In Treating Overstretched Ligaments & Tendons with Chinese Medicine Part 1 and Part 2, we discussed the use of Liniments, Soaks, Gao (Poultices), moxibustion and exercise in treating these kinds of injuries. Continuing our multi-modality approach to treatment, this article looks at the role Exercise, Internal Herbal Formulas and Lifestyle Modifications in treating Overstretched Sinews.
- Exercise/Physical Therapy:
According to Western medicine, damaged sinews cannot be strengthened or fully healed because, unlike muscle tissue, the sinews have little or no direct blood supply to help tissue regenerate. Having said that, usually doctors prescribe resistance exercises to strengthen and stabilize the joint. In Chinese medicine it is considered possible, although not easy, to heal these kinds of injuries. Resistance exercises can be useful in rehabilitating lax sinews, but they must be done very slowly over the whole range of motion.
Exercising slowly serves two purposes. First, it soothes the liver which, in Chinese medicine, regulates the flow of qi through the body. The Qi is easily regulated by slow, easy movements, but can be disordered fast movements that use maximum exertion. By doing the exercises slowly, the liver is soothed. When relaxed, the liver maintains a free-flow of Qi and blood. This allows Qi and blood allowing these substances to reach the injured area. When the liver is agitated, for example by hard, fast movements, the liver’s spreading and harmonizing action can be disrupted causing the Qi to block. Secondly, resistance exercises performed slowly work the entire length of the muscle evenly, thereby forcing the end points of the muscles, the tendons, to work to re-stabilize the joint.
Nei Gong and Qi Gong
Although resistance exercises can help, Qi Gong and Nei Gong exercises are critical to help regain proper use of the injured area. Qi Gong is not simply physical therapy, but a healing modality that both harmonizes the Qi dynamic of the body, and neuro-muscularly reprograms dysfunctional patterns. Chronic tendon injuries are usually due to misuse. Correct alignment and usage of joints, muscles and bones must be relearned for complete healing to occur. Qi Gong exercises also guide and lead Qi through the injured area. Qi brings with it the blood and fluids necessary for tissue repair to take place.
Because Qi Gong exercises are performed slowly, they relax the liver allowing a an unobstructed flow of Qi, blood and fluid to perfuse the tissues. Additionally Qi Gong exercises can fortify the internal organs, allowing them to function optimally and produce the Qi and blood necessary to strengthen the sinews.
Yoga and similar kinds of exercises that stretch the joints to their maximum are generally not useful in treating lax sinews. In fact I treat many people who have overstretched tendons and ligaments through yoga practice. Often those who are already hyper-mobile are attracted to this type of exercise, because it is easy for them to assume very difficult postures requiring extreme flexibility. Because these individuals can easily stretch their tendons and ligaments to the maximum, it is also easy for them to push past their limits and further overstretch the sinews.
What kind of Qi Gong exercises are particularly useful for overstretched sinews? Martial arts practitioners typically train in the Muscle Tendon Change (Yi Jin Jing 易筋经), Marrow Washing Nei Gong (Xi Sui Jing 洗髓经 ), or practices like Ba Gua Circle Walking Nei Gong, Ba Gua Zhan Zhuang, or Xing Yi Tu Na Si Ba, which combine elements of the Muscle Tendon Change and Marrow Washing Nei Gong with other movements and internal exercise.
- Herbal Therapy:
Even with correct diet, proper exercise, external liniments and poultices, acupuncture and sufficient rest, the body often needs an extra push to fully heal injuries to the sinews. Herbal formulas with constituents that tonify the Qi, and blood, and strengthen sinews and bones specifically target the sinews This can shorten the healing time, particularly when these internal formulas are used in conjunction with correct exercise, external application of herbs (liniments and poultices), and dietary considerations.
Two internal formulas can be useful for healing overstretched sinews.
For Overstretched sinews from a recent injury or to jump-start the process of healing chronically overstretched sinews Stage 3 Bone Setting Pill can be very effective. This formula tonifies Qi and blood, dispels wind damp and cold, nourishes the liver and kidneys and contains many herb that strengthen sinews and bones. While it is normally used to aid the knitting of broken bones, I have found it very useful in healing overstretched tendons, and in improving joint stability in individuals who have hyper-mobile joints. In cases if recbt injury with overstretched sinews this formula should be taken only after the intial stais and welling have subsided.
Strengthen Sinew Pills (Bu Jin Wan) are useful when there chronically loose joints, whether due to constitutional insufficiency, or in cases following injury in which sinew healing is delayed or slowed. Bu Jin Wan nourishes and invigorates the liver and kidney in order to strengthen the sinews and bones. It is effective for treating chronically loose joints, whether due to constitutional insufficiency, or in cases following injury in which sinew healing is delayed or slowed. Strengthen Sinew Pill can also be used for chronic and habitual dislocations due to impairment of the liver and kidney’s ability to nourish the sinews.
Two other tonic formulas that can be useful in strengthening the sinews are Tze Pao San Pills or “Three Whip Pills.” These pills are broad spectrum tonics that nourish Qi, blood and liver and kidney yin and yang. This in turn can nourish the sinews and restore their integrity. An alternative patent remedy for this purpose is Geijie Da Bu Wan, another broad spectrum tonic containing herbs that strengthen sinews and bones. Both of these are avialble at Chinese pharmacies and should be taken for about two weeks at a time
- Life Style
Lifestyle habits can be a big factor in healing chronic sinew injuries. The impact of lifestyle on health and healing is a large subject, but in terms of healing sinew injuries a few important lifestyle considerations are listed below.
- Getting sufficient rest.
- Training in harmony with the seasons and keeping the muscles warm.
- Training with the body in correct alignment
- Eating nutritious whole food.
- Avoiding habit postural habits that aggravate the sinews.
Avoiding habit postural habits that aggravate the sinews is an often overlooked aspect of healing injuries to tendons, ligaments and joints. There are several aspects to this. Often postural habits during sleep like sleeping with the arms overhead or with one arm pinned under the body perpetuate a sinew problem as the tendons are being stressed and and overstretched during sleep. The first step is to identify these habits and then to work out a strategy to correct them – for example sleeping with one arm inside a T-Shirt for a week to change the habit of sleeping with the arm overhead.
A second problem involves work habits and other daily postural habits. For example sitting at the computer or using hand held devices. Sitting hunched with your neck bent forward for long periods of time affects not only your neck, but your shoulder and arm, interfering with circulation and also creating unnatural stresses on the joints If the neck is kinked, it throws off the entire upper limb kinematic chain. Similarly always sitting on one foot, or always crossing the right leg over the left can create a chronic laxity on one side, balanced by chronic tension on the other. These things seem small, but can make a huge difference in the healing process.