Alternative Therapies in Sports Medicine Sue Falsone PT,MS,SCS,ATC,CSCS,COMT,RYT Owner, Structure & Function Education Owner, Falsone Consulting Associate Professor, Athletic Training, A.T. Still University
Disclosures Owner, Structure & Function Education, PLLC Teaches dry needling and cupping Educational Advisor Meyer PT Safer Pain Relief Committee Performance Health
Complimentary and Alternative Therapies As Classified by the National Center for Complementary and Alternative Medicine (NCCAM) Dietary Herbal Biologically Based Practice Whole Medical Systems Energy Medicine Mind-Body Medicine
Statistical Significance The probability that the null hypothesis is correctly rejected Yes or No Clinical Significance The minimal change that s important or worthwhile to patient or clinician Magnitude of Change
EVIDENCE Something that furnishes proof SCIENCE The state of knowing : knowledge as distinguished from ignorance or misunderstanding Webster s
Patient Assessment Treatment Outcomes Science Research Evidence
Mindset
The Meaning of Pain: Lorimer Moseley http://www.otpbooks.com/product/lorimer-moseley-pain-research/
Pain is. Conscious Subjective Peripheral Central Emotional Situational Movement and task Cultural Personal Past experience
Emotional Response to Injury Psychosocial aspects of rehabilitation in sports. Covassin et al, 2015. Changes in Social Behavior Fear Irritability Changes in Sleep Emotional Response to Injury Changes in Appetite Sadness Feelings of Isolation Lack of Motivation Anger
Dry Needling
Acu = sharp, needle Puncture- to pierce a surface Acu- -Puncture
Dry Needling vs. Acupuncture: the Ongoing Debate; Zhou 2015
MECHANISMS OF DRY NEEDLING
Pain Physiological Effects of Dry Needling, Cagnie, 2013 Dry Needling for Manual Therapists, Gyer, 2016 Cell damage and pain sensation Releases bradykinin, CGRP, histamine, substance P, nerve growth factor, etc. These can cause pain and inflammation, vasodilation Needle insertion stimulates A Beta, A Delta and C Fibers CGRP, NO, Adenosine locally Vasodilators and pain modulators It helps improve pain via Gate Control Theory, Neuromatrix Theory or Conditioned Pain Modulation Theory
Dry Needling Evidence to show it improves blood flow locally in the tissues (Komari, 2009) Evidence of several biochemical, mechanical and neural physiological processes occurring (Butts, 2016) There is histological evidence of inflammatory cells, collagen and elastin, and nervous tissue on the needle after removal (Kimura, 1992)
Cupping/ Vacuum Therapy/ MFD
History Dates back to 3000 BC however exact origin is unknown Much literature is Russian, Chinese, and Korean Wet Cupping- small incision is made in the skin to cause bleeding Dry Cupping- non-invasive (if performed correctly) Use of fire or hand pump to create negative pressure under the cup
Bottom Line: What Do We Know? Intrarater reliability appears to be good/ acceptable when using a mechanical pump (Huber et al, 2011) Novice to expert is a short duration (Huber et al, 2011) About 20 times Ramp up time of the pressure does not appear to matter in the long run (Tham et al 2006) Compression occurs under the rim, while tension is highest at the peak of the dome of the soft tissue (Tham et al, 2006) X 0.4 diameter Static/ static technique x 10 minutes on 17 LBP patients (symptomatic for at least 8 weeks) demonstrated Immediate improved significant differences in VAS scores, SLR, trunk flexion and statistically significant reduction in PPT in 4 places (Markowski, 2014)
VISCERAL
Visceral Manipulation Assists functional and structural imbalances throughout the body Evaluates and treats the dynamics of motion and suspension in relation to organs, membranes, fascia and ligaments Increases proprioceptive communication within the body Relieving symptoms of pain, dysfunction, and poor posture
Structure
Low Back Pain and Kidney Mobility Tozzi et al, 2012 101 asymptomatic people 140 subjects complaining of NSLBP Measured distance: superior pole of the right kidney to ipsilateral diaphragmatic pillar during maximal inhalation and exhalation Calculated the excursion of movement People with NSLBP present with a reduced range of kidney mobility compared to that found in asymptomatic subjects
Yoga
The Health Benefits of Yoga and Exercise, Ross, 2010
Meditation
Meditation Persistent lack of consensus in the literature on what meditation is and how it should be defined Defining a complex intervention: the development of demarcation criteria for meditation. (Bond et al 2009) Physiological and psychological changes occur with breath-based meditation Specifically the yogic breath Breath-based meditation: a mechanism to restore the physiological and cognitive reserves for optimal human performance. (Carter et al 2016)
Meditation Deep, rhythmic breathing can result in a state of relaxation that reduces depression and anxiety Breath-based meditation has also been shown to balance the autonomic nervous system, decreasing the fight or flight response that can often be associated with stress. Brown, RP, and Gerbarg, PL. Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part I-neurophysiologic model. J Altern Complement Med 11:189-201, 2005.
Auditory the roar of the crowd Imagery Olfactory the smell of the gym Kinesthetic how the body feels during movement Gustatory the taste of gum you chew when hitting Visual images of what you want to happen
Overall Conclusions on Alternative Interventions Adjunct and alternative treatments are limited by their evidence However often have a lot of science Often marred as pseudoscience Need research on combining adjuncts with conventional (not stand-alone) Above all do no harm Remain critical, but open-minded
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