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Perfomance Artist
“Artists are athletes”
The athlete
• High school/collegiate
• Governed by parents/ state and federal- administration/ medical community
• Geared to finish the season
• Low endpoint for source of income
• Performing artist
• Governed by parents• Geared to finish the
performance• High dependance for
life time income-(tolerance)
• More exposure to alternative treatment
Sir William Osler/Hippocrates
“Food is the best medicine”
Andrew Weil, MD
www.Drweil.com conservative in herbal medicine-ground breaking in western medicine reintroducing the concepts of nutrition and healing
Act 1: The Injury
docmassage
therapist
Injured guy
Electron microscope
• A twist, roll, bend or fall occurs with immediate pain
• Stiffness and spasm set in by one day
• Other areas start to spasm in a week
• Soft tissue (ligament, tendon and muscle) gets over stretched and torn off its connecting points to bone.
• The tissue reacts by sending more blood to the area and heat/redness prevail
• Compensating areas start to fail when they can’t do the work of the originally injured part
When tissue is torn/stretched:
• Inflammatory phase starts day 0-5• Bleeding• PMN’s• Macrophages and platelets stimulates GF
• Proliferative phase from day 5-21• GF stimulates endothelial cells, fibroblasts and myofibroblasts• Macrophages continue
• Maturation phase from day 21-whenever• Fibroblasts• Increased collagen and tensil strength
The Problem
Act 1, Scene 1: Inflammation
• When tissue damage occurs, the “cascade” starts
phospholipid
Arachadonic acidArachadonic acid
Pgcytoprotection
PgInflammatory response
Normal tissues*stomach*kidneys*platlets*endothelium
Inflammatory sites*macrophages*synoviocytes*fibroblasts
Regular nsaids block here:
phospholipid
Arachadonic acidArachadonic acid
Pgcytoprotection
PgInflammatory response
Normal tissues*stomach*kidneys*platlets*endothelium
Inflammatory sites*macrophages*synoviocytes*fibroblasts
Nonselective cox2
Steroids block here:
phospholipid
Arachadonic acidArachadonic acid
Pgcytoprotection
PgInflammatory response
Normal tissues*stomach*kidneys*platlets*endothelium
Inflammatory sites*macrophages*synoviocytes*fibroblasts
corticosteroids
Cox 2 blocks here:
phospholipid
Arachadonic acidArachadonic acid
Pgcytoprotection
PgInflammatory response
Normal tissues*stomach*kidneys*platlets*endothelium
Inflammatory sites*macrophages*synoviocytes*fibroblasts
Cox-2
Act 2: The Villan and the Hero
• Rest• Ice• Compression• Elevation
• NSAID’s• Therapy• Steroids(injection or pills)• Muscle relaxers and narcotics
Non steroidal antiinflammatory agents
acetic acids diclofenac, etodolac, indomethacin, ketorolac, sulindac, tolmetin fenamates meclofenamate, mefenamic acid propionic acids fenoprofen, flurbiprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium, oxaprozin nonacidic nabumetone salicylic acid diflunisal, salsalate oxicam meloxicam, piroxicam cox-2 inhibitors celcoxib, valdecoxib
Generic and Trade Names• Diclofenac potassium fast release• Diclofenac sodium delayed • Etodolac• Indomethacin• Ketorolac• Sulindac• Tolmetin• Mefenamic acid• Fenoprofen• Flurbiprofen• Ketoprofen• Oxaprozin• Nabumetone• Diflunisal• Celecoxib• Valdecoxib• Meloxicam• Piroxicam
• Cataflam• Voltaren• Lodine• Indocin• Toradol• Clinoril• Tolactin• Ponstel• Nalfon• Ansaid• Orudis• Daypro• Relafen• Dolobid• Celebrex• Bextra• Mobic• Feldene
ROID’S
• Not anabolic’s
• Prednisone
• Medrol dose pack
• Kenalog
• Celestone
Pain pills• Acetominophen• Tylenol with codeine• Vicodin• Ultram• Morphine• elavil• flexeril• Skelaxin• zanaflex
Act 3: Secondary Effects
From the meds From the inactivity
• Sleep is disturbed and fatigue starts
• Joints above and below the area of pain stiffen up and are hard to stretch
• Chronic pain and immobility result in weight gain and lack of exercise, carb hunting occurs and depression starts
• More muscle spasm more pain less tolerance
• Due to chronic spasm the sleep cycle is disturbed and memory/concentration off
• Due to immobility, the muscle/tendon units involved with the injury become stiff and sore (trigger points)
• Stagnation starts to affect emotion and body wants satisfaction previously found with endorphin-rush, now found with medicines or foods/alcohol/drugs
• Serotonin gets depleated and depression starts along with side effects from new addictions
Side Effects from Medicines
• Allergy to nsaids• Reflux/ulcers• Kidney damage• Hypertension• Diarrhea• Asthma flare up• Bleeding• Drug interaction• Steroid dependance
• Drowsiness• Dry mouth• Poor coordination• Dizziness• Blurred vision• Addiction• Drug interaction• Liver toxicity
The COX II controversy
• Initially made to protect the stomach
• Selective for cox 2 receptor
• Less stomach ulcers
• New data that vioxx caused heart attacks
• Celebrex is under study by the FDA
• Pulled off but ok’d for now?
Act 4: The Alternative
• Herbal meds• Acupuncture
• Massage
• PT
• Manual Therapy
• Modalities
• Diet
GAIT Study
• Glucosamine/chondroitin Arthritis Intervention Trial
• University of Utah/NIH funded• First large-scale multicenter center clinical trial
with dietary supplements for treatment of knee arthritis
• Testing the effectiveness of short term(6month) treatment in pain reduction
• 20% reduction in pain in 24 weeks with moderate to severe pain using combo
Zyflamend by new chapter
• Holy Basil• Turmeric• Ginger• Green tea• Rosemary• Oregano• Scutellaria• Hu Zhang• Chinese Gold Thread and
Barberry
If Relief by Natures Sunshine
• Turmeric Root• Mangosteen• Andrographis
Paniculata• Boswellia Gum• White Willow Bark• salicin
Postgame by ameriscience
• Manganese• Devils Claw• Glucosamine Hcl• Vitamin C• Potassium• MSM• Hyaluronic acid• Bromelain• Papain• Lipase• Amylase
Back to basics
The Anti-inflammatory Diet
• No dairy• No pork or beef• No alcohol• Cut back on wheat• Stop smoking• Get 7+hours of sleep • Hydrate all day• Stretch, yoga, tai chi
Early movement important
Hang up the towel
Epilogue: “Back” to basics
• Avoid injury by knowing when to quit, stretching, maintaining proper diet
• Get help immediately (as the cascade starts)• Relative rest/ice/• Supplements• Meds if necessary, stop etoh and tobacco• Know what you take and watch side-fx• Maintain stretching and proper diet and sleep• And when ready…….