Over the past few years, the Nintendo Wii has become very popular in homes, as well as in physiotherapy for rehabilitation. The Wii Fit exercise program was introduced in May 2008 and has sold more than 6.5 million copies in the United States. Worldwide sales of Wii Fit as of April 2009 are 18.2 million. This has been a fabulous way to get otherwise sedentary individuals back on their feet and moving again.
However, along with the enthusiastic response to the games, we find new kinds of injuries have also surfaced. For the past couple of years, I have been seeing more patients with Wii-related injuries from neck and back pain, to shoulder, elbow, wrist, fingers, hip, knee and ankle injuries. These injuries present mainly as a result of overuse.
Typically, athletes get injuries after training over a long period of time. Whereas weekend athletes tend to get injuries due to lack of consistency in training and stretching, Wii injuries happen because many individuals do not warm up or stretch prior to playing any of the activities. The Wii is seen as entertainment and fun, rather than a sport, and many lose track of time playing the game for hours on end. The difference in dealing with Wii injuries is in working with the conditioned versus deconditioned state of the muscles. These emerging injuries are mostly related to delayed onset of muscle soreness (DOMS), from sudden overuse that develops into more serious tendonitis. What usually gets overlooked is the fact there are three mechanisms developing into pain associated with these Wii injuries: lactic acid buildup, DOMS and micotrauma. Understanding the mechanism of these injuries assists acupuncturists with further differentiation within Oriental medicine and our diagnostic methods and treatment strategies.
Lactic acid is a buildup of waste byproduct of anaerobic glycolysis (fuel use without oxygen), producing burning pain. This is experienced during and after intense exercise, creating fatigue caused by muscular ischemia (lack of oxygen). The pain temporarily goes away when lactic acid is metabolized.
Delayed onset of muscle soreness is soreness that appears 24 to 48 hours after exercise. It takes approximately four to five days before it goes away. The intensity of the exercise dictates the severity of potential tissue damage. Additional variables include fatigue and muscle stiffness. Basically, this type of muscle loading can damage the cell membranes, which triggers the sudden increase in the inflammatory response.
Microtrauma consists of microscopic lesions that involve the tendon, or the junction of muscle and tendon (musculotendinis junction) and/or the junction of the tendon and bone (tenoperrisotal junction). The changes result from inflammatory response to the microtrauma of continual stress, which also leads to edema and possible hemorrhage. There are four stages of tendonitis: Stage I (pain only after activity), Stage II (pain during and after the activity), Stage III (pain during and after activity with functional disability) and Stage IV (constant pain with functional disability).
In Chinese medicine, the mechanisms of Wii injuries include a number of pre-existing patterns of differentiation that contribute to stiffness, pain and numbness. These mechanisms include qi deficiency, blood deficiency, wind cold damp invasion and damp heat, not to mention blood and qi stagnation in the vessels. Contributing to qi deficiency is irregular diet, overwork, and mental and physical exhaustion. This causes the qi to be excessively consumed which does not allow the spleen to do its function of transformation and transportation. When the fluids cannot be transformed, this in turn causes damp accumulation. This accumulation slows the transportation of qi moving throughout the body. Blood deficiency is caused by pre-existing long-term overuse consuming the blood, sudden loss of blood, females giving birth, and/or long term SP qi deficiency. Blood is responsible for nourishing. Once blood becomes deficient, it cannot nourish the muscles and skin. Wind damp cold is an invasion from the exterior that invades the channels/vessels. Once this happens, qi and blood flow become either partially or completely blocked, depending upon the severity of pre-existing conditions.
The integration of modalities and treatment principles can enhance the recovery and prevention of these injuries altogether. Typically, acupuncture would include ah shi points local to the area, which is basically what “dry needling” entails. Segmental point selection would be based within segmental innervations. Segmental acupuncture treatment uses the points found in the dermatome and myotome of the affected segment. The posterior horn of the spinal cord contains the afferent sensory information, as a result of the manual and/or electrical stimulation of the acupuncture point using the sensory neuron. Acupuncture stimulates primarily the lateral horn (autonomic) using the efferent information and the anterior horn (somatic) uses the myotome of the spinal cord (motor neuron).
Using Chinese medicine, we would implement local, adjacent and distal points related to the vessel/channel/meridian involved, in conjunction with individual pattern of differentiation dealing with underlying conditions. This is what differentiates the applications of treatment methodologies. Heat would be applied to the belly of the muscles with Tiger Balm, or white flower oil and then wrapped with a plaster formula for a few days.
Stretching and tui na (massage) would be implemented. Moxa is also very effective, providing the individual constitution is not hot. Cupping works very well too. The integration of these treatments is extremely effective in treating Wii injuries.
Wii injuries can benefit greatly from Oriental medicine, which really goes beyond the traditional symptom-based treatment protocols into integrated diagnostic methodologies addressing prevention. When dealing with Wii injuries, education is paramount with quality of care. It’s about management and prevention of injuries for the Wii enthusiast.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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