Ihsan Antoine Azzam , MD, MPHIhsan Antoine Azzam , MD, MPH June 24, 2005 June 24, 2005

Sport InjuriesSport Injuries In the Martial ArtsIn the Martial Arts

Treatment and Treatment and PreventionPrevention

What are Martial Arts (Sports) What are Martial Arts (Sports) Injuries?Injuries?

What is the Difference Between What is the Difference Between Acute Acute and Chronic Injuries?and Chronic Injuries?

What Should We Do in Case of What Should We Do in Case of Injury? Injury?

How are These Injuries Treated?How are These Injuries Treated?

Individuals/Groups at High RiskIndividuals/Groups at High Risk

How Can We Prevent These Injuries?How Can We Prevent These Injuries?

Recent AdvancesRecent Advances

Today's Topics Today's Topics

Most sports injuries can be treatedMost sports injuries can be treated

effectivelyeffectively

Most people who suffer injuries can return Most people who suffer injuries can return to a to a

satisfying level of physical activitysatisfying level of physical activity

after an injuryafter an injury

Many sports injuries can be prevented if Many sports injuries can be prevented if

people take the proper precautionspeople take the proper precautions

Statistical Facts Statistical Facts

““Injuries that most commonly occur Injuries that most commonly occur

during sports or exercise.”during sports or exercise.”

Sports Injuries - Definition Sports Injuries - Definition

Could be due toCould be due to::

Unintentional accidentsUnintentional accidents

Poor training practicesPoor training practices

Improper equipmentImproper equipment

Lack of conditioningLack of conditioning

Insufficient or inadequate Insufficient or inadequate

warm-up and stretchingwarm-up and stretching

Could InvolveCould Involve::

MusclesMuscles

BonesBones

Associated tissues:Associated tissues:

LigamentsLigaments

TendonsTendons

CartilageCartilage

Any part of the bodyAny part of the body

What Are Sports Injuries?What Are Sports Injuries?

Sprains and StrainsSprains and StrainsJoint SprainJoint Sprain:: Stretch or tear of a Stretch or tear of a

ligament ligament (the band of tough soft tissues that connects (the band of tough soft tissues that connects

bones to bones)bones to bones)

Caused by trauma Caused by trauma

Most vulnerable to sprains areMost vulnerable to sprains are::

AnklesAnkles

KneesKnees

Wrists Wrists Signs Signs

includeinclude::

Tenderness or painTenderness or pain

BruisingBruising

InflammationInflammation

SwellingSwelling

inability to move a limb or jointinability to move a limb or joint

joint looseness, laxity, or instabilityjoint looseness, laxity, or instability

Joint Strain: twist, pull, or tear of a muscle or

tendon (the band of tough soft tissue that connects

muscles to bones)

Could be None-contact injury Could be None-contact injury

May result from over-stretching orMay result from over-stretching or

over-contractionover-contraction

Most vulnerable to sprains are:

Ankles

Knees

Wrists

Signs include:

Pain

Muscle Spasm

Loss of Muscle Strength

Swelling

Knee Injuries Knee Injuries

knee is the most commonly knee is the most commonly

injured jointinjured joint

Each year > 5.5 million Each year > 5.5 million

Individuals visit orthopedic Individuals visit orthopedic

clinics for knee problems.clinics for knee problems.

Ranges from mild to severeRanges from mild to severe

Functionally limitingFunctionally limiting

Pain or tenderness Pain or tenderness

Causes of Knee Injuries Causes of Knee Injuries

Running too Hard too MuchRunning too Hard too Much

Training without Warm- upTraining without Warm- up

Blow, Kick or Punch Blow, Kick or Punch

TwistTwist

Improper Landing Improper Landing

Compartment SyndromeCompartment Syndrome

Ongoing overuse (chronic)Ongoing overuse (chronic) or one-timeor one-time traumatictraumatic

injury (acute compartment syndrome),injury (acute compartment syndrome), such as:such as:

Fractured bone Fractured bone

Hard blow to the thigh (or repeated hard blows)Hard blow to the thigh (or repeated hard blows)

OccursOccurs when muscles become swollen, and filledwhen muscles become swollen, and filled

the compartment to capacity, causing damage to thethe compartment to capacity, causing damage to the

muscles and interference with:muscles and interference with:

Nerves Nerves

Blood vessels. Blood vessels.

Achilles Tendon InjuriesAchilles Tendon Injuries

Stretch, tear, or irritationStretch, tear, or irritation

Tendonitis Tendonitis

degenerative caused by degenerative caused by

aging*or overuseaging*or overuse

Rupture.Rupture.Lateral View of the Ankle

* Healthy and active lifestyle may delay soft tissues degeneration

Shin SplintsShin SplintsDefinition: Leg pain along the tibia associated with exercise

Running and Overtraining

Jumping on hard surfaces

Running in shoes that don't have enough support

Overuse or incorrect use of the lower leg

Improper stretching, warm-up, or exercise technique

Flat (over-pronated) feet

Additional Images of the Knee Joint

Common Types of Sports InjuriesCommon Types of Sports Injuries

Muscle sprains and strains Muscle sprains and strains

Tears of the ligaments that hold joints togetherTears of the ligaments that hold joints together

Tears of the tendons that support joints andTears of the tendons that support joints and

allow them to moveallow them to move

Dislocated joints Dislocated joints

Fractured bones, including vertebraeFractured bones, including vertebrae

HerniasHernias

Fractures Fractures Quick, Acute or one-time injury Quick, Acute or one-time injury

Repeated stressRepeated stress

Simple and Clean breakSimple and Clean break

Compound Compound

Most Most acuteacute fractures are emergencies fractures are emergencies

Symptoms: Symptoms:

PainPain

TendernessTenderness

SwellingSwelling

Broken bonesBroken bones

Broken ArmBroken Arm

Humerus Fracture Humerus Fracture

DislocationsDislocations When bones that form When bones that form

a joint become a joint become

separatedseparated

Due to excessive force, Due to excessive force,

stretching or stretching or

fallingfalling

Emergency situationEmergency situation

Fractures and DislocationsFractures and Dislocations

Acute Versus Chronic InjuriesAcute Versus Chronic Injuries

Acute InjuriesAcute Injuries such such

as:as:

sprained ankle,sprained ankle,

strained backstrained back

fractured handfractured hand

Chronic InjuriesChronic Injuries

Result from OveruseResult from Overuse

Signs of an acute injury include the following: Sudden, severe pain Swelling Inability to place weight on a

lower limb Extreme tenderness in an upper

limb Inability to move a joint through

its full range of motion Extreme limb weakness Visible dislocation or break of a

bone

What's the Difference Between What's the Difference Between

Acute and Chronic Injuries?Acute and Chronic Injuries?

STOP IMMEDIATELYSTOP IMMEDIATELY

Severe pain, swelling,Severe pain, swelling, or numbness or numbness

Can't tolerate any weight on that area Can't tolerate any weight on that area

Pain or dull ache of an old injury that is Pain or dull ache of an old injury that is

accompanied by increased:accompanied by increased:

swelling swelling

joint abnormality joint abnormality

instability.instability.

When to Seek Medical AttentionWhen to Seek Medical Attention??

When Injury Occurs When Injury Occurs

What Should We Do in Case What Should We Do in Case

of an Injury?of an Injury?

Managing Injuries at HomeManaging Injuries at HomeFollow “RICE” for 48 hours Follow “RICE” for 48 hours

• RRestest

• IIce (for maximum 48 hours, no more than 10 times/day 20-30 ce (for maximum 48 hours, no more than 10 times/day 20-30

minutes each) minutes each)

• CCompression (should be performed by skilled individuals ompression (should be performed by skilled individuals

only)only)

• EElevation (slightly above the level of heart)levation (slightly above the level of heart)

If pain or other symptoms worsen If pain or other symptoms worsen

check with your healthcare providercheck with your healthcare provider

How Are Sport Injuries How Are Sport Injuries

Treated?Treated?

How Are Sport Injuries Treated?How Are Sport Injuries Treated?• Start with “RICE”Start with “RICE”

• Immediate Immobilization Immediate Immobilization

• SurgerySurgery

• None Steroidal Anti-Inflammatory Drugs (NSAIDs) None Steroidal Anti-Inflammatory Drugs (NSAIDs)

• Rehabilitation:Rehabilitation:

• Gradual ExerciseGradual Exercise

• Early MobilizationEarly Mobilization

• Avoid PainAvoid Pain

• Avoid Re-injuryAvoid Re-injury

• Other Therapies include: Other Therapies include:

• Electrostimulation Electrostimulation (reduces pain, swelling, functionality, and produce passive muscle contraction - not recommended in the first 72 (reduces pain, swelling, functionality, and produce passive muscle contraction - not recommended in the first 72

hours)hours)

• CryotherapyCryotherapy

• Thermotherapy Thermotherapy (enhances and speeds up the healing process not recommended in the first 72 hours)(enhances and speeds up the healing process not recommended in the first 72 hours)

• Ultrasound Ultrasound (not recommended in the first 72 hours)(not recommended in the first 72 hours)

• Massage Massage (not recommended in the first 72 hours)(not recommended in the first 72 hours)

High Risk Individuals (Vulnerable High Risk Individuals (Vulnerable

Groups) Groups) Children and AdolescentsChildren and Adolescents

Bones, Muscles Tendons and Ligaments still GrowingBones, Muscles Tendons and Ligaments still Growing

Neck, Spinal Cord and Growth Plates (contact Sports) Neck, Spinal Cord and Growth Plates (contact Sports)

Middle Aged Martial ArtistsMiddle Aged Martial Artists

Aging (physical activity and some medical and food supplements* Aging (physical activity and some medical and food supplements*

may delay the progress of arthritis)may delay the progress of arthritis)

Moving too Quickly to Active Lifestyle Moving too Quickly to Active Lifestyle

Women (High Prevalence of Osteoporosis among inactive Women (High Prevalence of Osteoporosis among inactive

women who are not on Calcium supplements) women who are not on Calcium supplements)

Conditioning LevelsConditioning Levels

Structural DifferencesStructural Differences

Hormonal LevelsHormonal Levels* NSADs, Glucosamine and Chondroitin may play a role in slowing the progress of arthritis

Individuals and Groups at High Individuals and Groups at High

Risk for Sport InjuriesRisk for Sport Injuries

Preventing (Sports) Martial Arts Preventing (Sports) Martial Arts

Injuries Injuries • Do Warm-up Exercises.Do Warm-up Exercises.

• Don't OverdoDon't Overdo

• Accept Your Body LimitAccept Your Body Limit

• Modify Activities as NeededModify Activities as Needed

• Increase the Emphasis on ConditioningIncrease the Emphasis on Conditioning

• Maintain “Normal” Body Weight (some cushion could be helpful) Maintain “Normal” Body Weight (some cushion could be helpful)

• Avoid Twisting Knees by keeping feet as flat as possible during stretches.Avoid Twisting Knees by keeping feet as flat as possible during stretches.

• When Jumping, Land with your knees bentWhen Jumping, Land with your knees bent

• Wear Protective GearWear Protective Gear

• Use Soft Exercise SurfaceUse Soft Exercise Surface

• Increase Your Exercise Level GraduallyIncrease Your Exercise Level Gradually

• Avoid Excessive ActivitiesAvoid Excessive Activities

• Strive for A Total Body Workout (Cardio, Strength and Flexibility) Strive for A Total Body Workout (Cardio, Strength and Flexibility)

How Can We Prevent Sport How Can We Prevent Sport

Injuries?Injuries?

HerniasHernias Hernias of the abdominal wall must be considered in Hernias of the abdominal wall must be considered in

patients who present with abdominal or groin painpatients who present with abdominal or groin pain

Inguinal hernia pain can be confused with pain due Inguinal hernia pain can be confused with pain due to chronic muscular-skeletal conditions encountered to chronic muscular-skeletal conditions encountered in a variety of sporting activities, especially Martial in a variety of sporting activities, especially Martial Arts and Weight LiftingArts and Weight Lifting

Herniated (prolapsed) inter- vertebral discs is Herniated (prolapsed) inter- vertebral discs is extremely common among over-achiever martial extremely common among over-achiever martial artists artists

Recent Advances Arthroscopy

Tiny Incisions (less trauma, swelling and scaring)Diagnostic Tool Treatment Tool (torn meniscus or ligament)Better Healing

Tissue EngineeringCartilage Transplanting Improve Healing

Targeted Pain ReliefPatches

What Are Some Recent Advances in What Are Some Recent Advances in

Treating Sports Injuries?Treating Sports Injuries?

I/Azzam - 2004

Thank

Thank you you Questi

Questions ons