The Daily Snowboarding Prescription
Today I wrote a prescription for snowboarding. It’s in my patient’s chart, and I gave her a doctor’s note for work.
This prescription came to be after I asked a patient (let's call her Jasmine) when she felt best. She said to me: "I know it sounds silly, but since the accident, I only feel like myself when I'm snowboarding."
Now that didn't sound silly to me at all- and it isn't the first time I've heard that either. When you look at snowboarding (or skiing) through the lens of Naturopathic Medicine, it breaks down into a mix of ecotherapy, exercise, flow state, and light therapy.
It turns out that there is evidence that those things can be helpful for Jasmine’s conditions: post concussion syndrome, endocrine imbalance, and major depressive disorder. Links to research at the end of this post.
As a Naturopathic Doctor, it’s my job to know about research-based natural therapies, but just knowing something is natural + researched, isn’t enough for me to select it as a therapy. I also have to know how it will interact with each patient’s case, and where, in terms of the therapeutic order, I’m intervening.
Snowboarding is a particularly appealing prescription, because through snowboarding we can harness a uniquely Naturopathic understanding of healing: “the Vis”.
The Vis is central to both the Therapeutic Order (which helps NDs decide what therapies are appropriate and when) and the Principles of Naturopathic Medicine (which underlie all of our practices). These concepts underlie my worldview and inform my decision-making. They are what makes seeing me different than looking up natural therapies online.
Not that there’s anything wrong with looking up a natural remedy online- it’s just different than what I do!
The Vis is a term used among Naturopathic Doctors to describe the healing power of nature and the vital force within that governs healing.
You see, Naturopathic Medicine differs from other systems of medicines in that it is based on six principles, the first of which is to harness the healing power of nature.
Here is the complete list of Naturopathic Principles:
Vis Medicatrix Naturae: The Healing Power of Nature
Tolle Causam: Remove the Cause
Primum Non Nocere: First, Do No Harm
Docere: The Doctor as Teacher
Treat the Whole Person
Harnessing the healing power of nature is a nice thought, but what does it really mean?
First you have to understand that the concept of the healing power of nature is based on two beliefs:
The body is able to heal and does so through something called the Vital Force (aka the Vis).
There are factors found in nature- like plants, sunshine, water, Qi, touch, love, etc- that are able to stimulate the Vis and therefore healing.
These are the core beliefs which Naturopathic Medicine is based on. So, when people say that Naturopathic Medicine is faith-based, that is what they mean: we have faith that bodies are capable of healing and there are things we can to that may stimulate that healing process.
The body's ability to heal isn't exactly something that we can prove (so far), but it is something that we can observe: wounds heal; our bodies fight infections; livers regenerate; anxieties are overcome; nightmares resolve; and people living with despair find hope. In those cases I help make sure your body has the nutrients needed to function optimally, and the support necessary to heal itself.
And as we all know, there are sometimes aspects of ourselves which can’t be healed: kidneys that need dialysis, congenital abnormalities that need surgical repair, chronic infections you have to live with, and mental/emotional/spiritual wounds that change you forever. In those cases my job is to help you live your best life alongside whatever cannot be altered.
To figure out how to best support the Vis and stimulate healing, I use something called the Therapeutic Order.
The Therapeutic Order
The Therapeutic Order helps me choose the most appropriate treatments. For example, establishing the conditions for health is always the first step in a healing plan. That's why I ask about diet, sleep, exercise, water, social support, and time outside. If you don't have these in place, your body should be giving you symptoms to tell you something is wrong.
Imagine that you are dehydrated, and your body tells you in the language of a headache. If you notice that you haven't had enough water today and have a big drink, the headache should resolve shortly. If you forget about water and take a Tylenol, then the repercussions of dehydration will move deeper into your body, plus you'll have to process the biochemical stress of the Tylenol. You can see how establishing the conditions for health, in this case hydration, would have been the most appropriate treatment.
Sometimes providing your body with it's basic needs isn't enough (or isn't possible), and you have to move up the Therapeutic Order to choose an action with a larger impact.
That's why, when you see me, I'll often choose a gentle therapy to support a weakened system for a month or two before I start using stronger therapies to impact systems. Sometimes supporting a weakened system will be all that is needed for healing, and in cases when it is not, having strengthened the organs in question will often help them respond better to the stronger therapies we use later.
Here is the full Therapeutic Order:
Establish the conditions for health
Stimulate the Self-Healing Mechanism
Support damaged or weakened systems or organs
Address structural integrity (with massage, chiro, bowen, etc)
Address pathology with natural therapies
Address pathology with synthetic drugs
Suppress pathology with drugs or surgery
If we think back to Jasmine’s case, you can see that snowboarding intervenes on the first and second levels of the Therapeutic Order.
Exercise, sunlight and contact with nature are all necessary conditions for optimal health.
Being in flow, exercise, sunlight, and contact with nature can all help to stimulate the self-healing mechanism (the Vis again!).
When you think about it that way, there might not be anything better than snowboarding for this patient. The ski-season only lasts so long- to get to feel like yourself for a couple moments a day during the healing process is priceless in terms of the velocity it adds to the healing journey.
Now, snowboarding alone isn’t going to be enough to bring Jasmine back to optimal health- if it was, I’m sure she would be there by now and wouldn’t have needed my help! So I have to look to the therapeutic order to find the strategies that we need.
Jasmine’s plan includes nutrient supplementation in areas I believe she’s deficient (level 1 & 5), acupuncture (level 2 & 5), homeopathic medicine to lift trauma (level 2), counseling with her therapist (level 3), chiropractic care (level 4), and a synthetic drug (level 1 & 7).
Wait, what? A synthetic drug? A pharmaceutical? Isn't that... against Naturopathic Medicine or something?
How Do Synthetic Drugs Fit Into the Practice of Naturopathic Medicine?
Jasmine, like many of my patients, was surprised that I was encouraging her to try a pharmaceutical drug for one of her symptoms.
The confusion is understandable: Naturopathic Medicine sounds a lot like Natural Medicine, and to be fair, we do focus heavily on natural therapies. However, sometimes a symptom or condition is impacting a person so strongly that we simply have to do whatever we can to stop it so that we can heal the underlying imbalance.
Some examples of symptoms/conditions that make me grateful for conventional medicine are:
Chronic Pain- I prefer to use natural painkillers, but when they are inadequate, there is no shame in stepping up to synthetic painkillers while we work on healing the source of the pain.
Heavy Bleeding- I often treat hormonal imbalances that result in heavy bleeding during menses. However, if iron stores get too low, it impairs hormonal function and we end up in a loop where hormonal dysfunction is causing blood loss and the blood loss is worsening hormonal function. So while we work on hormones, we may have to stop bleeding via a synthetic drug until iron levels are normalized.
Severe Depression and certain other mental health concerns- Natural therapies have been proven effective for a number of mental health concerns including mild and moderate depression. However, for severe depression, anti-depressant drugs show an advantage.
Certain Infections- Many infections respond well to natural therapies, however there are some infections which respond better to conventional medicines. HIV would be a prime example of this, but also rapidly spreading infections, certain other chronic/acute infections and just about anything affecting a young infant.
Once you understand the principle of the Therapeutic Order, it becomes clear that Naturopathic Medicine isn’t really about using all natural medicines- it is about using the most appropriate medicine... which according to my experience and training is most often natural.
Remember: it’s all medicine.
Time in nature: Ecotherapy
Low-Medium Intensity exercise
PS. This story was shared with the permission of my patient, who is not named Jasmine. She’s stoked to get up the hill and get feeling better!
PPS. I don't snowboard. I ski (haphazardly). But this article isn't really about me.