Traditional Oriental Medical Approach to Treating Shoulder Injuries

By James A. Swan, Ph.D*

Last July I went out on a charter fishing boat out of Homer, Alaska. We went 35 miles out to where Cook Inlet meets the Bering Sea. In eight-foot swells, we baited up with whole salmon heads and dropped our lines, weighted with three-pound sinkers, some 200 feet down.

Almost immediately I hooked a big fish. Twenty minutes later I ended up with a 45-pound Pacific halibut flopping on the floor of the boat next to me. When you landed a fish in the stern, you moved to the bow. Soon after positioning myself in the lurching bow, I hooked another big halibut. Then I slipped and fell, stressing my right shoulder as I grabbed the rail.

The next morning, my shoulder was very sore. I took some ibuprofen but continued fishing. What’s a little shoulder pain when you are in paradise! When I got home, my shoulder was not only still sore, but also weak, and the range of movement was restricted. I could not draw either my compound or recurve bow, take a full back swing with a golf club, or even sleep on my right side. I knew that I needed help.

For years, our family doctor has been an acupuncturist, Dr. Xiao Rocky Wang **. Rocky is a unique medical practitioner. In Beijing, he trained in traditional Chinese medicine for six years and then spent five more years to become an orthopedic surgeon. Before leaving Beijing, he was the surgeon in-charge of traumatology in an ER at a major hospital, performing over 1000 operations, as well as a medical school clinical teacher.

In the US Rocky was a professor at the College of Traditional Chinese medicine for seven years before going into private practice. Several of his former students are now physicians with national sports teams, including the Chinese women's Olympic soccer team, and (formerly) the Chinese women’s world champion volleyball team.

Rocky was very familiar with shoulder injuries. In China he had operated on some shoulder injuries and found mixed results. He said there was damage to the rotator cuff, the biceps and the deltoid muscles, but it was possible to treat me without surgery. He advised that I would have to start treatment right away as I was suffering from adhesive capsulitis -- adhesions of scar tissue in the fascia that would limit my range of movement and create pain. He said that there was a three-month window for healing; otherwise the adhesions would grow worse and it would be very difficult to treat.

From a western point of view I had muscle tears and the solution would initially be R.I.C.E. – rest, ice, compression and elevation – followed by painkillers, possibly surgery, and physical therapy. I was willing to consider a non-surgical approach, especially after reading articles on the Internet about mixed results of various surgical procedures for shoulder injuries, plus research that found acupuncture to be superior to the use of braces and pain-killing medications for treating tennis elbow. (1) In addition, I trust Rocky, which is always important in the healing relationship.

Traditional Chinese medicine sees health as a the result of a natural flow of life force energy, “chi” or “Qi” that travels through 14 major meridians in the body most of which are associated with organs, like the stomach, spleen, kidney and bladder. Along those meridians there are 365 acupuncture points where meridians intersect, or change direction. Acupuncture needles, herbs and massage treat blockage of Qi flow that results in imbalances that create the conditions for disease and injury to occur and hinder healing.

Western science cannot explain Qi but studies using electrical fields and tracing radio isotopes injected into locations of meridians have documented the existence of a spidery network of channels that do not correspond to any physical system recognized by western science and medicine. You can debate whether Qi exists or not, but the system works, and that seems most important.

Diagnosis in traditional Chinese medicine involves reading a subtle pulse of Qi in the patient’s wrist, plus examination of the skin, the tongue, overall vitality, and odor. An injury is seen as the result of multiple causality and a symptom of overall imbalance in Qi, caused by excessive or weak flows of Qi from or to internal organs. For example, liver and kidneys influence the tendons, the muscles are related to the spleen and stomach; and a lung meridian runs through the deltoid muscle in the shoulder.

From this perspective, when I was injured I was fighting seasickness, so my stomach meridian was weakened. It was cold, and the choppy seas were somewhat frightening, causing reduced flow of Qi in the kidney meridian, which is associated with fear. When you are frightened, your breathing shallows, thus the lungs produce less Qi, so the lung meridian would also be weaker. These external conditions resulted in weakness in the shoulder that made the injury more likely to occur.

Treatment

A typical treatment session began with Rocky inserting a dozen or more wispy-thin, sterile, three inches-long metal acupuncture needles into my shoulder. Sometimes when the needles are inserted, there is little or no sensation. Other times you feel pain. At first it is like a spasm and then release. The pain never lasts long and the subsequent relief of tension is welcome, and sometimes unexpected. When the needles first started being inserted in my shoulder my stomach would growl and then grow warm. (Remember how the stomach meridian is related to the muscles.)

After inserting the needles in my shoulder, Rocky had me lie still with an infrared light trained on my shoulder for 15-20 minutes. Halfway through this period, he would come in and touch each needle to stimulate it. Ten minutes later he would remove the needles and the lamp and begin tuina. Tuina, which translates as “grabbing and pulling,” and is also called “hand technique,” is an over 2000 year-old physical treatment system involving stretching and acupressure to stimulate the muscles, tendons, ligaments, spine and joints to encourage the healthy flow of Qi and blood.

Part of tuina therapy is relaxing the spine and neck, much like vigorous massage. When the patient is relaxed, the practitioner begins to pull on a limb, such as an arm, gradually increasing the range of motion. Yes, it does hurt. Rocky says that the strokes not only are guided stretching, they break down the adhesions in the fascia. Those adhesions prevent the arm from its full range of motion, and reduce strength. With the body relaxed, and the adhesions broken down, the body can then heal and regain natural strength and range of motion.

Rocky said that in China, tuina is commonly used by M.D.’s to treat all kinds of orthopedic injuries, including fractures, joint dislocation, spinal injuries, and joint, muscle and ligament injuries. Almost all of the Oriental massage, bodywork, and chiropractic techniques in the West have been substantially influenced by tuina. Personally, he said that he found that sometimes tuina is more effective for treating injuries than surgery. To prove his point, he showed me letters from several people who he had successfully treated for adhesive capsulitis, including a cinematographer and an Alexander Method teacher.

Rocky began treating me in August. Yes, initially it did hurt when he used tuina. The pain, he said, was necessary to break up the adhesions, and restore range of movement. The pain did not last long after a treatment.

At first I saw him every week, then every other week, and then monthly, as before. Also, he prescribed certain herbs to speed healing. Chinese herbal medicines are blends that seek to balance the five elements of earth, air, water, fire and metal that work in the Qi. They are not so much aimed at suppressing symptoms as with western medicine, but more concerned with overall stimulating and toning the Qi to remove the stagnation that had caused the original weakness in the shoulder that led to the injury. Herbal medicines are commonly used in Chinese hospitals. Some herbal formulas have been used for over 2000 years.

He also gave me daily stretching and strength exercises for my shoulder. One important exercise was hanging from a chin-up bar with both arms fully extended. My goal was to work up to a slow count of 100

By mid-October I was shooting my compound bow and hitting short irons. By Christmas I was doing sets of chin-ups and push-ups, shooting my recurve and working on my full driving backswing. I have about regained about 95% of my original range and strength and progress continues.

The origins of acupuncture are not fully known, but one legend has it that a warrior was wounded with an arrow in battle, but found that he felt no pain. It is said that the attending healer was inspired by that incident to discover how acupuncture can be used as an anesthetic. The rest is history.

Acupuncture and Chinese medicine is rooted in ancient philosophy and observation of the human body. Western medicine is rooted in natural science. It draws upon the latest science and technology. Both can help the archer heal his or her precious shoulder, and much more.

Footnotes:

1) Dorsher, PT. Treatment of chronic lateral epicondylitis with acupuncture: a pilot study. Presented at the annual meeting of the American Academy of Physical Medicine and Rehabilitation, San Francisco, CA, November 4, 2000.

*James A. Swan, Ph.D. is the author of seven popular books, including Nature As Teacher and Healer. He has taught at the Universities of Michigan, Western Washington State, Oregon and Washington and is currently a Research Adjunct at the Institute of Transpersonal Psychology. He has studied martial arts and holistic healing methods over the last 35 years, and enjoyed shooting a bow even longer.

** Rocky Wang Acupuncture and Herb Clinic, 1299 4^th Street, Suite 406, San Rafael, CA 94901, 415-258-9199.