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 pain.
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.
‘Tendinitis 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.
PREVENTION AND STRENGTH TRAINING
• Lunges are an important exercise to enhance quadriceps strength.
• Thorough un-contraindicated stretching should always accompany training. Lots of dynamic stretching.
• Doing balancing 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 TRAINING
• Ligament Sprains
– 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
– The exercises that are best for functional reeducation of the muscle require a physical therapist.
– Rolling out 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:
GRADE 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.
GRADE II: Discoloration or bruising is more prevalent at this level of severity. Macroscopic tears, possible discoloration, slight swelling, some loss of function and sharp pain is present.
GRADE III: The 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.
PREVENTION AND STRENGTHENING
• 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 measure.
•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 position.
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.
GRADE 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.
GRADE II: Macroscopic 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.
GRADE III: There 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.
STRENGTHENING AND PREVENTION
• 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:
-two-foot balance/single foot balance/single foot balance with leg chambered/single foot balance with eyes closed
Walking forward and backwards on a balance beam.