Physical Training June 2001

Preventing & Rehabilitating Injuries--A Commonsense Guide for the Martial Artist

 by Dr. Diane Mirro BA, MA, DC

(Note: This information is for educational purposes only. It is in no way intended for use as a substitute for direct professional evaluation and treatment. ALL injuries should be examined by a certified health specialist to determine their extent and prognosis.)


        As martial artists, we are all at risk for injury due to the physical nature of our activities.  However, by making good choices in our training and other exercises, we can limit the number and severity of such injuries. Additionally, we can speed recovery by using correct methods of rehabilitation when injury occurs.

        In this article, I will talk about ways to strengthen your body to better stand the rigors of martial arts training.  I will also cover what happens physiologically when the body is injured.  Finally, I will discuss various methods of conservative rehabilitation that will help you prevent a recurrence of the original problem.  Bear in mind that everyone is unique, and that without examining you in person, I cannot diagnose or treat you, no matter how well you may be able to describe your problems.  But perhaps by sharing this information with you, it will enable you to seek out health practitioners who share my conservative and patient-oriented methods of treatment.

Injury Prevention

        Let me introduce two of my “patients”, Sampson Swordswinger and Sidney Bladegeek*.  (*Any resemblance to any persons living or deceased is purely intentional.) Sampson and Sidney both practice three times a week at the Bludonda Walse Dojo, which teaches various forms of weapons and empty-handed martial arts.

        Sampson, a personal trainer, is a young, buff hotshot in his twenties who also weight-lifts at a local gym almost every day.  He likes to impress the ladies by telling them that he practices “Samurai Sword”.  His sensei is always telling him to use less muscle in his cuts.

        Sidney, a librarian, is in his early forties.  When he is not at work or in training, he spends time with his wife and two preteens. Although not athletically inclined, he takes Iaido very seriously and makes a concerted effort to follow Sensei’s directions during practice. Consequently, he has developed very good form.

        Which of these two has a greater chance of injuring himself?  In reality, both are neglecting important aspects of their training. Although Sampson is more physically active, he does not do enough stretching or aerobic activity during his workouts.  And while Sidney has developed good Iaido form, he does not exercise adequately or symmetrically.

        Both of these men would do well to add stretching and aerobic conditioning to their weekly activities.  Stretching helps to bring contracted muscles back to a longer, healthier resting length in between times of physical exertion.  This leads to better nerve conduction and increased blood circulation, which supplies more oxygen to the muscle tissues.  Also, the improved flexibility would allow Sampson and Sidney to do larger sword cuts and have greater extension in their punches, strikes and kicks.

        Aerobic conditioning increases stamina by training the heart, lungs and muscles to work at an increased capacity more efficiently.  This enables the athlete to place a greater demand on his/her body without causing undue strain.

        Both Sampson and Sidney are resistant to changing their routines.  “I work out plenty--I don’t need no stinkin’ stretches!” gripes Sampson as he unconsciously flexes his biceps.  But when I ask him to do a simple toe touch, he has trouble getting his fingertips past his knees.  Sidney, on the other hand, agrees with what I say, but mumbles that he just has no time to add another physical activity to his tight schedule.  He also cannot touch his toes.

        I ask the two men to stand in front of the mirrored wall of their dojo with their arms at their sides.  Both of them appear to have a left shoulder which is higher than their right--also, the fingertips of their left hands are higher than those of their right.  This is a phenomenon I have observed in many Iaidoka, and it is due to how we hold and cut with the sword.  The muscles of our left arms and shoulders will stay more contracted unless we make an effort to stretch them out.  Over the years, this can seriously inhibit proper Iaido cuts--when I mention this, Sidney turns pale.  And Sampson is really upset because the asymmetry of his shoulders ruins the perfection of his physique.

        Muttering and grumbling, both agree that they want to fix this problem--what can they do?  Here are a few solutions:

Yoga--Yoga is a discipline from India that incorporates stretching, breathing exercises, strength training and even aerobic conditioning, depending on the style practiced.  Yoga is at the top of my list for a reason.  I think every martial artist can benefit from incorporating Yoga into his or her regular practice. Hatha Yoga is an excellent style for beginners. In a typical Hatha Yoga class, the instructor demonstrates and assists the students in performing a variety of poses, called asanas. These asanas should NOT be held to the point of pain, because that prevents the muscles from relaxing properly.  Iyengar is the method of Hatha Yoga developed by Mr. B.K.S. Iyengar, and includes the extensive use of “props”--blankets, blocks and straps--to assist the students in achieving the correct pose more comfortably.  Teachers certified in his style can be found all over the world.  I defy anyone who believes that Yoga is for wimps to participate in an Iyengar class.

        A more active style of Yoga is Ashtanga or “Power” Yoga.  While the poses are similar to Hatha, the pace is faster and students flow from one pose into the next.  You will definitely sweat in an Ashtanga class, and I do not recommend it unless you have experienced Hatha
Yoga first.

        While you can follow along with a Yoga book or video, the best way to get started in correct Yoga practice is to enroll in a class that meets two to three times a week.  You will then have an instructor to guide you and other students to commiserate--uh, that is, work out with, a great motivating factor.

Tai Chi, or Tai Chi Chuan-I could insert a big “Ditto” here, since Tai Chi conveys many of the same health benefits as Yoga.  Tai Chi, which originated in China, consists of a variety of poses practiced in a slow, continuous motion.  There are several styles, and they may include swordwork and partner practice.  Some instructors emphasize the martial aspects whereas others focus on Tai Chi as a movement therapy.  For the beginner, Tai Chi may be somewhat stressful since you are, in essence, learning a long, involved, complex kata. However, once it is learned, you can practice anywhere, by yourself or with others, and the rhythm of the movements is extremely refreshing.  Breathing, flexibility, cardiovascular work and stretching are all benefits of Tai Chi.  Again, I recommend a class setting at least twice a week for the beginner.

Swimming-The buoyancy you experience in water allows you to exercise your muscles differently from on land, complementing all other forms of physical activity.   Additionally, swimming helps strengthen the arms, rotator cuff, back, and legs in an efficient and aerobic manner.  It is most effective if you vary the stroke rather than doing a basic crawl lap after lap.  Many rehabilitation programs utilize swimming and other forms of water therapy as a safe way to gently build back areas of tissue damage.  Swimmers develop long muscles and toned physiques, as well as flexibility and stamina.

Walking-A simple walking program, especially one combined with stretching, is an excellent supplement to your martial arts training.  Walking does not strain the knees, a serious problem among martial artists and those who jog or run on hard surfaces.  While standard walking does not give you much of an upper body workout, speed walking (in which the torso and arms play an active role) yields many of the benefits of another excellent activity, cross-country skiing. I recommend taking AT LEAST fifteen minutes beforehand to stretch your neck, shoulders, arms, back, legs, hands and feet--don’t just do a runner’s lunge or two and take off.  After your walk (which can be anywhere from twenty minutes to an hour or so), continue to stretch as you cool down.

Other physical conditioning-These are just a few of the dozens of ways you can supplement your martial art routine.  Aerobics, jazzercise, Pilates, NIA, cycling, horseback riding and other activities will also work.  However, the four I discussed above have several things in common.  First, they are methods that have endured for hundreds, even thousands of years.  We can see the health benefits enjoyed by long term practitioners of these activities. Second, they are very accessible both in terms of availability and cost of instruction.  Third, it is possible to find these classes in most areas, or to practice on your own if necessary.  So what, you ask, is the absolutely BEST choice?  It’s the one you will do.  Pick something you enjoy, and you are more likely to stick with it.  Plan on doing your supplemental activity for about an hour at least twice
a week.

        I advised Sampson to cut down on his weight training and attend yoga classes instead.  For Sidney, I urged that he persuade his wife to join him on walks around the neighborhood in the evening, and for the two of them to sign up for a Tai Chi class twice a week at a local Y, maybe while the kids take swimming lessons.

Massage-It is so difficult to convince people that massage is a necessity, not a luxury.  Almost everybody can benefit from massage. It relaxes muscles, assists with lymphatic drainage, increases blood circulation and results in stress relief.  It is a sad commentary on today’s society that some people cannot differentiate between a therapeutic, nonsexual touch and one that is intended to be intimate. Therapeutic massage is nonsexual.  In most states in the US, massage therapists are licensed professionals who must graduate from an approved school of massage and pass a state licensing exam.  There is also a national certification that many therapists choose to complete.  Licensed therapists have studied various forms of massage, as well as anatomy, physiology, hygiene, hydrotherapy and more.  I recommend finding a therapist who is well-versed in Swedish, sports, deep tissue, trigger point or neuromuscular therapy, among the more frequently encountered styles.  Shiatsu (Japanese) and Reflexology (Chinese foot therapy) are also good choices.  Remember: therapeutic massage is nonsexual, so it makes no difference if your therapist is a male or a female.  Most importantly, choose your therapist based on word-of-mouth referral--and that goes for all health practitioners.

Chiropractic treatment-Chiropractic is a natural, scientifically proven method of treating injury and illness by enabling the nervous system to function correctly.  It was “invented” by Dr. D. D. Palmer in 1895, but similar methods have been utilized in many cultures for thousands of years.  All Chiropractors have completed a 4-year postgraduate program with more hours in anatomy, neurology, nutrition, diagnosis and radiology than required of medical doctors.

        A chiropractic treatment is an adjustment.  During the adjustment, the doctor moves bones into their proper alignment, reduces muscle spasms with physical therapies, and uses other methods to enable healthy nerve conduction.  Chiropractic physicians do not prescribe drugs or perform surgery.  People choose chiropractic care to eliminate pain or to simply maintain health in natural way.  A monthly visit to a Chiropractor can keep the body functioning at an optimal level, and can help prevent small discomforts from turning into severe disabilities.

        Okay, our two friends see the light--Sampson enrolls in the Yoga class at his gym, and Sidney convinces his wife to do Tai Chi with him twice a week at a community education class.  Both of them also visit a massage therapist I recommend, and they come in for adjustments every month or two.  However, Sampson continues to overuse his shoulders, and he turns up in my office a year later with a torn rotator cuff.  And Sidney starts putting in longer hours at work, missing more and more of the Tai Chi classes, much to his wife’s consternation.  Sure enough, Sidney calls me to complain of the same knee pain that he was experiencing before taking up Tai Chi.

Injury Rehabilitation

The RICE formula-Fortunately, the sensei at Bludonda Walse Dojo insisted that both men immediately cease practicing when their discomfort became apparent and had them put ice on their injuries. She then told them to follow the RICE formula:

Rest-This means TOTAL avoidance of any strain to the injured area for at least several days.

Ice-Use an icepack for 10-20 minutes on, 40 minutes to one hour off. This will reduce the pain and swelling, and promote healing.  DO NOT USE HOT PACKS.  Yes, I know, heat is comforting, but it is deadly; direct heat will dilate the blood vessels around the injury, leading to swelling, muscle spasm and MORE pain later.   This was reported in the Journal of the American Medical Association several years ago, causing the Red Cross to revise their first aid training, but many doctors unknowingly continue to advise the use of heat.

Compression-Lightly wrapping the area will also help prevent swelling (edema), but do not keep it wrapped all the time, and definitely not when sleeping.

Elevation-Prop your arm on a shelf or your leg on a footrest whenever you can--this will also promote better blood circulation.

        If the injury is very painful, swollen, and does not improve in a day or so with the RICE treatment, you MUST have it checked out by a health professional such as a medical doctor, chiropractic physician or doctor of osteopathy.  X-rays or MRIs may be needed to check for bone fractures or severely torn soft tissues.  If the films are negative, or the injury is not that severe, you can work with your health professional to devise an appropriate program of

        When I examine Sampson, I find that he has strained the muscles of his rotator cuff--they are swollen and tender when he moves his arm.  Sidney experiences no pain except when he bends his knee too deeply, and then he is afraid to put too much weight on it.  I explain to both of them that when the body is injured, it wants to stabilize and repair the injury as quickly as possible.  To do this, it patches the area with collagen fiber--scar tissue.  This is the same tough material, which makes up the fascia, the protective coating around each muscle.  As the area is patched with collagen, it may bind muscles, trap nerves and lead to a restricted range of motion.  If this is not corrected, it can result in pain and further injury due to the brittle nature of the scar tissue.

        Neither Sampson nor Sidney have broken any bones or caused severe damage to their muscles, tendons or ligaments.  Therefore, I can start them on a conservative program of rehabilitation, which includes chiropractic adjustments with myofascial therapy, massage, light exercise and hydrotherapy.

Myofascial therapy-Similar to massage, therapeutic deep tissue work relieves muscle spasms, but it also breaks up scar tissue and releases adhesions in the muscles.  This restores the blood circulation necessary to nourish healthy cells, repairing and strengthening the injured area.  Myofascial therapy can also repair chronic areas of past injury and free up restricted ranges of motion by getting rid of accumulations of scar tissue.  This is NOT a pleasant, relaxing massage, but practitioners work within the patient’s tolerance.  Most people are motivated to endure the discomfort when they experience the decreased pain and increased range of motion after a single treatment.  I do myofascial therapy in conjunction with my chiropractic adjustments in order to achieve a synergistic effect--by first reducing the scar tissue and adhesions, I can then put the bones in their proper alignment more easily, and they are less likely to be pulled out by muscle spasms

        The body continues to break up scar tissue for several days after a treatment.  The old scar tissue and other toxins must be flushed out of the body through the kidneys, so I insist that my patients drink copious amounts of water--at least 6-8 glasses a day, in addition to whatever other fluids they ingest.  In fact, increasing water consumption is an excellent idea for everyone, since well-hydrated muscles are less likely to cramp.

Follow-up Care
        I also advise the continued use of cold packs for any areas of tenderness--again, 10-15 minutes on per hour, as often as desired. The heat of a warm shower or hot tub is fine, but I do recommend following up with a cold pack to the injured area.

        As soon as possible, I want my patients to return to a moderate activity program, since the movement and blood circulation will contribute to the healing process.  This is a good time to incorporate lifestyle modifications to help prevent recurrence of the injury.  Such modifications may include an improved workstation and better work habits, a new mattress, a cervical pillow, dietary guidelines and specific exercises to strengthen previously injured areas.

For Sampson, I also advised using a lighter sword and concentrating on form, rather than muscle development in Iaido.  For Sidney, I enlisted his wife’s aid in making sure he got back into a healthy exercise routine.  Both men returned to regular martial arts practice successfully, and have not had recurrences of their previous complaints.
        I hope these examples have been helpful.  Remember, everybody (and EVERY BODY) is unique, so I cannot predict how you would respond to the treatments outlined here as examples.  I recommend you find competent health practitioners in your area that practice some of the modalities I have discussed.  Above all, ease back into regular practice carefully.  Remember that pain is the last symptom to appear and the FIRST to disappear when there is an injury--do not use it as a gauge to determine when you are healed.  Listen to the advice of your health professional--this is their area of expertise.

Dr. Mirro practices Myofascial Chiropractic, Iaido and Yoga (not necessarily in that order) in San Antonio, Texas.
Physical Training June 2001