This section will provide a basic overview of the most common combat arts injuries; clicking on the body part of concern in the table of content above will take you to an overview, the associated symptoms and potential causes. This content is designed to help provide a foundational understanding of the type of injury you are potentially suffering from to set the stage for a constructive conversation with your Healthcare Professional.
There are various moves that can cause ligaments to strain and tear. The lack of a proper warm up and stretching prior to training in combat arts can compound injuries. Ligaments are nothing but connective tissue made up of collagen fibers.
They connect bones together especially the joints. In full combat sparring, ligament injuries can present as a complete tear, a partial tear, a stretch injury, or a change in function due to an associated fracture. The injury could take place in isolation or it could be simultaneously involving the capsule of a joint, muscle, bone or cartilage.
How Ligament Injuries Occur
Trauma in contact sports is common. The knee is one of the commonly injured joints where ligaments are injured. The trauma to the joint can be so severe that it can disable a martial artist. Take for example, this black belt karate practitioner who after a swift-withdrawal of a reverse-roundhouse-kick tore his ACL.
Any overstretching of the joint can strain the attached ligaments and cause them to tear. A sudden twisting motion while pivoting on a foot can injure the anterior cruciate ligament in the knee. Or a violent tackle can tear the posterior cruciate ligament. Ligaments in the shoulder are injured due to repetitive injuries while ligaments in the wrist are injured due to the torque or a fall.
Injuries could result from the interstitial tearing of collagen fibers, partial tears that may extend to the surface and full thickness ligament ruptures. The laxity of the ligament is increased from its usual taut state. Occasionally, there is fluid around the ligament during the acute phase which leads to swelling. It may also be accompanied by bone contusions, fractures or joint effusion. If it’s not treated then it may heal may as a thick, weakened ligament prone to further or recurrent tearing.
Check out our Common Diagnosis Section to see how ligament injuries are diagnosed by doctors.
A stress fracture is a small break across a bone or severe bruising within a bone. These fatigue fractures usually develop in the normal bone when there is an abrupt increase in training patterns or physical activity. The body cannot adapt quickly enough to the corresponding activity.
This stresses the bone causing it to develop microfractures. Usually, there is a three-week lag until symptoms develop. The most common sites to develop stress fractures in decreasing order are metatarsals, tibia, tarsals, femur, fibula, followed by the pelvis. In full combat artists and contact sports, spondylosis is common where the hyperextension of the spine causes stress fractures in the vertebral column.
How Stress Fractures Occur
Stress fractures account for over 20% of all sports injuries. That’s how prevalent they are. Other factors also influence the development of stress fractures. Occasionally, the muscles get fatigued or lose mass and cannot attenuate the increased force being applied through the bones. Lower testosterone levels in males, estrogen in women, and Vitamin D deficiency can contribute to stress fractures especially those with restricted calorie diets. Over time, repetitive overuse causes a weak point to break.
A full fracture is a complete break or separation of the bone, there are several types of fracture / broken bones:
Fractures are widespread martial arts injuries, particularly in the full contact martial arts and fight events such as Krav Maga, Karate, Brazilian Jujitsu, MMA and UFC.
How Full Fractures Occur
Bones fracture occur when too much force is applied to a specific area. Examples include:
Learn more about how stress fractures are commonly diagnosed by browsing through Our Common Diagnosis Section.
A bone bruise shows damage occurred to the bone itself, but not enough to break the bone. This is also called as a microfracture mainly because some of the trabeculae in the bone are broken. Blood pools under the periosteal layer and this is called a subperiosteal hematoma. The bleeding takes place between the cartilage and the bone it’s called a subchondral bone bruise. If the bleeding occurs in the medulla of the bone it’s called an interosseous bone bruise.
How Bone Bruises Occur
Martial artists may get bone bruises from any sudden trauma, similar to a broken bone. The force may not be severe enough to break the bone but is enough to jar the medulla of the bone and cause its vessels and trabeculae to break. A violent kick, a sudden fall, or a punch can cause the bones microvessels to break. Since bruising takes time to develop, its more difficult to determine if there is a fracture.
Learn more about how bone bruises are commonly diagnosed by browsing through Our Common Diagnosis Section.
BONE CHIP OR OSTEOCHONDRITIS DISSECANS
An injury to the bone or joint may create a loose bone chip inside of the joint. This injury can be very painful if the bone chip moves inside of, impacts or gets caught in different areas of the joint. The lateral aspect of the medial femoral condyle of the knee is the most affected joint. This is followed by the elbow and ankle.
The most common symptom of a bone chip or osteochondritis dissecans is extreme pain often triggered by movement, training, sparring or combat fight events. Other symptoms include swelling, inflammation, tenderness, weakness in the joint, decreased range of motion, and a popping or sucking sound with motion.
How Bone Chips Occur
During a sudden violet tackle, a bone could fragment or chip away. A small focus of bone creates a defect between the lesion and the parent bone. This causes less blood supply and degeneration of that fragment. Stable fragments are held in place by the overlying articular cartilage that is usually intact.
The defect progresses to involve the overlying cartilage making the fragment unstable. If it becomes unstable, it could remain in situ or displace from the primary site. This is called a loose body within the joint. This can also trigger early osteoarthritis if it remains untreated.
A chip may break off the bone of a martial artist during any blunt force trauma. For example:
Browse through our Common Diagnosis section to find out more about how bone chip injuries are diagnosed.
A bunion is a deformity or hard bony bump that forms typically at the base of the first metatarsophalangeal joint (MTP) joint or big toe on the inner edge of the foot, although bunions may also develop on the fifth MTP joint or little toe MTP joint on the outside of the foot. The MTP are located at the base of the toe and connect the first metatarsal toe bones to the foot bones. These MTP joints help hold and distribute weight when the body is standing or moving. MTP joints have a thin joint capsule which surrounds them, and ligaments which connect and support them. The first MTP joint or big toe joint is the most prone to developing bunions.
How Bunions Occur
A bunion develops when the first metatarsal bone of the foot starts to shift its position from straight forward to angling off to the side. The big toe then leans into and presses against the other toes which causes an unnatural and painful angling of the joint. A bunion usually feels painful from the beginning and becomes progressively more so as the protruding bone increases in angle and size due to swelling, restricting movement of the toe, foot and body.
As a bunion increases in size, it increases pressure upon other toes, and may inflict damage at this primary juncture. Pressure on bones, ligaments, and tendons in this area can impair the foot's functioning and create a condition called hammer toe, or the bursa, which are cushioning fluid-filled sacs or pillows between joints may become sore, inflamed, or infected.
Martial artists, whose feet are constantly stressed, standing, running, jumping, or moving on the feet for long periods of time are susceptible to developing bunions. They are also likely to develop bunions because of physical stress placed on feet from repetitive movement, pounding, and often badly fitting shoes. Most shoes don't allow sufficient room for a bunion and place added pressure on the swollen and misaligned joint, increasing pain and promoting further deformation of the area.
Bunions run in families because certain foot shapes, for example, narrow or wide feet, foot structures such as high or low arch, shape of metatarsal head on toe joint, long or short toes. Bunions may develop from obesity.
Learn more about how injuries to the bunions are commonly diagnosed by browsing through Our Common Diagnosis Section.
Tendons are thick, fibrous collagen that attaches bone to muscle. Tendinitis, or inflammation of the tendon, occurs from trauma. Tendinosis is a degeneration of the tendon from chronic overuse. The primary injury and acute inflammation set a vicious process in motion. Mechanical stressors and repetitive overloading can further aggravate the condition, preventing its healing unless the stressors are removed.
How Tendonitis / Tendinosis Occur
Tendonitis and tendinosis occur in martial artists who perform one repetitive move hundreds of times or strain during a technique, such as twisting through the ankle during a roundhouse kick. Damaging the Achilles’ tendon is one of the most common tendinosis injuries. Tendonitis is a multifactorial process that while described in stages happens simultaneously.
Stage one is when the tendon experiences the initial injury. It could be due to acute overload or repetitive stress. If martial artists are taking antibiotics like fluoroquinolones for other infections, then they can also contribute to tendonitis.
This is because these molecules are linked to the death of tenocytes. In stage two healing of the tendon has failed as steroids and NSAIDs alter the normal healing process, by providing short-term relief but contributing to the pathology by preventing inflammatory molecules to act at the site of injury. In the third stage, there is a mechanical weakness due to tears or increased pain. During this stage, fighters realize they have a problem with the tendon.
Browse through our Common Diagnosis section to find out more about how Tendon injuries are diagnosed.
TENDON SPRAIN / STRAIN
Strains and sprains are two types of similar injuries that involve overreaching the limits of the tendon (strain) or ligament (sprain).
For example, a sprained ankle means the ligaments of the ankle were twisted or stretched. If the ankle was forced to roll inward which is called an inversion sprain and is the more common type. Sprains that occur from the ankle rolling to the outside are called eversion sprains and cause pain along the inside of the ankle. Strains often occur in the foot, plantar fasciitis may be caused by one.
A sprain or strain typically causes pain, instability, difficulty in putting weight on affected joint, swelling, and popping or cracking sound heard at the time of injury. Bruising may or may not be present.
How Sprains Occur
Any overreaching motion may cause a sprain or strain. For example:
Take a look at our Common Diagnosis Section to identify how tendon injuries are diagnosed.
PINCHED OR IMPINGED NERVE
A pinched nerve occurs when bone, tendon, or other tissues of the body place pressure on a nerve.
Martial artists often get compression of the nerve space in the spinal column from throwing an opponent incorrectly which can create a pinched nerve or sciatica. Pinched nerves and spinal misalignments are common injuries in martial arts.
How Pinched Nerves Occurs
Any repeated movement or shock to a joint may cause a pinched nerve. Pathology across the course of a nerve, like a vertebral compression, muscle injury, joint dislocation can cause a nerve to be pinched or injured. In the leg, this could manifest as sciatica. Often pinched nerves are also referred to as compressed nerves. Nerve compression syndromes though have a constellation of symptoms and are also more prolonged in duration. Pinched nerves might be acute and relieved in a short period and usually refer to spinal nerves
Browse through our Common Diagnosis section to find out more about how injuries to the nerves are diagnosed.
In Manitoba, Canada 45% of all martial artists have suffered nerve compression injuries. Whether they’re breaking boards with the knife hand incorrectly, sustaining repeated injuries to the arm, or subluxation of the elbow causes compression of the ulnar nerves. Similarly, there are plenty of nerve compression syndromes. There’s compression of the median nerve, ulnar, radial, pudendal, tibial, obturator nerve, and the list goes on.
How Nerve Compression Occurs
Nerve compression occurs during various maneuvers in martial arts. Nerve entrapment can occur when a martial arts practitioner uses an incorrect technique to break objects or during repeated wrist throws which stretches the nerves and compresses them. Armbars can also compress the axillary plexus of nerves. In the lower limbs, associated fractures, injury to the femur, and falls can entrap the nerves.
Read more about how nerve injuries are diagnosed in Our Common Diagnosis section.
Neuralgia and neuropathic symptoms are common. In a study conducted on an online martial arts website, nearly half of the practitioners had neuralgia. For those who had practiced it for more than five years their symptoms were worse. Various techniques particularly in Asian martial arts, target specific areas, or nerve points.
They are also known as acupuncture points, vital points, dim mak points, kyusho points, or pressure points. Kyusho jitsu, the Japanese term means one-second fighting or vital strike fighting. These moves are usually taught in advanced martial arts and commonly focus on the carotid sinus, distal median nerve, facial nerve, trigeminal nerve, radial nerve, and ulnar nerve. These moves can seriously impact a novice martial artist.
How Traumatic Neuralgia Occurs
Specific moves to target pressure points can damage the nerve if the injury is sustained repeatedly. The back, groin, and head were some of the most common areas of strikes that incapacitate the nerves temporarily through a traumatic strike. Some athletes get used to these “stingers.”
However, many novice athletes who go through routine practice with these techniques experience shooting or electric pain on impact. This impact could be slight or forceful depending on the targeted nerve.
Browse through our Common Diagnosis section to find out more about how injuries to the nerves are diagnosed.
CRAMPS AND SPASMS
Muscle cramps and spasms are involuntary contractions occurring in one or more muscles. The muscle or muscles tighten up in a painful fashion, and are unable to relax for a few seconds to minutes, the most common are exercise associated cramps. These are continuous, involuntary, localized contraction of an entire muscle group, an individual muscle, or select muscle fibers accompanied by sharp pain. Who can forget that infamous video of Rafael Nadal developing a muscle cramp while giving a press conference.
How Muscle Cramps and Spasms Occur
Usually, muscle cramps and spasms occur from illness, exercise, or dietary originations. Most people will experience muscle cramps after an intense workout or if they’ve been dehydrated and have severe depletion of electrolytes. Inadequate blood supply or even nerve compression can cause muscle cramping.
A strain occurs when muscles have been overstretched, sometimes to the point of creating tears in the muscle, pain, and injury. Muscle strain usually results from overwork and over-stretching of the muscle. Tears in the muscle may also occur, along with damage to small blood vessels which will create bruising.
Martial arts training can include extreme exercises that push the body to the limit, e.g. – such as staying in low horse stance for an hour, doing hundreds of kicks at a time, or doing 400 duck walks. This may create thigh strains, especially if the legs were not gradually strengthened.
Learn more about how muscle injuries are diagnosed in our Common Diagnosis Section.
A dislocation means a bone has slipped, been shoved, or moved out of place and is not where it should be. A dislocation is an extreme injury to a joint where two or more bones come together. This injury is usually very painful and temporarily immobilizes the joint. Most joints in the body can be dislocated, including ankle, knee, toe, finger, hip, and shoulder.
A ‘trick’ knee can temporarily slide out of joint, then back in, for instance, and not necessarily require medical attention.
How a Dislocation Occurs
Dislocations can occur as a result of being thrown and hitting a wall or hard floor specifically impacting a joint such as hip, shoulder, hand, or elbow.
After a joint dislocates the first time, it will be easier to dislocate again. There will be a slight to noticeable weakness, and the martial artist will benefit from targeting that area for extra strength and flexibility training to ensure joint integrity.
Read more about how bone dislocation injuries are diagnosed through various tests in Our Common Diagnosis section.
Bursae are small cushioning sacs filled with lubricating synovial fluid that is found between bones, muscles, joints, ligaments, and tendons. The bursae are essential to the body for natural tendon and muscle movement and correctly functioning joints and other juncture points. Bursitis means that one or more bursae have become inflamed, irritated, and sore which typically makes the joints swollen and movement difficult.
The human body has about 150 bursae that form cushions between tissues and facilitate movement in the musculoskeletal system.
How Bursitis Occurs
Bursitis occurs from repeated small trauma or blunt force trauma that impairs the bursae. Prolonged pressure stresses the bursa. Kneeling repeatedly can cause prepatellar bursitis that’s called housemaid’s knee. Repetitive motions can also irritate the bursa and cause inflammation. These could be throws, elbow movements, armbars, kneeling, etc. Any motion repeated over time can stress the bursa by increasing friction between the bone and the hard surface. An external injury can also introduce bacteria into the bursae and cause septic bursitis.
Find out more about how bursitis injuries are diagnosed in our Common Diagnosis Section.
The joint is surrounded by a lubricating capsule that helps keep bones from rubbing and getting irritated. The lining of the capsule is called the synovium and it releases synovial fluid to help lubricate joints. Chronic synovitis means the synovium is irritated or injured and releasing too much fluid. Here enzymes are released within the joint that may destroy healthy cartilage and bone within the joint, causing pain and degeneration.
How Chronic Synovitis Occurs
Repeated trauma to the ankle or other joint are ways martial artists may get chronic synovitis. These include shin strikes, leg bars, direct kicks, and grappling. It may also result from other illnesses such as gout and arthritis.
Find out more about how chronic synovitis injuries are diagnosed in our Common Diagnosis Section.
BRUISES OR CONTUSIONS
The site of a bruise may be smooth and normal, or it may have a bump or inflammation from injured blood vessels leaking into the tissue, along with the body’s general response to an injury. Many fighters will typically not even notice a bruise, unless it’s huge and/or painful. Re-injuring the same area repeatedly before it heals may cause deeper damage.
A bruise is an injury resulting from a blow, for example a strike, kick, or fall where the surface of the skin was not penetrated, but the subsurface tissue was injured, causing blood vessels to be damaged or broken.
Learn more about how bruises or contusions are diagnosed by going through our Common Diagnosis Section.
LACERATIONS, CUTS, ABRASIONS AND PUNCTURES
The skin is designed to envelope and protect the body from immediate attacks and is the body’s primary defense. Martial artists are constantly experiencing minor damage to their skin in the form of abrasions, cuts, and lacerations. The skin is composed of three different layers including the epidermis or outer layer, the dermis or middle layer, and the subcutaneous tissue layer or sub cutis.
The degree of injury to the skin is typically judged by how deeply it has been injured. Abrasions are minor injuries affecting the top layer of skin. Cuts are usually only penetrate the epidermis or dermis. They may bleed, but are not dangerous. Lacerations cut all three layers of the skin and may penetrate muscle, organ, or bone. Punctures are usually small, deep injuries (think of a nail puncture).
The depth of the injury and length of time left untreated dictates the potential of infection and rate of healing. Bleeding is a natural way for the body to flush out debris and bacteria. 13.8 million visits to the ER are for laceration care.
How Lacerations, Cuts, Abrasions, and Punctures Occur
In martial arts, lacerations, abrasions, and punctures can be caused due to weapons. Striking and grappling can cause abrasions. Kicks and punches can also cause lacerations and cuts. Sudden jabs to the face can lacerate some of the more delicate structures like lips and ears.
Go through our Common Diagnosis Section to find out about how injuries to the skin are diagnosed and classified.
The cartilage has many functions in the human body. It enhances bone resilience, provides bone support, and resists compressive forces. Cartilage lacks any blood or lymphatic supply. The lack of blood supply is the reason why cartilage injuries take so long to heal. There are three types of cartilage. Hyaline cartilage is commonly found in the ribs, sternum, trachea, and nose. The elastic cartilage is found in the ear and larynx. The fibrocartilage is found in the intervertebral discs and menisci.
How Cartilage Injuries Occur
Cartilage injuries occur mostly due to wear and tear. Overuse of a joint can cause the cartilage to break down over time. In the case of the knee, this results in degeneration of the menisci and then causes osteoarthritis. In the case of the vertebral spine, constant bending and injuries to the back can wear out the cartilage and lead to disc herniation. In the ear, cartilage tears are common due to jabs, hooks, and cuts. In the wrist, this degeneration leads to loss of wrist movement.
Learn more about how cartilage injuries are diagnosed by going through our Common Diagnosis Section.
Full contact sports like martial arts tends to cause some dentialveolar injury. This could range from anything like a contusion of the tooth to total dislocation from the alveolar bone. A significant amount of force is needed to cause tooth avulsion. The maxillary central incisors are the most commonly affected.
How Dental Injuries Occur
The periodontal ligament (PDL) is the soft tissue that connects the cementum to the alveolar bone. The cementum covers the roots of the teeth. When there’s a violent punch, jab, kick, or even a fall face first, the fibers of the periodontal ligament tears. This displaces the tooth from the socket. In the case of many martial artists, few wear a dental guard especially in day to day workouts and during training. Accidental knocks and kicks can cause dental trauma.
Find out more about how dental injuries are diagnosed in our Common Diagnosis Section.
BLUNT FORCE TRAUMA
Blunt force trauma is an injury resulting from a blow or intense physical injury to the body.
A high-speed kick into the stomach, back, leg, calf or chest at the right angle, an uppercut into the liver, or knee into the body can result in significant damage. In this case, a blow to the abdomen, the timing, angle, speed and force of the blow causes damage by tearing blood vessels, potentially caving a lung, liver damage, internal bleeding, and or more.
How Blunt Force Trauma Occurs
Blunt force trauma occurs in martial arts sparring, training and events, and has been documented to happen more often in certain martial arts styles such as jujitsu, kick boxing, MMA and UFC events. Martial artists may experience blunt force trauma from kicks, punches, elbow and knee strikes, weapons practice and sparring with a staff, for instance.
It can also happen during a grappling match or take-down when a knee impacts soft tissue. The blow will either create compression or deceleration injury to internal organs. Compression injury occurs as the result of a direct blow to an organ such as the liver, causing internal bleeding, and possibly rupture depending on the organ and type of blow. Deceleration injury creates severe stretching, particularly at the points of anchor for organs such as the bowel, leading to tearing, shearing, and injury to blood vessels, creating internal bleeding of liver, spleen, small intestine, renal arteries, bowel, kidneys, colon, etc.
Find out more about how blunt force trauma injuries are diagnosed in our Common Diagnosis Section.
Vascular injuries can occur from blunt trauma or penetrating trauma with a weapon. Armed martial arts like Kendo, Kenjutsu, Kyudo, Arnis, and Silat all use weapons that can cause trauma. Cases have been recorded where a submission maneuver in BJJ has resulted in carotid artery dissection and then stroke. The symptoms vary based on which vessel is affected or injured.
Martial artists are prone to bleeding when they encounter punches and cuts. These are more common and visible injuries that are identified and treated rapidly. Moreover, certain body parts are more vulnerable to vascular injury. In Olympic boxing, as fighters boxed without headgear for the first time in 36 years, the consequence was gore. Facial cuts with vascular injuries were common, especially around the eye.
How They Occur?
Penetrating injuries occur in martial artists that use weapons. Gatka Haidong Gumdo, HEMA, Itto-Ryu, Kendo, Kenjutsu, Kobudo, Krabi-Krabong, Kumdo, and Siljun Dobup train with swords. Jukendo uses bayonets, Kyudo and Yabusame use archery, Kobudo and Nunchaku-do use nunchucks, Tessenjutsi uses war fans and sojutsu uses spears. All of them can injury a vessel accidentally and cause hemorrhage.
Blunt vascular injuries occur when a martial artist takes a jab, cut, kick, or punch. Five different injuries occur in trauma to vessels. This includes complete wall defect resulting in hemorrhage or pseudoaneurysm, there’s the intimal injury which leads to subintimal/intramural hematomas, flaps, disruptions, arteriovenous (AV) fistula can develop, a complete transection of the vessel with hemorrhage or occlusion, and a vascular spasm. Blunt traumas are commonly associated with intimal defects. Comparatively, penetrating trauma cause wall defects, complete transection, or AV fistulas.
Find out more about how vascular injuries are diagnosed in our Common Diagnosis Section.