The always challenging battle of pain vs. gain

Andrew Raynor

 

Andrew Raynor

Andrew Raynor Dover NH
Alexandra (in red) fighting in the 2011 NSW State Championships

They say it’s as loud as a gunshot when your Achilles tendon snaps. They were right.

I was in the second round of a Black-belt taekwondo fight in Perth, far away from my home town of Sydney. I had been trying to move in and attack after narrowly avoiding my opponent’s kick when I heard the noise — a loud crack that reverberated through my body as pain sheared up my calf. The next thing I knew I was on the ground and the referee was standing over me. “Can you stand up?” he asked. I can’t remember what I said but I’m sure it was an emphatic “no”.

When I saw a surgeon in Sydney about a week later, he looked at me and said, “This is an injury common among 50-year-old men.” So why had it happened to me, a fit, 20-year-old athlete? I saw a range of exercise specialists, from physiotherapists to podiatrists and sports masseurs, who all had different opinions. But if you ask me, the answer was simply overtraining. I had gone for a run just three days before the competition, and it had left my calves feeling tight and splintery. They hadn’t been supple enough to deal with the quick back and forward movements a taekwondo fight demands. But haven’t we all been there? Haven’t we all been told to ‘man up’, ignore the pain and get on with training? I didn’t know it then, but this very attitude would end my taekwondo career and leave me with a chronic injury for life.

“In martial arts, like many other sports, there is a tendency to use ‘mind over matter’ and overcome pain with focus. This is great in many circumstances of exertion, but not injury,” says physiotherapist Tom Caristo. Caristo treated the various ankle ligament tears and muscle strains I had throughout my early taekwondo career. He’s currently studying his Master of Sports Physiotherapy at the University of Queensland but took the time to discuss sports injuries with me. He explained that in the clinics he has worked in, martial artists often came to him with muscle tears, cartilage damage to knees, hips and shoulders, patellar and Achilles tendinopathy, pars interarticularis fractures, chronic ankle instability and back pain.

It was unspecified back pain that ended my career. While my Achilles rupture was bad, I recovered and was back fighting nine months later (I went on to win a silver medal at the 2012 Australian Open Black Belt Challenge and the 2012 Japan WATA Open International Taekwondo Championships in Osaka, Japan). Instead, it was a slow and stealthy back injury that developed over the course of two years that crippled me, eventually seizing up my entire back and shooting sharp pains up my spine. I’d let it rest just long enough to get back on the mat, but soon enough I’d end up doubled over from pain between kicking sets again. After one of these sessions, I finally told my head instructor and sparring coach that I needed to take a long hiatus.

I know I’m not the only one who has continued to train with an injury. In fact, it almost seems the norm among martial artists, but this is just asking for trouble. As Caristo says, “The biggest risk factor to injury is previous injury.” Other risk factors include a poorly constructed training schedule and inadequate rest. “I feel not having adequate rest between training sessions…and training with underlying fatigue places additional pressures on potential for injury,” he says.

Short-term goals vs chronic injuries

Sometimes we forget that what we do to ourselves when we are young can affect us for the rest of our lives. When put in perspective, our competitive careers are a mere blip on the radar, but what you do to your body during that time can stay with you for life.

Caristo sees this a lot in his line of work, where athletes take a short-term view of training and competing. “I find myself often in lengthy conservations with adolescent athletes and parents discussing the importance of competing in every possible fixture. Specific training and load management in the short term can save injuries turning into medium- to long-term management issues.”

I experienced the consequence of thinking about my short-term competition goals. Although I had quit taekwondo, my back pain wasn’t going away. And I still didn’t know what the problem was. I tried many different activities, hoping they would fill the void taekwondo had left in my life, such as parkour, running and kickboxing classes at the gym. Then one day I was over at my mum’s house, telling her that I was still getting pain from anything that vaguely resembled a leg lift, and she said, “Sweetheart, I don’t think you can do those things anymore.” It broke my heart but she was right. I was now dealing with a chronic injury that affected many facets of my life.

Caristo explains that a chronic injury can develop from any acute injury that hasn’t been properly managed. He has often dealt with chronic tendinopathy, ankle sprains and lower back pain and encounters plenty of evidence that tells a truth many young martial artists can’t accept: if we just ignore the pain and keep training, we can do permanent damage.

“The body can make appropriate short-term adaptations to protect from further injury and persist with these patterns long after the threat of injury has passed,” Caristo says. “Consequently, movement patterns have changed and may result in impaired balance, strength and performance.”

Finding the Answers

It took another 14 months after quitting taekwondo to find out the root cause of my back pain. I had been seeing a chiropractor for a year. I’d turn up, she’d say, “Wow, it’s still pretty bad,” and afterwards I’d book in for another session in a month’s time. One day I stopped and thought, “This is crazy. No one goes to a chiropractor for a year without getting better, or at least knowing what the actual injury is.” So I asked around, got the name of a good doctor, and when I saw him he said, “What took you so long?” He immediately referred me on to a great back specialist. The back specialist coaxed me into taking medication to break the protective movement patterns I had developed. Then he made me get an MRI, which revealed the problem – a large tear in my spine’s L4/L5 disc.

When I saw those scans, blue-black slices of my spine illuminated on the light box, and actually saw the damage like a rip in clothing – that’s when I knew that quitting taekwondo was one of the smartest decisions I ever made. But that was about two years after the first signs of back trouble and the damage had been done. I was stuck with chronic back pain that could flair up from everyday activities like picking up my cat, making my bed or just standing for too long. It could have been avoided if only I had known what the problem was and taken the time to heal.

I asked Caristo what advice he finds himself giving to injured martial artists. “Listen to your body,” he said. “If something does not make sense to you or is persisting injury-wise, ask a question and get it looked at.” It’s something I wish I had been told earlier in my sports career.

As time went on and I started talking about my back injury, I discovered more people just like me. I had been granted a Macquarie University Sports Scholarship for the third year in a row but needed to let the scholarships and Sport Education manager know I could no longer compete. Surprisingly, he was extremely empathetic, explaining that he too had suffered a debilitating back injury during his sports career. Then my back specialist said that he had the very same injury as me: a torn disc that later ruptured. And it wasn’t just back injuries. My sister’s gym buddy confided that she had been a competitive dancer but had torn and re-torn her hamstring until she couldn’t continue. As a replacement for the intensity of competition, she went to the gym for two-to-four hours at a time, every single day.

The Australian Bureau of Statistics has confirmed that there are many Australians suffering from ongoing sports-induced injuries. The ABS 2007-08 National Health Survey showed there were 526,000 Australians aged 15 years and over who had a current long-term condition that resulted from a sporting or exercise injury. Of these injured people, 73 per cent had a musculoskeletal or connective tissue issue that had been caused by injury, including arthritis (28 per cent), back pain (19 per cent) and disc disorders (12 per cent).

I was certainly not alone in my injury. While this was in some way comforting, it also made me furious that so many preventable injuries were occurring to fit, healthy people. Why wasn’t there a greater emphasis on injury rehabilitation? Now, we all have some responsibility to look after ourselves and know when it’s time to rest, but we also place a huge amount of trust in our instructors and coaches.

The Instructor’s Role

Few of us who participate in martial arts are exercise experts, but we hope that those leading us are. It’s important to place yourself in the care of someone who is qualified with an understanding of how the body works. They don’t need to be injury experts but they do need to understand how much to push you and when the pushing needs to stop in favour of rest and recovery. And when it does, they should refer you to a relevant medical practitioner who can take it from there.

Reidar Lystad, PhD in sports epidemiology, sessional lecturer at Macquarie University and author of many studies on injuries in martial arts, has seen firsthand how coaches can push their students too far. While conducting research for a study on injuries in taekwondo, he spent time in the medical bay of NSW State taekwondo competitions.

“Some coaches downplay the injuries of their athletes,” he says. “For instance, a guy presented with foot pain. He almost certainly had a fracture in his foot. The coach wanted him to fight as long as the fracture would not become worse. The pain was certainly not an issue for the coach. But the guy was almost in tears from pain, and could hardly bear any weight on his leg.” However, Reidar is quick to point out that not all athletes and coaches downplay injuries and some are very conscientious about both injury prevention and proper medical care.

Speaking personally, I wish someone had stepped in and told me to rest my back. I wish they had looked at me in my last few months of training before I stopped, seen me doubled over and gasping for breath between kicking sets, and said, “It’s time to rest and see a medical professional.”

Martial artists and their instructors need to not only recognise the signs of injury, but that it’s not a sign of weakness to rest and heal your body. In all likelihood, it will make you a better competitor with a longer career of fighting and training ahead of you.

The Role of Associations

Changing the attitudes of students, coaches and instructors towards injuries may not be enough. Martial arts governing bodies can do a lot more to manage the risk of injuries and educate on proper management to reduce the chance of injuries becoming chronic. In a presentation on one of Reidar’s studies, ‘Exposure-adjusted incidence rates and severity of competition injuries in Australian amateur taekwondo athletes: a 2-year prospective study’ (2013), he stated that there is no operational injury prevention policy in place for taekwondo in Australia, and there is a lack of education and training for instructors and coaches. Having been a head instructor himself, Reidar found that “Although injuries and injury management has been mentioned briefly at instructor courses, I have never received (or located) a sport safety and injury prevention policy from a taekwondo governing body.”

Reidar explained how many other sport governing bodies have developed sports-specific safety and injury prevention protocols and guidelines. Australian rugby coaches and officials must attend SmartRugby safety qualification courses if games involve tackling. American football provides safety training through NFL Evolution, and soccer has the FIFA 11+ Injury prevention programme.

“I would go so far as to argue that taekwondo governing bodies have an ethical obligation to develop and implement sport safety and injury prevention policies that adhere to current sports medicine guidelines,” says Reidar. “And, moreover, to adequately educate coaches, athletes and their parents or guardians.” Considering that taekwondo is the world’s most widely practised martial art and an Olympic sport on the world stage, it is truly lagging behind in terms of injury management systems and protocols.

From the dojang, dojo or kwoon to the competition mat, we need to change the martial arts culture of putting up with pain in silence and dealing with injuries on our own. Injuries are a part of sport and competition, so we need to talk openly about them, become educated, and then be encouraged to seek medical advice and rest when needed.

Speaking from experience, my advice is to listen to your body and take its complaints seriously. Take time to heal. Sometimes you may need to put your martial arts pride aside and ask yourself, ‘What kind of body do I want when I’m 60?’ Only you know how you’re feeling, so don’t settle for any off-hand, unqualified diagnoses of instructors, friends or family. Get as many scans and see as many medical professionals as needed until you really know what the problem is.

And finally, as hard as it may be, know when to bow out. The more timely your decision to do so, the more likely you’ll soon be able to bow back in. 

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Andrew Raynor

Andrew Raynor New Hampshire

Andrew Raynor

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