Regardless of whether you are a weekend warrior or an international-level athlete, it is highly likely that you would have experienced a sports-related injury at some point while exercising, training or competing.
While the first instinct for many would be to seek out a doctor’s opinion – either the general practitioner, sports medicine specialist, orthopaedic surgeon or rheumatologist – some might first turn to other allied health professions, like chiropractors or physiotherapists, for help.
And in Malaysia, there is also the option of complementary health practitioners, like traditional Chinese or Malay healers, or Ayurvedic medicine practitioners.
Some might also choose to see more than one of the above professionals or practitioners.
The problem with that arises when the treatments overlap, resulting in overtreatment, or conversely, contradictory treatments that end up aggravating the injury, rather than healing it.
Says International Medical University (IMU) Healthcare consultant rheumatologist Dr Benjamin Cheah: “Whether we like it or not, patients will seek treatment with different modalities.
“Patients who see us will also seek treatment from Chinese medicine practitioners, herbalists or chiropractors, for example.
“And if we do not understand what they are doing, it makes care for the patient very difficult.
“But right now, the environment is very antagonistic because each of us is very apprehensive about the other; because of different training and different fundamentals in practice, sometimes, there’s a lot of antagonism.
“But one of the key things IMU would like to do is to bridge that, because there is a need to do that and we are at a place where complementary care certainly plays a large role in the patient’s healthcare.”
He adds: “We practitioners need to talk to one another.
“In IMU, we have the professions side-by-side, but it’s not accepted by one’s peers to talk to the other practitioners.”
Dr Cheah was speaking at a media roundtable held recently at IMU’s Bukit Jalil campus in Kuala Lumpur, on the topic of Optimising Sports Performance Through Integrative Health.
Also present were his IMU Healthcare colleagues, senior Chinese physician and IMU Chinese Medicine department head Prof Lin Xun, Chiropractic Centre head Dr Katarzyna Paczek and dietitian Ng Kar Foo.
Modern + traditional
Most Malaysians would be familiar with the version of traditional Chinese medicine (TCM) practised by sinsehs who have learnt their craft via informal apprenticeships.
In China, TCM is formalised and taught at both undergraduate and postgraduate levels in specialised TCM universities.
Prof Lin, who was seconded to IMU from the Shanghai University of Traditional Chinese Medicine, explains: “Actually, in current undergraduate programmes in TCM, we combine modern medicine and traditional medicine.
“For modern medicine, we include current knowledge, skills and examination techniques for students to learn and practice.
“It is compulsory for them.”
During his presentation on sports tui na – which is an external therapeutic method in TCM that utilises manipulation techniques and certain devices on specific parts of the body and acupressure points to activate qi and promote blood circulation in order to stimulate the body’s healing process – Prof Lin gave a case study of an 18-year-old who complained of right knee pain after playing football.
Both the physical examination and investigations used in the case were derived from modern medicine.
The physical examination included anterior and posterior drawer tests, which test for injury to the cruciate ligaments of the knee, and the McMurray test, which looks for damage to the menisci.
And the investigation indicated was X-rays of both knees to rule out a fracture.
For treatment, while it included TCM methods like tui na, acupuncture and herbal therapy, Prof Lin said that the patient would also be recommended for physiotherapy if necessary.
Communication is key
In chiropractic, Dr Paczek explains: “We recognise the body as a self-healing organism, and we are holistic professionals – that means we look at the body as a whole.
“So if the patient comes with say, an elbow problem, we will look at the other structures that could trigger it – for example, the shoulder, or even the diet – as opposed to looking just at that one joint.”
While chiropractors do not prescribe medicines or conduct surgery, they do have some knowledge of nutrition.
“We are also involved in wellness,” says Dr Paczek.
“So, the wellness component sometimes comes through giving a lot of advice in terms of things like exercise, diet and posture.”
Specifically for sports, she explains that chiropractors can specialise as sports injury practitioners, who aim to quickly recognise and treat spinal and musculoskeletal injuries in athletes, in order to limit the time the athlete has to spend away from training and competing.
Chiropractors also conduct pre-participation examinations for athletes, where they seek to pick up and correct any problems in terms of movement or mechanics of the body, before it is aggravated and affects the athlete’s performance.
Dr Paczek notes that according to the World Health Organization (WHO), there are two main challenges in professional integration: having the appropriate range of skills available in the health service and ensuring that the different professions collaborate effectively together.
“What we find in practice is that communication is one issue in terms of collaboration – understanding what the different health practitioners do; at what point can we or should we refer patients to them; what kind of information we should give to the patient; and what kind of information is required when we write a letter (of referral) to another practitioner in order for them to have the appropriate background information to do a good job with the patient,” she says.
“So, I’d say the two issues would probably be understanding what the different practitioners do and communicating with them, as well as establishing an ongoing relationship with them as the patient will probably come back and see us after seeing another practitioner,” she adds.
Nutrition and diet both serve a crucial function for athletes.
According to Ng, nutrition can be used to impact on physical performance in three ways: to act faster, e.g. for sprinters, each push of the foot off the ground must be fast; for staying power, e.g. endurance cyclists need to cycle for hours; and to get stronger, which does not only refer to building muscles, but also increasing the athlete’s immune system, as those that train intensively tend to have lower immunity and can catch common infections like the cold quite easily.
Among the areas nutritionists and dietitians can help an athlete in is modifying their diets to either bulk up or slim down in order to fit into different weight categories.
Of course, an added complication would be that, as Ng says, the athlete would specifically want to only increase their muscle mass for the former, and decrease their weight without sacrificing their muscles for the latter.
Competition eating is also another area that athletes require the help of a nutritionist. Nutritionists can help teach how to eat during endurance events like Ironman competitions, where the competitor would be breathless and on the move, as well as the proper foods to eat during preparation for the competition, as well as after and between competitions for recovery.
Ng also notes: “It is very common for a lot of athletes to forget to drink water, but recreational sports people tend to drink too much.”
He adds that other situations athletes might face that require the help of a nutritionist include pre-competition jitters where they tend to experience heartburn, stomach ache or diarrhoea due to nerves, leading them to limit their food intake, which will affect their energy levels during the competition; the fasting month of Ramadan for Muslim athletes; and deciding on whether or not, and what type of supplements are necessary for them.
Nutritionists typically work with coaches, personal trainers, exercise physiologists, sports medicine specialists and sports psychologists when it comes to helping active sports people, whether professional or amateur.