Application of TCM Manipulation Techniques in Sports Injury Management

1. Application of TCM Manipulation Techniques
in Sports Injury Management
Introduction
The assessment of the injury should be carried out as early as possible. For
effective treatment, the following classification can provide useful reference and
guiding principles.
1. According to the degree of injury severity
a. 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 hinders
day-to-day activities. However, during training and competition, emergency
treatment may be required for the athletes to continue their participation. This
can only be attended by qualified personnel eg. team doctors.
2. According to the time after injury
a. Acute injuries. From the treatment point of view, fracture, dislocation within two
weeks is usually referred to as the acute injury or a fresh injury. Soft tissue injury
within 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 handled
properly or misdiagnosed, not only will it move into the chronic phase, it will also
result in structural changes in musculo-skeletal functions.
b. Chronic injury: two weeks after injury, also known as the old injury. Chronic
injury, due to mishandling or misdiagnosing of acute and secondary injury may
result in the calcification of supraspinatus tendon of the supraspinatus tendon,
rupture of Achilles tendon in long jump, chronic knee bursitis in the long-distance
running.
c. Strain: the long-term accumulation of micro-tear caused by injury, such as
lumbar muscle strain. From the injury point of view, they are different from the
chronic injury. Hence, treatment and rehabilitation programs will also different.

2. 3. According to the site of injury
a. Muscle, tendon, ligament, fascia, joint capsule and adipose tissue. The main
pathological changes in fibers of connective tissue from damage, degeneration
and inflammation.
b. Articular cartilage damage. The main pathological manifestations of the
degenerative changes to cartilage include spin twist injury, impact injury and
open wound.
c. Bone tissue strain and trauma. The most common is fatigue periostitis and
stress 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, synovial
membrane, adipose tissue , joint capsule as well as peripheral nerves, vascular
damage in different situations. These are known as soft tissue injury.
4. According to the characteristics of sports injuries
Sports injury compared with other trauma, mainly occurred in the locomotive
system of the limbs and back. It has its own unique rules and features of the
incidence. In 2000, the China State Sport General Administration identified a total
of 317 kinds of trauma.
a. Small wound, and less severe trauma, the majority were "mild" trauma. The
so-called mild, is a relatively general terms, or where in general orthopedics, may
be regarded as a small injury, but for athletes, this will disrupt training and affects
competition, performance, and even ruin a lifelong campaign. So there is need to
pay attention to the standard of treatment which should not only based on the
elimination of symptoms, but revert to pre-injury sports level.

3. Fig 1
Muscle Ligament Joint Waist Knee Ankle Shoulder Foot
Fig 1
b. More soft tissue injury, with muscle, fascia, tendon, tendon sheath, ligament
and joint capsule damage, followed by the articular cartilage, meniscus, cartilage
wrist triangular plates, such as rotator cuff injury (Fig 1). Sports injury
epidemiology 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 meniscus
injury, 4.07% of rotator cuff injury, 3.57%. patella enthesiopathy
However, treatment is difficult when atheletes have to go on with their training
and competition. So the challenge is in the degree of recovery time and
recovery.
c. Chronic injury, an accumulation of small injuries caused by repeated or chronic
strain, or participation in training and competition when the chronic injury is not
completed treated and still recurrent. In a 2000 report involving 6810 athletes in
China, the surveys showed that 32.95% were chronic injury, acute to chronic
injury at 45.95 percent, and 21.10% of acute injury.
d. Injury-prone and complex injury. Long-term training of professional athletes
prone to multiple complex injuries especially in young people where the injury
can occur again.

4. 5. Pathophysiological sports injury
When the body is damaged, a series of pathological changes can occur such as
local bleeding, swelling, circulatory disturbance, hypoxic-ischemic injury which
lead to degeneration. Over time this can result in a number of complex
pathological conditions which can be summarized as follows.
a. Hyperemia and edema
Due to damage to the nerve excitability, increase vasodilation, vascular and
capillary blood filling and partial emergence of congestive phenomena. After the
increase in vessel wall permeability, vascular permeability both within and
outside the tissue fluid balance, tissue fluid accumulation in the interstitial
membrane, so that injury showed edema-like state.
b. Hemorrhage
Soft tissue injury occurring at the local vascular injury, capillary bleeding,
hematoma formation. Platelet aggregation at this time, the pain caused by the
release of various chemicals directly stimulate pain nerve endings.
c. Exudative and proliferative
Seepage damage occurred mainly in the early days, when the soft tissue injury
suffered after the injury first appeared as a result of neural response to
vasoconstriction, then the blood vessels and capillaries vasodilate, increasing
blood to the blood plasma and leukocyte infiltration to the injured and its
surrounding area. This is a human body's 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, but
recurrent hyperplasia will cause soft tissue on the vessel walls to thicken in some
parts and narrow in others. This connective tissue proliferation is particularly
vulnerable to the formation of adhesions, Common are stenosing tenosynovitis,
hypertrophy of ligamentum flavum caused by spinal stenosis, spinal canal
stenosis, such as nerve root.
d. Ischemic
Swelling as a result of cellular injuries, cellular pressure, vascular spasm,
thrombosis caused by hypoxic-ischemic injury, decline in physiological functions
of cells, the loss of elastic stiffness.
e. Cellular degeneration
Injury within the capillaries of adipose tissue hyperplasia, vascular expansion,
stasis, a number of large vascular endothelial cell hypertrophy, endometrial
hyperplasia, marked muscular hypertrophy, adventitial collagen fiber hyperplasia
with hyaline degeneration. Adipose tissue can be seen in lymphocyte-

5. predominant inflammatory cell infiltration and collagen fiber bundles of plastic as
well as in adipose tissue wrapping around the fiber. In severe cases, this may
result in calcification, cartilage metaplasia and irregular scar formation. Fascia,
striated muscle can be seen scattered in the form of localised inflammatory cell
infiltration, or the surrounding fascia and striated muscle fibers are irregular scar
formation. In addition, under the electron microscope, there is a prevalence in red
blood cell infiltration, red cell deformability, ferritin particles deposited on the
surrounding membrane. Pain receptors - free nerve endings of the Schwann cells
are wrapped out or masked.
The application of Chinese medicine for these pathological changes have certain
positive outcome and is considered in the overall operation of the meridian qi and
blood circulation, resulting in non-Xu (deficient) Qi stagnation, do not dampen or
obstruct blood and body fluid.
Treatment of musculo-skeletal problems
When treating musculoskeletal injuries, there will always be some form of muscle
shortening or decreased joint mobility present. Even though using acupuncture
is very effective in treatment, there comes a time in the treatment of an injury
when you will need to open the channels physically to allow qi and blood to flow
smoothly and to return the shortened muscle back to its normal length. Where
the body work/rehabilitation has not been applied and have found shortened
muscle fibres or diminished joint mobility still present, hence the stagnation still
exists.
Contributed by SOHA Institute 2012