Author: Physician Niklas Seet | October 2021 | Zhongjing TCM
What are “sport injuries”?
A specific definition of sports injuries would refer to soft tissue or joint injuries as a result of a sporting incident. But its general definition would encompass injuries due to any movement, not just restricted to sporting incidences.
While this article would be referring sport injuries in the specific definition, the principles of understanding and prevention would also apply to daily physical activities, including injuries that occur in our everyday life due to the execution of a physical action such as the lifting of a mattress to change the bed sheets or forcefully opening a tight jar lid. All these movements require our muscular action and control for their execution, and it is often these day-to-day movements which we often pay little attention to that can potentially cause much discomfort.
Sports injuries can be acute or chronic. Acute injuries are usually sprains and strains, with its symptoms manifesting within a short period of time. These symptoms are usually quite uncomfortable and pronounced, with the common ones being pain and swelling, and subsequent restriction of movement. Some other symptoms that may be observed include redness and warm sensation of the affected area.
For chronic injuries, these would usually manifest after a prolonged period of time, sometimes taking weeks or even months to develop. They may start with a slight discomfort which is often disregarded, with individuals only seeking medical attention when it gets aggravated. They can also be due to a previous acute injury which had not recovered properly. These injuries are often milder, with the most obvious being pain but at a lower intensity. Some sport participants may observe their injuries being aggravated after physical exertion, subsiding after rest until the next sporting activity.
What are the TCM theories that are important for the understanding of Sports Injuries?
TCM theories suggest that in order to prevent disease, the body’s internal environment (five Zang and six Fu organs) must be in a functional and harmonious state. When we execute physical movements, the important structures involved are the muscles, ligaments and bones, and as such their respective governing Zang organs needs to be optimal as well.
Spleen: Governs digestion, transformation and transportation of Qi, associated with the muscles and four limbs
In TCM, the spleen is the organ in charge of digestion, and the subsequent transportation of the absorbed nutrients throughout the body. After the transportation of nutrients, it is then converted into Qi, which would sustain the various structures and organs of the body for their function, including the muscles. If the spleen and its function is optimal, the muscles of the body would be well-developed and the limbs would be nimble and forceful.
If the spleen is dysfunctional, digestion would be compromised and the uptake of nutrients and subsequent transportation and transformation would then be negatively affected. The muscles would not be getting enough nutrition in order to sustain function or recover. More effort is spent in order to complete basic movements, and this would increase the likelihood of overloading and damaging them. Over time, loss of muscle mass may also occur, further increasing the energy needed and chance of injury.
Liver: Governs circulation and flow of Qi and blood, promotes transportation and transformation function of spleen and stomach, associated with tendons and ligaments.
The liver regulates and ensures smooth flow of Qi and blood in the body. This also promotes the transportation and transformation function of the spleen and stomach, and maintains normal function of the internal environments. When this flow is hindered, our internal environment would become dysfunctional, as the various organs are unable to receive an adequate supply of Qi and blood for function. If the spleen and stomach are affected by the inadequate supply, digestion and nutrient transformation and transportation would be impacted, resulting in poor recovery and weaker muscular strength.
Liver blood (肝血) is a nutritive element that plays an important role in nourishing our tendons and ligaments, allowing them to be strong and be able to stabilise our joints. When the liver is dysfunctional, and consequently liver blood is weakened, our tendons and ligaments lose this nourishment, affecting the flexion and extension of joints and hence weaker movements. This would result in our movements being impaired due to weaker and unstable joints. Sometimes, spasms may also be encountered in the limbs, and in severe cases numbness may also be experienced.
Kidney: Stores essence, governs reception of Qi, associated with bones.
The kidney stores the essence of the body. Kidney essence is vital in maintaining the various organs and their functions, as well as support growth, development and reproduction. When this essence is deficient and lacking, the body would be functioning sub-optimally, leading to an increased chance of injury and poor recovery.
The kidney also governs the reception of Qi. While respiration is governed by the lung, the kidney receives and governs the inhaled air, allowing the body and the organs to make use of it. When the kidney is sufficient, respiration is consistent and harmonious. But if the kidney becomes deficient, this reception of air would be affected, resulting in the body not receiving enough for normal function. This would impair various processes involved with nutrition and recovery, and in the long run may result in some respiratory symptoms such as breathlessness that is aggravated with physical exertion.
Kidney essence also plays a role in generating marrow within bones to nourish it. When kidney essence is sufficient, bones would be strong and firm. In contrast, if kidney essence is deficient, our bones lose their nourishment, making them weak, increasing the chance for fractures.
While the spleen, liver and kidney play a more prominent role in physical movement, all organs must be working in harmony in order for the body to properly function. The heart and lung too play a role in physical movement, but in comparison to the other three, their roles are relatively smaller.
Heart: Governs blood, emotions and spirit, associated with blood vessels, and sweat in secretion
The heart governs blood, emotions and spirit. Smooth flow of blood would allow the flow of Qi and nutrients to be optimal. This is slightly different from the physiological understanding of the heart organ in Biology.
Blood is governed by the heart, and sweat is regarded as the fluid component of blood. Hence, it is regarded that sweat is the secretion of the heart, and can directly impact the heart’s function. Blood would undergo transformation to become sweat. Thus, if sweating is in excess, the body would need to draw from blood in order to produce more sweat, thus slowly depleting the blood in the body. This would cause blood flow to be impeded, and our emotions and spirit to be affected.
Lung: Governs Qi
Similar in function in both TCM and physiology, the lungs play an important role in respiration. In TCM, the lung is responsible to take in the clear air from nature and to expel turbid gases from the body. Besides this exchange of gases, the lung also circulates Qi of the entire body, ensuring that nutrients and Qi are properly transported to the entire body.
If the lungs are weak and deficient, this would mean that Qi exchange and subsequent production and circulation would be compromised. Poor Qi exchange would mean more effort required to perform respiration, making the individual more easily tired especially during exercise. The different structures of the body would suffer from a lack of nutrients, and in the case of our muscles, they would not be able to recover as efficiently as before.
Factors today that play a role in Sports Injuries
There are many factors that can affect our body’s physical ability. Using athletes as a reference, they adhere to a properly tailored training plan in order to maximise performance, which also includes a strict diet plan for nutrition. Some of the restrictions include not being able to consume certain foods or foods prepared in a certain way, and having sufficient rest daily and between training.
Their lifestyles are not for everyone, but they can allow us to learn more and evaluate some of our lifestyle choices. These choices can impact our physical abilities which we may overlook, especially from a TCM perspective.
Diet – not eating enough or irregular meals, and cold or oily or sweet foods
When diet is discussed, many would think of the reduction of the amount of food consumed. A diet does not mean reducing the intake of food, but rather having a more determined food programme in order to achieve a goal.
TCM physicians often would enquire on an individual’s preference for consumed foodstuffs during a consultation. Depending on the constitution and the problem the patient is having, the attending physician may then suggest some dietary restrictions in order to hasten recovery.
Not eating enough or not having regular meals are regarded as harmful to the spleen and stomach. If done on occasion, the impact may be minimal, but repeated skipping of meals or insufficient food would cause spleen and stomach dysfunction. In the long run, this would result in a deficient physical constitution, becoming more easily fatigued and getting injured.
In TCM, cold and fresh foods are considered sources of pathogenic cold. Cold is regarded to have constrictive properties, causing various structures in our body to contract when exposed to it. When we consume too much cold or fresh foods, we are introducing pathogenic cold to our body. Blood vessels would constrict, causing blood and Qi flow to be obstructed. When obstructed, nutrients are not able to reach various structures effectively as well. This would result in recovery being slowed. Not only is recovery affected, the muscles would also lose warmth due to the excess cold, and together with the constricted blood vessels, muscular problems such as cramps would be more likely to occur.
Oily and sweet foods can also affect our body constitution. Under controlled situations, oily and sweet foods can be nourishing for the body. In TCM, consuming too much oily and sweet foods can result in a build-up of dampness in the body, causing obstruction in the flow of Qi and blood. With this build-up of dampness, not only would nutrient transport be affected, but our movements may also feel heavier and more cumbersome. Our muscles would again be more easily fatigued during day-to-day activities, and this would increase the likelihood of injury due to overloading.
Balance of activity and rest
A balance between an active lifestyle and rest is extremely important. This balance gives the body the time needed to repair and recover, especially after an intense session of physical activity.
In TCM, over-exhausting the body will harm Qi, causing dysfunction of the internal organs. This would also cause the body to draw on reserves and work harder to maintain physiological processes in the body, further weakening it.
For individuals who do sporadic physical training, it is advised to have at least one day of rest between days of physical activities. This would allow the body to rest and recover before the next training session. Gradually, the frequency of training can be increased over a period of time. For seasoned sport veterans, their bodies are conditioned to the physical demands of exercise, thus they are able to participate at a higher intensity and frequency.
The right choice and intensity of exercise
It is important for an individual to evaluate if the exercise is suitable for his or her level of physical ability. For beginners, it is important to start at a comfortable pace and get used to the physical load. This can include participating in fundamental training or strength training first, before progressing into more complex movements or workouts of longer duration.
An increasing trend in Singapore today are High Intensity Interval Trainings, or HIIT for short. HIIT workouts are excellent in maximising the work done over a short period, and is guaranteed to work up a sweat and make you feel good at the end of the session. However, for some individuals, HIIT may actually be doing more harm than good, especially if the body is not acclimatised to that level of physical intensity. For experienced and well-trained individuals, it may be beneficial to them in order to reach higher levels of performance, especially if they have been maintaining that intensity for many years.
However for a beginner in HIIT, these training sessions may actually be harmful. As mentioned earlier, sweat is derived from blood and is the “fluid” of the heart. Excessive sweating would harm both heart Qi and blood, causing a dysfunction to its function. HIIT may cause a lot of sweating in a short period of time due to its physically demanding nature on its participants. If the participant is also not ready for the intensity – the physical form is not well-conditioned and periodised, there is a considerable risk of injury. Besides physical injuries, physical overexertion can also cause dysfunction in the internal organs. In the case of HIIT, some participants may experience some chest discomforts or heart palpitations even at rest, and some may even have changes to their sleep patterns.
Prevention + strengthening
Prevention is always better than cure. If an individual can understand how to better condition the body, not only can the returns from exercise be maximised, but the risk of injury can also be mitigated. Injury can cause time-off from the sport in order to recover. These time-offs will result in the loss of physical conditioning and strength as well as muscle memory, wasting all those long hours of training spent. For injuries that take longer to recover, not only does the individual need to tolerate any physical discomforts, but mental stresses may also start to develop.
For newcomers to any physical exercise, it is important to start slow and be patient, and attend regular trainings. This slow start allows a better understanding of the body and any weaknesses that may be present. These weaknesses should then be addressed via fundamental training. These trainings involve basic movement or conditioning exercises that will train and make the body ready for physical exertion. There should also be enough rest in between training sessions, with at least a day of rest in between workout days – exercising on Monday and resting on Tuesday, before having another go on Wednesday. If engaging in strenuous activities such as lifting weights in the gym, it would be advised to have a qualified instructor present for guidance at the early stages.
Eating enough is also another way to prevent injury. While it seems counter-intuitive, having enough calories is also important in recovery. It is important to be mindful for the food consumed and make good choices in order to maximise gains and recovery. The strategy of mini-meals can be considered, eating less amounts per meal but at a more frequent rate.
As we age, the loss of muscle mass is natural, slowly compromising our mobility. It is important to maintain some level of physical activity at the appropriate level in order to slow down this muscle mass loss. Different forms of physical training can be considered depending on personal abilities, such as the use of resistance bands instead of weights, or brisk walks instead of runs. Consistency and regularity are key in order for everyone to maintain their physical abilities.
Importance of warm-ups and cool-downs
Many do not understand the importance of warm-up exercises, and may even confuse them for the static stretches that are supposed to be done at the end for cooling-down! It is important to understand the difference and the importance of dynamic warm-up and static cool-down, as these movements can also prevent injuries.
Dynamic warm-ups are movements which mimic the exercise that is going to be done. These can range from simple movements like a jog or jumping-jacks, to slightly more complex movements such as agility or coordination drills. These movements are meant to get the body ready for the exercise, allowing the muscles and joints to be primed for coordinated movements. For example, for running, besides having a short jog to warm up, it is also recommended to include movements such as knee lifts and lunges to engage and activate the muscles in the lower limbs and hips. Every sport has a different physical demand, so it is recommended to spend some time researching these movements and drills.
In contrast, static cool-downs are not as energetic, and usually involve slow stretching movements. These stretching movements are meant to loosen up and increase blood flow to the muscles, allowing for the removal of lactic acid built up over the activity.
The same principle also applies for our daily physical activities, such as household chores. It is important to start slow at the beginning and slowly increase the intensity and load over time.
Professional insights
As an avid practitioner of Judo for more than ten years, I have had my fair share of sports injuries, ranging from strains to dislocations. In my practice, I often consult with cases pertaining to pain management and sports injuries. For the middle-aged population, these injuries are often as a result of poor or sudden movement either at home or at work. For the younger generation, these pain maladies are often due to sports such as gym training and martial arts.
Initially, I had always considered injuries to be due to Qi stagnation and blood stasis, physical trauma or sprains. These acute conditions are usually on the smaller joints such as the wrist and ankles (e.g. de Quervain’s tenosynovitis, sprained wrist and ankles), often showing at the incident of injury. For the middle-aged population, they may have already been weaker in constitution but are otherwise fine, but sudden exertion would then cause an injury to occur.
However, I have recently noticed and encountered more cases that are due to overuse or poor physical constitution. These conditions are often not obvious or the pain would reduce during the episode of physical exertion and would often worsen the following day. These include conditions such as tennis or golfer’s elbow, runner’s knee or neck pain.
In TCM theories, this can be attributed to Qi deficiency that is further aggravated on physical exertion. This weakness would then cause the muscles or joints to lose their stabilising function, increasing the likelihood of injury. Qi is needed to push blood to flow in the body. With Qi deficiency, blood does not flow as well, and hence blood stasis occurs more easily. All these can be further aggravated by lifestyle factors as mentioned earlier, such as diet and inadequate rest.
For these conditions that are of a Qi deficiency and blood stasis nature, pain is at a manageable level, and most would be able to tolerate the discomfort during their day-to-day activities. The slight pain would often be accompanied by other symptoms as well, such as poor sleeping patterns, easily fatigued, poor digestion, headache and/or giddiness, muscular cramps or spasms.
It is important to understand one’s own constitution before deciding to undertake some physical activity. It is also equally important to progress at your own pace, especially if it is a sport that is unfamiliar or after a long lay-off from physical activity. Physical activity and mobility are important, but injury as a result of physical activity can be extremely demoralising and may cause other problems if left untreated.
