Physical Therapy: Martial Art Injuries

The morbidity of injury in martial arts is pretty high, higher than actually getting injured in a self defense situation (which many martial artists claim to train for). Soft tissue damage seems the most consistent injury in martial arts. At the beginner and amateur level, the most common injuries are sprains and strains, while at the veteran and professional level you see fractures and joint dysfunction. For today I'm going to discuss three common joint dysfunctions and the physical therapy stretches and exercises to treat them.

Rotator Cuff

What is it: The rotator cuff is a group of muscles, bones and tendons that make up the shoulder joint and rotate the arm inward or outwardly and stabilize the arm. The bones consist of the clavicle, scapula, and the humerus head. The muscles involved are the suprapinatus, infraspinatus, teres minor, and subscapularis (SITS).

The Injury: The most common injuries are bursitis, which is inflammation of the bursa (the gel sac that surrounds the head of the humerus at the glenohumeral joint), tendonitis, which is inflammation of the muscle tendons, and strains and tears. If tendonitis is left untreated, the muscle tendons weaken and become more susceptible to strain or tear. The most common muscle that strains is the suprapinatus, which runs under the acromium of the scapula and inserts on the greater tuberosity of the humerus. The injury I'll look at is a muscle strain or tear.

Diagnosis:
 

Stretches:




Walking Wall Stretch, Can stretch (external rotation), Towel stretch


Exercises:
Subscapularis



Infraspinatus



Supraspinatus
 




Patellar Tendinitis

What is it?: Commonly known as Jumper's knee or Sinding-Larsen-Johansen disease, is pain located on the anterior proximal origin of the patellar tendon on the patella.

The Injury: It is caused by overuse of the extensors muscles at the knee joint (the quadriceps femoris: rectus femoris, vastus medialis, vastus lateralis, vastus intermedius). Overuse leads to edema in the patellar tendon, which leads to further weakening of the tendon and increased tearing and degeneration of the tendon.

Diagnosis:


Stretches: Quadriceps stretches, standing, kneeling, prone variations

Exercises : The key is the strengthen the quadriceps muscle with a heavy emphasis on eccentric loading. Eccentric is when the muscle lengthens under tension, commonly known as the negative rep to many body builders. Studies suggest that eccentric exercise is the best  tissue remodeling which is perfect for rehabilitation.

Eccentric squat on decline


Eccentric single leg raise


Step up



Achilles Tendinitis

What is it: The Achilles tendon is the joining of the gastrocnemius muscle and soleus muscle that attaches onto the calcaneus or the heel bone.

The injury: The tendon heals slowly as it is does not get very good blood supply, as such microtears in the the tendon can accumulate, inflammation occurs, scar tissue or cross fibers adhesion occurs, further increasing the likelihood of tears.

Diagnosis: An example of a test to check for a complete achilles tendon tear.


Stretches:

1. The gastrocnemius stretch; 2. The soleus strech, similar to 1. but with knees bent to deactivate the gastrocnemius.


Exercises: