Will Chinese Medicine Help Yao?

April 7, 2008— -- The decision of NBA superstar Yao Ming to head to China to seek traditional Chinese medical treatment for his stress fracture has orthopedic physicians and traditional medicine experts at odds over whether the healing techniques will do any good.

The 27-year-old, 7-foot-6 all-star center for the Houston Rockets was forced out of the season by a stress fracture in his left foot — specifically, a crack in the tarsal navicular bone, between the ankle joint and the middle of his foot.

Yao underwent surgery early last month when surgeons inserted a screw to stabilize the bone. Doctors involved with the surgery reported that the procedure was successful and that Yao would begin an aggressive rehabilitation program once he was up to it.

The surgery carries with it a normal downtime of four months. But it appears Yao is also looking to traditional Chinese medicine — a system that includes acupuncture and herbal remedies — to help speed his healing. On Friday, the Associated Press reported that Yao had arrived back in his home country to consult with the nation's top experts.

Some U.S. doctors, such as Dr. Robert J. Neviaser, professor and chairman of orthopaedic surgery at George Washington University in Washington, D.C., are skeptical that this extra step will do much, if any, good.

"I am aware of no scientific evidence that has established that traditional Chinese medicine modalities have any positive effect on stress fractures," Neviaser says. "We do not know a great deal about acupuncture, which seems to have value as an anesthetic alternative for surgery, but there is no data which show that it can help heal a fracture."

But some experts in Chinese medicine said that, despite the lack of published evidence, the modalities offered by Chinese medicine may go a long way in helping Yao cope with the painful injury.

"It is not unwise, and I would do the same if I was Yao Ming, given that, conventionally, there is not much active treatment — aside from passive rehab — offered by Western conventional medicine for stress fractures, either," says Dr. Raymond Chang, president of the Institute of East West Medicine in New York.

"TCM is familiar and reputed — by empiricism, not by studies — to be helpful in such settings and quite familiar to almost all Chinese as a part of our upbringing, so it is only natural that Yao Ming would seek this therapy," added Chang.

Stress Fractures Painful, Persistent

Stress fractures, unlike many other types of fractures, don't occur all at once. Rather, they are generally the result of repeated mechanical stress to a vulnerable, weight-bearing bone, such as those in the feet.

While such fractures can happen to almost anyone, there are certain groups of people who are particularly vulnerable — those who engage in demanding sports, those who are tall, and those whose weight puts constant pressure and strain on their bones.

In this respect, it is little surprise that the towering, 310-pound Yao has had the misfortune of suffering such an injury.

In some cases, such as Yao's, treatment involves surgery. But in less severe cases, the placement of a cast and a hiatus on the activity that brought about the injury are enough. Pain and inflammation can also be treated with NSAIDs (non-steroidal anti-inflammatory drugs) and other pain medications.

Chang says Chinese modalities for this type of injury usually involve external applications of herbal balms and liniment and ointments, and does not necessarily involve the ingestion of herbs.

The dearth of high quality studies on traditional Chinese techniques to deal with these injuries means that they are not yet part of the canon of conventional treatments. Still, some orthopedic experts say there may be benefits that will come to light through future research.

"As I know little about Chinese medicine, I can only comment on the possible benefits," says Dr. Andrew J. Elliott, assistant professor of clinical orthopaedic surgery at Weill Medical College of Cornell University. "Those might be increasing blood flow to the area to speed healing, and possibly ingesting things that might help stimulate bone cells to heal."

And studies confirming some of the purported benefits of Chinese medicine for bone repair may be on the way. Dr. Regis J. O'Keefe, chair of the department of orthopaedics and rehabilitation at the University of Rochester Medical Center, along with his colleagues, presented evidence at a recent meeting of the Orthopaedic Research Society, showing how one Chinese remedy appears to have some benefit, at least in mice.

"There is a compound in traditional Chinese herbs that can stimulate fracture repair," O'Keefe says. "It alters a signaling pathway well known to regulate bone formation."

O'Keefe and his colleagues are investigating the compound, which is derived from shellfish, primarily to determine whether it can help stimulate bone formation in osteoporosis patients. But their findings may one day provide new avenues for fracture repair, as well.

Conventional Approach Still Gold Standard

But for weekend warriors and other athletes who do not have the resources to catch the next flight to China, the best remedy for stress fractures may still be the tried and true options of rest and moderate pain management.

"[Stress fracture sufferers] should seek professional attention as soon as the problem arises and realize that certain medical conditions will require them to stop training or participating to allow their body to heal — even if they don't want to," Elliott says. "They should also take an active role to educate themselves so they can weigh all their options and participate in their care."

And for the time being, Neviaser says, those who ascribe to alternative therapies would be best to keep their expectations in check.

"The message is that, while trying alternative treatment modalities, such as this, may not be harmful, one needs to know that they are unlikely to heal fractures and can delay the return to athletic activity because of the persistence of the fracture, and potentially convert a stress fracture into a common variety displaced fracture," he says.