DOES COMPLIMENTARY and ALTERNATIVE MEDICINE (CAM) HAVE a ROLE IN SPORTS MEDICINE PRACTICE? MARJORIE A. KING, PHD, ATC, PT DIRECTOR OF GRADUATE ATHLETIC TRAINING EDUCATION PLYMOUTH STATE UNIVERSITY [email protected] EATA 69 TH ANNUAL MEETING ~ 2017
DOES COMPLIMENTARY and ALTERNATIVE MEDICINE (CAM) HAVE a ROLE IN SPORTS MEDICINE PRACTICE?
MARJORIE A. KING, PHD, ATC, PTDIRECTOR OF GRADUATE ATHLETIC TRAINING EDUCATIONPLYMOUTH STATE [email protected] 69TH ANNUAL MEETING ~ 2017
What ARE Complementary & Alternative Medicine (CAM)
Allopathic Conventional of main stream medicine
Complementary medicine Medical practices outside of main stream medicine used in
conjunction with conventional medicine
Alternative medicine Medical practices outside of main stream medicine used without
any additional conventional medicine
Integrative medicine The blending of conventional and complementary medicine
https://nccih.nih.gov/health/integrative-health
National Center for Complementary and Alternative Medicine (NCCAM)
Five (5) Domains
Alternative Medical Systems
Mind-body Interventions or techniques (facilitates mind’s effect on bodily functions and symptoms)
Biologically-based systems (such as herbalism)
Manipulative and body based methods (chiropractic, massage therapy)
Energy Therapieshttps://www.nlm.nih.gov/tsd/acquisitions/cdm/subjects24.html
Mind Body Practices
Yoga
Chiropractic
Osteopathic manipulation
Meditation
Massage therapy
Tai chi
Qigong; Qi gong; Chi Kung/Gung
Healing touch
Hypnotherapy
Relaxation Techniques Breathing exercises
Guided imagery
Progressive muscle relaxation
Movement Therapies Feldenkrais method
Alexander techniques
Pilates
Rolfing Structural Integration
Trager psychophysical integration
Institutes
http://www.chi.is/indexhome
http://tiih.org/
http://www.miraglofoundation.org/
Chopra Foundation
https://www.choprafoundation.org/
http://www.noetic.org/
http://cewm.med.ucla.edu/
Sara Lazar, Ph.D.Neuroscience of Yoga and MeditationNeuroscience of Yoga and Meditatioin
http://scholar.harvard.edu/sara_lazar
https://nccih.nih.gov/
http://www.bumc.bu.edu/integrativemed/
http://www.umassmed.edu/cfm/
Department of Medicine, Division of Preventive and Behavior Medicine
Benson-Henry Institute for Mind Body Medicine
Katherine A. GallagherIntegrative Therapies Program
http://www.massgeneral.org/cancer/supportservices/integrative.aspx
AcupunctureArt Therapy
Massage TherapyMusic Therapy
ChigongTai Chi
http://www.massgeneral.org/bhi/
http://isharonline.org/ Interdisciplinary Scholar’s Hub
Integrative Studies Historical Archive & Repository
JOURNALS
JOURNALS
The Journal of Alternative and Complementary Medicine http://www.liebertpub.com/acm
Evidence Based Complimentary and Alternative Medicine (2015 Impact Factor 1.931) https://www.hindawi.com/journals/ecam/
Complimentary Therapies in Medicine http://www.journals.elsevier.com/complementary-therapies-in-medicine
Journal of Traditional and Complementary Medicine http://www.journals.elsevier.com/journal-of-traditional-and-complementary-
medicine/
Journals ~ cont.
Asian Journal of Complementary and Alternative Medicine http://www.literatipublishers.com/Journals/index.php?journal=
A-CAM
BioMed Central Complementary and Alternative Medicine https://bmccomplementalternmed.biomedcentral.com/
(Impact factor 1.375)
Global Advances in Health and Medicine http://www.gahmj.com/
MECHANISMS
Familiar Aspects of Medicine
http://www.webmd.boots.com/pain-management/guide/shoulder-pain
http://www.webmd.com/pain-management/knee-pain/picture-of-the-knee
http://www.onehealth.co.uk/orthopaedics-procedures-tendonitishttps://www.pinterest.com/pin/431290101796810902/
Forgotten Aspects of Medicine
http://mskuksclass.weebly.com/lesson-2-forms-of-energy.html
Comfort Level….
Energy Medicine
Comfort Level…..
Mechanism(s)
Information DeliveryElectricalHormonal
Information Delivery SystemNervous system (sympathetic,
parasympathetic, enteric) Information ReceiversReceptors
The Body’s Communication
Nervous system Autonomic
Sympathetic & parasympathetic & enteric
Communicate through receptors Eyes, ears, nose, tongue, skin
Receptors communicate Mechanically
Chemically
All of which create or redistribute energy….
Transportation systems – microtubles….
Electrical: Neuron Depolarization
https://www.youtube.com/watch?v=qDUjVzVq7xEhttp://www.slideshare.net/andymartin/a2-nervesystemscolstons-29106121
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Nervous System Communication
Hormonal Communication
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hormoneregulation of metabolism.
Rashmi Mullur et al. Physiol Rev 2014;94:355-382©2014 by American Physiological Society
Hypothalamic-Pituitary-Thyroid Axis
RECEPTORSht
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Cell Membrane ~ Protein Functions
http://www.proteinatlas.org/humanproteome/secretome
Body Activity Taken for Granted
EYE RECEPTORS
https://askabiologist.asu.edu/rods-and-cones
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tTOUCH RECEPTORS
EAR RECEPTORS
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SMELL RECEPTORS
http://droualb.faculty.mjc.edu/Course%20Materials/Physiology%20101/Chapter%20Notes/Fall%202011/chapter_10%20Fall%202011.htm
TASTE RECEPTORS
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Nervous SystemVOLUNTARY
INVOLUNTARY ~ AUTONOMIC
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AUTONOMIC NERVOUS SYSTEMS
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TWO CONTROL SYSTEMS
Brain GUT (ENS)
Furness, JB Nature Reviews Gastroenterology and Hepatology 9, 286-294 (May 2012) | doi:10.1038/nrgastro.2012.32
Woo ~ Woo??
Electrical EnergyChemical/Hormonal Energy
Autonomic Nervous System (3)
Receptors
Complimentary and Alternative Medicine in Sports Medicine
Not much out there….
Pain Management
Anxiety Management
Cancer Care
Possible Modalities
Acupuncture
Cupping
Gua Sha
Fascial Tensegrity
Mindfulness & Meditation
Breathing
Yoga
Feldenkrais & Alexander Techniques Motor Learning
Selected Outcome Measures
Pain
ROM
Functional movement
Performance
Balance
Whole person health
Performance of the overall system Quality of Life
Easier to sleep
Feel less tension
Hurts less
Acupuncture vs Dry Needling
Acupuncture Balance the energy flow within
the body Open up the channels of the
body meridians (5) Needle inserted into a meridian
point The body will heal itself Medical Acupuncture (MD, DO)
Dry Needling Orthopedic in Nature
Focuses on Trigger Points
Needle inserted into the trigger point of the muscle
Dry Needling Mechanism
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Acupuncture Meridians
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Mechanism
No Consensus
Animal Models Release of endogenous opiates
Release of serotonin
Influence on receptors to excitatory amino acids at the spinal cord level
Regulation of the immune system through the autonomic nervous system
Lin, Jaung-Geng, and Wei-Liang Chen. "Acupuncture Analgesia: A Review of Its Mechanisms of Actions." The American Journal of Chinese Medicine 36.04 (2008): 635-45. Web.
Mechanisms
Local Pain relief through neuropeptides
Spinal Gate control
Supraspinal mechanisms Descending pain inhibitory system through the sympathetic
nervous system
Cortical Possibly placebo
Carlsson, C. "Acupuncture Mechanisms for Clinically Relevant Long-term Effects - Reconsideration and a Hypothesis." Acupuncture in Medicine 20.2-3 (2002): 82-99. Web.
Mechanism
Vagus Nerve (autonomic nervous system) Anti-inflammatory: regulation of the inflammatory response
Protein regulation
Positively influences splenic tumor necrosis factor (alpha)
Lim, Hee-Don, Min-Hee Kim, Chan-Yong Lee, and Uk Namgung."Anti-Inflammatory Effects of Acupuncture Stimulation via the Vagus Nerve." Plos One 11.3 (2016): n. pag. Web.
Transport Mechanism: Microtubule
https://online.science.psu.edu/biol011_active002/node/4184
CUPPING
http://backinhealthosteo.com.au/the-myths-truths-behind-myofascial-cupping-therapy/
• Heat the air inside the cup• Cooling of the air creates suction• Blood vessels expand ~ redness
Olympic Pseudo-Science
http://www.blackchiropractic.org/ba-guan-ancient-chinese-therapy/
Efficacy ~ Multiple Applications….
Pain ~ no consensus Kim, Jong-In, Myeong Soo Lee, Dong-Hyo Lee, Kate Boddy, and
Edzard Ernst. "Cupping for Treating Pain: A Systematic Review." Evidence-Based Complementary and Alternative Medicine2011 (2011): 1-7. Web.
Neck Pain ~ no consensus Chi, Lee-Mei, Li-Mei Lin, Chien-Lin Chen, Shu-Fang Wang, Hui-
Ling Lai, and Tai-Chu Peng. "The Effectiveness of Cupping Therapy on Relieving Chronic Neck and Shoulder Pain: A Randomized Controlled Trial." Evidence-Based Complementary and Alternative Medicine 2016 (2016): 1-7. Web.
Potential Benefits Cao, Huijuan, Xun Li, and Jianping Liu. "An Updated Review of
the Efficacy of Cupping Therapy." PLoS ONE 7.2 (2012): n. pag. Web.
Gua Sha
An instrument-assisted unidirectional press-stroking of a lubricated area of the body surface to intentionally create transitory therapeutic petechiae called ‘sha’ representing extravasation of blood in the subcutis.
Nielsen, Arya. "Gua Sha Research and the Language of Integrative Medicine." Journal of Bodywork and Movement Therapies 13.1 (2009): 63-72. Web.
http://www.pacificcollege.edu/news/press-releases/2015/05/05/science-gua-sha?mailaddress=true
Science of Gua Sha
Outcome Increase in micro-perfusion
Anti-inflammatory Heme-oxygenase-1
Immune effect
Effects pain, stiffness, fever, chill, cough, wheeze, nausea, etc.
Effects acute and chronic internal organ disorders
http://www.pacificcollege.edu/news/press-releases/2015/05/05/science-gua-sha?mailaddress=true
Nielsen, Arya, Nicola T.m. Knoblauch, Gustav J. Dobos, Andreas Michalsen, and Ted J. Kaptchuk. "The Effect of Gua Sha Treatment on the Microcirculation of Surface Tissue: A Pilot Study in Healthy Subjects." EXPLORE: The Journal of Science and Healing 3.5 (2007): 456-66. Web.
Add strain to the system and the deformation gets distributed across the structure
https://www.anatomytrains.com/fascia/tensegrity/
In the body – pain – break down at the weakest link
TENSEGRITY
Structural Basis of Life
RESOURCES (soft tissue)
Tensegrity Ingber,DE. “The Architect of Life”. Scientific American, 1998:48-57
Strolling Under the Skin https://www.youtube.com/watch?v=eW0lvOVKDxE&feature=you
tu.be
Mindfulness / Meditation
Alterations in Brain Function (cognition) Brain Changes = NEUROPLASTICITY Changes Neurobiology
Alterations in Brain and Immune Function doi: 10.1097/01.PSY.0000077505.67574.E3 Jon Kabat-Zinn ~
http://www.umassmed.edu/cfm/
Neuroplasticity
http
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Meditation & Telomeres
http://articles.mercola.com/sites/articles/archive/2010/02/23/science-finally-reveals-how-you-can-actually-revese-aging.aspx
Telomerase Activitydoi:10.1038/tp.2016.164
Alteration in Gene Expression
Telomeres
http://www.ackc.org/kidney-cancer-information/aacr-conference-2011/telomeres-and-cancer-prevention/
• Telomeres protect the ends of the DNA• When telomeres are lost It leaves the DNA unprotected against change• Broken DNA is dangerous (changes gene expression)
Mindfulness & Meditation
Meditation vs Vacation Effect
Improvements in Cellular Health (identified by blood markers) Improved regulation of stress response
Improved regulation of immune function
Improved regulation of amyloid beta metabolism (amino acid involved with Alzheimer's; amyloid plaques)
doi:10.1038/tp.2016.164
Mindfulness ~ Meditation
Increase in Grey Matter Increase in Learning & Memory Processes
Improved Emotional Processing
doi:10.1016/j.pscychresns.2010.08.006
Results in Functional and Structural Plasticity doi:10.1093/scan/nss056
Other Considerations
Other Consideration
Breathing
Yoga
Imagery (Motor Learning Literature)
Systemic effect of Emotional Chemistry
Role of Micro-Biomes N Engl J Med 2016;375:2369-79.DOI: 10.1056/NEJMra1600266
Autism and Autism Spectrum http://dx.doi.org/10.1016/j.cell.2013.11.035
Obesity
Cancer
Role of the western diet……
Other Considerations
Epigenetics vs Genetics (5%)
Role of Inflammation Heart Disease
Cancer
Obesity
Alzheimer's
Whole Body Interventions Peterson, C. T. et al. Identification of Altered Metabolomic
Profiles Following a Panchakarma-based Ayurvedic Intervention in Healthy Subjects: The Self-Directed Biological Transformation Initiative (SBTI). Sci. Rep. 6, 32609; doi: 10.1038/srep32609 (2016).
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Identifying theMechanisms…
The Challenge…
Complimentary MedicineAlternative Medicine
Integrated MedicinePerson as a kinetic chain