Ihsan Antoine Azzam , MD, MPH June 24, 2005

1. Sport InjuriesIn the Martial ArtsTreatment and Prevention Ihsan Antoine Azzam , MD, MPH June 24, 2005

2. 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

3. 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

4. “Injuries that most commonly occur during sports or exercise.” Sports Injuries - Definition What Are Sports Injuries? Could be due to: • Unintentional accidents • Poor training practices • Improper equipment • Lack of conditioning • Insufficient or inadequate warm-up and stretching • Could Involve: • Muscles • Bones • Associated tissues: • Ligaments • Tendons • Cartilage • Any part of the body

5. Sprains and Strains • Joint Sprain:Stretch or tear of a ligament (the band of tough soft tissues that connects bones to bones) • Caused by trauma • Most vulnerable to sprains are: • Ankles • Knees • Wrists Signs include: • Tenderness or pain • Bruising • Inflammation • Swelling • inability to move a limb or joint • joint 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 • May result from over-stretching or over-contraction • Most vulnerable to sprains are: • Ankles • Knees • Wrists • Signs include: • Pain • Muscle Spasm • Loss of Muscle Strength • Swelling

7. 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

8. Causes of Knee Injuries • Running too Hard too Much • Training without Warm- up • Blow, Kick or Punch • Twist • Improper Landing

9. Compartment Syndrome Ongoing overuse (chronic)or one-timetraumatic injury (acute compartment syndrome),such as: • Fractured bone • Hard blow to the thigh (or repeated hard blows) Occurswhen muscles become swollen, and filled the compartment to capacity, causing damage to the muscles and interference with: • Nerves • Blood vessels.

10. 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

11. 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

12. Additional Images of the Knee Joint

13. 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

14. 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

15. Dislocations • When bones that form a joint become separated • Due to excessive force, stretching or falling • Emergency situation

16. Fractures and Dislocations

17. Acute Versus Chronic Injuries • 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 Acute Injuries such as: • sprained ankle, • strained back • fractured hand Chronic Injuries Result from Overuse What's the Difference Between Acute and Chronic Injuries?

18. STOP IMMEDIATELY When Injury Occurs • Severe pain, swelling,or numbness • 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. When to Seek Medical Attention? What Should We Do in Case of an Injury?

19. Managing Injuries at Home Follow “RICE” for 48 hours • Rest • Ice (for maximum 48 hours, no more than 10 times/day 20-30 minutes each) • Compression (should be performed by skilled individuals only) • Elevation (slightly above the level of heart) If pain or other symptoms worsen check with your healthcare provider How Are Sport Injuries Treated?

20. 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)

21. 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 supplements* 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 Individuals and Groups at High Risk for Sport Injuries * NSADs, Glucosamine and Chondroitin may play a role in slowing the progress of arthritis

22. 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?

23. 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

24. Recent Advances • Arthroscopy • Tiny Incisions (less trauma, swelling and scaring) • Diagnostic Tool • Treatment Tool (torn meniscus or ligament) • Better Healing • Tissue Engineering • Cartilage Transplanting • Improve Healing • Targeted Pain Relief • Patches What Are Some Recent Advances in Treating Sports Injuries?

25. Thank you Questions I/Azzam - 2004