For many people, summertime means increased physical activity and outdoor recreation. Health-wise, that's definitely a good thing, and as a doctor you want to encourage patients to take advantage of nice weather and get moving.
But increased activity often means increased risk of injury, especially for patients prone to over-doing it. People who suddenly throw themselves into summer sports after months of inactivity are putting themselves at risk.
There's a lot you can do to help people prevent summertime injuries. If they do get hurt, there are a host of natural therapies you can offer that are much safer than prescription painkillers and muscle relaxants.
Strengthening Connective Tissue
"The better someone's overall health, the lower their chances of injury, and nutritional status is a big influence on that," says Michael Gerber, MD, a Reno, NV, family physician who specializes in treating sports-related injuries. Reno, like much of the West, is a magnet for outdoor sports lovers and Dr. Gerber says he routinely treats people with activity-associated injuries of the elbow, knee, lower back and shoulders.
"We see all sorts of stuff. Sometimes it's severe as when people get thrown from bikes, or get into what we call 'horse-wrecks,' which are common out here."
The risk of activity-associated joint and muscle injury is directly related to the overall health of the connective tissue, and this is greatly influenced by diet. Vitamin C is one of the most important factors. "You need high levels of vitamin C, manganese, and copper to make or repair connective tissue. Humans are one of the few creatures on Earth who don't make their own vitamin C. So it's very important to support the connective tissue via supplementation."
Dr. Gerber recommends that all physically active people take the following every day:
• 2-3 g buffered Vitamin C
• 3-5 mg copper
• 25-50 mg zinc
• 3-5 mg manganese
This is particularly important for high-performance athletes who put major strain on their tendons, ligaments and other connective tissues. The greater the connective tissue integrity, the less chance they will hurt themselves, and the faster they will recover if they do cause damage.
The adrenals play an important role in maintaining stamina and keeping steady blood sugar levels during exercise, explained Dr. Gerber. Athletes who push it, especially if they go above VO2 max, start burning glycogen, and this puts a huge strain on the adrenals. You can minimize the damage by making sure these individuals get enough vitamin C, as well as pantothenic acid (vitamin B5).
Minerals & Muscles
Muscle cramping is an inevitable phenomenon during intense exercise, but the frequency and intensity can be greatly reduced if someone has ample levels of minerals, especially calcium and magnesium, which are critical for proper muscle function. "It's always sad to me to see professional players sidelined because of muscle cramps. It's almost always a mineral deficiency, and their doctors really should be on top of that," Dr. Gerber told Holistic Primary Care.
He recommends a mineral product called Nema Base (Nestmann Pharma). The tablets contain potassium hydrogen carbonate, calcium carbonate, calcium hydrogen phosphate, magnesium carbonate and sodium hydrogen carbonate, all of which are highly bioavailable forms of these minerals.
"I call it my sexy German baking soda," he joked, noting that Nema Base is effective for buffering lactic acid during exercise, minimizing muscle soreness, fatigue and cramping. Essentially, it increases alkaline reserves in the blood and improves the ability to neutralize lactic acid and other acids that build up in the muscle and connective tissue during exercise.
The product also happens to be good for stomach pain if caused by excessive HCl production. Nema Base is made by the Nestmann Pharma, a German biological therapies company, and available in the US from Marco Pharma International.
While generally safe, Nema Base is contraindicated in patients with any form of alkalosis, hypokalemia (which is almost always accompanied by alkalosis), or hypercalcemia. Individuals with a history of kidney failure and those requiring low-sodium diets should not take it, nor should those with bladder infections (high bicarbonate content increases urine alkalinity which encourages bacterial growth), or those with stomach ulcers (hydrogen carbonates react with stomach HCl to form caustic carbolic acid).
Active people should also make sure they are getting enough potassium. The "push the limit" types almost always need supplementation. "I find that high-dose prescription strength effervescent potassium is quite good, especially for long-distance cyclists, runners, and other athletes who tend to push themselves," said Dr. Gerber.
Therapeutic Injections: Minimally Invasive, Maximally Effective
Neural plexus injection therapy, based on the techniques pioneered by Dr. Deitrich Klinghardt, is a mainstay in Dr. Gerber's practice. He has found it invaluable for common joint and connective tissue injury (see Naturopathic Perspective, p.___ for a related article). The technique involves direct injection of procaine and homeopathic preparations like Heel's Traumeel formula (www.Traumeel.com), into autonomic ganglia, peripheral nerves, trigger points, and connective tissues affected by traumatic injury.
Over the years, Dr. Gerber has used neural therapy to treat everything from sprains and strains to chronic back problems, headache, and longstanding joint dysfunction. "Essentially, it re-energizes injured nerves and gets the action potentials going again. The peripheral nerves usually sit on top of capillaries, and following injury if the nerves are damaged, the capillaries shut down, leading to poor circulation." Blood flow to connective tissue is fairly limited even under the best of circumstances, one of the reasons why damaged tendons and ligaments are so slow to heal. Injection therapy opens circulation and speeds healing.
Neural injection was first described in the 1920s, not long after Einhorn developed procaine. The techniques are widely used in Europe, particularly in German-speaking countries. Since those early days, clinicians have developed many variations on the basic principle. The addition of injectable homeopathics like Traumeel and Zeel is relatively new.
"Traumeel has all the homeopathic mainstays for treating trauma and injury, including Arnica, Calendula Belladonna, Aconitum, and others. It also has things for bleeding and infection," said Dr. Gerber, who has used the procaine-plus-homeopathics approach to treat wrist sprains, shoulder tears, tennis elbow, and knee/ankle connective tissue damage.
Neural injection therapy is a highly versatile skill set for primary care doctors to acquire, he noted. While there are many nuances, the basic techniques are easy to master. "I have four boys, all soccer players, and they're constantly injuring themselves. I've taught them how to do their own injections," said Dr. Gerber. He recommended the training seminars offered by the Klinghardt Academy of Neurobiology.
Topical homeopathic preparations can provide patients with a great, non-addictive self-care option for relief of sprains, strains, bruises and other minor trauma. Several good formulas are available including: Heel's Traumeel cream; Topical BioMedic's popular Topricin cream (www.Topricin.com); and Hyland's Muscle Therapy Gel (www.hylands.com).
Decompression Traction Therapy
It may look like a modern version of a mediaeval torture instrument, but a decompression traction table can provide tremendous relief to patients with low back injuries, especially those with lumbar disc problems.
Disc injury often results in impaired circulation to the affected area. Restricted blood flow means poor delivery of nutrients, reduced oxygenation and very slow healing, as anyone suffering these injuries will readily attest.
For decompression therapy, the patient is fitted into specialized corsets that are hooked into the table, which allows for precisely controlled traction to decompress the damaged disc(s) and open the circulation. "These tables provide very fine increments of stretching that you can gradually increase over the course of several sessions. It's a great treatment for all sorts of back issues," said Dr. Gerber. There are a number of different decompression traction systems on the market; Dr. Gerber uses a system made by American Back Solutions.
The treatment sessions are 30 minutes long, and the system enables patients to listen to music while they're on the table. Most common back injuries can be greatly improved with 20 sessions over a course of 4-5 weeks.