The lower extremity
injuries that most martial artists come across are not necessarily unique to
martial arts. They range from the
same types of tendinitis', 'pulled groins' and 'tweaking knees" that we hear
about from our parents playing a game of tennis or golf. But the fact is, that the commitment to
the training offers so many benefits that it is worth taking the risk of
incurring these injuries, especially if you have the tools to prevent
them. In the second part of this
topic we will address the lower extremities. I picked the common ones that I run across as an instructor
and feel can be prevented with simple exercises. Try some of them out after your training - give yourself 10
minutes to explore them and make them part of your routine.
KNEE - TENDINITIS : LATERAL AND ANTERIOR
There are numerous ways
in which the knee is placed under stress in the martial arts. I will address two different types of
knee injuries. However, it is
important to identify the common ways in which constant strain is placed on the
knee (which may lead to chronic injuries). For the martial artist, kicking is a critical aspect of
training. Upon analyzing the basic
kicks, we can identify that there are the chamber-extension-chamber
movements. It is the extension of
the kick that often leads to tendinitis and other chronic pains. This can be caused by hypertension of
the knee joint. Definitely experienced by beginners and when a partner is
holding your pads or targets in the wrong place. Hypertension of
the knee causes strain to the posterior capsule (back of the knee), the
patellar tendons, as well as compression of the patella (or kneecap). It is this type of misuse of the knee
that is usually presented as anterior (front - top or front bottom area) knee
IDENTIFICATION OF PATELLAR FEMORAL DISCOMFORT OR
TENDINITIS (ANTERIOR PAIN)
Weak quadriceps can lead
to many different types of problems.
When this type of weakness is coupled with hypertension of the knee it
can lead to pain or discomfort around the anterior portion of the knee and
thigh (front). The discomfort felt
may range from a dull ache to a sharp pain around the knee cap. Because of the mechanics of a kick, the
knee is vulnerable to stress from long-term hyperextending of the knee, via the
chamber - extension - chamber steps of the kick. If the quadriceps are weak then it is difficult to learn to
control the extension of the kick without 'locking it or popping it out.' Furthermore, the condition can be
accelerated if a martial artist practices throughout their career without
shoes. The constant impact also
causes the knee to weaken. In
addition, chronic anterior tendinitis of the knee tends to be more common in
women and will develop sooner, than in men, especially if the quadriceps and
hamstrings are weak.
is a condition that is chronic and therefore is developed over time. Improper training, technical errors in
a sport, unsupportive footwear and neglect to ice and rest when discomfort is
felt can lead to many different chronic joint problems, whether it be
tendinitis of the knee, ankle or hip.
It is critical to acknowledge when your knees appear to be swollen or
ache (dull pain) after training. '
RICE is the most effective
method of immediate care. As with
most injuries, it is critical to seek the care of a physician.
Lunges are an important
exercise to enhance quadriceps strength.
un-contraindicated stretching should always accompany training. Lots of dynamic stretching.
exercises on a BOSU or balance board works wonders in increasing overall knee
joint strength. Anything from:
standing one leg, squats, leg lifts, lunges and even slow kicks will create a
stronger connection between every joint in the leg.
IDENTIFICATION OF LATERAL KNEE DISCOMFORT: IT
BAND (ILIOTIBIAL BAND ) STRAIN OR
A LIGAMENT SPRAIN
When discomfort is felt
on the side of the knee (lateral region) it could be either an IT band strain
or a ligament sprain. With
ligament sprains, the discomfort will range from instability of the inside of
the knee which will easily be identified through pain when engaged in lateral
movement (side to side: i.e. shuffling), to a sharp shooting pain along the
side of the knee.
On the other hand, an IT
band strain is a more difficult injury to identify. Usually, it is identified by ruling out most other knee
injuries. However, when severe,
the pain will surface itself in the hip.
Since the IT band attaches in the hip, sharp pain may be present.
These types of injuries
are common from sparring. For
example, while sliding in on your opponent with a side kick and the weight of
your body does not follow the movement of the kick. Or years of kicking without pivoting.
As with all other
conditions RICE must be followed.
Any ligament or IT band damage will require a doctor's referral for
physical therapy. Strength
training will be an integral part of recovery.
TREATMENT AND STRENGTH
- lying on your side while lifting leg
is the first step in strengthening the
ligaments that support the knee.
the multi-hip machine often found in a gym can be used for many leg lifting
exercises on your side.
IT Band Strain
that are best for functional reeducation of the muscle require a physical therapist.
your IT band on a foam roller.
The hamstring strain is
located in the group of muscles on the back side of the thigh. The hamstring runs from behind the knee
to the base of the buttock.
Hamstring strains are small tears to the muscle. As with other strains or sprains there
are three grades of severity. This
common injury most often occurs from an improper warm-up. Many school do not warm-up the muscles
before stretching or kicking. The
warm-up phase is different than the sit a stretch. The warm-up would involve any consecutive movement for 6-10
minutes which elevates the heart rate and heats the muscles safely allowing laxity
or stretching to occur. Ideally
dynamic stretching occurs before any deep static stretching. Strains are often overlooked as normal
onset muscle soreness from a tough workout.
Aside from severe tightening of the
muscle which is often described as pain, a strain could also cause
discoloration. The three grades
are as follows:
I: Minimal microscopic
trauma (tears) to the muscle (hamstrings), with minimal swelling,
discoloration, a minimal loss of function, and discomfort commonly occurring
from a poor warm-up and stretch phase .
With a grade I strain, a burning sensation will often be felt during
stretching, which is the most common symptom.
or bruising is more prevalent at this level of severity. Macroscopic tears, possible
discoloration, slight swelling, some loss of function and sharp pain is
level of discoloration is higher and a divot can be felt on the back of the
thigh along the muscle fibers.
This divot will feel like a
hole in the muscle. Severe pain
and discomfort will follow along with loss of function.
Rest, ice, compression
and elevation is the best form of treatment. Also, seek the care of a physician so that the grade of
sprain can be determined and the proper therapy can be prescribed.
Hamstring curls are the
best form of strengthening. This
can be done standing or lying on your stomach . Most gyms have one type of
hamstring curl machine.
A thorough warm-up preceding
stretching, kicking, sparring, stance work or forms is the best preventive
Even split squats,
lunges or walking lunges strengthens the entire leg to help ensure a stronger
leg. This is an ideal exercise for
preventing all of these injuries.
The ankle sprain is a
common injury in all sports. For
martial artists , it is commonly acquired while sparring or during
calisthenics. A sprain indicates
that there are small tears in the ligaments surrounding the ankle wall. Usually the sprain comes from 'rolling
the ankle' or causing the ankle to invert (inward roll). Because this type of injury is so
common, it is important to strengthen the ankle regularly. This could prevent a sprain or an ankle
roll from occurring at the grade II or III level (see below). The lack of supportive footwear in
martial arts training places the martial artist's ankle in a susceptible
The ankle sprain is easy
to identify following an ankle roll.
When the ankle has suffered a sprain it is important to note that there
are three different grades of severity.
All sprain will have swelling surrounding the ankle bone (lateral
malleolus), some discoloration and loss of function. However, Mrs. Lynn Grossman points out that the amount of
swelling and discoloration is not directly related to the severity of sprain.
I: Microscopic tears to one or more
ligaments, with possible swelling and soreness is present. An individual with a grade I sprain may
be able to handle a weight bearing stance.
tears to one or more ligaments is present. Swelling and discoloration may be present to the outside of
the foot, toes or lower leg. The
athlete may have difficulty walking - crutches may be needed.
is a complete ligament rupture at this level of severity. It is important to note that although
there are three major ligaments possibly involved, each ligament could have
their own grade of severity. With
a grade III sprain, there is complete loss of function. However, the nerve endings are often
ruptured which can prevent severe pain from being felt. Instability on the other hand will be
present. The athlete will usually
hear or feel one or more "pops" or "snaps."
Rest, ice, compression
and elevation is the best form of treatment. Also seek the care of a physician so that the grade of
sprain can be determined and the proper therapy can be prescribed.
Basic calf raises are
useful for strengthening lower leg musculature and the ankle wall. These can also be done on a single leg.
The use of a rocker or
wobble board is one of the most useful tools for martial artists (see
photos). This inexpensive piece of
equipment ( from $50.00 - $100.00) can fit in any closet. The best exercises to
begin with are:
balance/single foot balance/single foot balance with leg chambered/single
foot balance with eyes closed
Walking forward and
backwards on a balance beam.