August 8th, 2016 Dr. Eric St. Pierre

TREATMENTS

Athletes Go For Gold With Red Spots Blazing

Michael Phelps shows signs of cupping on his way to another gold medal in Rio de Janeiro.

Michael Phelps shows signs of cupping on his way to another gold medal in Rio de Janeiro.

Al Bello/Getty Images

Swimmer Michael Phelps won Olympic gold again Sunday while covered in red — red spots, roughly medal-size, all over his shoulders and back.

The marks were the result of an ancient Eastern medicinal therapy known as cupping that is achieving new popularity among some athletes in the United States, including numerous Olympians.

Cupping typically involves treating muscle pain and other ailments with cups that apply suction to skin. Cupping is often combined with other forms of alternative medicine, such as acupuncture and massage.

“The practice itself is very old,” says Karyn Farrar, a physical therapist at Rehab 2 Perform in Frederick, Md. “In the past five to 10 years it’s becoming prominent in terms of physical therapists, athletic trainers and massage therapists [in the United States] using it more and more.” Farrar’s office treats five to 10 athletes — mostly high school and college students — with cupping each day.

Farrar says cupping is like a reverse form of massage. Instead of applying pressure downward onto muscles, she says, “you’re using negative pressure to pull soft tissues apart” from the suction of the cup. “As you’re pulling, you’re also getting increased blood flow to the tissues.”

She claims the practice decreases swelling in acute injuries and speeds up healing. The large red spots are caused by the bursting of small blood vessels near the skin.

Farrar says she expects more athletes to ask about the treatment after seeing the very visible signs of its aftermath on some of this year’s Olympians.

According to Ted Kaptchuk, a professor of medicine at Harvard Medical School who is trained in Asian medicine, the cupping trend isn’t exactly new in the U.S. Cupping has a long history in Western medicine and was commonly practiced by American physicians in the 18th and 19th centuries.

But Kaptchuk says cupping fell from favor in the U.S. in the 1920s when practitioners of Western medicine began to see the practice as “old-fashioned,” in part because of a lack of scientific evidence that it had a true healing effect.

Today, while some studies have explored the effects of cupping, there is still scant scientific evidence supporting its healing potential.

“We need rigorous research to understand whether there is a physiological effect associated with cupping and currently that is unknown,” says David Shurtleff, deputy director of the National Institutes of Health’s National Center for Complementary and Integrative Health.

NCCIH currently doesn’t fund research on cupping, partly because the studies are challenging to design. It is difficult to know whether a patient feels better after cupping because the treatment worked on a physical level or because the patient expected to feel better and so does — in other words, the placebo effect.

But Shurtleff and Kaptchuk agree that a placebo effect from cupping could work to reduce pain with or without an underlying physical benefit.

While there is still limited scientific evidence supporting cupping, Kaptchuk says that “what we do have, is that people feel better after it’s done.”

For Olympians, that feeling may be just enough to help them on a trip to the medal podium.


Therapeutic Walking

Patients often ask what the best exercise is for their life in general. Although I feel that a series of exercises to address a particular concern or condition is most ideal, I


Graston Technique

Graston Technique is the contemporary form of the Ancient Chinese Medicine Therapy- Gua Sha, where the skin/soft tissue is “brushed” or “scraped” to break up injured, tight or deficient tissue. Graston Technique is often the work horse of my treatment protocol and is widely used within elite sports medicine circles. Michael Phelps credits Graston Technique for helping maintain and improve his recovery and healing.

There are a few main differences between the two therapies. The first being the type of instruments used. Gua Sha uses bone, wood, metal, stone or other material, where Graston Technique utilizes stainless steel instruments to perform the “scraping” aspect of the technique. Don’t be fooled by practitioners using other metal instruments or stating that they are performing “Graston”, because it’s not the same quality and they’re usually missing the boat on the function of the instruments and the technique. Another difference is the aggressiveness of the “scraping”. Although Graston Technique may occasionally utilize a more firm application of treatment, if physiologically appropriate, it generally consists of may different strokes, maneuvers and variations that are at a comfortable tolerance. For me, if you’re already in pain and I “crank” on you, you will often be upset and feel much worse after the treatment, so there is no reason I


Advanced Healing Techniques

Patients often wonder what the difference is between my practice and most other health care providers treating injury, pain or other physical complaints. The main difference between our style of “Physical Rehabilitation”, “Chiropractic” or “Sports Medicine” treatment is based on the unique techniques and strategies utilized, let alone I am surrounded by a team of medical providers, colleagues that compliment the services I offer. I am committed to first ensuring that you are in a manageable, active and efficient healing state. Most people assume that when they are injured, or hurt, that they are healing. They are probably correct, but they are not accurate. Depending upon the physical, emotional, physiologic factors and other stressors placed upon you, it is a sure bet that your healing process is somewhat sluggish, disoriented and simply slow. Oh, and just because you’re over 40 years old, you should still have a strong healing ability, no excuses.

One of the major factors that limit muscle, nerve, ligamentous and connective soft tissues healing, aside from the production of pain, is the amount and quality of blood flow reaching the injured cells. Blood carries oxygen, nutrients and other constituents necessary to promote energy production within a cell in order to heal. Poor blood supply at the cellular level = poor healing ability. Often, blood flow is limited to the soft tissue because of the “quality”, “shape” and “consistency” of the connective tissue enveloping it. Connective Tissue/Fascia is similar to “plastic wrap”, as it is thin and filmy, but if it gets thick it will become very restrictive to the muscle and limit blood flow, almost suffocating it. Connective Tissue/Fascia is also highly conductive and can encourage and potentiate the production of pain when thick or disorganized in its quality. If the layers are not layed down in linear, parallel patterns like grains of wood, then the tissue is weaker in terms of tensile strength, and must become thicker in order to support the physical stressors we place on our body. Ever wonder why your low back, shoulders and neck continue to be tight, achy and stiff, maybe feeling better for a short periord if someone massages you, adjusts you, strengthens or stretches you? These techniques are inferior in effectiveness because the central issue as to the quality (shape, layering and blood flow) of the tissue was never addressed, and your complaint will come back.

We are essentially “vaccum sealed” in connective tissue/facsia. It is the layer under your skin and laying over all off your muscles and wraps every muscle fiber. It’s what holds our body together, a tensile protective wrapping, and because of it’s eletro-conductive quality we feel that it may provide a super highway for your cells to communicate with each other and with your brain. Statistically, if the quality of the tissue is compromised then you will most likely develop an increased propensity to develop a pain syndrome, heal at a slower rate and essentially be encouraging a dysfunctional nervous system. You need treatment strategies that are more specific that the common conservative techniques utilized, and we haven’t even talked about invasive medical procedures. I utilize contemporary sports medicine techniques that have roots in Traditional Chinese medicine, but have been re-developed to support and work in harmony with our Modern Sports Medicine principles and healing strategies. The modern techniques of Dry Needling, Vacuum Cupping, Graston Technique and Therapeutic Exercise are based on neurophysiology principles, and not Traditional Chinese Medicine. We don’t have time to wait for healing or pain relief, and when combined with our physical rehabilitation strengthening and conditioning principles, we can produce an accelerated healing process. If we are able to apply these treatment strategies before an injury occurs, then you will see injury rates also decline in an active population.

Unlike most other conservative health care providers providing physical rehabilitation services, I am not going to assume you are healing well. Rather, I will promote a healing response and help manage your healing process while respecting your individual physiological state and meeting you where your needs are. You cannot truly rehabilitate an injury until you have soft tissue that is responsive. Otherwise, your treatment is simply a “bandaid”, a reality that dominates the health care industry. Function is better than strength. Quality in healing, tissue and movement is a necessity. Open your mind and give some of these treatment techniques a try. But, although my techniques can produce soreness, they should never hurt. Beware of practitioners being too aggressive.