Application of TCM Manipulation Techniques in Sports Injury ManagementIntroductionThe assessment of the injury should be carried out as early as possible. Foreffective treatment, the following classification can provide useful reference andguiding principles.1. According to the degree of injury severitya. Mild injury: does not affect the work, only if the movement will result in pain,otherwise normal daily activities such as exercise and training is not a problem.b. Moderate injury: cannot engage in strenuous activities after 24 hours (day-to-day activities will have symptoms).c. Severe injury: requires hospital treatment – a result of injury which hindersday-to-day activities. However, during training and competition, emergencytreatment may be required for the athletes to continue their participation. Thiscan only be attended by qualified personnel eg. team doctors.2. According to the time after injurya. Acute injuries. From the treatment point of view, fracture, dislocation within twoweeks is usually referred to as the acute injury or a fresh injury. Soft tissue injurywithin the first three days is in the acute stage, three days -2 weeks for sub-acute,after two weeks considered old (chronic) injury. If the acute injury is not handledproperly or misdiagnosed, not only will it move into the chronic phase, it will alsoresult in structural changes in musculo-skeletal functions.b. Chronic injury: two weeks after injury, also known as the old injury. Chronicinjury, due to mishandling or misdiagnosing of acute and secondary injury mayresult in the calcification of supraspinatus tendon of the supraspinatus tendon,rupture of Achilles tendon in long jump, chronic knee bursitis in the long-distancerunning.c. Strain: the long-term accumulation of micro-tear caused by injury, such aslumbar muscle strain. From the injury point of view, they are different from thechronic injury. Hence, treatment and rehabilitation programs will also different.
3. According to the site of injurya. Muscle, tendon, ligament, fascia, joint capsule and adipose tissue. The mainpathological changes in fibers of connective tissue from damage, degenerationand inflammation.b. Articular cartilage damage. The main pathological manifestations of thedegenerative changes to cartilage include spin twist injury, impact injury andopen wound.c. Bone tissue strain and trauma. The most common is fatigue periostitis andstress fracture, avulsion fracture, short bone fractures.d. Micro-damage of nerve tissue mainly due to stretch, oppression and adhesion.e. Organ damage other organizations. The highest incidence of sport injury is usually in clinical locomotive system(between the skin and bone) of the muscles, ligaments, fascia, tendon, synovialmembrane, adipose tissue , joint capsule as well as peripheral nerves, vasculardamage in different situations. These are known as soft tissue injury.4. According to the characteristics of sports injuriesSports injury compared with other trauma, mainly occurred in the locomotivesystem of the limbs and back. It has its own unique rules and features of theincidence. In 2000, the China State Sport General Administration identified a totalof 317 kinds of trauma.a. Small wound, and less severe trauma, the majority were "mild" trauma. Theso-called mild, is a relatively general terms, or where in general orthopedics, maybe regarded as a small injury, but for athletes, this will disrupt training and affectscompetition, performance, and even ruin a lifelong campaign. So there is need topay attention to the standard of treatment which should not only based on theelimination of symptoms, but revert to pre-injury sports level.
Fig 1 Muscle Ligament Joint Waist Knee Ankle Shoulder Foot Fig 1b. More soft tissue injury, with muscle, fascia, tendon, tendon sheath, ligamentand joint capsule damage, followed by the articular cartilage, meniscus, cartilagewrist triangular plates, such as rotator cuff injury (Fig 1). Sports injuryepidemiology survey shows the top five injury are low back muscles 14.48%fasciitis, fibular ankle ligament injury 4.49 percent, 4.20 percent of knee meniscusinjury, 4.07% of rotator cuff injury, 3.57%. patella enthesiopathyHowever, treatment is difficult when atheletes have to go on with their trainingand competition. So the challenge is in the degree of recovery time andrecovery.c. Chronic injury, an accumulation of small injuries caused by repeated or chronicstrain, or participation in training and competition when the chronic injury is notcompleted treated and still recurrent. In a 2000 report involving 6810 athletes inChina, the surveys showed that 32.95% were chronic injury, acute to chronicinjury at 45.95 percent, and 21.10% of acute injury.d. Injury-prone and complex injury. Long-term training of professional athletesprone to multiple complex injuries especially in young people where the injurycan occur again.
5. Pathophysiological sports injuryWhen the body is damaged, a series of pathological changes can occur such aslocal bleeding, swelling, circulatory disturbance, hypoxic-ischemic injury whichlead to degeneration. Over time this can result in a number of complexpathological conditions which can be summarized as follows.a. Hyperemia and edemaDue to damage to the nerve excitability, increase vasodilation, vascular andcapillary blood filling and partial emergence of congestive phenomena. After theincrease in vessel wall permeability, vascular permeability both within andoutside the tissue fluid balance, tissue fluid accumulation in the interstitialmembrane, so that injury showed edema-like state.b. HemorrhageSoft tissue injury occurring at the local vascular injury, capillary bleeding,hematoma formation. Platelet aggregation at this time, the pain caused by therelease of various chemicals directly stimulate pain nerve endings.c. Exudative and proliferativeSeepage damage occurred mainly in the early days, when the soft tissue injurysuffered after the injury first appeared as a result of neural response tovasoconstriction, then the blood vessels and capillaries vasodilate, increasingblood to the blood plasma and leukocyte infiltration to the injured and itssurrounding area. This is a human bodys physiological responses to self-protection, but it has a negative impact over time by the formation of blood stasis,blood flow obstruction, increase in swelling.Hyperplasia is a human body response to the repair of injured tissues, butrecurrent hyperplasia will cause soft tissue on the vessel walls to thicken in someparts and narrow in others. This connective tissue proliferation is particularlyvulnerable to the formation of adhesions, Common are stenosing tenosynovitis,hypertrophy of ligamentum flavum caused by spinal stenosis, spinal canalstenosis, such as nerve root.d. IschemicSwelling as a result of cellular injuries, cellular pressure, vascular spasm,thrombosis caused by hypoxic-ischemic injury, decline in physiological functionsof cells, the loss of elastic stiffness.e. Cellular degenerationInjury within the capillaries of adipose tissue hyperplasia, vascular expansion,stasis, a number of large vascular endothelial cell hypertrophy, endometrialhyperplasia, marked muscular hypertrophy, adventitial collagen fiber hyperplasiawith hyaline degeneration. Adipose tissue can be seen in lymphocyte-
predominant inflammatory cell infiltration and collagen fiber bundles of plastic aswell as in adipose tissue wrapping around the fiber. In severe cases, this mayresult in calcification, cartilage metaplasia and irregular scar formation. Fascia,striated muscle can be seen scattered in the form of localised inflammatory cellinfiltration, or the surrounding fascia and striated muscle fibers are irregular scarformation. In addition, under the electron microscope, there is a prevalence in redblood cell infiltration, red cell deformability, ferritin particles deposited on thesurrounding membrane. Pain receptors - free nerve endings of the Schwann cellsare wrapped out or masked.The application of Chinese medicine for these pathological changes have certainpositive outcome and is considered in the overall operation of the meridian qi andblood circulation, resulting in non-Xu (deficient) Qi stagnation, do not dampen orobstruct blood and body fluid.Treatment of musculo-skeletal problemsWhen treating musculoskeletal injuries, there will always be some form of muscleshortening or decreased joint mobility present. Even though using acupunctureis very effective in treatment, there comes a time in the treatment of an injurywhen you will need to open the channels physically to allow qi and blood to flowsmoothly and to return the shortened muscle back to its normal length. Wherethe body work/rehabilitation has not been applied and have found shortenedmuscle fibres or diminished joint mobility still present, hence the stagnation stillexists.Contributed by SOHA Institute 2012