It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
It was game one of the 2014 NBA finals in San Antonio, Texas. Lebron James was the star player for the visiting Miami Heat. An unforeseen technical glitch occurred in the arena though. The air conditioning stopped functioning and it became hot. Temperatures reached as high as 90 degrees during the game.
Due to the vigorous nature of the game, players were no doubt sweating profusely and losing body fluid. Lebron James received intravenous fluids during the game and trainers placed ice on his neck to cool his core body temperature. In pictures, ice is seen placed on his left leg. The working diagnosis as to the cause of Lebron James cramps was "dehydration." Certainly, dehydration should be considered a factor in getting cramps. However, an alternate explanation thus far unmentioned was the use of ice.
In the preeminent procedures and principles of acupuncture and Oriental medicine, cold is a factor that can trigger pain or stabilize a painful condition (meaning that it can keep one in a painful condition for longer period of time). "Cold contracts and obstructs and this often causes pain." In the mechanism of muscle trigger points, where muscles are shortened due to the presence of knots, the use of ice will contract the muscle and shorten it even more.
Muscle Trigger Point therapy
Trigger points are knots or nodules located in muscle tissue. The first mechanism that occurs due to the presence of knots in the muscle tissue is that the muscle becomes "shortened." The analogy is if you take a piece of rope and tie it into a knot, it will shorten the length of that rope. Knots (Trigger Points) are clusters of fascia which tangle up and shorten the length of muscle.
The second mechanism that occurs due to trigger points is that they add increased tension and strain on the tendons. If the muscle is shortened, it adds more strain on the tendon. A stretched and tightened tendon will likely rub with increased friction against adjacent tissues. Tendinitis (inflammation of the tendon) and muscle strains/sprains are the most common injuries and diagnosis resulting from shortened muscles.
The third mechanism that occurs due to the presence of trigger points is the range of motion of the joint or limb will be decreased. The pull and strain from the shortened muscle and tightened tendon, simply will not allow the full range of motion of the joint or limb. When we do accidentally twist our foot or limb beyond its inhibited range of motion, a muscle sprain or strain will occur. Further damage such as a tear can also occur.
Fourth mechanism that occurs due to the presence of trigger points is that they inhibit the circulation of blood and oxygen to the muscle tissue. Blood and oxygen have a harder time circulating through the cluster of knotted tissue and fascia. The muscle becomes dehydrated. Dr. Hyungsuk Choi of Samra Acupuncture Center states the muscle tissue becomes a "Beef Jerky" like consistency, very dry and stringy.
Fifth Mechanism, a muscle that is dry and stringy with trigger points is unable to be strengthened. To strengthen, you must restore it to its normal length, tenderness, and pliability first. Sixth Mechanism, the trigger point is painful upon palpation. The pain felt does not have to be local to the trigger point area. Pain will refer to points where the muscle attaches and inserts. Many painful diseases are actually located distantly away from where the trigger point occurs. Seventh Mechanism is that trigger points can be present without any pain or physical complaint. Until a triggering event occurs (like accident, injury, or exposure to cold and ice). There may be no physical complaint, even though the trigger point is present.
Use of ice and dehydration
The most commonly used form of ice as therapy occurs after a muscle strain/sprain like a twisted ankle. When a joint or limb accidently move beyond its normal range of motion, micro blood vessels in the tissues tear and hemorrhaging of blood and body fluid begin to cause swelling. The use of ice is applied to restrict blood vessels and the circulation of blood, stemming the hemorrhage and keeping the swelling down. This same mechanism of using ice can exasperate a dehydrated condition, further depleting blood, body fluid, and oxygen to tissues.
Dehydration
According to the Mayo clinic, "overuse of a muscle, dehydration, muscle strain or simply holding a position for a prolonged period of time may result in a muscle cramp. In many cases, however, the exact cause of a muscle cramp isn't known." Other causes may be due to inadequate blood supply, nerve compression, and mineral depletion.
Dehydration in Oriental Medicine
The initial diagnosis a practitioner of acupuncture and Oriental medicine would probably make in the case of dehydration is blood and body fluid deficiency. "The main function of blood is that of nourishing the body... Besides providing nourishment, blood also has a moistening function. Blood ensures that body tissues do not dry out." The liver stores and rejuvenates blood when we rest. When we are active, the liver sends blood to the sinews and tissues. "Deficiency of the liver blood deprives the tendons of nourishment and thus stirs up a deficiency wind type in the interior." A muscle spasm or cramp is classified as a wind condition in Oriental medicine. The analogy of blood deficiency generating wind, is when barometric pressure drops, it foretells stormy windy conditions. "When blood fails to nourish the limbs and tendons, there may be numbness of the limbs and spasms of the tendons."
Cold can also be a cause of dehydration as it blocks the mechanisms of transport to and from the tissues, especially in one who is yang deficient and unable to use the body's resources to warm up. "Pain with a cold sensation and preference for warmth often occurs in the head, lumbar, epigastric, and abdominal regions. It is caused by cold blocking the collaterals or lack of warmth and nourishment in the zang-fu organs and meridians due to deficiency of yang qi."
The analogy of cold causing dehydration is Antarctica, an extremely cold and dry environment. Cold dehydration may be identified with symptoms of cold hands and feet when the weather drops or from exposure to air conditioning. Growing up in a cold environment may make one susceptible to cold influences. Cold dehydration can be exasperated from under dressing in cold weather, ice cold drinks, going barefoot on cold ground surfaces, or swimming in cold water. If I were to ask Lebron James one question, it would be whether he easily gets cold hands or feet when the weather turns cold. An athlete of his caliber, I would expect the answer to be "no." However, he grew up and lives in Cleveland, Ohio, along the banks of Lake Erie which gets extremely cold and windy in the winter. So, maybe he has some deep lingering cold? If so, then the use of ice on him should be contraindicated.
Warm Therapy
In the preeminent procedures and principles of acupuncture and Oriental medicine, if cold is identified during the examination of the patient, then the use of cold as therapy in the form of herbs or otherwise is contraindicated. Warming herbs or procedures such as (moxibustion) are used to counter the influence of cold.
Oriental Medicine Therapy
In the case of dehydration causing muscle cramps, herbal medicine such as the formula Shao Yao Gan Cao Tang can be used. This two herb formula of blood and qi tonic herbs, "softens the liver, moderates painful spasms, and alleviates pain. Indications for the use of this formula are for irritability, slight chills, spasms of the calf muscles, and lack of coating on the tongue. There may also be cramps in the hands and abdominal pain. This formula is used for when the inappropriate use of sweating has injured the liver blood or yin. Today, it is used for any type of pain in the calves with blood deficiency or injury to the fluids. The irritability and lack of tongue coating are attributed to injury to the yin. The spasms, cramps, and abdominal pain are typical spasmodic, wind - like manifestations of Liver blood deficiency."
Ginseng is another herb that can support the body against dehydration. One of its many uses is for "generating fluids and stopping thirst, in cases when the qi and fluids have been injured by high fever and profuse sweating."
Acupuncture Trigger Point Techniques
For muscle trigger point release, I practice the Korean Acupuncture techniques of VST Acupuncture (Vertex Synchronizing Technique), Korean Kinetic Acupuncture, and Jaseng Hospital's "Motion Style" Acupuncture.
Saam Acupuncture: Spleen Jungguk - the energetic aspect of the Spleen Jungguk is to bring warmth and moisture within. The harmonized technique of adding the small intestine helps to generate blood. Lung Jungguk - The energetic aspect of the Lung Jungguk is to add cool and moisture within, making it useful for heat dehydration.
Dr. Evan Mahoney (DAOM) specializes in the treatment of pain and pain management using the Korean Acupuncture techniques of VST and Korean Kinetic Acupuncture. His practice is in Cape Coral, Fla.