Perfomance Artist

“Artists are athletes”

The athlete

• High school/collegiate

• Governed by parents/ state and federal- administration/ medical community

• Geared to finish the season

• Low endpoint for source of income

• Performing artist

• Governed by parents• Geared to finish the

performance• High dependance for

life time income-(tolerance)

• More exposure to alternative treatment

Sir William Osler/Hippocrates

“Food is the best medicine”

Andrew Weil, MD

www.Drweil.com conservative in herbal medicine-ground breaking in western medicine reintroducing the concepts of nutrition and healing

Act 1: The Injury

docmassage

therapist

Injured guy

Electron microscope

• A twist, roll, bend or fall occurs with immediate pain

• Stiffness and spasm set in by one day

• Other areas start to spasm in a week

• Soft tissue (ligament, tendon and muscle) gets over stretched and torn off its connecting points to bone.

• The tissue reacts by sending more blood to the area and heat/redness prevail

• Compensating areas start to fail when they can’t do the work of the originally injured part

When tissue is torn/stretched:

• Inflammatory phase starts day 0-5• Bleeding• PMN’s• Macrophages and platelets stimulates GF

• Proliferative phase from day 5-21• GF stimulates endothelial cells, fibroblasts and myofibroblasts• Macrophages continue

• Maturation phase from day 21-whenever• Fibroblasts• Increased collagen and tensil strength

The Problem

Act 1, Scene 1: Inflammation

• When tissue damage occurs, the “cascade” starts

phospholipid

Arachadonic acidArachadonic acid

Pgcytoprotection

PgInflammatory response

Normal tissues*stomach*kidneys*platlets*endothelium

Inflammatory sites*macrophages*synoviocytes*fibroblasts

Regular nsaids block here:

phospholipid

Arachadonic acidArachadonic acid

Pgcytoprotection

PgInflammatory response

Normal tissues*stomach*kidneys*platlets*endothelium

Inflammatory sites*macrophages*synoviocytes*fibroblasts

Nonselective cox2

Steroids block here:

phospholipid

Arachadonic acidArachadonic acid

Pgcytoprotection

PgInflammatory response

Normal tissues*stomach*kidneys*platlets*endothelium

Inflammatory sites*macrophages*synoviocytes*fibroblasts

corticosteroids

Cox 2 blocks here:

phospholipid

Arachadonic acidArachadonic acid

Pgcytoprotection

PgInflammatory response

Normal tissues*stomach*kidneys*platlets*endothelium

Inflammatory sites*macrophages*synoviocytes*fibroblasts

Cox-2

Act 2: The Villan and the Hero

• Rest• Ice• Compression• Elevation

• NSAID’s• Therapy• Steroids(injection or pills)• Muscle relaxers and narcotics

Non steroidal antiinflammatory agents

acetic acids diclofenac, etodolac, indomethacin, ketorolac, sulindac, tolmetin fenamates meclofenamate, mefenamic acid propionic acids fenoprofen, flurbiprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium, oxaprozin nonacidic nabumetone salicylic acid diflunisal, salsalate oxicam meloxicam, piroxicam cox-2 inhibitors celcoxib, valdecoxib

Generic and Trade Names• Diclofenac potassium fast release• Diclofenac sodium delayed • Etodolac• Indomethacin• Ketorolac• Sulindac• Tolmetin• Mefenamic acid• Fenoprofen• Flurbiprofen• Ketoprofen• Oxaprozin• Nabumetone• Diflunisal• Celecoxib• Valdecoxib• Meloxicam• Piroxicam

• Cataflam• Voltaren• Lodine• Indocin• Toradol• Clinoril• Tolactin• Ponstel• Nalfon• Ansaid• Orudis• Daypro• Relafen• Dolobid• Celebrex• Bextra• Mobic• Feldene

ROID’S

• Not anabolic’s

• Prednisone

• Medrol dose pack

• Kenalog

• Celestone

Pain pills• Acetominophen• Tylenol with codeine• Vicodin• Ultram• Morphine• elavil• flexeril• Skelaxin• zanaflex

Act 3: Secondary Effects

From the meds From the inactivity

• Sleep is disturbed and fatigue starts

• Joints above and below the area of pain stiffen up and are hard to stretch

• Chronic pain and immobility result in weight gain and lack of exercise, carb hunting occurs and depression starts

• More muscle spasm more pain less tolerance

• Due to chronic spasm the sleep cycle is disturbed and memory/concentration off

• Due to immobility, the muscle/tendon units involved with the injury become stiff and sore (trigger points)

• Stagnation starts to affect emotion and body wants satisfaction previously found with endorphin-rush, now found with medicines or foods/alcohol/drugs

• Serotonin gets depleated and depression starts along with side effects from new addictions

Side Effects from Medicines

• Allergy to nsaids• Reflux/ulcers• Kidney damage• Hypertension• Diarrhea• Asthma flare up• Bleeding• Drug interaction• Steroid dependance

• Drowsiness• Dry mouth• Poor coordination• Dizziness• Blurred vision• Addiction• Drug interaction• Liver toxicity

The COX II controversy

• Initially made to protect the stomach

• Selective for cox 2 receptor

• Less stomach ulcers

• New data that vioxx caused heart attacks

• Celebrex is under study by the FDA

• Pulled off but ok’d for now?

Act 4: The Alternative

• Herbal meds• Acupuncture

• Massage

• PT

• Manual Therapy

• Modalities

• Diet

GAIT Study

• Glucosamine/chondroitin Arthritis Intervention Trial

• University of Utah/NIH funded• First large-scale multicenter center clinical trial

with dietary supplements for treatment of knee arthritis

• Testing the effectiveness of short term(6month) treatment in pain reduction

• 20% reduction in pain in 24 weeks with moderate to severe pain using combo

Zyflamend by new chapter

• Holy Basil• Turmeric• Ginger• Green tea• Rosemary• Oregano• Scutellaria• Hu Zhang• Chinese Gold Thread and

Barberry

If Relief by Natures Sunshine

• Turmeric Root• Mangosteen• Andrographis

Paniculata• Boswellia Gum• White Willow Bark• salicin

Postgame by ameriscience

• Manganese• Devils Claw• Glucosamine Hcl• Vitamin C• Potassium• MSM• Hyaluronic acid• Bromelain• Papain• Lipase• Amylase

Back to basics

The Anti-inflammatory Diet

• No dairy• No pork or beef• No alcohol• Cut back on wheat• Stop smoking• Get 7+hours of sleep • Hydrate all day• Stretch, yoga, tai chi

Early movement important

Hang up the towel

Epilogue: “Back” to basics

• Avoid injury by knowing when to quit, stretching, maintaining proper diet

• Get help immediately (as the cascade starts)• Relative rest/ice/• Supplements• Meds if necessary, stop etoh and tobacco• Know what you take and watch side-fx• Maintain stretching and proper diet and sleep• And when ready…….