Recurring injuries and long term injury management.

Robert Barton 

There is within the general athletic and martial arts communities a not uncommon problem with recurring injuries. We have all seen this type of situation and we have known people with this problem and we have perhaps been the person with these injuries. We are going to look at the two most common causes for this phenomenon with an eye toward prevention and management. By examining this issue closely and educating ourselves as instructors we can reduce the occurrence of repetitive injuries in ourselves and in our students.

Our first common cause for recurring injury is poor injury management in which a person never completely recovers from or rehabilitates an injury. The result of this is that the person returns to training or full activity levels with a weakened system which cannot handle the stress and so is injured again in the same way. We want to look at a few simple things that we as instructors can do in order to minimize this. 

First and foremost in managing any injury is proper medical treatment by a medical professional. Often a regime of physical therapy is prescribed in order to return the injured body part to full strength and function. Other treatments may be required. Ignoring an injury until the pain goes away or just ignoring the pain is never a treatment and is actually very damaging and will compound an injury. We as instructors should be willing to recommend that our student see a doctor. If we as instructors believe that an injury is not being cared for properly we can simply tell the student that they need a release from a doctor to resume training.

In martial arts as with any extremely physical activity there are going to be minor pains, bumps and bruises. There are going to be times when an injury seems minor and for which a student does not seem to need or does not seek medical attention. As instructors we should never suggest that a student not see a doctor for even a minor complaint. No matter how minor the complaint we cannot ethically suggest that a student not worry about it or not see someone. To tell a student that something is minor and doesn’t need attention can actually be breaking the law and can open the instructor up to liability issues.

If a student decides that medical care is not required and that the injury is too minor for a doctor and we are comfortable as the instructor with that choice there are still some things that we should do. We should make sure that first aid is done for the injury. We should also make sure that the student takes reasonable care of the injury by taking it easy and letting the injury heal. Then the student should only do simple stretching and range of motion exercises with no training for strength or speed. The progression back to full training should be managed carefully.

We should maintain a rule of thumb that says that when the initial pain has subsided the injury should be considered 25% healed and that amount of time should be noted.  This will help us to avoid the problem of a student throwing the injured body part back into full training as soon as the pain stops but the healing a rehabilitation process has not finished. At this time the student should only be allowed to train at 25% intensity for strength and speed and should focus on exercises designed to develop the injured area.  After the noted amount of time for the pain to stop has doubled the student should have only worked back to a 50% intensity level and should still be doing some dedicated exercises for the injured area. After the noted amount of time has tripled the student should have worked up to 75% intensity in training and should still be doing some specifically beneficial exercises. Only after the original time has quadrupled should a student be considering returning to full intensity in training the injured area. If at any tie during this process a further irritation of the site is noted the intensity should be lowered and the allotted time for returning to full intensity increased. In short, if it takes two weeks for the immediate trauma related pain of an injury to subside then the student should not be allowed to attempt a return to the full intensity of training for a minimum of eight weeks. By following this formula we can often prevent injuries from recurring.

The second common cause for these recurrent injuries is the making of mistakes in movement and training. The mistake or similar mistakes keep being made by the student and this mistake is occasionally resulting in the same or similar injury. These mistakes can be difficult to for the student to change because they are often long practiced habits of motion which have become ingrained.  The movements associated with the problematic injury should be closely examined by the instructor in order to assess what may be improved or altered in order to move in a safer and more effective fashion.

            When a movement is identified as needing improvement this should be done in a positive and building fashion always working toward the goal and not dwelling on the problem. The mental approach here is not one of trying to unlearn something which is basically an impossible task and certainly an ineffective mental approach. A proper mental approach in this situation is one in which the student learns a new way of doing something and then he or she has another better option and chooses that option. The student receives positive instruction and is able to maintain a more positive attitude toward problem solving.

            We have some standard tools for working on this process. Slow motion practice of a movement or technique can be an excellent method because it takes the stress out of the technique and allows the student to safely and calmly learn a new approach. Breaking the motion don into component parts and building the new technique in the same way that a new student is taught to build complex moves is another great exercise for learning to replace a flawed movement with a better movement.  Careful visualization of the new technique can also be a great help. An instructor can also use the tendency of the human mind to mirror in order to help the student by performing the improved or altered movement along with the student.

            The standard rule of thumb for injury management given in our first treatment and prevention of recurring injury can be combined with our second treatment in a very beneficial way. We can assess the causes of the initial injury and find out why and how it happened in doing this we can find out if there is a movement mistake being made. If we find a movement mistake which needs to be adjusted then we can use the time controlled process to teach the proper movement. We can start of by using the proper movement in slow motion as part of our specialized exercises to address and strengthen the injured area. As the percentage of intensity and healing increases we can increase the intensity with which the newer movement is being practiced and so it remains as part of the rehabilitation process. Once the student is back to training at full intensity the injury will have been properly managed and rehabilitated with the added benefit of the newer movement or corrected technique having become ingrained and worked into the overall movement patterns of the student. If this approach is incorporated into the earlier scenario the student will have had six weeks of learning the proper way to do the technique along with enough time to properly return the injured area to full function.

            Prevention of injury is the first and best method for insuring that our students do not suffer from recurring injuries. This means that we should have good safety policies in place. Students should be properly stretched and warmed up and warmed down as part of regular training. As instructors we need to pay very close attention to form and movement especially when a new technique is being learned. The more time that we take in teaching a new technique the better the technique will be. When we break a technique down into component movements we arte better able to make sure that the student has it properly. Slowing a technique down and allow the student to fully assimilate the proper movement before we speed it up also insures that a technique is more fully understood by the student. As always this comes down to a sound teaching philosophy in which our priorities as we teach should first be the well being of our students and second the proper continuation of our art. 

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