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Sport Injuries In the Martial Arts Treatment and Prevention Ihsan Antoine Azzam , MD, MPH June 24, 2005 Today's Topics What are Martial Arts (Sports) Injuries? What is the Difference Between Acute and Chronic Injuries? What Should We Do in Case of Injury? How are These Injuries Treated? Individuals/Groups at High Risk How Can We Prevent These Injuries? Recent Advances Statistical Facts Most sports injuries can be treated effectively Most people who suffer injuries can return to a satisfying level of physical activity after an injury Many sports injuries can be prevented if people take the proper precautions Sports Injuries - Definition “Injuries that most commonly occur during sports or exercise.” What Are Sports CouldInjuries? Involve: Could be due to: Unintentional accidents Poor training practices Improper equipment Lack of conditioning Insufficient or inadequate warm-up and stretching Muscles Bones Associated tissues: Ligaments Tendons Cartilage Any part of the body Sprains and Strains Joint Sprain: Stretch or tear of a ligament (the band of tough soft tissues that Joint Strain: twist, pull, or tear of a muscle or tendon (the band of tough soft connects bones to bones) tissue that connects muscles to bones) Caused by trauma Could be None-contact injury May result from over-stretching or Most vulnerable to sprains are: Ankles Knees Most vulnerable to sprains are: Tenderness or pain Bruising Signs include: Wrists Signs include: over-contraction Inflammation Swelling inability to move a limb or joint joint looseness, laxity, or instability Ankles Knees Wrists Pain Muscle Spasm Loss of Muscle Strength Swelling Knee Injuries knee is the most commonly injured joint Each year > 5.5 million Individuals visit orthopedic clinics for knee problems. Ranges from mild to severe Functionally limiting Pain or tenderness Causes of Knee Injuries Running too Hard too Much Training without Warm- up Blow, Kick or Punch Twist Improper Landing Compartment Syndrome Ongoing overuse (chronic) or one-time traumatic injury (acute compartment syndrome), such as: Fractured bone Hard blow to the thigh (or repeated hard blows) Occurs when muscles become swollen, and filled the compartment to capacity, causing damage to the muscles and interference with: Nerves Blood vessels. Achilles Tendon Injuries Stretch, tear, or irritation Tendonitis degenerative caused by aging*or overuse Rupture. Lateral View of the Ankle * Healthy and active lifestyle may delay soft tissues degeneration Shin Splints Definition: 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 Injuries Muscle sprains and strains Tears of the ligaments that hold joints together Tears of the tendons that support joints and allow them to move Dislocated joints Fractured bones, including vertebrae Hernias Fractures Broken bones Quick, Acute or one-time injury Repeated stress Simple and Clean break Compound Most acute fractures are emergencies Symptoms: Pain Tenderness Swelling Broken Arm Humerus Fracture Dislocations When bones that form a joint become separated Due to excessive force, stretching or falling Emergency situation Fractures and Dislocations Acute Versus Chronic Injuries Acute Injuries such as: sprained ankle, strained back fractured hand 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 Acute and Chronic Injuries? Chronic Injuries Result from Overuse When Injury Occurs STOP IMMEDIATELY When to Seek Medical Attention? What Should We Do in Severe pain, swelling, or numbness Case of an Injury? Can't tolerate any weight on that area Pain or dull ache of an old injury that is accompanied by increased: swelling joint abnormality instability. Managing Injuries at Home Follow “RICE” for 48 hours • R I •How Are Sport Injuries est ce (for maximum 48 hours, no more than 10 times/day 20-30 minutes each) C •Treated? • E ompression (should be performed by skilled individuals only) levation (slightly above the level of heart) If pain or other symptoms worsen check with your healthcare provider • • • • • • How Are Sport Injuries Treated? Start with “RICE” Immediate Immobilization Surgery None Steroidal Anti-Inflammatory Drugs (NSAIDs) Rehabilitation: • • • • Gradual Exercise Early Mobilization Avoid Pain Avoid Re-injury Other Therapies include: • Electrostimulation (reduces pain, swelling, functionality, and produce passive muscle contraction - not recommended in the first 72 hours) • • Cryotherapy Thermotherapy (enhances and speeds up the healing process not recommended in the first 72 hours) • • Ultrasound (not recommended in the first 72 hours) Massage (not recommended in the first 72 hours) High Risk Individuals (Vulnerable Groups) Children and Adolescents Bones, Muscles Tendons and Ligaments still Growing Neck, Spinal Cord and Growth Plates (contact Sports) Middle Aged Martial Artists Aging (physical activity and some medical and food Individuals and Groups at High supplements* Risk for Sport Injuries may delay the progress of arthritis) Moving too Quickly to Active Lifestyle Women (High Prevalence of Osteoporosis among inactive women who are not on Calcium supplements) Conditioning Levels Structural Differences Hormonal Levels * NSADs, Glucosamine and Chondroitin may play a role in slowing the progress of arthritis Preventing (Sports) Martial Arts Injuries • • • • • • • • • • • • • Do Warm-up Exercises. Don't Overdo Accept Your Body Limit Modify Activities as Needed Increase the Emphasis on Conditioning Maintain “Normal” Body Weight (some cushion could be helpful) Avoid Twisting Knees by keeping feet as flat as possible during stretches. When Jumping, Land with your knees bent Wear Protective Gear Use Soft Exercise Surface Increase Your Exercise Level Gradually Avoid Excessive Activities Strive for A Total Body Workout (Cardio, Strength and Flexibility) How Can We Prevent Sport Injuries? Hernias Hernias of the abdominal wall must be considered in patients who present with abdominal or groin pain Inguinal hernia pain can be confused with pain due to chronic muscular-skeletal conditions encountered in a variety of sporting activities, especially Martial Arts and Weight Lifting Herniated (prolapsed) inter- vertebral discs is extremely common among over-achiever martial artists Recent Advances Arthroscopy Tiny Incisions (less trauma, swelling and scaring) Diagnostic Tool Treatment Tool (torn meniscusAdvances or ligament) What Are Some Recent Better Healing in Treating Sports Injuries? Tissue Engineering Cartilage Transplanting Improve Healing Targeted Pain Relief Patches I/Azzam - 2004