Athlete’s Are Not All Just Wheels and Chassis: Mastering the Ability to Heal

Injury is part of an athlete’s life; it can be a minor inconvenience, an ongoing niggle or, sometimes, a devastating blow. Injuries can be frustrating, a test of patience; athletes often do not cope very well with a period of enforced inactivity. An injury which prevents you from participating in your chosen sport for several months can even lead to depression.

So, how you respond to injury, especially serious or long term injury, is, or should be, part of what it means to be an athlete – whether professional, amateur or weekend. Consider for a moment how you might respond if someone you are close to starts to complain about your relationship with them. If you are wise you will listen to what they have to say and consider it carefully, even if your first instinct is that they are wrong. You may not agree with what they are saying, but you can’t afford to ignore them – something is up. Ignoring them, or “papering over the cracks”, is the worst thing you can do.

It’s the same thing with your relationship with your body – it is not a coincidence that the word ‘complaint’ can mean either a spoken objection or a medical problem. If you sustain an injury, it means your body is complaining and, especially if the injury is long term or recurrent, or if it is the latest in a series of apparently unrelated injuries (commonly but erroneously considered to be ‘bad luck’) you need to stop and listen. As an athlete, in fact, you need to learn to be sensitive to your body and what it is telling you, not just when you have an injury, but before you get that injury. We must learn how to know and trust our body’s healing process.

We  can take this healing process for granted, but if you stop to think about it, we have a really rather incredible ability to repair ourselves. It might be instructive to compare yourself with your car, if you have one. (An interesting question to ask may be how much do you spend on keeping your car working, versus how much you spend on keeping yourself working.)  If your car is damaged, you can’t just leave it in the garage for a few days and expect it to be mended. Sometimes it might need a bit of help from a clinician, but your body can often heal itself pretty well; if it couldn’t, our species would not have survived, medicine of any kind being a rather late human invention. What a good clinician does is to support the natural healing process where it needs it. The father of the poet W. H Auden, a doctor and professor of public health, put it well: “healing… is the intuitive art of wooing nature.”

From this point of view, the easy availability of some painkillers is a mixed blessing. There is a growing body of evidence to suggest that Non-Steroidal Anti-inflammatory drugs such as ibuprofen actually slow down the healing process. Inflammation is painful, but it is also part of nature’s way of starting that process. (Of course the pain also serves nature’s purpose – it tells us we may need to stop doing what we are doing and recover, and tells us a lot about what the problem is and where it is.) This is not to say that you need to avoid all painkillers or other forms of analgesia (especially the ones without so many side effects!), but that getting into the habit of unthinkingly blocking out pain is like getting into the habit of not listening to your friends when they say things you don’t want to hear.

Another way in which we are different from cars is that we are so much more complex; we are an organism, not a machine. Our body is a miraculous network of inter-relationships, and our idea of how it works is usually hopelessly simplistic. So if we have a recurrent or chronic injury in a particular area, say the Achilles tendon, we need to realise that our Achilles is not something which exists in isolation from the rest of us. The healing process, for instance, relies on the appropriate nutrients being transported effectively around the body so that damaged tissues at the extremities can start to heal. If our circulatory system is not tip-top (one clue might be a propensity to cold feet and/or cold hands) then our tendon injury will not heal as fast as it would otherwise. Obviously, you can make the same kind of case for other organ systems; a weakness in one area has effects on everything. Our digestive system needs to be good at absorbing nutrients; our kidneys need to be good at expelling waste products; our lungs need to be good at getting oxygen in, and so on. In fact a problem with any of the organ systems will inevitably have an impact on our injury – whether we get it in the first place, how quickly it heals, whether it recurs. Recurring or chronic injury is probably telling us that there is a weakness somewhere, and not just in the site of the injury.

Another difference between you and your car is that you have a mind, a soul, consciousness, or whatever you want to call it. Responding to injury is not just a matter for purely physical processes in your body. In fact one might doubt whether there are such things as purely physical processes in human beings, in that emotional and cognitive aspects of our being have such significant impacts on healing. If you doubt this, you only have to consider the placebo effect. Fifty years ago many medical professionals might have doubted that such a thing existed, but nowadays it is such a recognised medical fact that all new treatments are compared against placebos to measure how effective they are. In fact, the idea that mind and body are separate entities is an idea which is a few hundred years out of date. Mind effects body, body effects mind. Mind and body are perhaps better thought of as two aspects of the same reality, with a very blurred boundary between the two.

What this means for an athlete is, of course, that mental factors affect not only athletic performance, but recovery from injury. As already mentioned, long term injuries can be mentally challenging, so that in the treatment and management of such injuries we need to include ways of supporting ourselves mentally and emotionally.

What this all means is that as athletes we need an holistic approach to our body and its injuries, not a mechanistic one. We need to develop our understanding of and sensitivity to our body, heed the messages it gives us, and promote health, healing and performance in a way which does not seek to over-ride nature, but work with it.

Proper acupuncture draws upon a substantial and sophisticated understanding of human health, developed over millennia, called Traditional Chinese Medicine. An acupuncturist who uses the technique within this traditional context, (rather than as an adjunctive technique tacked on to modern medicine after a couple of weekends training – check this link for more on this distinction), can help an athlete’s body-mind regain the balance that once existed before the injury began. They can therefore help facilitate improved athletic performance both physically and mentally.

In contrast to more modern mechanical approaches, the outcome of the treatment process is thus not just the absence of injury but also more energy, improved mental state, better sleep and, ultimately, improved performance. These are the outcomes we love to watch with our athlete patients at The Sean Barkes Clinic.

Demystifying Chinese Medicine – Yin and Yang

If you know anything at all about Chinese Medicine, or about the classical Chinese culture that it grew out of, it is probably the words Yin and Yang. The T’iai Chi Tu symbol, depicting the way Yin and Yang harmonise with each other, appears frequently. I even knew an accountant who had it on his business card! I guess balance is important in accounting too!

Yin and Yang are indeed key concepts in Chinese Medicine, but what do they really mean? Is it just a lot of mystical hot air?

The concepts originate in the observation that many aspects of the natural world are bipolar, they have two opposite poles. Day and night. Hot and cold. Up and down. Earth and sky. Winter and summer.  This is something so obvious it can be overlooked. Yang corresponds to daytime and therefore to warmth, light and movement. Yin is night-time, cold, dark, still. By extension, Yang is energy and consciousness, Yin is matter and substance.

In human life too the same thing is observed: inhaling and exhaling, systole and diastole, waking and sleeping, talking and being quiet, working and relaxing,  we move between opposites all of the time. The ancient Chinese, however, developed this apparently banal observation into a rather sophisticated philosophy of life which encompasses not just medicine but everything from martial arts to flower arranging.

When applied to medicine, this leads to the crucial idea, somewhat similar to the rather neglected western medical notion of homeostasis, that health involves maintaining balance. If Yin and Yang are harmonised in our body, in our mind, in our life, we are healthy people. Lose this balance for some reason, and illness results. The balance is not a static one, however; as the T’ai Chi Tu illustrates, Yin and Yang are inter-dependent, fluidly transforming into each other in the same way as day gradually gives way to night. A healthy person moves from Yin to Yang and back again in harmony with their environment.

Still, that is all a bit vague perhaps. It becomes more concrete when we start to apply it to specific aspects of the human being. For example, consider the blood. The Yang aspect of the blood is its movement; the Yin aspect is the actual substance of the blood, what it is made up of.  Clearly we need both; the blood needs to circulate and flow freely, and it needs to contain enough oxygen and other nutrients. If the Yang of the blood is lacking, we may have circulation problems such as Raynaud’s disease. If the blood is Yin deficient, we may, for instance, have anaemia.

As with the blood, so with any aspect of our being; we can speak of the Yin and Yang of the digestive system or of the kidneys; of the food that we eat and of our daily routine; of our constitution and of our temperament; of our body weight and of our body temperature. Ill health from this perspective starts to arise when, at some level of our being, we start to get out of balance. Maybe this initial disharmony begins in our emotional life or with poor eating habits; maybe it begins with an adventitious infection or with overdoing it at work. To begin with we can probably cope but, if we do not take steps to put things right, eventually our ability to self-regulate can be overwhelmed and imbalance starts to take root, and this has a knock on effect throughout our system.

To take an example, suppose we get into the habit of working late into the evening and not getting enough sleep. Maybe we use caffeine or some other stimulant to keep this up. After a few months of this we start becoming irritable and edgy, but we choose to ignore this. As well as not giving our self sufficient time to rest, we now find that the quality of the sleep we do get is not so great. Alarm bells are ringing, but we are choosing to ignore them!

As time goes by, our palms are becoming sweaty, and we have lost weight; we have a bit of a dry mouth a lot of the time, and a tickly cough. Sometimes at night we feel our heart fluttering, which finally wakes us up to the fact that we ought to get some help.

From the classical Chinese perspective, we have been giving the Yin side of our nature a bit of a hammering. When we should have been relaxed or asleep (Yin) we have been awake and active (Yang). To achieve this we have been using a Yang stimulant (caffeine) at the time of day when Yang should be taking a back seat.

So we end up without enough Yin. We are undernourished and over tired. Since Yin is related to stillness and calm, we are edgy and nervous. Sweaty palms, insomnia, weight loss, a dry mouth and a tickly cough are all classic signs of Yin deficiency, as are heart palpitations that happen in the evening. A practitioner of Chinese medicine will probably consider that the Yin deficiency relates especially to the kidneys, lungs and heart.

To restore health we clearly need to make some changes to our lifestyle; in particular we need to nourish the Yin by giving ourselves time to rest, perhaps by learning (again) to simply be for a bit, without so much doing (if we have been overworking because we need the money, this may be challenging, but not as challenging as what will be happening further on down the road if we don’t take ourselves in hand!). We may also need some treatment to help us; in Traditional Chinese Medicine this may be some acupuncture to calm the mind and nourish the Yin of the heart, kidneys and lungs, maybe also some herbal Yin tonics, and some advice on foods we can eat to nourish the Yin. Qigong or meditation are also a good idea.

Now the human being is a complex thing, and most health problems are not a straightforward case of Yin deficiency or Yang deficiency – or of Yin or Yang excess for that matter. Often the picture is complex and it takes some skill to fathom the ways in which Yin and Yang are out of kilter. There may, for instance, be Yin deficiency in one part of our system and Yang deficiency in another part. It becomes more complex still when we consider that one of the principal characteristics of Yin and Yang is that they transform into each other, as the day passes into night and an arthritic finger joint becomes hot and painfully inflamed if exposed to cold weather.

The human being is an incredibly complex system of inter-relationships and balances, and a big part of the art of healing is for the clinician to perceive just where the fundamental disharmony lies, so that when this is rectified by the appropriate treatment everything else falls into place and we start feeling ourselves again. One of the characteristics of this traditional Chinese medical approach is thus that it looks to treat the disharmony at the root of our problem, rather than just giving symptomatic relief which is not likely to successful in the long run; either our symptoms will return, or new ones will take their place.

Science, Scientism, Healing and Medicine

Today I had a mooch around Waterstone’s. I meandered past the section on religion, where the first book I noticed looked something like an anti-religious polemic; part of the blurb was an endorsement by Richard Dawkins, warning any religious apologist not to risk getting into a debate with the author, who would presumably run rings around their pathetic and irrational arguments. I wandered on to the science section, replete with several titles by the aforesaid Professor Dawkins, but nothing I noticed along the lines of an anti-scientific polemic. Science gets all the good PR these days.

Now I’ve got a physics degree and a healthy respect for the scientific method. But working as I do now in healthcare, I’m not altogether sold on the ability of modern science to make life better and people healthier. In their book ‘Why Do People Get Ill?’ Darian Leader and David Corfield suggest that doctors would be better prepared for their profession if they did an arts degree, rather than a science degree. What leads them to this radical suggestion is their belief, which their book aims to substantiate, that key factors in what make people get ill lie in their emotional life, and thus a good doctor is one who can meet the patient on this emotional level, with understanding, empathy, humanity. (Of course, one might want to question whether people graduating from arts courses have any more humanity than their scientific colleagues!)

 In other words, healing is as much art as science. People cannot be understood if they are just understood as a set of numbers, a set of data. Can illness really be fully understood by science? (It is a sad fact that the word ‘clinical’ connotes a kind of cold rationality.) Of course you want a doctor, a healer, to be able to think clearly: this is no apology for the worst kind of woolly minded alternative therapists. But you also want them to have humanity, even compassion. Not just because it makes the treatment experience more bearable, more civilised, but because it is an essential part of that treatment.

 Good medical treatment isn’t entirely reducible to numbers. In traditional acupuncture, for instance, a lot of emphasis is placed on the Qi of the acupuncturist. The Chinese word Qi is impossible to translate accurately into English – it is something like the vital energy of the individual, which in a healthy person is free-flowing and abundant. The Qi of the acupuncturist includes such things as the quality of the attention of that acupuncturist, their freedom from distraction and sense of presence. Included here is the rapport between the acupuncturist and the patient. Included here is the ability to find the exact right spot to insert the needle, the exact right depth for it, and the ability to sense what lies at the end of the needle, how the needle interacts with the patient’s own Qi. (Of course there are guidelines about where to put the needle and so on, but the fine tuning relies on the Qi of the acupuncturist.) These things are not measured in most scientific trials of acupuncture, probably because they are not so easy to measure, but there is a world of difference between having an acupuncture needle inserted by someone who has been on a few courses and is thinking about what they are going to have for their dinner, and by, say, a serious traditional acupuncturist who practises Chi Kung (a traditional Chinese form of meditative exercise and health preservation) for two hours every morning, and is able to focus his entire attention on what he is doing. Medical treatments of this kind are very complex interactions between two very complex entities: human beings.

 One can distinguish between science and scientism. Scientism is the belief that science is the only valid form of knowledge, the reduction of all forms of knowledge to that which is measurable. My fear is that scientism is invading the world of medicine and healing, so that any form or aspect of treatment which is not measurable (or perhaps not easily or cheaply measurable) is disregarded or downplayed, when in fact it is an essential part of that treatment.

 I remember reading an article by a surgeon who described how he had postponed an operation by a day for no other reason than he had an intuitive sense that it would be better to wait 24 hours. Personally, if a good surgeon told me he had a gut instinct that we should wait an extra day before my operation, I would be glad to go with that. Some of the most important things that happen in a healing context are not measurable by scientific means. Science, therefore, should know its place! In its place it is fantastic, but it is not the be all and end all of medical treatment.

 

The Healing Power of Touch

At another clinic where I work in Sherwood, Nottingham, there is a cartoon on one of the notice boards which has been there for as long as I have. It shows an old man in a cloth cap sat in front of a doctor. The old man is complaining of back pain. The doctor says, “Well, at your age you have to expect a few aches and pains. Take two of these four times a day”, and hands the old man a prescription. Then you see the old man getting up to go. There is an arrow embedded in his back.

Admittedly this is a relatively rare cause of back pain, even in Nottingham (Robin Hood and all that.) It is perhaps unfair on doctors (or at least on some doctors) who must see lots of people with back pain and do not have time to examine them all. But I see it as a criticism of a form of health care in which the practitioner does not or even cannot interact fully with the patient – does not look properly at them, does not examine them, does not even touch them. It is probably only recently in the history of humanity that any kind of professed healer could treat someone in pain without even touching them.

I get the impression in my clinical practice that patients only fully feel that I have started to understand their painful condition when I start to examine them. If I put my hand on their back and they say, ‘yes that is where the pain is’, that seems to me important, possibly even the beginning of the healing process. Perhaps they feel that I have somehow validated their experience; maybe with some people if they are just given pills, they may unconsciously believe that they are being told the problem is all in their mind. They need to be interacted with on a physical level to feel they are being taken seriously. If I then say something like ‘yes, this muscle feels very tight’, or ‘it feels unusually warm to the touch here’, (or, ‘you appear to have been shot by outlaws or Native Americans’) this further validates their experience.

Furthermore, how I do this matters. If I do it in a routine, mechanical way, this feels different to the patient than if I do it with sensitivity and awareness. People can tell the difference; we are very sensitive to the way we are touched. Examining a patient who is in pain with a heightened level of care, attention and sensitivity is often the beginning of their healing process.

The Necessarily Human Face of Medicine

More grim news in Monday’s Daily Telegraph for statin takers – this time a personal account by a London businessman who developed severe knee pain after being put on simvastatin by his GP. The galling part of his story, actually, was the seeming reluctance or inability of a number of doctors to take his knee pain seriously. And in the very same issue another columnist declared she would rather have her injured foot treated by the butcher at Tesco rather than go to her local A&E department! Now it is no unheard of for people like me in the so-called alternative medicine line to slag off the NHS and western medical practitioners in general, but on the whole my recent experience, while rather limited, is certainly more positive than you might expect if you are reading the Telegraph lately.

Last month, for instance, I accompanied my aged father on a trip to see the cardiologist at his local hospital. This doctor’s manner was everything you could wish for – he was quick to make an easy, human connection with my father, he was informative and communicative, and able to tell difficult truths without hiding behind his stethoscope. A pleasure to witness such a professional at work. He reminded me a little of the Macmillan nurse who supported my mother, and me and the rest of the family too, through her dying days in the same hospital ten years ago. I will always be profoundly grateful to this man for the seriousness, honesty, authenticity, compassion and practical wisdom he brought to us all during an intensely trying couple of weeks.

These people had what is, I should think, the most important quality for anyone in the medical line – humanity. In their book ‘Why Do People Get Ill?’ Darian Leader and David Cornfield at one point suggest that the assumption we have that doctors’ education be science-based should be questioned, and that they might be better off studying philosophy and literature rather than chemistry and physics. This may seem bizarre if you have not read the book, which discovers just how much of illness may be caused by emotional factors, so that, to treat ill people, you need to be able to treat them on an emotional level, a human level, as well as a biological one. Sick people are not machines that have gone wrong; they are people who are suffering.

The trouble is that people want to think of healthcare as a technical thing. Just measure someone’s cholesterol level, and ladle out the statins – a robot could do that (and maybe soon will.) But real healthcare must involve human interaction, and quite often it must involve quite deep human interaction. A real healthcare professional, whether mainstream, alternative or whatever, needs to be someone with humanity, someone who feels what it truly is to be a human being, and whose humanity can resonate with that of the other human being sitting opposite him in the consulting room.