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Movement in Medicine 02 - why exercise is so important

Thu, 18 Aug 2022 23:58:13 GMT

In the first of this 2-part blog on exercise we discussed the fact that, by itself, exercise is a poor way to lose weight, but in conjunction with other lifestyle changes it can help in weight loss and improved quality of life. In this, the second blog regarding movement I hope to offer some practical tips, and reflect on my own journey and how I have had to adapt my approach to exercise and movement over time.

As was shown in my previous blog, exercise has many important attributes including:

• Reduction of inflammation – a major cause of many of our modern diseases;

• Improved immune function;

• Reducing resting fight and flight hormones and;

• Relieving stress.

How to change

According to Dr Jeffrey Bland, 12 weeks is the average time it takes to make a real change in cellular biology and patterns of gene expression and that any programme should:

• Incorporate exercises that build endurance, strength and flexibility;

• Bring pulse and breathing into aerobic zone (calculated at 180 minus your age);

• Have minimal impact on joints and muscles and;

• Be something that you routinely do 5 to 6 days per week.

I would also add DO WHAT YOU FIND IS INTERESTING AND FUN , (since if you don’t enjoy it you won’t keep it up) – and keep it up – REGULAR ACTIVITY IS KEY .

Dr Bland also states that any programme should;

• NOT exceed your physical capabilities;

• NOT produce serious muscle or joint strain;

• NOT total less than 120 minutes per week (equates to around 20 minutes per day), and;

• NOT follow excessive physical demand with proper conditioning – a “weekend warrior”

He goes on to recommend purchase of a pedometer in order to track the number of steps walked per day – the goal being to get to a MINIMUM of 10,000 per day. This regime has been shown to improve cardiovascular function, psychological well-being, blood cholesterol and HDL levels (Bland, 2014). He goes on to comment that studies show after stopping a regular walking programme, insulin sensitivity decreases followed by a commensurate increase in angry fat – surmising that cellular communication processes from the altered physiological fitness is key in development of Type 2 diabetes.

There is an old saying in Chinese Medicine – “the door that never moves, rusts”. Lack of movement (especially when doing sedentary work that involves lots of sitting – e.g. computer / desk work / driving) is one of the main causes of chronic pain and dysfunction that I see in my clinic. In addition movement can also be a great stress reducer and is shown to help in condition like anxiety and depression.

A personal journey - my early years

From a Traditional Chinese medicine point of view – the main thing is balance; do not try (especially in the early stages) to attempt what a twenty year old can do whilst you are in your forties, fifties or sixties - especially if you have not led a fit and active life and are starting from a sedentary base level. We all know of people who may have started extreme sports in their later years, however from a Yang Sheng (nourishing life) principle – too much exercise can be as bad as insufficient exercise.

In my youth I was very unfit and overweight – being the sole carer for my mother on home dialysis, most of my teenage years was spent at home. So in my early twenties (after my mother was able to receive a kidney transplant) I went to look for a way to improve this.

I started attending a Tai Qi class – however at that time I was unimpressed with the very large classes and only receiving about 1- or 2-minutes instruction from the teacher for the entire session. So a quick magazine search (the days before Google and the internet!!) I saw an advert to “Learn Kendo in small classes – direct transmission”. The small classes interested me, and at 21 I started my almost 40-year relationship with my sensei Mike Finn at Elite Academy.

I must admit the only reason I lasted the first year was that I paid for my fees upfront and I was not going to waste that hard earned cash!!! However, after many months where I would arrive home with bleeding feet and blistered hands, my body morphology started to change and I actually enjoyed the numerous “bunny hops” we did around the dojo and the 500 cuts we did to warm up a Kendo session!! Perseverance and bloody-mindedness definitely helps!!

In my twenties I was spending probably 5-6 hours per day, 5-6 days per week training. My life was literally work train and sleep and I was fortunate enough to be able to spend quite a long time in Japan training with my teacher and his teachers. From a Chinese Medicine point the Yang energy in the body is at its maximum in your late twenties – you heal quicker and are more energised.

I progressed on to learn other skills, eventually gaining 3 ^rd Dan Black Belt in Kendo, 3 ^rd Dan Muso Shinden Ryu Iaido, 3 ^rd Dan Shindo Muso Ryu Jo, 2 ^nd Dan Tomiki Aikido and 1 ^st Kyu Goshinjustu. However, meeting my wife and best friend of 35 years and wanting to spend more time with her and my children, shift work, studying and starting up a business meant that my early training regime couldn’t be maintained and had to be moderated – however to this day I try to train at home at least a couple of times a week, and when in London I still train with my teacher at his dojo on Fulham.

As Finn Sensei often pointed out to me -, fortunately we don’t life in a time where we have to fight every day to survive – however what martial arts does provide is a vehicle for respect, self-discipline and confidence.

Later life

Through studying acupuncture, I was introduced to Qi Gong and re-introduced to Tai Qi ( I try to do my Qi Gong exercises daily) however in my 40s and 50s with working away from home so often and studying at university I found that it was not easy to maintain a regular exercise regime.

After completing my Osteopathy degree and its emphasis on self-maintenance, now in my 60's I have since made a determined effort to maintain a regular exercise regime. Whilst living up in Malvern I have been able to engage in my other interest – dancing. I believe that dancing has many things common with martial arts – timing, an appreciation of distance (between you and your partner – stepping on their toes is not conducive to a good relationship!!) and focus of mind – together with a good cardiovascular workout – win, win !!!

From my ambulance service career as a paramedic, what struck me was the importance of balance in later years (as discussed below) and fear of falling. I find the blend of martial arts, dancing and Yoga works for me and really does help with this. Work allowing (when I am at home and not around the country) I try to dance 3 evening per week - in Malvern (Wednesdays) and Ledbury (Thursday) evenings you will often see me with Steve at Coolmoves dance and fitness learning swing jive. In addition I incorporate a 20 minute short Yoga routine together with my Qi Gong exercises almost every morning (usually before the dog-walking) - unless it is one of the days I attend the formal Yoga classes.

On Fridays my wife Judi and I travel up to Pershore with Paul and Tracey from Danceat8 for Latin and Ballroom – it is also great fun being able to engage in an activity with one's partner.

For further information on the benefits of dancing click here for an article by Phil Hardesty on 3 reasons why dancing improves heart health.

On Monday and Wednesdays whilst in Malvern, I also try to go to The Fold at Bransford where I attend Yoga classes with Melissa at Melissa Porter Yoga .. Mondays is the more challenging Vinyassa style and Wednesdays I attend the Yin Slow Flow with Judi– again, it is great fun being able to engage in an activity with one's partner.

Maintaining your exercise programme

It can be challenging to maintain this activity whilst travelling around the country teaching, and maintaining a busy work schedule at home treating patients. However, simple steps I have found that help include:

1. Taking the dogs out once or twice a day (morning and evening) when I am home – this can notch up 5-6,000 steps;

2. Try to instigate a daily routine - they say it takes up to a month for any practice to become a habit. Personally I try to go to bed earlier and get up earlier. This enables me to do my 20 minute Yoga, 20 minute Qi Gong and 20 minute core-strengthening exercises before taking the dogs out for their morning constitutional, and still have time for breakfast before off to the clinic.

2. Simple things like

a. Walking up the stairs (as opposed to taking the escalator / lift)
b. Parking my van as far away from the service station in their car park and taking a long walk can help, and;
c. Getting off the tube a station before the destination and walking that extra section.

3. I have also

a. invested in a set of kettle bells to engage in muscle strengthening and core exercises at home;
b. purchased a set of bands that I carry with me to undertake some exercises in my motel room if necessary and have;
c. membership with Anytime Fitness that allows me to pop into a gym anywhere in the country to do a workout

When I return to London, I always try to pop into the dojo to train and, when traveling elsewhere in the country, I often google a dance class around the country and they are always very welcoming. When I'm down in London, on a Monday evening at Fulham I often try to go to Swingland for some Lindy and Charleston practice - all around the country there are dance classes with friendly people all too eager to welcome visitors.

It does take planning to maintain, however it is worth it. I look on exercise as an investment in my health and wellbeing – if I don’t make the effort for that investment – who will? I wish to be able to maintain a healthy life into my 70s and 80s and to engage with my children and grand-children (and possibly great-grandchildren) and in order to do that I need to keep moving.

In the ambulance service I found that the elderly often became more sedentary for fear of falling over - this then reduced their balance and confidence which led to more sitting and less movement and being more prone to falls. This spiraling downwards often led to a very great reduction in quality of life and increased fear. I firmly believe you are never too old to start, however the younger you start moving and the more it becomes a part of your daily routine, the better.

So, if you are not yet exercising –

Find out what interests you and google any local groups / classes that you can join;
Try to incorporate movement into your daily schedule – no matter how busy you are you can find 10-15 minutes to incorporate some movement in your life, and:
Keep it fun - if it isn't fun, you won't keep it up.

To paraphrase an old Buddhist saying “every long journey starts with making that first step”.

REFERENCES

Bland, J (2014) The Disease Delusion – conquering the causes of chronic illness for a healthier, longer and happier life, Harper Collins, New York

Deadman, P (2016) Live Well, Live Long – teachings from the Chinese Nourishment of Life Tradition, Journal of Chinese Medicine, Hive

Hardesty, P (2022) 3 reasons why dancing will improve heart health - Ornish living. Found at https://www.ornish.com/zine/3-reasons-why-hitting-the-dance-floor-will-improve-your-heart-health/

Pontzer, H (2019) Evolved to Exercise (The New Science of Healthy Ageing – Original paper published in Scientific American, 320 (1); 20-27 (January 2019), Scientific American, New York

Movement in Medicine 01 - why exercise is so important

Tue, 21 Jun 2022 19:30:47 GMT

A very big problem is that we are led to believe that to lose weight one must exercise, and the more you exercise, the more weight you will lose. Recent evidence has shown this to be false – exercise is a poor way to lose weight HOWEVER it is vital for our survival.

According to Roberta Anding, director of Sports Nutrition and Clinical Dietitian, Bayer College of Medicine and Texas Children’s Hospital, for the average calorie consumption of 2,000 kcal (incorrectly called calories in lay-terms) – an increase of 100 kcal per day would, over a year, amount to an extra 10lb body weight.

She goes on to point out that “most people actually out-eat their exercise”. She points out there are many ways to calculate calories, however in general 100 calories are used to walk 1 mile (or 2,000 steps). Therefore, if one goes out to walk 3 miles (6,000 steps) around 300 calories are used – but then you go and eat one muffin from a coffee shop (about 450 calories) you have now out-eaten your exercise by 150 calories (Anding, 2009). So what is the function of exercise and WHY IS IT SO ESSENTIAL?

From the earliest days of Chinese health cultivation regular exercise, with its emphasis on balance and rooting the body as an integrated whole combining both breath and movement, was a given to maintaining health and longevity. However, balance should be maintained since according to Hua Tuo (a 3 ^rd century physician) “The body should be exercised until it is tired, but this should not be carried to an extreme. As it is agitated (exercised) digestion improves and the circulation through the blood vessels is freed so that disease is unable to arise” (Deadman, 2016).

The need for exercise, however, goes back far beyond modern civilisation. In his 2016 paper in Scientific American, evolutionary biologist Professor Herman Pontzer commented on his observations whilst a PhD student in Kibale National Park. Against his pre-conceptions, chimpanzees’ daily routine revolved around 10 hours per day of eating, grooming, more eating, napping, eating and then sleeping for 9 hours – walking under 3km / day and probably only climbing about 100 meters (Pontzer 2019).

This lifestyle, in humans, would result in increased risk of cardiovascular and metabolic disease which are unheard of in our primate cousins who, with their leisurely lifestyle, have low BP, ultra-low risk of diabetes (even in captivity) and no atherosclerosis. Whilst working in Lincoln Park Zoon in Chicago Pontzer noted that chimpanzees have less than 10% body fat, similar to Olympic athletes – how does this happen?

He points out that our ancestors split from our primate cousins about 6 million years ago and that recent anthropological finds points to the fact that, between 2 and 4 million years ago, a crucial event occurred. Our hominin ancestors adopted an upright posture and, over the subsequent 1 million years, we developed basic tools, changed our plant-based diet to include meat and expanded out of Africa into Eurasia and Indonesia.

In an earlier blog we introduced the interrelationship between structure and function, however Pontzer points out that, in evolution, DIET IS DESTINY. For example. early mammals evolved a multistep process to make vitamin C. However, tens of million years ago our primate ancestors were so fixated on eating fruits high in vitamin C that genetic mutations and modifications occurred which resulted in the removal of the gene responsible for vitamin C synthesis – which meant that today’s primates – monkeys, apes and humans - cannot make vitamin C and that inadequate dietary vitamin c results in scurvy and death.

Pontzer believes that species who have evolved to eat foods that are plentiful and stationary (e.g. grass) need not travel far or be too clever to satisfy their nutritional needs. However, food that are hard to find and / or capture (e.g. animals) require many additional tasks including

· Travelling increased distances – carnivores on the African savanna travel three times further than their herbivore victims and fruit eating spider monkeys in central America travel 5 times further than their leaf-obsessed howler-monkey cousins that share the same environment;

· Increasing communication skills (requiring larger brains) and tighter communities willing to work together, and share the fruits of their labours, since they must work harder for their food;

· Requiring less sleep – humans on average only require about 7 hours a night – much less than our ape relatives – even in countries that do not possess modern lighting or night-time distractions.

Unlike our primate cousins who rarely hunt, humans do - in fact humans hunt A LOT. Another thing is that human metabolism is much higher than primates, built to burn more calories per day than apes and that, even in hunter gather societies, we have more body fat. Why is that?

Our faster metabolism is necessary to feed our much larger brain. Dr Pontzer goes on to cite Dr Raichlen’s work which puts forward the hypothesis that it rewards us for prolonged activity by producing endocannabinoids in response to aerobic exercise, since exercise causes the release neurotrophic molecules that promote brain growth.

Reinforcing the interplay between structure and function, our maximum power output is four times greater that that of chimpanzees (coming mainly from our leg muscles with a greater proportion of slow-twitch fatigue resistant fibres) and we have more red blood cells able to deliver greater oxygen to feed this metabolism.

Exercising muscles release hundreds of signalling molecules that reduces chronic inflammation (a key player in the formation of cardio-metabolic diseases including heart attacks, strokes and diabetes) and vital when our ancestors walked the savannah in bare feet eating potentially contaminated meat. Exercise also seems to lower resting levels of testosterone, oestrogen and progesterone together with improving insulin sensitivity. Exercise also improves the efficiency of our immune system to fight disease and helps clear fat from circulating blood.

Simply put, it seems exercise is a poor way to lose weight (as has been shown) but helps our metabolic engine run smoother thereby reducing the risk of the diseases of affluence so prominent in the West.

So is there a role for exercise in reducing weight. The answer is in fact yes. Strength training build up lean muscle mass and, although muscle weighs more than fat and initially may result in a slight weight gain, this is far offset by the positive effects. Muscle burns more calories, so your base metabolic rate increases with the greater muscle mass - this means that you will be able to eat more food.

The flip side is that if you go on a calorie controlled diet, but the calories are restricted too low - once the body has used up its glycogen and fat stores, it will then turn to the body's protein to make energy - which will result in less lean mass and possibly disastrous consequences. This will be the subject of a future blog.

Remember no one thing solves everything – a moderate exercise routine should be done in conjunction with whole food (minimally processed) food, fresh air and social support from family and friends. An integrative health-care model – one that has been observed for thousands of years by many cultures is are the mainstay of many traditional medicine practices including Ayurveda medicine from India, and Traditional Chinese Medicine.

This has more recently been “re-discovered” by integrative health and functional medicine - but supported by modern research and a current evidence base. As author Dr Dean Ornish, professor of medicine at University of California, San Fransisco succinctly puts it:

EAT WELL;
MOVE MORE;
STRESS LESS;
LOVE MORE.

On a final note, with modern research we are starting to understand how these processes come together – the fact that, whether genes get switched on (or off) depends more on the surrounding cellular environment than the genes we are born with. The fact that, instead of being a passive receiver of fates hand, we are the masters of our own destiny and can change the outcome (Bland, 2014).

References

Anding , R(2009) Nutrition Made Clear, The Great Courses, Virginia. Accessed via The Great Courses, www.thegreatcourses.com

Bland, J (2014) The Disease Delusion – conquering the causes of chronic illness for a healthier, longer and happier life, Harper Collins, New York

Deadman, P (2016) Live Well, Live Long – teachings from the Chinese Nourishment of Life Tradition, Journal of Chinese Medicine, Hive

Pontzer, H (2019) Evolved to Exercise (The New Science of Healthy Ageing – Original paper published in Scientific American, 320 (1); 20-27 (January 2019), Scientific American, New York

Acupuncture & Tuina : Osteopathy and Functional Medicine – the synergy between East and West – part 01

Fri, 17 Jun 2022 22:55:44 GMT

“The object of a physician is to find health; any darn fool can find disease”. This could easily be attributed to an ancient Chinese sage-physician (although the use of “darn” gives it away!!) but it was in fact attributed to A.T. Still, the founder of Osteopathy, back in the 1870’s (AACOM, 2022).

Unknown (Library of Congress collection), Public domain, via Wikimedia Commons

https://upload.wikimedia.org/wikipedia/commons/e/ed/Andrew_Taylor_Still_1914.jpg

Classically Acupuncture and Tuina (not Tuna!!) are 2 of the 4 legs of Classical Chinese Medicine – the other two being herbal medicine and the movement disciplines (including Qi Gong and Tai Qi (link to Tuina page).

People are often surprised when I inform them that I combine these disciplines - however, the more I research and practice, the more I think there are more similarities than differences.

We often forget in the West that until the 18th Century China was probably the most technologically advanced society in the world and Chinese Medicine was the only medicine available to them – and had served them well for well over 2,000 years

A common misconception is that Osteopathy is simply “cracking bones” – in fact Osteopathy was defined as a philosophy, art and science. Osteopathy presupposes that the body unit combines both mind, body and spirit and that no one part works independently of the other – with a healthy body relying on the balance of all three parts. (AACOM, 2022).

Another of the basic tenets of Osteopathy is that health is a natural state and that the human body is a self-healing mechanism and, if left to its own devices, the body will try to heal itself. The viz medicatrix naturae (lit the healing power of nature), or viz for short, was initially attributed to Hippocrates, which stated that organisms left alone can often heal themselves (Wikipedia, 2021). Unfortunately, as human beings, we tend to put a spanner in the works by either over-use, under-use or ab-use of our body (see later blogs on movement, nutrition and lifestyle, the Yangsheng - or nourishing life - principles of Chinese Medicine).

A further principle of Osteopathy is that “the rule of the artery” is supreme and that adequate circulation is paramount for life and the healing process. Chinese Medicine concurs, with the flow of Qi and Blood being necessary for survival and healing.

Another principle of Osteopathy is that both structure and function of the body are inter-related with structure informing function, and function relying on structure (more of this in a later blog) and that a rational treatment is based on the basic principles of body unity, self regulation and the interrelationship of structure and function.

Interview on UK Health Radio on the interplay of East and West healthcare - together with a little about my journey

The Osteopathic principle of viz also incorporates the idea that we are born with a vitalism, a differing amount for each person (their inherent constitution) and that when this fixed amount is used up - we die. This vitalism can be supported by good lifestyle, and can be drained by poor lifestyle. A similar concept was put forward in the 1980,s by Dr James Fries, a professor of medicine at Stamford university. who described the idea of a functional reserve for all the body's organ systems which, in youth, is far greater than the body's needs - a "savings account for extra biological needs". He termed this "compression of morbidity" (Stamford News, 2021).

Professor Jeffrey Bland PhD (often acclaimed as the "father of functional medicine") in his book clarifies this, saying that we can utilise this reserve in times of need e.g. trauma / stress (the stress response of the body allows 4-5 times normal oxygen supply to the vital organs, and our kidneys / liver can detoxify bodily toxins). However, as we age, this functional reserve diminishes - but that lifestyle changes can help retain this organ reserve for as long as possible, thereby reducing the time we spend with chronic illness. He goes on to cite Fries who followed up his 1980 paper in 1998 with the results of a study of 1,741 university alumni who were followed since 1962 (average age 43). The results of this study showed that those who followed high-risk lifestyle behaviour experienced twice the cumulative disability and the lower risk group postponed the first onset of disability by 5 years (Bland 2015)

My Chinese Medicine and Applied Channel Theory teacher, Prof Wang Ju-Yi stated that, after 50 years of clinical practice and study, the following expression summerised his views on Chinese Medicine and Acupuncture:

"The 5 Zang (organs) foster essence thus govern destiny" - our inherited constitution (or essence) gives us our pre-disposition which is supported by organ function - cultivation of this is necessary for life and to fulfill our potential destiny. Disciplines like Yoga / Tai Qi. and lifestyle advice, following the yangshen principles, help us prolong this. He goes on to say that;
"The " channel system permeate, thus govern life" (Wang Jy-Yi, 2013). What is actually achieved in acupuncture is to regulate the channels to allow the body to heal itself (see a later blog on the 5 Zang organs and the channel system). For further information on Prof Wang (including articles and podcasts) - click here

According to Dr David Miller (2020) a common criticism in the West is that Traditional / Classical Chinese Medicine is “unscientific”. However, he points out that Chinese Medicine is “observational biology and that it does follow a scientific process - it:

1. Observes a phenomenon – it gathers knowledge of pathology (signs and symptoms of a disease process). It then;

2. Formulates a Hypothesis to explain the phenomena, using the scientific terminology of the period. It then;

3. Predicts other phenomena by use of this hypothesis. Finally, it;

4. Confirms the results by the performance of test – literally undertaken by several thousand experimenters (Chinese Medicine Practitioners) over thousands of years to billions of patients.

It is impossible to directly equate Western and Chinese medicine, as they come from different historical views on how the body-system works. However, as you can see many of the philosophical and practical roots of Osteopathy and Chinese Medicine are not dissimilar, and I personally believe that their differences are outweighed by their similarities.

References

AACOM (2022) American Association of Colleges of Osteopathic Medicine – The Philosophy of Osteopathy . Found on https://www.aacom.org/become-a-doctor/about-osteopathic-medicine/philosophy-tenets-of-osteopathic-medicine

Bland J (2015) The Disease Delusion - conquering the causes of chronic illness for a healthier, longer and happier life , Harper Collins,

Stamford News (2021) Stamford Medicine Professor James Fries, a proponent of healthy medicine, dies at 83 . Found on https://med.stanford.edu/news/all-news/2021/12/james-fries-obituary.html

Wang, Ju Yi (2013) Applied Channel Theory in Practice, Found on https://www.channelpalpation.org/theory

Wikipedia (2021) The Viz medicatrix naturae , found on https://en.wikipedia.org/wiki/Vis_medicatrix_naturae

If you have a spare hour or so look at the “Introduction to Traditional Chinese Medicine” video below by Dr David Miller MD, L..Ac (a Western Medical Doctor and Acupuncture Practitioner) where he explains these concepts to a groups of Medical Students from Harvard Medical School.

Acupuncture and Martial arts in the East and West -

alex@holoshealthcare.co.uk (Alexander Brazkiewicz) — Fri, 17 Jun 2022 22:35:34 GMT

Acupuncture and Martial Arts

Classical Chinese Medicine was taught very differently than today, and in a very similar vein to classical Martial Arts:

The student chose a teacher, and if he was accepted by the teacher had a very long apprenticeship, to prove (literally through sweat, blood and tears) that he (this was a very male-orientated domain) was worthy to receive instruction.
This however is not a very useful business model, and is very manpower intensive, inapplicable to a university based system where the priority is to train a lot of people to a safe standard within a certain budget, and:
As previously described, this can limit the knowledge base to those only personally experienced by the clinician

When dealing with the classical oriental traditions, be it Chinese Medicine or Martial Arts, that context is everything;

In China and East Asia (where the culture of ancestor respect and worship was prevalent) to write down procedures that contradicted those that were written down by their predecessors, bordered on sacrilege, and to openly criticise the written word, frowned upon . However in reality, the teacher / disciple relationship provided a clinical filter, the teacher would often say that 'this technique or point would be "more appropriate" than that point'. In martial arts, this filtering was more blunt - those who applied techniques that were less effective, had a very short lifespan and could not pass them onto the next generation!!!
Those that wrote the medical texts came from a select group - termed the 'gentlemen physicians'. To be able to write these texts and to support oneself meant you had to come from a certain income stream, and their patients had certain requirements.
I remember my teacher in China, Professor Wang Ju Yi who was both steeped in Classical Chinese Medicine but was equipped with a very enquiring (one would say 'Western oriented') mindset and who was willing to question (in a very respectful way) the classics discussed the history of channel palpation. In his opinion the physical palpation of the channels was commonplace in the time when the original classics were written. Although the classics were written between 1,500 to 2,500 years ago, no extant copies remain - the physical copies that are available today are usually Song or Qing dynasty copies and commentaries, which date from only about 1,000 years ago. However during the feudal period, the physical touching of patients (especially those from a higher social class) was frowned upon and emphasis placed on symptom taking, together with pulse and tongue diagnosis. He was of no doubt that the palpation was carried on by the lower class doctors who treated the general population - however they rarely wrote the books!!! On the plus side, the specialisations of pulse, tongue and symptom taking was raised to an entirely new dimension.
For further insights into Channel Palpation click onto short 20 minute video below. Alternatively please go to the Applied Channel Theory website, by clicking here , where you will find numerous articles, podcasts and further resources.

I believe that there is already much crossover between Traditional East Asian Medicine (TEAM) and the West:

Dry needling (also known as Intra Muscular Stimulation IMS) is where a thin, solid filiform needle is inserted into the body to treat dysfunction of skeletal muscle and connective tissue, to improve pain control and reduce muscle tension. The term Dry Needling was originally attributed to Dr Janet Travell MD (who was physician to the Whitehouse and to 2 presidents - Kennedy and Linden-Johnson) who dedicated her life developing the theory of, and practice of, myofascial Trigger Points to treat pain. People often state it is different to acupuncture since it is scientifically based and does not rely on energy meridians. However, again context is everything. There are many types of channels in Chinese Medicine, which include the Jing Luo (which are the meridian lines you often see on acupuncture charts and models) but also the Jing Jin (or channel sinew meridians) which are more akin to the myofasical planes seen, for example, in the Anatomy Trains book by Tom Myers. Treatment here often involves treating the local painful points (called Ah Shi or 'Oh Yes").
Fascial tools, e.g. Graston technique (often used by Chiropractors) and IASTM (Instrument Assisted Soft Tissue Mobilization, often used by Physiotherapists) are methods of instrument assisted mobilization to help reduced pain, identify restricted areas, break down scar tissue, improve local circulation and promote healing - which is basically a modern version of Gua Sha. For more information by a specialist in this field, Dr Arya Nielsen PhD, - click here
Myofascial Decompression (MFD) Techniques where negative pressure is instigate by applying suction sups to an area of the body, thereby drawing skin and fascia away from the midline thereby altering blood flow and metabolic exchanges, drawing out toxins and reducing pain by endorphin release. This is basically Ba Guan, or cupping.

As has been eluded to, there is much similarity in the training, philosophy and discipline required between traditional martial arts and traditional Chinese medicine.

You may recognise a much younger me training with my teacher, Mike Finn Sensei, in empty hand techniques

References

Greenhalgh T (2014) How to Read a paper, the basics of Evidence Based Medicine, 5th Ed, BMJ Books, Chichester, West Sussex (hard copy and Kindle eBook)

Hruby, J and Hoffman, K (2007), Avian influenza, an osteopathic component to treatment, Osteopathic Medicine in Primary Care, 2007; 1 : 10, Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1939852/

Markel H et al (2007) Nonpharmaceutical Interventions Implemented by US Cities during the 1918-1919 Influenza Pandemic, JAMA, Vol 298 (19), Available at https://jamanetwork.com/journals/jama/fullarticle/208354

Miller D (2016) Introduction to Traditional Chinese Medicine, Integrative Health Network, Available at: https://www.youtube.com/watch?v=WKpKEYo3me0

Nielsen, A (2012), Gua Sha: a traditional technique for modern practice, 2nd Ed, Churchill Livingstone, Edinburgh (Available as a hardback and eBook)

Root Bernstein, R and M (1998) Honey, Mud, Maggots and other medical marvels: the science behind folk remedies and old wives' tales, Houghton Mifflin Company, Boston (available as a book and on audible)

RICE, PRICE or POLICE - revised thoughts on the management of acute injuries

alex@holoshealthcare.co.uk (Alexander Brazkiewicz) — Tue, 02 Jun 2020 10:07:25 GMT

"Experience must indeed, as Hippocrates says in his first aphorism, be fallacious if we decide that a means of treatment, sanctioned by the use of between two and three thousand years, and upheld by the authority of the ablest men of past times, is finally and forever given up............" W. Mitchell Clarke, M.D., 1875

No, I haven't gone mad!! This is not about the cost of takeaway food to Law Enforcement Officers. What have these three acronyms in common - the answer is the evolving treatment of injury. We all are told of conflicting advice about what to do with an injury. "To ICE" or "not to ICE", 'To Rest' or "too much rest is bad for you". This blog hopes to answer some of those questions.

If you are not familiar with the acronym R.I.C.E., it is the often used treatment for acute injury and stands for:

R - Rest
I - Ice
C - Compress
E - Elevate

However this conflicts with the Chinese Medicine concepts of injury management.. The Classical Chinese Medicine (CCM) paradigm holds that pain is caused by stagnation - and whereas the CCM paradigm approves of Rest (in the early stages at least) and Elevation (to help in the reduction of swelling) it tends not use Ice or Compression, since it is felt that these two will increase stagnation and may slow the healing process. CCM prefers to utilise herbal poultices or plasters that are energetically cooling, but still promotes moving of Qi and Blood (including lymph and other fluids). If plasters were not available, then a cold compress in the initial stages could be used (but for no more that 5 minutes every hour) to help with the acute pain. This dichotomy often led to heated discussions between myself and some of my Western Medicine tutors - however it seems that the ICE model may be due for an upgrade !!

Latest research seems to support the idea of Resting for the first 24-48 hours after acute trauma to stop further injury (Bleakley et al, 2012) - however too much rest can actually cause more harm than good (hence that is why many post-surgical regimes have patients up and mobile much sooner than was the case 10 or 20 years ago). It seems that excessive rest can cause joint stiffness and weakness and may lead to a change in biomechanics due to adaptation and compensation by neighbouring structures, increasing the possibility of re-injury. Again, according to that 2012 study the evidence supporting the use of Ice is mainly anecdotal (focusing mainly on its analgesic effects) together with the use of compression.

As was pointed out by Dr Bahram Jam from the Advanced Physical Therapy Institute (Jam, 2020) humans have spent about 7 million years evolving an effective method of tissue repair post injury - initiated by the inflammatory response. Inflammation prevents further damage, stops infection and kick-starts the repair process (termed proliferation and remodeling).

Blood vessels dilate and become 'leaky' (permeable) thereby;
Allowing the arrival of white blood cells (leukocytes) to kill off any infection and to signal reinforcements (in the shape of cell eaters or macrophages) to help mop up the damage.;
Any waste products and excess fluid are then removed by the lymphatic system - which (unlike the cardiovascular system) does not have its own pump and relies mainly on movement, skeletal muscle contraction and breathing for lymphatic drainage.

Whereas icing modulates pain, it also limits muscle contraction (Bleakley, 2012) which may then also temporarily effect lymphatic drainage at the site. Ligaments and tendons, both of which have a poor blood supply normally, may be adversely affected by too much ice, which constricts blood vessels and theoretically may reduce healing.

The ICE model was then revised to PRICE,. However the model currently in favour is P.O.L.I.C.E.:

P - Protection - this aims to reduce further damage to the injured area by using devices (such as crutches, braces or supports - traditionally associated with rest) to avoid complete rest and still move, whilst protecting the area;
OL - Optimal Loading - this refers to the start of gentle movement of the injured area. Controlled mechanical loading up-regulates gene expression of proteins that are used in soft-tissue healing (Bleakley, 2012) thereby prompting healing at a cellular level. The problem is that if tissues are stressed to much, too early further damage could be caused. Guidance can be given at the clinic regarding exercises that progressively load the area to promote healing and increase proprioception. Optimal Loading also prevents problems such as muscle tightness or muscle wasting that can happen form too much rest;
I - Ice, applying ice (putting a towel between the ice pack and skin, avoiding ice burns) to the injured area for 10 minutes every 2 hours;
C - Compression - gentle compression of the injured area with a bandage may minimise swelling - however insure there is not skin colour changes or pins-and-needles since it may be too tight;
E - Elevation

In addition, the use of Anti-Inflammatory pain killers (e.g. Ibuprofen) in the acute stages (usually 24-48 hours post injury) is now frowned upon since, as had been described, inflammation is required for the healing process and a key response to tissue damage. If necessary, paracetamol could be used for analgesia. Click here to download a brief advice leaflet, or look at the video below for further information.

F urther treatment

Seeing a competent physical therapist (e.g. osteopath or sports therapist) can assist with hands-on-treatment (e.g. massage and mobilisation), exercises and taping to ensure a return to full range of mobility. For example NICE (the National Institute for Health and Care Excellence, which provide national guidance and advice for Health & Social Care) in their UK guidelines for the treatment of Lower Back Pain recommend the use of manipulation and massage, in conjunction with exercise (NICE, 2016). In addition, the Advertising Standards Association has been provided with clinical evidence to support the use of:

Acupuncture in the short-term relief of headaches (tension-type and migraine), chronic low back and neck pain and temporomandibular (TMJ) pain and as a temporary adjunctive treatment for osteoarthritis of the knee (ASA, 2019) and;
Osteopathy for the treatment on a variety of conditions including arthritic pain, frozen shoulder, shoulder and elbow pain (arising from associated musculoskeletal conditions of the neck and back), headaches (arising from the neck), joint pains, general and acute back-pain, minor sports injuries, muscle spasm, sciatica, uncomplicated mechanical neck pain, tension and inability to relax (ASA, 2016).

It therefore seems that advice seems to have completed a full circle. I firmly believe that, by dismissing everything that was done in the past, we are in danger of throwing out the baby with the bathwater. Conversely, not everything that was done historically was necessarily good or beneficial and by accepting everything that was written historically as the ultimate truth can lead to tunnel vision and possibly dangerous, clinical practice. . One must look at what is clinically effective and that having a pragmatic approach, with the ability to critically appraise information and to integrate the best of all paradigms, is the way forward in a balanced, efficacious practice of 21st century healthcare.

References

ASA (2016) Advice online Health: Osteopathy 2nd Dec 2016, Advertising Standards Authority, [online] Available at https://www.asa.org.uk/advice- online/health-osteopathy.html;

ASA (2019) Advice online Health: Acupuncture 26th Feb 2019, Advertising Standards Authority, [online] Available at : https://www.asa.org.uk/advice- online/health-acupuncture.html

Bleakley, C. et al (2012), 'PRICE needs updating, should we call the POLICE', British Journal of Sports Medicine, Vol 46 (4), published by the BMJ, Available at https://bjsm.bmj.com/content/46/4/220

Jam, B (2020) 'Paradigm Shifts: Use of Ice & NSAIDs Post Acute soft Tissue Injuries", Physical Therapy web, Available at https://physicaltherapyweb.com/paradigm-shifts-use-ice-nsaids-post-acute-soft-tissue-injuries-part-1-2/

NICE (2016) NICE publishes updated advice on treating lower back pain, National Institute for Health and Care Excellence. Available at https://www.nice.org.uk/news/article/nice-publishes-updated-advice-on- treating-low-back-pain