Questions and Answers on Sports Injuries (continued)

by Thomas Kurz

Information on this Web page is for educational use only, and is not intended as medical advice.
Every attempt has been made for accuracy, but none is guaranteed. If you have any serious health concerns, you should always check with your health care practitioner before treating yourself or others.
Always consult a physician before beginning or changing any fitness program.

In this article I continue answering typical questions on sports injuries, their causes and treatments.

Question: I am 35 and have been involved in Taekwondo for several months now. It seems that I am constantly pulling my muscles.

I was a high school athlete (track and field, basketball) and I still like playing basketball with my kids. I am pulling muscles that I have never had any problems with before. I am very careful to ensure a proper warm-up, always stretching, and loosening up. I have popped my calf doing a roundhouse kick, pulled the upper part of the hamstring and muscles in the knee doing an ax kick.

At first I thought it was because TKD is very rigorous, especially at my age. But I do walk to and from work every day. From my train to the office it’s approximately 1 mile each way across the Chicago loop. I average 8–10 miles a week just walking.

I would appreciate it if you could make some recommendations. I thought I should add running a couple days in my routine to build more muscle.

Answer: You have inadequate physical preparation for Taekwondo training. If you run another 10 miles per week in addition to your walking then maybe in a few months you will be in the adequate shape to begin Taekwondo training.

Overuse or gradual onset injuries are caused by increasing the frequency of workouts with “normal” loads, excessive increase of training loads at a “normal” frequency of workouts, or by excessive loads at increased frequency (Peterson and Renström 1986). Mechanisms of developing gradual onset injuries are explained in the previous (tenth) article of this column.

What load is normal and what is excessive, as well as what is a normal frequency of workouts, depends on the athlete’s current shape. Effects of training done years or even a few months ago are long gone from your body, so no matter what shape you were then, now you are out of shape because you were not training continuously through all those years.

You also write that you are “always stretching, and loosening up.” If by that you mean static stretching prior and between kicking, then no wonder you rip your muscles.

Question: When I get down as far as I can into the side split position, I feel a pain in my hip joints. I try to tilt my pelvis forward, though the tension of my hamstrings and other muscles may be limiting the tilt. In my previous training in Taekwondo, I was never able to achieve side splits due to chronic adductor and flexor strains (I never gave myself a chance to heal), although I could get into the front splits. Do you think that this joint pain is due to the fact that my hip joints are not used to this range of motion, or is it a structural limit?

Answer: Tension of the hamstrings should not limit the tilt of the pelvis. If it does, then it may mean that your hamstrings are short and weak. Do you do deep squats (feet flat, buttocks nearly touching the heels)? How much did you lift in a deep squat prior to this injury? If you could not do a minimum of 10 repetitions with the equivalent of your body weight on the bar, then I would suspect that you were too weak for reentering Taekwondo training. By the way, you may have heard the myth that deep squats destabilize the knees. It is not true. Deep squats with weights improve knee stability provided that the feet are placed so there is no lateral rotation in the knees (Tipton et al. 1975).

To check whether you have normal range of motion in your joints and to treat your past chronic injuries, as well as to find out the source of your problem with hamstrings, see a physician specializing in Applied Kinesiology.

You can find an AK specialist near you at www.icakusa.com.

If you have a choice, go to those doctors who are Diplomates of the International College of Applied Kinesiology and have the initials DIBAK after their names.

Question: I have ordered your book and all your reports. I can’t tell you how much flexibility I’ve gained from the information learned from you.

I have a problem with my ham-glute tie-ins. When I stretch my left hamstring, I get a sharp, intense pain that sort of surrounds my upper left leg where it meets the hip. The only way to consistently reproduce the pain is to lie on my back, straighten my leg and attempt to bring it toward my chest.

The problem started on my left side (and is worse on this side), but has spread mildly to my right side. I first noticed it about 4 months ago. At that point, I was only doing lying leg curls for my hams (usually about 8 sets). For quads, I was doing 12 sets consisting of leg press, hack squats, and either power squats (vertical squat machine) or leg extensions. I have been doing dynamic stretching first thing in the morning. My isometric stretching was done on leg day and 3 days later if I was recuperated (if not, I delayed it). As my injury started to worsen and [pain] spread to my right side, I started doing standing single leg curls and stiff-leg deadlifts to try and correct the injury. I also increased the volume of my hamstring training under the theory that my hams were too weak in comparison to my quads. In addition, I started a fairly aggressive stretching regimen to help remedy the situation. It has been about six weeks since I made these changes. At this point, I have seen very slight improvement.

I train legs every 6 days and I am on a solid mass-gain diet averaging about 4000 cal/day with 1.75 grams of protein/lb. of body weight and 5-6 tablespoons of EFAs (Udo’s Choice and Flaxseed oil) daily so recovery shouldn’t be an issue.

My question is this. Where do I go from here? I have started sprinting 2–3 times per week (actually, its hard to call it sprinting because of the pain, I can’t really sprint that hard). I am doing dynamic stretching first thing in the morning and before I lift in the afternoon. I have also started static lunges on my hamstring day (in other words, I place my foot on a bench holding dumbbells in my hands and do lunges without my foot leaving the bench).

Answer: It is true that an imbalance of strength increases risk of injury—for example, Orchard et al. (1997) showed that a hamstring-to-quadriceps strength ratio less than 61% measured isokinetically at 60 degrees per second, as well as an imbalance of the strength of the right and left hamstrings greater than 8% predisposes one to hamstring strains. You already have strained your hamstring, however, and it is too late for prevention. Now you have to let it heal first and then slowly rehabilitate it.

I think that sprinting and any other intensive efforts may only prevent healing of your injury. The same goes for leg curls. If you continue activities that overstress the involved muscles you continue to rupture some of their muscle fibers and tendon fibers, preventing them from healing properly. (With proper healing the scar tissue is extensible rather than rigid and less likely to be reinjured.) The spread of pain from your left hip to the right side is likely caused by general inflammation, which may weaken your other muscles to the point of tearing, or it may affect your joints.

If I were you, I would let the injury heal first and then use primarily squats (no hack, no machines) and deadlifts to strengthen the legs. The rationale for not using machines is this: Most resistance machines offer either isolated exercises (knee extension, knee curl) or alter the natural path of movement in complex exercises.

The Smith machine forces you to move the bar on a straight line while your body is planted in one spot. This is not a natural movement pattern. In a natural squat the bar moves in an arc, more pronounced when you squat on the whole surface of the soles of your feet. The straight up and down movement of the bar while your feet are planted in a Smith machine squat produces excessive strain on the lower back and knees (Bompa and Cornacchia 1998).

The isolated exercises, such as leg extensions or leg curls, produce greater shearing forces within the moving joint than complex exercises such as squats, so leg extensions with less than 50° of knee flexion (meaning at any angle greater than 50°), for example, can strain the anterior cruciate ligament of the knee. To produce similar shearing forces in a natural squat, you would need to flex your knees below 50°, practically sitting on your heels (Barrentine 1996).

Both squats and leg presses produce greater activity of the hamstring and gastrocnemius (calf muscle) throughout the majority of the movement than do knee extensions. Natural squats generate 20–50% more quadriceps activity, 65–140% more hamstring activity, and 15–35% more gastrocnemius activity than leg presses (Barrentine 1996).

To build useful strength of muscles and bones, do exercises that closely resemble the natural forms of human movements, such as squats, lunges, deadlifts, push-ups, presses, chin-ups, sit-ups, abdomen crunches, varieties of clean and jerk and snatch done with both arms and with one arm. In all those exercises your muscles work the way they do in your sport and in life.

Question: I have an injury in my hip joint and I am into Judo and wrestling. The injury is 7 years old and my doctor told me that an operation is not needed because it is just a small “empty space” in the bone. Sometimes after training I feel pain (but not a sharp pain) in this joint area. In your opinion, is it safe for me to do lower body stretching exercise and to attempt to do side/front split? Do you have any general recommendations for my overall training? (I am 26 years old, 6’1”,185 lb.)

Answer: I can’t possibly give you any recommendations regarding training because you have an orthopedic problem and I am not an orthopedic surgeon. Nevertheless, I can tell you what I would do in your situation. I would consult with the best orthopedic surgeon specializing in sports medicine, with experience in treating judoka and wrestlers, and perhaps with a doctor who specializes in applied kinesiology.

Dull, aching pains around a joint may very well be signs of grave damage because the joint cartilage has no pain receptors and what you feel may be general inflammation causing swelling of the tissues surrounding the joint while it eats away the cartilage of the joint surfaces. When the cartilage is gone, then you will feel sharp pain and you will need an artificial joint. Before that happens, if you do have an inflammation, it is very likely that you will irreparably tear tendons of the muscles moving the joint.

My hard-earned experience taught me to trust only doctors who know my sport (either did it competitively or are team doctors). It is incredible how few doctors in the U.S.A. have any clue about the demands of judo training. There are three types of wrestling in Olympics: freestyle, Greco-Roman, and judo—and most doctors still have no clue and think judo is some kind of a martial art with point sparring.

Question: The day before I injured my hamstring, I had stretched out with a friend. As a result, I felt very limber the next day during class. We started practicing double side-kicks and when I did the second part (higher) kick, my planted left leg’s hamstring made a gruesome noise. I’ve been limping since (2 weeks as of today).

In your opinion, how/why did this injury occur?

How can I tell if I ripped or merely pulled my hamstring?

Finally, have you come across anything that can aid in the recovery process?

Answer: Why did this injury occur? Its cause may have been overstretching the day before, wrong warm-up during the workout when the injury occurred, and also wrong training methods—especially strength training and flexibility training.

By stretching with a partner you went against the advice in my book Stretching Scientifically, so perhaps you did other things wrong too.

I know that intense static passive stretching decreases strength for up to an hour (Fowles and Sale 1997). I have witnessed poor saps who religiously performed static stretches before dynamic work only to rip the stretched muscles during kicking or other dynamic efforts. If you did static stretches in the warm-up prior to kicking, then I would suspect that they were the immediate cause of the muscle tear. If you did not stretch statically prior to kicking, then perhaps your stretching on the day before was so intense that you have either overstretched the structures of muscles or (less likely) deregulated their stretch receptors to such a degree that they were off the next day.

How to tell if the hamstring is ripped or merely pulled? By touch. If you can feel a hole in the muscle, then it is torn completely and you should see an orthopedic surgeon. If one spot is very tender but the muscle looks normal then the continuity of the muscle is preserved but the damage may still be extensive. If you do not obtain good help with rehabilitation this injury will keep recurring because of bad formation of scar tissue.

What can aid in the recovery process? Two weeks after a muscle strain is too late for minimizing the damage with supplements that reduce bleeding and speed up healing. It may be too late for surgery too—usually surgeons suture a torn muscle within two weeks of the injury because later the atrophy and shortening of the muscle makes it very difficult to join it back. But I advise finding a good orthopedic surgeon, experienced with sports injuries, and also an applied kinesiology specialist to help with rehabilitation.

In the next article you will learn about properly warming up for a workout so as to reduce the likelihood of injuries and to increase the effectiveness of your workout.

This article is based on the books Science of Sports Training, Stretching Scientifically and DVDs Power High Kicks With No Warm-Up! and Secrets of Stretching. Get them now and have all of the info—not just the crumbs!

References

Barrentine, S. W. 1996. The Biomechanics of Knee Exercises. Research Quarterly for Exercise and Sports vol. 67, no. 1 (March), Supplement, p. A-19.

Bompa, T. O. and L. J. Cornacchia. 1998. Serious Strength Training. Champaign, IL: Human Kinetics.

Fowles, J. R., and D. G. Sale. 1997. Time course of strength deficit after maximal passive stretch in humans. Medicine and Science in Sports and Exercise vol. 29, no. 5, Supplement abstract 155.

Kurz, T. 1990. Secrets of Stretching: Exercises for the Lower Body. Island Pond, VT: Stadion Publishing Co., Inc.

Kurz, T. 1994. Stretching Scientifically: A Guide to Flexibility Training. Island Pond, VT: Stadion Publishing Co., Inc.

Mierzejewski, M. 1996. Power High Kicks with No Warm-Up! Island Pond, VT: Stadion Publishing Co., Inc.

Orchard, J., J. Marsden, S. Lord, and D. Garlick. 1997. Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian footballers. American Journal of Sports Medicine vol. 25, no. 1 (Jan-Feb), pp. 81–85.

Peterson, L., and P. Renström. 1986. Sports Injuries: Their prevention and treatment. St. Louis: Year Book Medical Publishers Inc. imprint of Mosby-Year Book, Inc.

Tipton, C. M., R. D. Matthes, J. A. Maynard, and R. A. Carey. 1975. The influence of physical activity on ligaments and tendons. Medicine and Science in Sports vol. 7, no. 3, pp. 165–175.