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 UNIVERSITYMAKING1@PLYMOUTH.EDUEATA 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

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Cell Membrane ~ Protein Functions

http://www.proteinatlas.org/humanproteome/secretome

Body Activity Taken for Granted

EYE RECEPTORS

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tTOUCH RECEPTORS

EAR RECEPTORS

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SMELL RECEPTORS

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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

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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

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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