A big thank you to all participants of our Sports Injury webinar on 13 August 2022, Saturday! During the session, the relationship between TCM and Sports Injury was shared and there was an overwhelming response during the Q&A session; fret not as Physician Niklas from ZhongJing TCM has answered them below!
Thank you to Physician Niklas as well for the time in going through and providing the answers.
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U Live Team :)
Q&A with Physician Niklas
When do we use ice or heat pack?
Ice pack should be used at the onset of injury or inflammation – the hallmarks of inflammation are redness, swelling, warmness, pain. This is usually the first 24-48 hours from onset.
This may be when you first had a sprain, or when the inflammation is triggered e.g. gout. Icing helps to decrease blood flow circulation to the affected area, preventing inflammatory markers from triggering further inflammation reaction. However, icing for injuries/inflammation has become a topic of discussion in recent years.
Do also understand that not all inflammation is bad, some inflammatory reactions are beneficial for the body as it would trigger the repair processes to start healing. (This is my theory for acupuncture and how it helps with injuries)
Heat pack should be used for recovery, or after swelling has stabilised (no longer worsening). Heat would increase blood flow to the affected area, allowing for nutrients to reach the injured tissues for repair, and for the reabsorption of oedema.
Does drinking the canned snake water, 3 legs cooling water etc. have any benefits?
The aforementioned drinks are generally safe for consumption. The amount of herbal content in them are at an extremely safe level, and should not cause any health issues unless consumed in copious amounts.
The above drinks are regarded as “cooling” in nature and can be beneficial to rid heat from the body. However, for those who have weak stomachs (prone to gastric pain or frequent loose bowels), it would be advisable to not consume as much, or if necessary, consumed at room temperature rather than chilled.
Is muscle ache considered an injury? Should treatment be sought when it constantly feels sore?
Muscle ache after sport is not considered an injury. There is a phenomenon known as “Delayed Onset of Muscle Soreness” (DOMS), that would occur anytime between 1-3 days after exercise. This is due to muscle fatigue and the build-up of lactic acid and other metabolic waste during physical activity. It should go away in about 1-3 days with good rest, stretching, recovery exercises and nutrition. (Take note that during DOMS, it is advisable to perform some light exercises, as compared to total sedentary rest, to facilitate recovery).
Treatment is advised if discomfort still persists longer than 1 week after exercise and good rest, and/or discomfort becomes pain and results in restriction in daily activities.
What core resistance training would you recommend and we can do at home?
I am not in a position that can advise well for this question, as everyone and physical abilities are different. It would be advisable to approach a physical trainer/physiotherapist or medical practitioner for better advice that is tailored to your physical condition.
Some movements that are easier to perform include planks, wall sits, half squats, etc. However, not everyone is suitable to do these exercises (e.g. performing squats with knee pain). Generally, perform exercises within your means, this would mean starting slow and steady and slowly increasing the intensity as you go along (e.g. 5-10 secs hold for planks, 3-5 sets, slowly working up to 30 secs over 3 weeks).
Everyone is different, so it is important to go at your own pace, especially if you are injury-ridden (like myself), or you are close to/past middle age.
How to improve our physical constitution?
We can improve our physical constitution and health with nutrition, exercise, and adequate rest. As mentioned in my talk, the muscles in the body are governed by the spleen, which also governs digestion in the body.
With exercise, the muscles are trained, and in turn the spleen would also get strengthened. However, with all that training, nutrition is necessary to supply nutrients for recovery and growth. And for the body to recover and grow, rest is also important.
We can also supplement this with TCM herbs in our food (药膳; Chinese TCM food therapy), where we use some common herbs to strengthen the properties of our food. Some of the common herbs include 黄芪Astragalus、当归 Angelica root、党参Codonopsis root、枸杞 Goji berry、红枣 red dates, 山药 Chinese yam.
How effective is Tai Qi in helping improve our Qi?
Taiji is well-regarded in the TCM community for health purposes.
From a personal POV, Taiji is a good form of exercise to promote movement in the body. When I was doing taiji, I could feel a slight tingling sensation throughout the body (in TCM that is considered as the feeling when Qi is moving). We should still be looking towards other forms of exercise as well. I am a strong supporter of resistance/weights training.
Regarding exercise, do speak with a physical trainer/physiotherapist or medical practitioner for better advice.
However, it is important to note that safety is important, and that we exercise within our means. Some of the movements in taiji may not be suitable for everyone, for e.g. performing squatting movements with knee pain.
What are the nourishing herbs/food (not cooling/heaty) that can be taken by all age groups that you would recommend?
Some of the safe and common herbs include those mentioned in Question 5 - 黄芪Astragalus、当归 Angelica root、党参Codonopsis root、枸杞 Goji berry、红枣 red dates, 山药 Chinese yam.
For cooking soups for 3-4 pax, the dosage I would usually suggest would be as follows: (adjust accordingly if there are lesser persons)
当归Angelica root 5-10g
党参Codonopsis root 10-15g
枸杞、红枣Goji berry, red dates 5-10g
山药Chinese yam 15g
How to treat leg cramps?
Muscular cramps are due to a lack of blood flow to the affected area. In TCM, this can be due to poor blood circulation or blockage due to blood stasis in the area.
Generally, we can use acupuncture and TCM herbs to improve blood circulation, and reduce muscle tone to reduce the intensity and frequency of leg cramps episodes.
This is also the reason why some older individuals may prefer to wear long trousers or socks when sleeping at night, some even choose to wear compression stockings. All these would keep the affected area warm and increase blood circulation.
It would be best to approach medical practitioner for a better evaluation of your situation.
Can you please comment on lian hua qing wen. What it is and what it does for covid? What else is it used for?
Lian Hua Qing Wen (LHQW) capsules were first developed back in 2002, in order to SARS, and later on for the treatment of flu-like symptoms. Specifically, it is to address seasonal flu of wind-heat 风热 or heat-toxin 热毒 syndromes. (Do note that heat-toxin refers to a very high level of heat in the body. IT DOES NOT MEAN THERE IS POISON IN THE BODY)
Take note that the phrasing here is to treat FLU-LIKE SYMPTOMS; at no point was it mentioned that LHQW can treat COVID-19. It just so happens that COVID-19 causes flu-like symptoms, and that is what LHQW capsules are indicated for.
So, LHQW capsules can also be used for heat syndrome type flu-like symptoms, which includes symptoms such as fever, coughing, yellow phlegm, sore throat, etc.
There is a saying that “all medicines are 30% toxins” (是药三分毒). As with all medicines, it is advisable to seek a TCM practitioner to see if the capsules are indeed suitable for your condition.
*The following is my personal observation of Lian Hua Qing Wen (LHQW) capsules.
Personally, I feel that LHQW capsules is not suitable for everyone, due to the presence of cooling herbs such as gypsum. For some individuals with sensitive stomachs (refer to Question 2; and there are many people in Singapore now with weak or sensitive stomachs due to many reasons), cooling herbs can cause some gastrointestinal reactions, such as gastric pain, nausea and diarrhoea. This is stated in the contraindications panel on the packaging.
What causes the spur in the heel? Is it due to overwalking or overstanding? How to treat it in TCM?
A heel spur is due to calcium deposits, forming an osteophyte. This formation would take months to years to form, and would otherwise go unnoticed until it starts to cause inflammation in the heel.
Standing or walking for long periods may contribute to the calcium deposit, as it may cause straining/stretching of the plantar fascia, foot muscles and ligaments, or tearing of the membrane of the bony surface of the heel. Other factors include flat feet or high arches of the feet, diabetes, poor footwear (for work or for exercise).
In TCM, acupuncture and medication can be used to reduce the pain and symptoms. However, the type of medication may differ from person to person, so it is advised to seek a TCM practitioner for advice.
How to know what is our body constitution?
There are many constitutions that a human body can have. The most common way to differentiate would be to see if you are of a cold or heaty constitution. You have to observe what your body is telling you.
Cold constitution – body/limbs are cold to touch, heat is favoured, wind and cold is avoided
Heaty constitution – body/limbs are warm to touch, cold is favoured, heat is avoided
As physicians, we would also look at the tongue and pulse.
A red tongue may suggest a heaty constitution (take note, red like strawberry red), while a pale or dark/purplish tongue may suggest cold constitution.
A rapid pulse may suggest heat in the body, while a thin and taut pulse may suggest cold in the body.
These are the easier ones to use to categorise your body constitution, but there are also other more complicated ones, such as the excess or deficiency of organs, the presence of blood stasis or phlegm/morbid fluid, etc.
How should we treat tendonitis?
Tendonitis is an inflammation of the tendon of our muscles, that may be caused by wear-and-tear or sudden overloading.
Similar to Question 10, acupuncture and medication can be used to reduce the pain and symptoms. However, the type of medication may differ from person to person, so it is advised to seek a TCM practitioner for advice.
For self-help, you may refer to Question 1. Ice pack can be applied when the onset is first discovered for about 24-48 hours. After that you may apply some heat therapy to see if it helps with recovery. If it does not work, it would best to seek our medical help for your condition.
Besides experiencing random leg cramps during sleep, what other common or possible 'symptoms' indicate a current cold constitution of the body? Simple home remedies to balance the body's coldness?
Please refer to question 11 for symptoms of cold constitution.
To address the coldness in the body, a common tea used would be ginger and red dates tea. Also, do adjust your diet to include more warm and soupy foods, and some spices is also good. Of course, do avoid cold, icy, fresh or raw foods.
Regular acupuncture helps to improve body's constitution?
Yes, the belief in TCM is that organ function and the flow of Qi and blood in the meridians can be regulated through acupuncture, allowing for optimal function.
Is there a way to assess our muscle mass besides going for MRI?
Some health check-up clinics and gyms are equipped with some devices that can aid with the checking of muscle masses.
Under what circumstances does the injury treatment call for tuina or acupuncture treatment?
All injuries can be treated with tuina and acupuncture, just that the intensity of treatment may be adjusted according to the stage of injury.
Is intermittent fasting not recommend for TCM's point of view?
There are rules for intermittent fasting and they need to be observed strictly! You still have to eat your proper meals at the start and end of your fast. This would be considered as “regular”, and you have to eat enough as well! This would technically fulfil the TCM logic of eating regularly and eating enough at meals.
It is not recommended if you are unable to adhere to the rules of the fast, and/or if you start the fast too quickly, not giving your body to adjust to the cycles. You need to slowly adjust and give your body time to get used to the deficit.
I would also not recommend this as an easy way out for dieting. IT IS MORE IMPORTANT TO EXERCISE WELL AND REGULARLY if you are looking to reduce your body weight. Starving the body will allow you to lose some weight, but if you are not disciplined enough, it would just bounce back via “revenge eating”.
My intermittent fasting comes from my years of judo training, when I had to cut weight for my competitions. At my most extreme, I was able to go on liquid diet once a day in order to reduce caloric intake to such a level that I could still manage my physical workout. This is not recommended for the average person, as it is tremendously stressful for the body and mind. To reach this state, I had to slowly cut down my intake of food over a period of 6 months, and only did this 2-4 weeks prior to my competition.
Clinical Interests: TCM Internal Medicine (Respiratory diseases, sleep disorders, sub-health), TCM Tuina, Pain management
Physician Niklas has been a registered TCM Practitioner in Singapore since 2016. He has obtained his Double Degree in Biomedical Science and Traditional Chinese Medicine at NTU and BUCM in the same year.
Physician Niklas’s journey into TCM started when he joined his school’s Judo club. With the physical demands of the sport, he often turned to acupuncture sessions and TCM Tuina in order to continue his training. Tapping on his personal experiences in sports injuries, Physician Niklas understands the importance of proper management of injuries.
As such, Physician’s Niklas clinical interests lie in pain management, via acupuncture and TCM Tuina. Other interests include internal conditions, such as common respiratory diseases and sleep disorders. He also aims to advocate “Self-preservation and self-assistance, with perseverance”, combining good physical and mental health, that comes with determination.
Physician Niklas is also a lecturer with the Singapore College of Chinese Medicine (SCTCM).
About ZhongJing TCM
Zhongjing Traditional Chinese Medicine (Zhongjing TCM) was established in 2014 under the name of TCM Homecare and Nanyang Zhongjing Institution. A decision was made to rebrand and combine the strengths of both services. Therefore, in 2019, TCM Homecare was renamed Zhongjing TCM. The rebranding aims to collectively provide services of medical services and institution under the umbrella of Zhongjing TCM.
Zhongjing TCM prides itself in sharing TCM knowledge through lifelong learning with their very own Zhongjing TCM Institution. Zhongjing TCM is also committed to catering to individual needs encompassing personalized TCM modalities and herbs. Their state-of-the-art equipment, quality of herbs and products undergo the strictest quality checks so that you can enjoy with a piece of mind.
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