From New Sports, 2014 March issue, P100-101
Dictated by Bob Chen, written by Bai Qiang
 
Follow the Vine to Get the Melon
 
Even though I played water polo, I always like watching volleyball matches.  I especially like the action when the athletes jump high in the air, extend their arm backwards like drawing a bow, and then powerfully smash the ball. That moment is really enjoyable.  However, as a physical rehabilitation therapist, I would naturally often wonder, how many parts of the body would be affected by and react to this seemingly simple move?  Conversely, if any part of the body is not in good condition, it would also, to a certain extent, have impact on the completion of this move.  In many cases, people feel that this impact is unpredictable, or even unrelated.
 
I once admired Lu Weizhong, one of the main players of the Chinese Men’s Volleyball Team, who had a typical case that I’d like to tell you here. 
 
Before the 10th National Sports Meet, I was invited by the delegation of Jiangsu Province, checking injuries for athletes from various teams.  When I arrived at the Men’s Volleyball Team, I met with Lu Weizhong, who was then troubled by shoulder injuries.  At that point, he was in so much pain that he was not able to carry out normal training.  This was a rotator cuff injury, which is commonly seen in volleyball players.  Because they constantly spike with their arms, their shoulders are overburdened, so in the course of time, it causes small muscle group strain in the shoulders.  

I noticed that his shoulders were covered with purple marks that were left by moxabustion; obviously he went though a lot of treatment.  But after a few exchanges with the team doctor, I learned that the therapeutic result was not ideal.  At that moment, my professional experience and intuition had me wondering whether this was related to technique, especially to his spiking technique.  The reason behind my thinking is that incorrect technique often runs contrary to the laws of body force, and coupled with repeated powerful forces, it is bound to increase the probability of injury.  So, my focus was not confined to his shoulder area. 
 
Coincidentally Lu Weizhong was topless at that time.  I immediately discovered that his shoulders were crooked, and there were apparent marks of moxabustion on his left lower back.  I learned from him that he had injuries there also, and it had affected the activity of his waist.  Generally, for an athlete who spikes with his right hand, the left side of his waist is his main rotation part.  In other words, left lumbar pain was bound to bring deformed techniques to his right hand spikes, and limit the movement in that area.  But the intensity and speed of the spike could not be reduced, therefore, he had to compensate and make up for it instinctively by using force with his right shoulder.  In a long run, it caused his right shoulder to be over burdened. 
 
Finding out the potential culprit of Lu’s shoulder injury pleased me, but after a little while, another question popped out:  How come when Lu Weizhong walked into the room, his two feet seemed uncoordinated, and his right foot limped subtly. 
 
I carefully checked his lower body, and sure enough, I found he had injuries on his left foot.  It turned out that during a match three months ago, when he jumped, he landed on a teammate’s foot, causing serious ankle injury.  At that time, the injury was treated very lightly, and then he continued to play for the rest of the match.  Later on, everybody thought it was just a minor ankle sprain, and he did not take it seriously.  I asked if it was still swollen and he still felt pain, and he nodded, and said even walking gave him pain.  Logically speaking, a general ligament injury should not have such symptoms.  After further diagnosis, I was surprised to find that his feet had a hidden problem – a small joint bone dislocation.
 
A much clearer picture of the cause of his shoulder pain was then formed in my head.  Because his left ankle injury did not get treated effectively, the loss of strength and mobility were compensated by other joints of the body instead.  If the left foot was no good, then he used the right one; if the feet could not give force, then he used the waist instead; if the waist was no good, he replied on the swinging power of his shoulder...injuries caused by this compensatory overload were also consequential, and they gradually spread to his right foot, knees, hips, waist, and finally his shoulders.  In order to confirm this reasoning, I inquired about the development process of his injuries in detail, and it was completely consistent with this result. 
 
No diagnosis, no treatment
 
After finding out the chain of Lu Weizhong’s shoulder injuries, our treatment and rehabilitation plan showed an unusual situation:  upper-body injuries, but started from the lower-body. 
 
First, we used orthopedic treatment techniques to reset the small joints of his left foot, which had not been corrected for a long time.  It was as simple as it sounded; after a popping sound, the pain was gone as soon as he started walking.
 
Next, we focused our attention on Lu’s left flank.  On one hand, we showed him how to rotate his waist to stretch, so that his long stiffened muscles could be pulled; on the other hand, we strengthened its flexibility with personalized psoas muscle strength exercises.  Everything we did was to rebalance the load of his two legs and restore normal technical movements, especially the flexion and extension movements when turning his body to spike, in order to relieve the strain on his left flank, thereby reducing excessive reliance on his shoulder strength. 
 
Naturally, we also treated his shoulder injury simultaneously with the same conventional methods. 
 
Lu Weizhong not only quickly returned to his normal training and competition with our methods of treatment and rehabilitation, but also his performance was improved.  At the Tenth National Sports Meet, he led the Jiangsu Team and won the second place in men’s volleyball. 
 
Ask more whys
 
Lu Weizhong’s case is many years in the past, but the revelations left behind are still with us.
 
First, in the diagnosis and treatment of sports injury rehabilitation, we often fall into the trap of “curing the head when the head hurts,” and “curing the foot when the foot hurts.”  We only look at the surface, ignoring the deeper problems, and lack comprehensive analysis and in-depth investigation for the cause. 
 
The fact is that the human body is a kinetic chain; it operates with the joints as its axis, and the muscles as its forces.  If any link goes wrong, the transmission of the power will be limited or suppressed.  Sometimes, when a seemingly unrelated remote link goes wrong, it will exert its effects through a chain of reactions.  Therefore, during diagnosis of sports injuries, one must ask oneself a few more whys and carefully analyze the injury process.  Especially, one needs to check the functions of various parts of the body, as well as the relationship between the chronological order of the injuries and the technical movements, and eventually find the sources of the injuries. 
 
When encountering sports injuries, people tend to use the method of so called “symptomatic treatment,” or the relatively conservative treatment options, which stop injurers from exercise and training.  The condition of the injury is temporarily relieved, and therefore is considered cured.  In fact, if the source injuries are not eradicated, after returning to exercise or training, the injuries will reappear.  The fact that Lu Weizhong’s shoulder injuries would not heal was the best proof of that theory. 
 
Second, as an injured person, he should also understand this reasoning, and truthfully report the details and development of the injuries in his body to the doctor, which will help the doctor to have an overall picture of the injury, so that he can take the methods and techniques of the sport into consideration while identifying the mechanism of the injury, and cure it permanently.  This is a little like when our home is flooded; we cannot just try to clear the water and clean the floor, it is important to find the source of the water and stop it from coming in further. 
 
Third, after the injury, it is best to seek a doctor who specializes in sports medicine for diagnosis and assessment.  If one runs into questionable injuries, especially when the result of rehabilitation treatment is not ideal, it is best to find experts for consultation, or see several experienced doctors, and adopt each of their ideas comprehensively. 
 
Fourth, there are not many hospitals and doctors specializing in sports injuries in China, and diagnostic time is extremely limited.  During diagnosis, they often tend to rely overly on MRI, CT, X-ray and other high-tech means.  These machines alone may not be able to identify accurately the origins of injuries.  So, we must combine the patients’ clinical history of injuries with their personal description, and make a comprehensive analysis and judgment. 
 
Finally, I want to remind everyone, please do not ignore any injuries, especially those minor ones.  We need to get an early diagnosis, so that we can intervene as soon as possible.  Otherwise, they not only would exacerbate the severity of the injuries, but also affect other parts of the body, and by that time, it would be much more difficult to cure.