitates the tight muscle fibers to relax, aiding in proper body alignment, pain relief, improved circulation and increased range of motion,” promoting the healing process after an injury.
Chiropractic was established as a medical modality in the late 1800s by Daniel D. Palmer, who proposed that the alignment of the spine, and by association the function of the nerves, has a direct effect on our health. In addition to manually manipulating the spine and joints for optimal alignment, many current practitioners also include nutrition and lifestyle education and counseling.
When treating a sports injury Tom Crisofulli, DC in the Avon Chiropractic Wellness & Longevity Center takes it one step further and “…relates joint alignment to proper muscle and skeletal function thereby leading to optimal total body function.” In his experience, chiropractic benefits the lower back as well as the upper and lower extremity injuries.
Tom Palic, DC at Palic + Miller in Edwards uses a number of modalities to approach sports injury. He starts every patient on proteolytic enzymes which may include ‘glandular’ compounds. Proteolytic enzymes are substances that break protein molecules into smaller fragments. Glandular compounds are substances made from the endocrine organs of animals, usually pigs or cows. Palic reports this is a combination used by Lance Armstrong’s team doctor and has been very effective in his practice in conjunction with manual manipulation and cold laser treatments.
The concept of using solid needle insertion to affect trigger points was first introduced by the Czech physician Karel Lewit in 1979. Today it is common in multiple local physical therapy and chiropractic offices and seems to work very well for patients with chronic pain associated with muscular spasm. The needle is similar to that used in acupuncture and it is inserted into trigger points that are identified as the patient is examined. The insertion of the needle is theorized to mechanically disrupt the dysfunctional neuromuscular junctions associated with the trigger points.
Photo or light therapies have been used for many years for a variety of medical problems; in fact, the 1903 Nobel Prize in
Physiology or Medicine was awarded to Niels Ryberg Finsen for his novel use of “concentrated light radiation” to treat skin conditions. Recently near-infrared (NIR) therapy has been demonstrated to reduce swelling and to modulate the inflammatory responses. Light therapies are becoming more popular for the relief of sports related injuries.
Low laser light therapy (LLLT) or cold laser, has received a lot of attention in recent years. Multiple studies are underway and there is evidence of benefit for patients with chronic shoulder and neck pain, as well as post-surgical wound pain. Other preliminary studies indicate specific frequencies of LLLT have beneficial effects on collagen formation and tendon healing. In 2006 researchers reviewed literature regarding the short-term effects of LLLT use and concluded that when specific wavelengths were applied a decrease in inflammatory mediators were found.
Ascent Physical therapy and Drs. Palic and Miller use cold laser in their treatment of sports injuries. Dr. Sean Miller states, “Specific areas where we are seeing great results, are with patients who have old injuries [or have had] surgeries that are still causing the patients pain and limiting the patients activity level months and even years after the initial injury or surgery.”
Infrared sauna treatments have recently gained popularity for treatment of sports injuries. The Finis Boni infrared sauna has the advantages of a traditional sauna (heat therapy) as well as the delivery of near-infrared (NIR) light. Reported results include increased circulation, sweating, pain reduction and wound healing – some effects are the result of NIR light and others from the increase in body temperature. As with the LLLT, the infrared sauna also has the benefit of stimulating energy production at the cellular level. Mitochondria, the “power plants” of cells, are activated by specific light frequencies (some in the NIR range) stimulating energy production. More cellular energy could result in more rapid healing.
More studies are needed to discover the full clinical impact of photo therapies. However, healing support, the reduction of swelling and increased cellular energy are promising outcomes. Expect more to come from this field.
Historically sports massage has been used to prepare athletes for an athletic challenge, post-event “cool down” and treatment of injury. Mike Christenberry of Jointworx states, “Sports massage best addresses long-term, chronic injuries and dys- or mis-functions… [the] techniques that address neuromuscular re-education, active releases, proprioceptive self-maintenance and similar modalities put the rest of the healing work back into the conscious mind of the athlete.” Christenberry encourages clients to take an active and aware approach to their healing. He is there to apply focused “…attention to an injured area [which] can improve balance, flexibility and increase circulation.”
ORTHOPEDICS AND SPORTS MEDICINE – NONSURGICAL APPROACHES
An orthopedic or sports medicine evaluation is vital after a significant sports injury. If you are not sure if your injury is significant – you would likely benefit from an evaluation. A thorough examination will identify subtle instability as well as a more severe injury that requires surgical repair. Unstable joints need to be stabilized correctly for optimal results. Weak or unconditioned supporting muscles can be identified and a physical training program designed to reduce the chance for re-injury may be recommended.
First used in the 1950s, corticosteroids, the body’s natural anti-inflammatory compounds, continue to be used in the treatment of sports injuries to reduce swelling and inflammation, though very rarely. According to Rick Cunningham, MD, an orthopedic surgeon of Vail Summit Orthopaedics, injections of these steroids are now considered a “rescue option” for patients who have not responded to other forms of treatment. “Most cases [of sports injury] are non-surgical,” he reported. Though he employs a variety of treatment options from specialized braces to platelet-rich plasma, for those with pre-existing arthritis he has good results with hyaluronic acid, a natural viscosupplement produced from chicken combs. It is a viscous liquid that is the same as the body’s natural lubricant. Injections are given every six to 12 months. There is some evidence indicating it may stimulate the production of additional hyaluronic acid when injected into a joint. Adverse reactions to hyaluronic acid are low and similar to saline injection.
Platelet-rich plasma (PRP) is a novel modality to treat joint pain. Using a person’s own blood, a concentrate of platelets is prepared. The platelet, a small cell in blood, known for its role in blood clotting, also contains number of growth factors with healing potential. In the last several years a number of researchers have been using PRP in painful joints with degenerative changes. David Karli, MD, a physical medicine specialist at The Steadman Clinic finds a “…trend toward improved pain and function…” in those patients who have opted to try PRP because otherwise, they have been advised, the next step for them is joint replacement. The exact formulation and number of injections required for optimal healing is still under investigation. Currently injection number and frequency is determined by an individual’s report of response to treatment. No adverse rejection or allergic events have been observed to date.
In 1813, Per Henrik Ling established the first institute that included passive and active exercise as well as massage for therapeutic purposes, but it is thought that the first use of physical therapy was advocated by Hippocrates in the late 400s BC. Today, physical therapy is a mainstay for the treatment of sports injury. The Valley is blessed with many top-flight physical therapists. Sara Manwiller of Jointworx is emphatic, “All [sports] injuries can benefit from physical therapy… [The] primary goals are to restore normal range of motion… and strength in order to be able to return to sport without restrictions.”
Manwiller teaches her patients how to move properly so as to not cause additional injury and also how to apply the proper techniques for strengthening the muscles that support an injured joint. She also stresses the importance of lifestyle and eating properly for optimal healing. With her assistance, “improved function can happen immediately, but typically, soft-tissue and connective tissue injuries take four to eight weeks to heal.”
Aquatic therapies (e.g. whirlpool therapy) have been popular since the 1960s and remain a treatment approach for easing the pain of sports injury. Neuromuscular repro-gramming, a modality by which a practitioner assists the patient to re-establish normal nerve-muscle communication following an injury, is based on neuroplasticity, a concept only recently understood in human physiology. Alpha-stimulation, a method to reduce pain by also affecting neural pathways is another therapeutic approach that aids healing.
All of the interviewed providers indicated the continued application of a specific therapy is dependent on the patient’s individual response.
RICE, as well as surgery, will remain mainstays of sports medicine. However, sports medicine treatment has come a long way. There are exciting new modalities helping us optimize therapeutic outcomes. The bottom line is a thorough evaluation, coupled with a therapeutic program, will lead to your best results.