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
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
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?
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