Complementary And Alternative Therapies
Athletes Often In Forefront When Exploring New Treatments
By Tony DeFazio

Jaromir Jagr used it to speed his return to the ice, propelling the Penguins to an improbable upset of the New Jersey Devils in the NHL playoffs four seasons ago. The best baseball player of his generation, Barry Bonds, is such a firm believer in it that his specialist often travels with his team. Current Pirates pitcher Kris Benson believes it was one of the primary reasons his recovery from major arm surgery went so well. Atlanta Braves closer John Smoltz credits it with helping him become a dominant pitcher.

Many elite athletes have been using alternative or complementary medical therapies when conventional medicine fails to relieve their physical or psychological symptoms quickly enough.

Complementary and alternative therapies are groups of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary therapy is used together with conventional medicine. Alternative therapy is used in place of conventional medicine. Physicians have traditionally been skeptical of unconventional therapies, but the widespread use of such treatments is forcing the medical profession to respond.

"Athletes are more knowledgeable and seeking faster and more complete cures today," says West Penn Allegheny's Dr. Patrick DeMeo, medical director for the Pirates and head team physician at Duquesne. "Whether its physical or mental, they can be better prepared overall as long as they consult with their team doctors first. Both hands need to know what the other is doing so they are not hurting themselves long term."

DeMeo is a supporter of legitimate complementary treatment, provided it doesn't interfere with his treatment plan.

"There are plenty of alternative and complementary therapies that I have seen work well. Acupuncture, chiropractic, certain kinds of physical therapy…some good, some not so good," he explains. "My biggest role is as a diagnostician—there's gotta be a diagnosis first, then I develop a treatment plan that may incorporate complementary medicine."

Acupuncture

Originating in China almost 3,000 years ago, acupuncture involves inserting very thin needles into precise points on the body to promote healing and improve function. The needles, which may be stimulated electrically or with heat, are placed into locations on the body known as acupuncture points.

"The points stimulate the central nervous system to release endorphins into the muscles, spinal cord, and brain," explains Tonghua Yang, a licensed acupuncturist in Mt. Lebanon and at the UPMC Sports Performance Center. "The endorphins function as the body's pain killers. They block the pain signal and promote regeneration of the affected area by increasing blood flow."

Dr. Yang has a medical degree from Beijing Medical University in China and spent four years performing liver transplants under Dr. Thomas Starzyl at UPMC Presbyterian. His vast background in both western and Chinese medicine brings legitimacy to the procedure in the minds of many people in the region, who are sometimes are slow to trust unconventional therapies.

"There are 50 acupuncture schools in the United States but none in Pennsylvania," he says. "I see it as my duty to bring an understanding of Chinese medicine into Pittsburgh. Western medicine trusts a two-month study with 40 rats rather than trusting a 3000-year old science? This is a science, not a gypsy looking into a crystal ball."

Although most health insurers don't cover acupuncture, it is slowly gaining acceptance. Athletes may be leading the charge in exploring this treatment.

"I utilized traditional and non-traditional therapies to help in my recovery after surgery. I believe the acupuncture I received played an important role in my rehab," notes Kris Benson, one of a growing number of professional athletes who have used acupuncture as part of their rehabilitation and training programs.

Jagr, Shaquille O'Neal, Pete Sampras and Martina Hingis have all been public with their use of acupuncture. Many team doctors and trainers are combining acupuncture and drugs to control surgery-related pain in their patients. Jagr, in fact, was referred to his acupuncturist by Penguins trainer Mark Mortland.

"In addition to being effective, another benefit is that acupuncture doesn't involve drugs, therefore reducing the risks of unwanted side-effects, and also eliminating the possibility of inadvertently taking banned substances," adds Benson's acupuncturist, Thomas Ost.

Chiropractic

Chiropractic, probably the most established of the complementary medicine practices in the United States, manages neuro-musculoskeletal conditions primarily through spinal manipulation. Chiropractors focus on the relationship between bodily structure and function. Other modes of chiropractic treatment include exercise instruction, lifestyle modification and nutritional counseling.

Pittsburgh chiropractor Joseph Balobeck sees his specialty as a perfect fit for athletics because it emphasizes the balance of the biomechanical system over medication or surgery.

"Everyone is looking for an edge over their competition—in an age of drug testing and banning, this is a drug free way to increase performance and gain that edge," Balobeck says. "The medical approach tends toward medication and surgery. Those are not the first line of defense options, they are more last resort options. Drugs and surgery don't allow you to resume training as fast."

Prolotherapy

Another procedure gaining much notoriety lately is prolotherapy, performed by Dr. Marc Darrow at the Joint Rehabilitation & Sports Medical Center in Los Angeles. Darrow has demonstrated the procedure with excellent results on many athletes, including bodybuilder Lou Ferrigno and former long drive champion Lee Brandon.

"I describe prolotherapy as a series of injections in the areas of pain to promote the growth of collagen, which in turn causes the formation of new soft tissue. After treatment with prolotherapy, the ligaments and tendons become thicker and stronger, and are rejuvenated," Darrow explains.

"It works by simulating a small injury, in a sense, and then the healing takes place from the inflammation...it brings up the immune system, brings cells to the area that actually grow cartilage and collagen."

Some conventional medicine doctors are reluctant to place prolotherapy in the realm of complementary or alternative medicine, however.

"It certainly is a new and interesting technique, but I'm, not sure there is anything 'alternative' about an injection," says Dr. DeMeo.

Steelers neurologist Dr. Joe Maroon, for example, has been giving trigger point injections of cortisone to highly selected patients for 15 years. The difference, however, is that the solutions used in prolotherapy are most often Lidocaine (used in dental injections) and dextrose (sugar).

Darrow sees the procedure as highly alternative, because he views prolotherapy as a vehicle to save an athlete from more invasive surgery.

"Why stick a knife in there and cause damage, and take away a part of the anatomy?" he counters.

Massage Therapy

Massage therapy, or manual soft-tissue manipulation, includes a variety of methods, from the long, gliding strokes of Swedish massage to the targeted pressure of deep-tissue massage. Sports massage may be tailored to pre- and post-competition needs, but athletes also use regularly scheduled sessions to help avoid injuries. Massage was included in the official medical services at the Olympics for the first time in Atlanta in 1996.

"Sports massage can increase the range of motion 25% after one session," says massage therapist Craig Lyon. "Any type of massage is the next best thing to rest and the next best to exercise. It helps blood flow to muscles, which promotes faster healing."

Lyon believes that massage, as well as other complementary therapies, can be used in conjunction with conventional procedures to achieve the best results.

"The United States has the greatest mechanics in the world as far as surgeons, but we still have to be open to the idea of a team of people caring for the individual."

Relaxation Techniques

Personal Coaching

Guided Imagery

Many athletes, such as Braves pitcher John Smoltz, employ sports psychologists or personal coaches to prepare mentally for competition. Psyching oneself up or visualization is nothing new in sports, but complementary therapy lends a better understanding to the physical aspect of these techniques.

"When someone is under stress, they get tense, their muscles don't receive the proper oxygen, they cramp up and lose power," explains Michele Bertini, PhD, personal coach and performance enhancement specialist. "Don't lose power—use your mind to increase power.

"Be your own coach," Bertini continues. "Your sideline coach can only be there for you when you're within earshot. We all have the ability to mediate our own inner strength. Understanding the mind plays an important role in being your own best friend or your own worst enemy."

Pre-eminent integrative medicine specialist Dr. Andrew Weil is a proponent of relaxation techniques, not only for athletes but for any patient. Weil, a Harvard Medical School graduate, is the founder and director of the Program in Integrative Medicine at the University of Arizona's Health Sciences Center in Tucson.

"Integrative medicine views patients as whole persons—minds and spirits as well as physical bodies," explains Dr. Weil. "There is a partnership between patient and practitioner that addresses healing on all levels—lifestyle, diet, exercise, stress, quality of sleep, relationships and work."

Weil believes that guided imagery and visualization can help patients better prepare for and successfully undergo surgical procedures. Guided imagery involves using imagery suggested by books, audiotapes or a practitioner.

"For instance, someone with back pain might be asked to imagine breathing into the pain and having each out-breath ease the pain," Dr. Weil says. "Cancer patients might imagine their immune-system gobbling up cancer cells."

A growing number of medical professionals believe that patients under anesthesia are able to hear and are in a highly suggestible state. A study at Beth Isreal Medical Center in New York showed that patients who heard positive affirmations on a tape played while under anesthesia required 50 percent less post-operative medication than a control group.

Conclusion

Complementary therapy has been popular among elite athletes for some time. Athletes are searching for an edge and often willing to try something new to find that edge. Sports medicine practitioners understand this attitude, which is perhaps why many in the sports medicine field are often ahead of their conventional medicine colleagues in their acceptance of complementary medicine.

Popularity among other athletes, the weekend warrior types, is also increasing. The more success the professionals have, the more amateurs seek out acupuncturists and massage therapists. That comes as no surprise to those in the field.

"It is absolutely going to boom," says sports massage therapist Lyon. "Pittsburgh tends to have a bit of an old-school type culture, but the area is slowly coming around to the benefits of complementary medicine. It's going to boom."