Sports injury
Heel Pain & Autumn Equinox
I recently experienced mild heel pain around the center and edges of my right heel, if not for the first time ever, surely the first in a long time. While one night watching TV last week, I simply needled the “heel point,” located in the center of the base of the palm, just distal from the wrist crease—not one of the body’s more forgiving, gentle points, but tolerable. While the point was in, I rotated my foot and even massaged the heel a bit with my other hand. The next day it was better.
Why needle the hand? And how did this happen, beyond just the lazy etiological platitude of “getting older?”
We are embarking into autumn, the season ruled by the lungs and large intestine. The function of these wonderful organs is to distribute substances downward, quite obviously in the case of the latter, but we also think of the lungs’ function as down bearing, depurative, in distribution of gases and fluids to the lower region of the body—hormonal reserves and essential fluids.
This is why ancient Chinese called the lungs “mother” to the kidneys—the former “engenders” the latter by way of this mechanism of distribution. “Engenderment” in this case might be understood as adrenal and hormonal health’s reliance on ample distribution of fluids and gases from the upper regions of the body. This is why it is important, in my opinion, to consider daily yoga or qi gong routines before resorting to hormone replacement.
What’s more, many of us have also had the experience of having a morning bowel movement on the heels—no pun intended—of morning breathing exercises or yoga, underscoring the inseparable connection between the lungs and intestines along the gut-lung axis.
“The heel point” is not magical. The heels are where the kidney and urinary bladder vessels begin and end respectively, surely highlighting how overworked I may have been, as well as admittedly my own progress along the aging process. When we have heel pain, there is a good chance the lungs are not pulling their weight insofar as distributing anti-inflammatory substances to the bottom of the body. Located at the base of the palm, the point is just lateral to acupuncture’s lung vessel. It acts as a mirror to the heel, not just because of cute bodily holograms, but because the kidneys rely on their mother for circulation.
This “mother son” relationship exists between all our organs and structural parts. For example, pain in the groin exists along the liver vessel, whose mother is the kidneys, which reside in the lower back adjacent to the lumbar vertebrae that innervate the groin! Pain in the knees usually exists along the stomach or pancreatic vessel whose mother is the heart, another organ whose primary function is to distribute blood downward—and the knees can be a long way to travel.
If you or a loved one experiences pain, it’s great to understand it from a musculoskeletal perspective and take care orthopedically, but if you are interested in its root cause, why it happened to land in that place on your body instead of elsewhere, please reach out!
Throwing my Back Out! And Self-Treatment
I’ve arrived, folks. I’ve made it! I am finally “threw-my-back-out-doing-nothing” years old.
One morning last week, I was doing my Qi Gong practice, followed by stretching. I got up off the floor, and I felt my familiar old friend—my right sacroiliac joint—a sprain-like, nerve sensation coupled with soreness, say hello for the first time in years.
In fairness, the stage had been set leading up to this relatively non-expenditure of motion. I’d spent the week before doing an inordinate amount of housework, hosting family staying with us, much more cooking and cleaning, a bit more indulging, not to mention a home’s worth of laundry after my daughter’s Lice sequel, so my body was spent. On the day before I jumped as high as I could on our trampoline and wrestled maniacally with 4-year-olds.
I spent the next morning in pain, obsessively trying to stretch, but to no avail. It was apparently too inflamed, needed first to set in before it could heal, the way it is difficult to resolve a virus in its first 12 hours—that is before it shows itself for what kind of virus it is. By afternoon I could barely walk (unfortunately in parenthood rest is rarely an option). I surely couldn’t lift anything, and wondered if I’d make it to work the next day!
- SIMPLICITY & REPETITION: I decided to minimize, to consolidate my rehabilitative routine to just a few reliable stretches, which is important in my opinion, then did them constantly. Some physical therapists make the mistake of assigning 8 or 9 daily exercises, most of which might be beneficial, but if one or two are potentially aggravating, they might keep people on the hamster wheel of suffering, not realizing they could be doing less and getting better.
- HERBS: Once in a while we are forced off of our soap boxes and bow in humility in front of that which we resist. I prescribed myself a non-holistic formula—not individualized to my unique pattern—but one simply for inflammation in the low back and lower body. Well worth it short-term, though in fact I did suffer a side effect as a result. While excitatory/warm-natured eucommia bark probably helped my back, it did impact my quality of sleep that night. I cooked it in conjunction with pearl barley, phellodendron bark, and other blood movers to promote circulation in the lower portion of the body, then drank it while my wife warmed up a heating pad for me.
- HEAT: As we say in Chinese medicine: “Ice is for dead people”—dead bodies to be exact, but most injuries are not ones of inflammation to the degree of compartment syndrome, which merits ice. Most are minor, protective inflammations surrounded by tight, hypertonic muscles and ligaments that need relaxation, which heat provides.
- ACUPUNCTURE: While lying atop my heating pad, I obviously could not needle my own lower back, but I could use “distal points” that connect the spine, ligaments, and erector spinae muscles. I used “Small Intestine 3,” located next to the pinky joint, to treat the spine, “Spirit Bone,” located at the junction of the first and second metacarpals, for its endogenous opioid-releasing effects and connection with the low back’s complementary (lung) vessel; finally “Triple Warmer 9,” atop the forearm near the elbow, also to send blood to its paired vessel. I left the needles in for thirty minutes, basically the duration of a TV show we watched (Wednesday—not thus far recommending), and when I got up to go to bed I was about 25% better. When I woke up the next morning I was 75% better, still having not taken one single, solitary NSAID. No judgement for those that need painkillers, but in my opinion, their side effects should be respected enough to reserve them for times of actual need—pain in times when we need to be active, as opposed to discomfort in times where we can relax.
I should continue to get acupuncture from someone else for this as well. Also, I must do my daily stretches, gradually incorporating more every few days, and probably call it a year on my trampoline wrestling career. I share this story not to brag—though it’s nice to brag—but to reiterate the value of constant and appropriate physical movement and attention towards our ailments. I went from being unable to walk to a full commute and pain-free workday overnight!
Slow & Steady Heals the Shoulder
At the end of 2022 I tore my rotator cuff, not throwing a baseball for some important league game, not in some random construction accident nor act of heroism. Instead, one of my first favorite paternal pastimes was throwing my daughter as high as I could into the air then allowing her to crash down on to my palm, elbows flexed, held tight by my bicep’s insertion.
Everyone says the same thing: You blink and they’re all grown up! This isn’t exactly an example of that, but I definitely didn’t take adequate note that my favorite play toy had grown from 15 to 25 pounds, and as an acupuncture colleague who was treating me for the issue remarked: “Would you throw a 25-pound weight up and down and catch it in your palm?”
To which I replied: “It depends how adorable and joyful the weight was.”
Typical presentation of a torn supra-spinatous: Pain radiating into my deltoid, especially with my arm extended to the side and/or behind me—even worse with inward rotation (trying to pour water from pitcher into our filtration system). Occasional pain while lying on my shoulder at night, and I couldn’t throw a tennis ball, let alone a baby anymore. I had to find other ways to enjoy parenthood. I also got used to pouring water with my left arm, which was probably a temporarily decent brain exercise anyway.
My funny acupuncturist friend helped a bit—a lot of sports medicine, trigger points and gua sha techniques—though no classical points, and improvement was always temporary. For two years my intermittent, moderate pain continued, and I was terrified of the notion of surgery and determined as such to avoid it.
I continued to go for treatment, occasionally poked and cupped myself at home as much as I could (though the supraspinatous is located behind the shoulder, making local self-treatment relatively impossible), and got very diligent with my daily Qi Gong practice: Shoulder rotations, shoulder rolls, neck rolls and rotations, “silk reeling” exercises, which are great for creating unique notches of negative space around the joints for the corresponding breathwork’s oxygen to enter. “Qi moves the blood,” is one of our most ancient maxims, which means where oxygen goes, fluids follow. I couldn’t tell you when it happened any more than I could when my daughter jumped from 15 to 25 pounds, but somewhere between years 2 and 3 of my injury, enough fluids got to the tendon and joint for my pain to disappear!
Today I am unsure if the tear is still there—I’m 47, not 27, so my shoulder may never again be perfect. I continue to do my Qi Gong regularly, preventively, not only for my shoulder, but other vulnerable tendons and ligaments as well. Slow and steady heals the shoulder!
If you have chronic pain it is something that requires daily attention, an at home regiment, self-massage and gentle movement anywhere from 10-20 minutes 1-2 times a day, and patience, the “patient patient,” if you will. If you stop, if you half-ass it, or give up, you’ll likely be resigned to the “blue pill,” surgery and well… literal blue pills, either of which will eventually wear off. I often recommend tailored Qi Gong homework exercises to my patients with our sessions, but if you’d like local Qi Gong teacher referrals, please let me know—happy to refer!
Tyrese Haliburton’s Achilles & Voice!
As a Buddhist I feel guilty about the mixed emotions I had as a (resentful) Knicks fan when Tyrese Haliburton went down in Game 7 after re-injuring his torn calf muscle and probably his Achilles tendon, sidelining the Pacers’ star for the rest of the game. I’m sure once that happened the odds in Vegas went heavily in favor of OKC.
As a Chinese medicine clinician, I couldn’t help but wonder, in the interim since the original injury how much his trainers had iced it to “bring down inflammation” even though Chinese Medicine and Dr. Gabe Mirkin, the originator of the R.I.C.E. protocol, recommend against it due to its vasoconstrictive mechanism.
Ice should be limited to stage 1 of an injury, only if there is some local redness, and even then Chinese medicine has something better to offer, San Huang San plaster, for its extensively studied anti-inflammatory, analgesic, and blood circulating effects.
The vessel that runs from the Achilles heel up to the calf and in fact the entire back is named the “Foot Tai Yang,” or urinary bladder, which logically acquires its nutrients and blood via its complementary vessel, the “Hand Tai Yin,” the lung vessel.
I recalled a story from last year that Haliburton has an odd but presumptively harmless condition where his voice changes inflection frequently and without apparent cause or warning. He laughed about it after several press conferences, saying he’d never realized he had this condition, but noticed exactly what others had while listening to himself speak.
Our voice of course is dependent on proper pulmonary function, which is why everyone immediately understands what someone means by “smoker’s voice.” Smoking dries the fluids, which might also explain why cigarette smokers are three times more prone to bladder cancer.
The ancient Chinese understood this connection. For all their brilliance at what they do, it is unlikely that modern sports medicine physicians do. Their lens is to isolate and treat, whereas ours’ is to understand every piece of the puzzle, no matter how seemingly disconnected.
In the article I read on Haliburton, a voice specialist medical doctor cited the fact that athletes do have to use their voice quite a lot on the court when communicating, but probably not nearly as much as performers or teachers or several other professions, right? I don’t think athletes are generally more prone to dysphonia. Also, basketball players may be more prone to issues with Achilles tendons, ankles, and knees, but it is notable that the remaining starting nine players in the Finals were playing the same game on the same floors at the same pace, and did not tear their calves. Only the guy with the history of dysphonia did—in my opinion due to the physiological connection between Foot Tai Yang and Hand Tai Yin. So the next time you have shoulder pain, knee pain, or any pain, by all means go to the doctor and get assessed—then go to a (good) Chinese medicine clinician to understand what’s happening beneath the surface.
Congrats OKC!
Sprained Ankle Remedy: The Follow-Up
I want to begin this week’s newsletter by clarifying and/or elaborating on the previous. This is just part of the reason I appreciate and enjoy replies and feedback. The latter as it serves keep in touch with old friends—the former as it gives me the opportunity to improve my communication in educating people about Chinese Medicine.
Several people responded to my miraculous sprained ankle healing story with inquiries to whether they could or should use the same topical for their own chronic pain; which told me I fell a bit short in my explanation.
The external application I used for my acute injury, San Huang San, contains herbs that are very blood-invigorating, which can be good for most forms of pain, but also very COLD, which is only advisable in the very first stage of an acute injury. Past that interim, San Huang San would most likely do more harm than good (just like ice), as in contrast to allopathic medicine we offer no one-size-fits-all remedy for a particular symptom, i.e. Pain/Inflammation.
The same principle applies to internal medicine, as people have come into the clinic asking for “the herb for weight loss,” or “the herb for high blood pressure.” There is no such thing, and if an acupuncturist ever tells you or prescribes otherwise, run. From our perspective, either of these pathologies can be a result of different dysfunctions in different organ systems within each person. While in one case we may have to strengthen the lungs’ circulatory function and remove fluid retention from the urogenital microbiome, in another we might have to remove fluid from the gastrointestinal microbiome and sedate pulmonary function. Very different diagnoses and prescriptions.
For chronic pain the best things people can do, in my opinion, are yoga, qi gong, or pilates. Without a daily, or at minimum weekly routine, I can’t imagine how it is humanly possible to live without pain or discomfort. Topically, what I am presently using in the clinic and seeing best results with is a more warming analgesic liniment, nicknamed “Evil Bone Water”—bottles available upon request at my office.
As the weather in the northeast has suddenly shifted from very warm to cold and pouring rain it is common for people to be more vulnerable to viruses or exacerbations of musculoskeletal pain. The warm weather opens our pores and dilates our blood vessels, and we wake up the next morning and must go outside into the cold rain, which has greater opportunity to “enter” and exacerbate pre-exiting “dampness” at the neuromuscular or immunological layers.
This is why during this time of year it is especially important to dress relatively warm (I can’t tell you how many girls I’ve seen in cutoff belly shirts and guys I’ve seen outside jogging topless, both of which just begging for pathological dampness!), avoid raw foods, and eat ginger, garlic, and onions. This past weekend of torrential downpour we made a chicken soup cooked in chicken bone broth, with the typical accoutrement, chopped celery, carrots, potato, onion, garlic, and ginger, with quinoa cooked separately so as to add to the many leftover portions to come. Rice or noodles are a fine substitution here, but as we consume plenty of both in our home, I like to occasionally honor the western nutritional perspective as well.
I hope everyone is now a bit clearer on what San Huang San is, why it worked so well for me, but likely would not for you presently. However, there are other options for chronic pain, such as the now widely renowned in my world, “Evil Bone Water,” as well as the always advisable diet and exercise. Wishing everyone a pain and virus free week, in spite of this proverbial cold, wet rag that temporarily surrounds us.
