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Joshua Shrum
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Martial Arts Preventative Health & Healing

This article covers some of the most common injuries martial artists encounter and how to prevent/heal them when they happen.

http://www.confessionsofablackbelt.com/#!Martial-Arts-Preventative-Healt...

Iain Abernethy
Iain Abernethy's picture

That’s a good article and a useful resource. Thank you for sharing.

All the best,

Iain

Tau
Tau's picture

Random comments:

First, thanks for posting. I think everyone on this forum has a professional approach to training so I think suggesting that we take a serious approach to risk  minimisation, injury prevention, warm up and first aid is probably a given. I hope all instructors on here have a first aid qualification. Other advice and input is a great thing so it's great that you've taken the time.

My understanding is that research is currently suggesting that stretching is best done at the end of training, not at the start. Some types of stretching may actually to detrimental to some activities. I welcome any input from anyone knowing more about this.

We don't (generally) advocate RICE anymore. Instead it's RIPE (substituting compression for Paracetamol.) Never use compression on acute ankle injuries as research shows it slows healing time and has no healing benefit.

You description of the boxer's fracture isn't correct, but is close enough for the advice to be useful.

Your description of the knee and knee injuries is grossly simplictic, sorry. Knee injuries can be very difficult to diagnose. You haven't taken account of the cruciates at all or the co-laterals sufficiently. These are both relatively common knee injuries, both acute and chronic.

And of course, if ever in doubt consult a qualified health care professional (again, a given I hope)

Shameless plug: Rosi Sexton, former Cage Warriors champion, Doctor of theoretical computer science, UFC fighter and osteopath is doing a combined injury prevention/ grappling seminar at my dojo on the 3rd of April.

Joshua Shrum
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Thanks Tau for the response! I agree in the regards that we all should take time to have at least a basic understanding of risk management, and injury prevention! For those instructors that are not first aid certified, this should always be a must. Not just from a injury management standpoint, but a liability standpoint!

Tau wrote:
My understanding is that research is currently suggesting that stretching is best done at the end of training, not at the start. Some types of stretching may actually to detrimental to some activities. I welcome any input from anyone knowing more about this.

This is partially true. Stretching and light movement has been proven to increase blood flow PRIOR to training to deliver more oxygen to the specific muscle group. I will however agree that if you were to stretch/exercise incorrectly it can be detrimental to the end goal. Stretching at the end of your particular activity helps muscles break up lactic acid quicker. That will in the end, help the muscle recover quicker to become stronger. You are right in the fact that stretching afterwards should always be a big part of your post-training.

Tau wrote:
We don't (generally) advocate RICE anymore. Instead it's RIPE (substituting compression for Paracetamol.) Never use compression on acute ankle injuries as research shows it slows healing time and has no healing benefit.

I will have to disagree with this one. The American Academy of Orthopedic Surgeons produce a book every year that is the 'gold standard' in emergency medicine. 'Emergency Care and Transportation of the SIck and Injured' is the book and guidelines used for Emergency Medical Technicians as well as Paramedics. According to their newest edition (10th) they state that for soft tissue injuries to use the acronym R.I.C.E.S. Rest, ice, compression, elevation, and splinting.

What you are referring to with your ankle is where most people use RICE incorrectly. You and I may know this, but most people think of it as a long term healing solution. Where it is actually inteded to be used short term until a more permanent medical treatment is given. An example of this would be someone simply rolling their ankle during sparring. The compression would be a wrap or ace bandage to support the ankle from rolling again, and begin compressing blood vessels to reduce swelling. However you would not keep it one for the entire day, because like you said that will not provide any long term healing benefit.

I will add though right now there is talk about changing RICE to either POLICE or METH (and not the drug haha!). POLICE is protection, optimal loading, ice, compression, and elevation. Where METH is movement, elevation, traction, and heat. The term/methodology METH was coined in 2012 by a Toronto trainer and physiologist John Paul Catanzaro. But because it is still relatively new and currently not the national standard yet I recommended RICE. Just a side note of information.

Tau wrote:
You description of the boxer's fracture isn't correct, but is close enough for the advice to be useful.

Your description of the knee and knee injuries is grossly simplictic, sorry. Knee injuries can be very difficult to diagnose. You haven't taken account of the cruciates at all or the co-laterals sufficiently. These are both relatively common knee injuries, both acute and chronic.

The boxers fracture can also be cause by punching something flat fisted (without an angle/tilted fist) or striking with most of the impact pressure on the last knuckle. You are correct about that, I thought I had put more in there and must have slipped. Knee injuries can be extremely difficult to diagnose and often require other parts of the body to be examined. If you have more personal information about those specific knee injuries, more information is always better.

Closing comments, as I am not a doctor it always best to seek medical attention when in doubt. As for myself, I grew up in a house of EMT's, Paramedics, and nurses. Besides 13 years of martial arts training and instruction, I have an EMT certification through the State of Indiana, National Registry Emergency Medical Technician Certification, Emergency Wilderness EMT Cert., and an active American Heart Association CPR and First Aid cert. Didn't want you thinking I was an average Joe!

Always great to discuss topics to better ourselves and each other!

Tau
Tau's picture

Joshua Shrum wrote:
I agree in the regards that we all should take time to have at least a basic understanding of risk management, and injury prevention! For those instructors that are not first aid certified, this should always be a must. Not just from a injury management standpoint, but a liability standpoint!

Yes, and this is a good point. Of course we must do right by our students but we must also protect ourselves.

I just did a google search for ankle injury treatment in order to answer a point below. The results page is littered with sites offering to help you seek compensation rather than advising on treatment!

Joshua Shrum wrote:
Stretching and light movement has been proven to increase blood flow PRIOR to training to deliver more oxygen to the specific muscle group. I will however agree that if you were to stretch/exercise incorrectly it can be detrimental to the end goal. Stretching at the end of your particular activity helps muscles break up lactic acid quicker. That will in the end, help the muscle recover quicker to become stronger. You are right in the fact that stretching afterwards should always be a big part of your post-training.

I need to look into this further, partly because I have students who are marathon runners. My understanding is that some types of stretching are detrimental to some activities. For example static stretching adversely affects the muscle fibres used in running.

Joshua Shrum wrote:
Tau wrote:
We don't (generally) advocate RICE anymore. Instead it's RIPE (substituting compression for Paracetamol.) Never use compression on acute ankle injuries as research shows it slows healing time and has no healing benefit.

I will have to disagree with this one. The American Academy of Orthopedic Surgeons produce a book every year that is the 'gold standard' in emergency medicine. 'Emergency Care and Transportation of the SIck and Injured' is the book and guidelines used for Emergency Medical Technicians as well as Paramedics. According to their newest edition (10th) they state that for soft tissue injuries to use the acronym R.I.C.E.S. Rest, ice, compression, elevation, and splinting.

And I disagree with your disagreement. Actually what I find interesting here is that in the 21st century we should have access to the best evidence internationally but clearly this still not the case.

We don’t advocate compression on ankles.

I just did a google search to justify this. The most recent American resource that I found (2012) said more research was needed as there was no clear evidence as to most effective treatment.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396304/

In Britain we refer to the National Institute for Clinical Excellence (NICE.) Their conclusion in 2015 is that indeed some types of compression are detrimental. But more research is needed

http://www.ncbi.nlm.nih.gov/pubmed/25649317

Joshua Shrum wrote:
The boxers fracture can also be cause by punching something flat fisted (without an angle/tilted fist) or striking with most of the impact pressure on the last knuckle.

A boxer’s fracture, by definition, is a punch injury, so longitudinal forces. This is why there is commonly dorsal angulation. In my experience, nearly all fractures from punching result in dorsal angulation They can be the metacarpal of the ring finger, little finger or both. We refer all of them to orthopaedics but very few need any treatment.

Knees… where to start? I have a routine for examining them but the exact sequence of that routine will very based on the mechanism of injury. The first step is understanding intracapsular vs extracapsular injuries.

Joshua Shrum wrote:
Didn't want you thinking I was an average Joe!

I never thought that at all.

Joshua Shrum wrote:
Always great to discuss topics to better ourselves and each other!

Yes. Hopefully this thread will be of benefit to the forum and its members.

Joshua Shrum
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I consulted with a few of my fellow friends and colleagues that range from doctor, nurse, martial artist, and an herbologist/holistic healer (discussion for another day!) and they all gave me the same or similar answers. They said that for an ankle sprain the best route would be to first elevate and remove all pressure from it immeadiately. They then went to say to stabilize it using either a compression or a sprint for no more than 4-6 hours. During that time period place ice in a bag or wrapped in a towel and do 15 minutes on/15 minutes off. Should mention that they said to take ibuprofen during this course. They said that after you rest (24hrs approx.) that you should wear not a compression wrap but a support brace of some sort to prevemt further injury and allow you to move on the foot for natural healing to begin.

Tau wrote:
We don't (generally) advocate RICE anymore. Instead it's RIPE (substituting compression for Paracetamol.) Never use compression on acute ankle injuries as research shows it slows healing time and has no healing benefit.

Kind of funny... when you read this I had to look up Paracetamol to see what it was. I didn't realize it was a tylenol/acetaminphen and thats the name used for it overseas. Here in the US, its more common to recieve ibuprofen. I did a little researching and found out some more about the two if you care to look at the relationship between injury and what medication to take. Or at least I find it interesting...

http://www.medicaldaily.com/ibuprofen-vs-acetaminophen-when-should-you-u...

http://www.bmj.com/content/350/bmj.h1225

Tau wrote:
Actually what I find interesting here is that in the 21st century we should have access to the best evidence internationally but clearly this still not the case.

I have to agree with you ten fold... I think it is amazing that we can disect a body, and break it down to a molecular level...yet we can't agree on a common method to treat a simple ankle sprain! You would think that we would want some sort of international standard... at least with medicine! But what do we know, as simple minded, humble martial artists! Haha

Joshua

Tau
Tau's picture

Joshua Shrum wrote:
I consulted with a few of my fellow friends and colleagues that range from doctor, nurse, martial artist, and an herbologist/holistic healer (discussion for another day!) and they all gave me the same or similar answers. They said that for an ankle sprain the best route would be to first elevate and remove all pressure from it immeadiately. They then went to say to stabilize it using either a compression or a sprint for no more than 4-6 hours.

Remove all pressure, then apply compression? OK.

There will be a difference in our management plans as we're different disciplines. It'll be me that requests the x-rays (if necessary) and makes the diagnosis and treatment plan. It's a slow change in treatment but we're tending to cast less for fractures these days, but more for grade III sprains. Bit of a reversal.

Joshua Shrum wrote:
During that time period place ice in a bag or wrapped in a towel and do 15 minutes on/15 minutes off. Should mention that they said to take ibuprofen during this course.

Ice yes. Definately. Although there's a school of thought that ice doesn't work in isolation. I know some professional sports coaches that advocate intermittent ice/heat. We're constantly learning. RIght now I advise ice. Next year I may not. And that's as it should be. Constant increased understanding. Was it last summer that a new ligament was found in the knee?

And Ibuoprofen... there's an issue. I'm currently doing my first Master's module which happens to be in prescribing. Ibuprofen is wonderful drug as long as you don't have any of the contra-indications and don't suffer too much from the side effects. We do advise it... but again the jury's out.

Joshua Shrum
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Tau wrote:

Remove all pressure, then apply compression? OK.

There will be a difference in our management plans as we're different disciplines. It'll be me that requests the x-rays (if necessary) and makes the diagnosis and treatment plan. It's a slow change in treatment but we're tending to cast less for fractures these days, but more for grade III sprains. Bit of a reversal.

When I said remove all pressure, I meant all lateral/vertical pressure to the bottom of the foot. Then apply compression around the ankle for mainly support. And our difference would be logical since we play the same game but are at different ends of the field.

Tau wrote:
Ice yes. Definately. Although there's a school of thought that ice doesn't work in isolation. I know some professional sports coaches that advocate intermittent ice/heat. We're constantly learning. RIght now I advise ice. Next year I may not. And that's as it should be. Constant increased understanding. Was it last summer that a new ligament was found in the knee?

Funny that you mention that because though our protocol states to give ice to reduce swelling, I would do it differently for myself. On my ankle injuries and sore shoulders I would immediately ice but after that first 15 minutes, I prefer to heat it. It feels better, but again thats not our standard procedure...just my personal preference.

Tau wrote:
And Ibuoprofen... there's an issue. I'm currently doing my first Master's module which happens to be in prescribing. Ibuprofen is wonderful drug as long as you don't have any of the contra-indications and don't suffer too much from the side effects. We do advise it... but again the jury's out.

Personally I like using Ibuprofen if possible. I feel that it does a better job, but it does have a decent list of other drugs to not be combined with. Good luck with your schooling... I have a good buddy that is also a student of mine who is a registered nurse. He is in school for his doctorate in emergency medicine, and when he took pharmacology I stole it for a glance. Much more than what I had to do and way about my head. Good luck!