Injury Prevention for Old and New Warriors Colin Power

No matter what the reason we train in martial arts we can all agree that an injury slows us down. Injury prevention is at the heart of survival if you wish to keep up with the pack and not be left behind to fend for yourself. Contrary to popular belief the ‘lone wolf’ is usually at the end of the cycle and isn’t in any good shape to keep going for much longer. So how do we reduce our injury risk and keep going to fight another day.

Our training sessions whether they are in a supervised class or at home should be structured to provide the most benefit with the lowest risk of significant injury. The odd bump or scratch should be considered minor injuries, something that you could train with but a sprained joint, muscle / ligament tear or fracture should be considered major. We all have stories of ‘back in the old days’ we had blood on the floor at every training session and everyone nowadays are just soft. To that I say have a look around you and see if those blood hardened warriors are still attending regular training sessions 30, 40, 50 years down the track. If they are they most likely wised up and learned to train with more respect for their own bodies and their training partners. My father would say that he wanted to ‘die young and leave a good looking corpse’ and we would respond with ‘you aren’t that good looking so you may as well keep living’. I will say the same thing to you ‘train hard but don’t smash your body so you can keep on training’.

The level of injury in martial arts is actually relatively low compared to other contact activities and even better if your martial art is a non-contact activity. Even better than boxing however not so good if you are doing professional level mixed martial arts competitions. Consider your risk aversion to injury before signing on to a martial art and choose the one that has injury reduction strategies even if you are happy to play rough.

Warm-up and cool-down to prevent injury

How protective against injury are warm-up and cool-down sessions in a structured training program. Most research seems to agree that a warm-up session may be a good injury prevention strategy and this is where the agreement ends because the amount of prevention varies greatly across sports and the type of warm-ups used.

The whole idea of a warm-up session is to bring your body temperature up to an ‘optimum’ level for the activity that you wish to perform. You can do this actively or passively. The active version being low to moderate intensity exercise and preferably specific not only to the martial art or sport but specific to the activity that is in the next part of the session. A passive warm-up is when you use heat to warm up the body like a hot shower or heated jacket / trousers. You can also use a combination of both whereas you would use exercise to warm up the body and heated clothing to maintain the body temperature whilst you wait to perform at a martial arts tournament or display. Research suggests that a warm-up session may be more beneficial for some sports such as sprinting. Passive warm-up using heated clothing has been

successful used in maintaining body heat in team sports such as football after an active session to increase body temperature.

Many people will throw in flexibility training into the warm-up program because they think that this will protect against injury. I am going to suggest that you think of flexibility as a strength component and if you fatigue a muscle the strength/flexibility will be reduced and this fatigue may lead to injury. Preferably leave your flexibility training to the end of the training session as part of the cool down or as a dedicated focus session that will not be followed by complex movements or new skill accusation. Flexibility is a complex topic and requires more discussion than we are going to provide in this article.

Warm-up sessions:

• Sport specific and specific to the activity that is to follow • Active / Passive to bring body temperature to optimum and Passive / Active to maintain • Athletes competing in sprint and sustained high-intensity events seem the most likely beneficiaries of elevations in body temperature • Considered as only part of injury prevention strategy

Traditional martial arts Vs Modern martial arts

Recent research suggests that a 4wk session of Traditional martial arts can improve balance performance in Modern martial artists. It was found that doing a traditional form exercise that moves the ankle, knee and hip through large natural range of motion was able to increase balance performance in a group of young female martial artists that practice modern martial arts. Doing traditional forms seems to enhance balance and proprioception in young martial artists who practice non-form based modern martial arts. Balance and proprioception has previously been studied in the elderly population doing traditional forms such as Taijiquan to good effect and it is excellent to see that the younger population can benefit from traditional form exercises.

• Traditional forms should be included in your injury prevention strategy

Keeping with the theme of Traditional Vs Modern martial arts if we delve into what other activities that are associated with the Traditional styles that may not be included in the modern schools you may think of breathing patterns and mindfulness practices. Normal breathing mechanics play a key role in posture and spinal stabilisation. Breathing Pattern Disorders have been shown to contribute to pain and motor control deficits, which can result in dysfunctional movement patterns. Breath work is very important and often overlooked in many sports and martial arts. Many think of breathing techniques in a mindfulness practice but few of use would think of it affecting our movement patterns and potential injury risk.

Another study has looked at Biofeedback in an elite group of soccer players and found it not only assisted with peak performance but also injury prevention. They combined the use of a biofeedback devise using heart rate variability training and diaphragmatic breathing techniques as part of performance enhancement and injury prevention strategy. As many Traditional martial arts have combined breathing techniques and mindfulness practices it seems that they can be included as an effective injury prevention strategy.

Muscle balance and muscle asymmetry

Strength imbalance of muscles around the knee joint has been shown to increase the risk of hamstring injury. So what does that mean to use?

You will often see injuries in sportspeople when they have just returned after a previous injury and there can be many reasons for this but one of them can be that during rehabilitation they have been concentrating on one group of muscles (the injured muscle group) over another and have created a relative imbalance of muscle groups. The research around injury prevention is mainly about imbalances across a joint ( the quadriceps being strong and the hamstrings being weak) rather than one side of your body vs the other. If in your training you also concentrate on a particular group of muscles at the detriment of another group you may be increasing your injury risk. It is best to gradually build complexity in movement after injury so that all the muscle groups get to play their parts in a balanced way.

Most of use will have different muscle size from our dominant to non-dominant side and the body copes with this quite well. We are not symmetrical in design or function and our bodies have been adjusting for that our whole lives. It is when we have very large differences problems may arise. This imbalance/asymmetry may lead to movement dysfunction if we have large strength differences or poor movement control due to neuromuscular timing issues.

If I am training with dominant and non-dominant sided exercises I will train to my non-dominant sides strength level by doing the repetitions that I am capable of doing well with good form and then doing the same repetitions on my dominant side even though I could probably do more repetitions on my dominant stronger side. I am always going to be better on my dominant side however I am gradually improving my non-dominant side and attaining a degree of symmetry. It is easy to make your strong side even stronger and create a larger imbalance and this may lead to increased injury. Movement asymmetry has been shown to increase injury risk. This is why you should learn a new skill with your best side and then work on your non-dominant side once you are proficient. Gradually work on developing symmetry of movement knowing that you are not truly symmetrical.

I believe that traditional forms may have been designed to balance our physical body across muscle groups and this is why ‘unrealistic’ movements are found in forms and also why they should remain. Forms may be the fine tuning of the body and movement rather than teaching the best technique in a fight situation. Traditional forms work on balance and movement symmetry far better than you trying to come up with your own way to balance your body.

Core stability, bracing and hollowing

The “core” is a 3-dimensional space with muscular boundaries: diaphragm (superior), abdominal and oblique muscles (anterior-lateral), paraspinal and gluteal muscles (posterior), and pelvic floor and hip girdle (inferior). To date, there is no clear evidence that supports the relationship between poor core stability and musculoskeletal injury. We do know that people with lower back pain recruit core stability muscles differently but this may be a result after the injury rather than the reason for the injury. Some research does suggest that poor neuromuscular control of your core stabilisers could predispose you to injury. So it couldn’t hurt to improve your core stability but more research is required. I have many patients that are elite athletes that when assessed for core stability have large deficits in some of their stabilisers and we work on these to improve performance and as part of their injury prevention strategy.

Many movement coaches train you in abdominal hollowing, where you are drawing in your belly button towards your spine and then you perform your prescribed exercise in this hollowed position to improve your core. Others will have you brace your abdomen for core stability. Which is best for you?

The “Hollowers” will say they are correct and you are activating the deep stabilisers the “Bracers” will say they are activating the superficial stabilisers as well as the deep stabilisers…and I think they are both right at times. In traditional martial arts you will find training drills that require you to “Hollow” or fold slightly and other drills require abdominal bracing. I don’t believe you are meant to maintain a braced or hollowed position throughout but rather transition to the best stabilising position that suits the movement. You need to be able to hollow and to brace your torso at the appropriate time of a movement pattern.

Improving your core stabilisers and the ability to engage and release them is fundamental in efficient movement patterns. This ability will most likely reduce your injury risk at the same time as improving your performance. Sometimes a core stabiliser is strong and of the correct length (no need to stretch) but it may be over-active and is recruited at the wrong time of the movement pattern. The muscle that gives me trouble in this way is Psoas Major and most likely because I sit for too long with my job.

The Psoas Major is a muscle that connects many things…is joins the upper body with the lower, the outside to the inside, front to back and limb to spine. Muscles are often described as origin and insertion and you could say that this muscle originates from the spine and inserts to the front of the hip but muscles are far more complicated than that. This muscle will have associations with the diaphragm (affecting speech and singing) as well as associations with the pelvic floor and other muscles (iliacus) that it comes in contact with. The front (anterior) fibres function separately to the back (posterior) fibres due to the different nerves that innervate the muscle motor units. Thinking of your muscles as fibres and units of fibres that have relationships with other fibres that have an association with all different types of tissues is a complex and wonderful way to think about

ourselves. So complex that I find words fall short when trying to describe movement and so I ask myself what does that movement or posture feel like and then I create a memory of that feeling to reference later. Memory images of feelings is my reference library to better movement.

All sorts of problems can be associated with dysfunction of the Psoas Major however for me it is not a weakness of the muscle rather than it is over-active at times and will cause me pain at the front of the hip. I have found a number of different exercises useful for me that inhibit or down regulate my overexcited Psoas major portion (motor units). These may be fun for you to try also.

1. Assess your lumbar muscle relationship • Lay on your back on a firm surface, legs outstretched with head on the floor (no pillow). • Is your lower back arched off the floor or can it comfortably settle against the floor? • If you have a large arched lumbar region you may need to be assessed further 2. Psoas recovery position • Lay on your back with knees bend and feet on the floor, arms crossed over your torso. Your lower back should be able to flatten against the floor without strain • In this position you can also try rocking your pelvis forward to create a small arch of the lower back and then slowly rock your pelvis backwards as far as you can comfortably 3. Lying(supine) internal leg rotation • Lay on your back and rotate one leg inwards (firm contraction at end point — isometric) and hold for 3 seconds • Relax that leg and let it find its own position, pause for 3 seconds in relaxed position • Repeat 3 times on the same leg then perform on opposite leg 4. Lying(supine) external bent leg rotation • Lay on your back and slide one foot up your opposing leg at the same time bend your knee and let you leg rotate outwards • Keeping hips level contract your muscles to try and bring your knee closer to the floor, (firm contraction at end point — isometric) hold for 3 seconds • Relax and slide your foot back down your leg whilst trying to keep knee from coming up too high • Repeat 3 times on the one leg then perform on the opposite side

Exercises 3 & 4 should be done with firm contraction once you have reached the holding position and then slowly relaxed after the 3 count contraction and pause for 3 count before repeating. Take your time and don’t rush them using a natural breathing cycle. You can put yourself in the Psoas recovery position and chill out for a while and repeat if you wish. After you have done these exercises reassess your lumbar relationship by laying flat and see if your lower back is happier to lay flat against the floor.

What happens when things don’t go to plan

Injury can occur in many ways such as the sudden onset (acute) injury of an ankle sprain or that nagging pain (chronic) that has crept in over weeks, months or even years. Many people troll through google looking for answers for their health problems, sometimes they find the answer but often they don’t. I don’t mind people having a look for their own answers because I feel they are taking ownership of their problem and I listen to them when they tell me what helps and what does not. Best advise when you develop an injury is to seek help from a knowledgable health professional that listens.

The problem with most approaches to correcting postural dysfunction, muscle imbalance, core instability and musculoskeletal aches and pains is that prescribed exercises often help while you are doing them but when you stop the old physical habits creep back in. This is great for a health professional because we have a revolving door supply of patients getting better then coming back to us when it happens again and this is how mortgages get paid. If you don’t like this then you need to think differently. Your body is the worst nagging friend that you will ever have and it needs constant attention or it will go off and gets itself in trouble. Find yourself a movement practice (for me Taijiquan) that meets your bodies needs and do it…forever. You get no reward for…”I use to be fit and mobile when I was younger”. My clinic is full of people that tell me they were fit 20yrs ago…sorry but your body demands a more recent attentive approach to health and well being. You will not escape all the riggers of ageing but you may reduce some of those aches and pains.

Psoas Recovery Position

External bent leg rotation Internal leg rotation