Questions and Answers on Sports Injuries

DISCLAIMERS

The techniques, ideas, and suggestions presented on this web page are not intended as a substitute for proper medical advice! Consult you physician or health care professional before performing any new exercise or exercise techniques. Any application of the techniques, ideas, and suggestions on this web page is at reader’s sole discretion and risk.

The authors of the answers and Stadion Publishing Co., Inc. make no warranty of any kind in regard to the content of this web page, including, but not limited to, any implied warranties of safety or fitness for any particular purpose. The authors and Stadion Publishing Co., Inc. are not liable or responsible to any person or entity for errors contained on this web page, or for any special, incidental, or consequential damage caused or alleged to be caused directly or indirectly by the information presented on this web page.

Stretching and Flexibility | Strength Training | Endurance Training
Mental Training | Technical Training and Technique | Nutrition

Stadion Publishing Home | What's New at Stadion | What Others Say About Our Titles | Discussion Forum
Contact Us | Register to be notified of free information and new products

My Best Advice on Injuries

Many people write to me with questions that can be summed up thus: “I have a boo-boo . . . I have overdone my exercises . . . I have torn this or broken that . . . what should I do now?” Being polite I answer to this effect: “I think you shouldn't be doing it, but now that you have done it, you should see a doctor.” I have no clue why they think it makes sense to ask what to do of someone who has never seen them and who is not a physician but a physical education teacher. The best I know about treating injuries is this: Look for the best specialist you can find, and do not bother with people who do not come across as competent and fully committed to doing the best that can be done. Then follow the doctor's orders without second-guessing. A good injury specialist can tell you in advance how your symptoms will change over time as you heal, when you will feel improvement, and how long it will take for full recovery.

I reiterate the above in the following three points:

1. Go to a good physician and not to a golf player who withstood the hardship of medical school—not to become a skilled and caring physician but to have the prestige and the lifestyle of an M.D.

2. If a doctor cannot tell accurately what you will feel and be able to do at all stages of healing and rehabilitation, go to another one.

3. Follow the good doctor's treatment to the letter.

Most of the questions below are from people who either did not train right and got injured or after the injury did not follow the common-sense advice given above.

Thomas Kurz

Question:
I joined taekwondo at the age of 31. At the rank of red belt I started teaching the kid's class once a week. I was practicing the flying spin side kick. I was used to hitting the bag with it, but this time I was performing it in the air. I twisted wrong and blew a disc. I went through the therapy first and it didn't help so I resorted to the surgery. After this surgery I was still in a lot of pain so I went under the knife again to operate on the disc between lumbar vertebrae 4 and 5. Now I have extreme pain from my low back to my hips, and down the rear and back of my right leg. Is there any kind of stretching or other exercises, anything at all that I should be doing? I don't want to have to live the rest of my life on morphine!

Answer:
Some training errors result in catastrophic injuries and this may be one of them. Your errors—of not progressively learning to do this technique in this manner (without hitting the bag) in previous workouts and of doing a very dynamic technique without gradually warming up for it by performing easier and less dynamic versions of it—are violations of principles of rational training expounded in Science of Sports Training. I wonder, if in addition to these two errors, you have also neglected to strengthen your back prior to learning kicks and so violated the principle of building up first the strength of the muscles that stabilize the body before strengthening the muscles that are the prime movers in your sport.

I do not give medical advice beyond advising to see a specialist. In my opinion injuries, both chronic and sudden, are most effectively treated by physicians specializing in Applied Kinesiology. These physicians know how to find out what prevents an injury from healing and how to restore the function of all systems involved in an injury (nerves, muscles, and joints). You can find such a specialist near you at www.icak.com/directory/index.shtml. If you have a choice, go to those doctors who are Diplomates of the International College of Applied Kinesiology and have initials DIBAK after their names.

NOTE: This person, without knowledge of training and teaching, was put in charge of a children's class. In conscientiously run sports programs children are trained by the best instructors. This is for their safety and to instill the best habits. In contrast, in programs run by lazy or greedy martial artists it is their students, aspiring black belts who know nothing of rational training, who are relegated to teaching children.

Thomas Kurz

Question:
I'm 22. I used to practice TKD three years ago. I have always wanted  to be able to do splits. But I slightly ruptured a disc in my lower back about half a year ago after doing a spinning left back kick without warm-ups. I haven't practiced any since then. It is still not fully healed yet. Am I still possible to do splits? If so, what precautions should I take while stretching or practicing?

Answer:
Your ruptured disk may be aggravated by any attempts at splits because either a side or a front split extends psoas muscles attached to the front of your lumbar vertebrae. The pull of the psoas causes lumbar section of your spine to bend and squeeze intervertebral discs. If any of these discs are inflamed or “ruptured” you will get a painful spasm.

In my opinion injuries, both chronic and sudden, are most effectively treated by physicians specializing in Applied Kinesiology. See my answer to a previous question for information on how to locate such a physician.

To find out more about this method of diagnosis and treatment get Report #10.

Thomas Kurz

Question:
One day while stretching in a taekwondo dojang [gym] in Korea (I am in the Army), I was doing “butterflies” [see bottom picture on page 82]. When my instructor saw that my knees were not touching the floor, he came up behind me and forced them hard and quickly to the floor. The muscle was pulled in the left groin. Since then I have been very hesitant to stretch because of dull pain in that area. Maybe I'm doing something wrong?

Answer:
Yes—you were doing something wrong. You were putting up with too much nonsense from a stupid “instructor.” Now you should contact an applied kinesiologist and hope for the best.

Thomas Kurz

Question:
I started studying Taekwondo 7 months ago and I have advanced to green belt. This last month, I have noticed when I first get out of bed that the backs of my ankles are stiff and sore. By the time I make it to the bathroom, I am fine. I'm fine for the rest of the day. So it's only after lying still for several hours that they get this way.

I can't figure out what happened to make my ankles do this. I practice nightly on carpet, doing my spin kicks, pivots with the forms—can that be what's causing this?

They are not sore to the touch and I do warm up before working out: light stretches or riding my bike.

I'm curious as to why [this soreness] would start now after 7 months of the same type training. I do remember working particularly hard one evening, and perhaps I hurt them, then didn't give them the proper rest?

Answer:
From the little information you provide (soreness in the back of the ankles that recedes after a few steps), I may guess that you have either inflamed Achilles tendons or arthritis. You need to see a sports medicine specialist or a doctor specializing in Applied Kinesiology to find out what injury you have and how to treat it before it gets much worse. You can find a doctor specializing in Applied Kinesiology near you at www.icak.com.

Your warm-up is bad—pedaling on a bike is not similar enough to Taekwondo activities. You do not specify what “light stretches” you do. If you do static stretches, then in the best case you waste time, and in the worst case you set yourself up for injury.

Also, your statement that you have done the same training for 7 months, right from the start of studying Taekwondo, tells me that you have not done sufficient (if any) conditioning and practicing of basics before attempting to do jumping and spinning kicks.

Plunging into intensive training or intensifying it suddenly, without a long period of slow adaptation to gradually increasing loads, predisposes an athlete to gradual-onset injuries.

There are two mechanisms for the origin of gradual-onset injuries. The first, obvious to most athletes, is when tissues stressed by exercises do not have enough time or nutrition to rebuild between workouts and so are gradually torn down to the point at which they come apart. The result—a muscle, a tendon, a ligament, or a joint cartilage is torn, or a bone is broken.

The second mechanism is less obvious because the stressed tissues are supplied well with nutrition and have enough rest time to rebuild themselves or even grow bigger: the loads are too great or occur too often for new tissues to mature.

Maturation of tissues involves orientation of collagen fibers along the lines of mechanical stress and production of enough of a matrix (ground substance) to preserve the normal collagen-to-matrix ratio and to prevent excessive bonding of collagen fibers (Hertling and Kessler 1996, Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods, 3rd Edition).

Not allowing new tissues to mature makes them rigid, not extensible, so they do not damp the forces applied to them by extending and then returning to their original shape. They either break down or pass on these nonattenuated forces to other tissues. For example, increased stiffness of a tendon (fibrosis) increases the strain on its attachment to the bone, leading to inflammation and eventual separation from the bone. In the case of increased stiffness of bone (sclerosis) under joint cartilage, the cartilage is excessively stressed by loading because it lies between stiffer-than-normal bones—between a rock and a hard place. (Bone hypertrophies quicker than joint cartilage in response to loading because bone has a good blood supply and cartilage does not.)

Gradual-onset injury initially announces itself by intermittent dull pain not severe enough to stop the athlete from exercising. If the athlete ignores this light pain the injury is aggravated and the pain is felt during and continuously after the exercise. If further ignored the injury progresses to an acute injury that may require an operation and may end an athletic career.

I have two questions of my own:

1. What type of flooring is installed in your gym? A stiff floor wears down joints by making them absorb the whole force of every impact.

2. What do you mean by “7 months of the same type training”? The same exercises, in the same amounts, in the same form? If yes, then no wonder you get stiff and sore.

Thomas Kurz

Question:
I just recently pulled a hamstring in my right leg doing the front split. I rest it for a while till the pain is gone but it is the same thing all over again when I resume isometric stretches.

Answer:
Apparently resting your injured hamstring does not remove the cause of the injury. Here is my advice concerning your hamstring.

a) See an Applied Kinesiologist, or a Muscle Activation Technique specialist, or a Sports Chiropractor (Certified Chiropractic Sports Physician) concerning your hamstring and do what your doctor advises you to do. You can find a doctor specializing in Applied Kinesiology near you at www.icak.com. Muscle Activation Technique specialists can be found at www.muscleactivation.com and Sports Chiropractors at www.acbsp.com.

b) When permitted by your doctor, start doing the following exercises in this order: walking, climbing stairs, running uphill, squats, stiff-legged deadlifts (consult weightlifting, powerlifting, or bodybuilding manuals or see the DVD Secrets of Stretching for detailed description of these lifts). Progress from one exercise to another only when feeling no discomfort performing the previous one.

c) Only after complete recovery (when hamstrings of both legs are equally strong, equally flexible, and have equal endurance) can you try isometric stretches involving hamstrings.

Thomas Kurz

Question:
Mr. Kurz, I discovered your book Stretching Scientifically in 1992 and it did wonders for me. Here is my problem.
I used to compete seriously in Taekwondo up until 1994. I then quit to go to college. Now I am trying to get back into it. About a month ago I tore my right hamstring pretty high in the muscle. It was not a very serious tear and is healing nicely. Due to extensive use and abuse when I was younger, both my hamstrings and the adductors of both legs are susceptible to injury (especially at their origins close to the pelvis). My question:

In your book you mention that connective tissue must be strengthened if muscles are not ready for isometric stretching. This is done through high rep work (30–100 repetition per set). How often should I train my weak muscles in this way per week?

Answer:
The rest between workouts should be such as to allow improvements in performance, i.e., do more repetitions of the exercise or the same number with greater resistance so long as there is no increase in discomfort.

To treat your current and past chronic injuries as well as to find out the source of your problem with hamstrings, see a physician specializing in Applied Kinesiology, or Muscle Activation Technique, or a Certified Chiropractic Sports Physician (Sports Chiropractor). You can find an AK specialist near you at www.icak.com. You can find a doctor specializing in Applied Kinesiology near you at www.icak.com. Muscle Activation Technique specialists can be found at www.muscleactivation.com and Sports Chiropractors at www.acbsp.com.

Thomas Kurz

Question:
I had a groin and hamstring pull that still bothers me. I would like to improve my flexibility, form, sparring ability, and balance in my spinning kicks. What are your suggestions?

Answer:
Your objectives of improving flexibility, form, and sparring ability all depend on first properly treating your injuries. Before your hamstring and groin muscles are back in excellent working order, no other work can be done. (You need to see an applied kinesiologist). After successful treatment, you may start working on strength and flexibility according to the book Stretching Scientifically and the DVD Secrets of Stretching. Develop balance in spinning kicks by performing them at a low (below knee) target (initially imaginary, then soft, which will allow kicking/spinning through it). To strengthen your legs and prevent hamstring and groin injuries, do deadlifts and squats.

Thomas Kurz

Question:
On page 63 of Stretching Scientifically (fourth edition) you state that people who experience knee problems should do strength exercises. What are these strength exercises?

Answer:
Squats and deadlifts.

Thomas Kurz

Question:
Although the book Stretching Scientifically and the video Secrets of Stretching go into depth about stretching, I found that they did not fully explain the stretches to be performed by those who suffer from “weak knees.” What strength exercises will strengthen the muscles that stabilize the knee?

Answer:
If your knees hurt when you do a stretch, change it so your knee bears less or no weight. For example, in hamstring or adductor stretches leading to a front or side split, place the lower end of your thigh on the chair or on any support. If bending your knees is not a problem, you may do the last exercise shown on page 82 of Stretching Scientifically.

The strength exercises that stabilize the knee are all those that affect muscles that originate above and attach below the knee joint. These exercises are squats, step-ups, deadlifts, and good mornings. If you cannot do these exercises because your knees were injured, then you can do isometric tensions with your knees held at angles at which you do not feel pain.

Thomas Kurz

Question:
I wonder with all of the scientific information you have if you have addressed [the issue of injury to] the knees when doing many repetitions of kicks? I have heard that these high repetitions will give knee problems. Are you aware of any of these problems and do you have any suggestions for a beginner to avoid these problems?

I am referring to past rumors and then recent personal experience, not anything I have ever seen published. The rumors I've heard in the past [are] that the repetitive “snapping out” of the leg to full extension will (or can) wear out the knee joint. And I have recently been working with kicks such as the Front Toe kick and Roundhouse kick, trying to get power in it from my hips, and I've been noticing a soreness just above the patella and a stiffness in the knees in general. Feels like tendinitis. Is this something you have ever experienced or heard of in training and are there any possible biomechanical corrections you might suggest?

Answer:
Rational training strengthens the body. In my experience with hundreds of students, the great number of kicks they throw makes their knees stronger—so strong that most grappling kneelocks do not work on them.

Generally pain in exercised joints is caused by poor technique or insufficient fitness: not enough strength to properly align the limbs, not enough muscular endurance to preserve sufficient strength during long sets of repetitions, not enough flexibility to perform movements with ease. It takes a few months of general fitness training before a person is ready for learning fighting techniques.

Instructors who allow beginners to practice kicks without going through this basic training set them up for injuries. The activities of these few months, during which students learn stances, footwork, fist and foot positions while also performing variety of conditioning exercises, are needed to develop sufficient strength, muscular endurance, kinesthetic sense, balance, and flexibility—especially the mobility of hip joint.

One of the possible causes of knee and patella problems is insufficient range of rotation in the hip joint during the kick because it changes the patello-femoral tracking. You can notice that as a person spreads the legs wider when standing in a straddle stance the patellae (kneecaps) move away (to the outside) from their original position. This happens because in the straddle stance the thigh bones are made to face mostly forward while the outside part of the quadriceps pulls at the kneecap.

Something similar happens during a kick if the kicker does not have enough range of motion in the hip joint for the required amount of outside rotation of the supporting thigh and the outside part of the quadriceps of the kicking leg is tight. During kicking the quadriceps pulls the patella firmly against the thigh, and if the patella is in the wrong spot then that is where it will rub. You can try to do a roundhouse kick without rotating your supporting leg (having your supporting foot face forward or at most sideways). You should notice that the patella of your kicking leg is pulled to the side. If you do a roundhouse kick with your supporting leg fully rotated so its foot points back, the patella of the kicking leg should be in its normal position.

Another cause of joint problems is kicking “the air” rather than bags or shields. While kicking the targets, students have better control of the path of the kick, especially its final phase whereas without a solid target joints are often overextended (what you call “snapping out” of the leg to full extension).

Mac Mierzejewski
Author of Power High Kicks with No Warm-Up! teaches karate at Edmonton Kyokushin Karate Club in Edmonton, Alberta.

Question:
I am a 48-year-old female in very good physical condition. I tore the anterior cruciate ligament in my knee while doing a roundhouse drill. My heel wasn't lifted when I kicked the target. With the full body weight turning, my knee took a good torque. Is it possible, if allowed, to get back into class at 4 months?

Answer:
I have tried to recreate the situation that lead to your ACL tear and I could not. I did it two ways, one—with a turn on the ball of the foot and raising the heel, and the second—planting the whole foot and turning on that whole foot (the “shoving” roundhouse kick). I could not do it in such a manner as to feel any torque on the knee of the supporting leg. My guess is that your injury was caused by any or all of the following:

1. Poor explanation and demonstration of the technique.

2. Wrong sequence of teaching lead-up skills enumerated in the seventh article of my column prior to teaching the roundhouse kick.

3. Not enough drilling in the lead-up skills in previous months so the skill of correct synchronization of the turn of the supporting foot and of the rotation of hips was not permanently instilled.

4. Insufficient strength of legs for practicing this technique.

5. Poor sport-specific endurance (see point 3), which caused fatigue and desynchronization and discoordination in your technique.

6. Fatigue resulting from conditioning exercises (strength, muscular endurance) done during the workout prior to fighting and kicking drills. It is a common practice for bad instructors to lead their class through fatiguing conditioning prior to technical drills. They call it “warm-up” but it is not. Warm-up is not supposed to fatigue.

7. Static stretching prior to kicking drills. Such stretching is detrimental to neuromuscular coordination and can predispose one for an injury. In the next article of this column I will deal with this issue at greater length.

In the light of the above I would question the sense of ever returning to this class.

Thomas Kurz

Question:
After a hard squash game . . . my shoulder is sore and is becoming chronically sore. Also, my shoulder joints make all kinds of noises as I move my arms . . . creaks, snaps, pops, etc. . . . It feels like ligaments and tendons are catching on things and then suddenly snapping free. This can't be normal, is it? So I am doing the stretching routine for the shoulders.

Oh, that prompts a question . . . you say not to exercise until an injury or problem is totally solved. Does that mean avoiding the stretching routines until the joint is healed?

Answer:
I do not believe that stretching your shoulders will help you. Soreness of your shoulder after games that becomes chronic can be caused by working out too often, by too much anaerobic efforts in relation to your aerobic fitness, by weakness of some muscles of the upper body that causes misalignment of the shoulder joint and thus forces some of its muscles to work inefficiently, by overworking of the biceps brachii, which may cause swelling of its long head's tendon and grind against its groove in the arm bone.

Whenever ligaments or tendons “catch on things,” there is a possibility of inflammation and eventual damage to inflamed structures. An inflamed tendon of the long head of the biceps swells, rubs against the bony groove in which it moves, and pops out of it. As a result you get bone spurs in this groove. Also the ligament that holds the tendon in the groove gets overstretched so the tendon pops out of it easier and gets further aggravated. The bone spurs irritate the tendon and may eventually fry it.

Shoulder problems usually start with the impingement syndrome—when the biceps tendon or rotator cuff muscles are impinged upon by the coracoacromial arch. This impingement causes inflammation of the subacromial bursa and the muscles passing under the coracoacromial arch. Eventually you can get rotator cuff tears (partial or complete) and the biceps tendon inflammation possibly ending with its complete tear or avulsion (detachment) from its origin. When your muscles and subacromial bursa are inflamed, the cartilage in your shoulder joint may also be inflamed and badly damaged (ripped and shredded to the point where it does not even resemble joint cartilage). You won't feel the damage to your joint cartilage until the joint mechanics change drastically because joint cartilage has no pain receptors.

Clicking, catching, and popping sensations may be signs of a tear of the glenoid labrum (a fibro-cartilaginous rim attached around the shoulder joint socket).

Partial tears of muscles and bone spurs may require surgery to prevent more serious injuries to the joint and muscles. A surgical repair of a rotator cuff or biceps tear (often both are present) may put you out of your sport for at least six months if not forever. I suggest you read Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods, 3rd Edition, by Darlene Hertling and Randolph M. Kessler. This excellent book should help you evaluate qualifications of physical therapists or even design your own program of therapy.

Another cause of the swelling of the biceps tendon may be a digestive problem. This happens when the tendon is predisposed to swelling by a presence of bone spurs—result of the impingement syndrome. In some digestive problems the lymphatic system is overwhelmed by toxins and cannot remove metabolic waste from tired muscles. Muscles then recover poorly and stay painful, weak, and sometimes tense. For example, when the ileocecal valve between the small and large intestine does not function properly, the tendon of the long head of biceps brachii, if it is predisposed by previous damage, swells and does not fit in its groove. This digestive cause of your shoulder problems can be accurately diagnosed and removed by a doctor specializing in applied kinesiology. To find such a doctor in your area, visit www.icakusa.com.

Read Dr. Maffetone's books: Either In Fitness and in Health or The Maffetone Method: The Holistic, Low-Stress, No-Pain Way to Exceptional Fitnessto learn how too much anaerobic effort and stress affects muscle soreness.

Thomas Kurz

Question:
You say not to exercise until an injury or problem is totally solved. Does that mean avoiding stretching routines until a joint is healed?

Answer:
Unless told by a doctor otherwise, I would avoid all exercise with strong tension of muscles around that joint as well as any movements at the maximum range of motion. This may still leave gentle dynamic and static stretches available to you.

Thomas Kurz

Question:
I bought your video tape Power High Kicks with No Warm-Up! about a year ago, and it has been a revelation to me. I have been involved in Kyokushin Karate since 1984, and I can see why many of my friends now have knee problems due to improper technique. I haven't been training much in the dojo over the last year, but I have been going to the gym, and my flexibility is probably better than it was ten years ago when I went for my black belt!

My question concerns the weight training I am now doing. I had never done much in the way of weight training before, and late last year I suffered a shoulder injury. I was told that I was probably not stretching my shoulders properly before and after weight training (I was having most problems with the incline bench press).

Having studied your video tape on kicking, I am uncertain that the stretching methods I have been shown [in my gym] are the most effective. These are static stretches resisting against a wall. Your “law of specificity” makes me wonder if there is a better way. Can you enlighten me?

Answer:
You say that you “had never done much in the way of weight training before.” Perhaps you progressed too fast and caused a gradual-onset injury by a mechanism described in Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods.

I do not believe that not stretching your shoulders has contributed to your injury. I never do any form of static stretching prior to weight lifting or any resistance exercises. Static stretches temporarily weaken and predispose to injury the stretched muscles (more information on this is in the ninth article of my column). Static stretches are to be done after and not before resistance exercises, but I am not aware of any detrimental effect of not stretching the shoulders after the resistance exercises. After all, if the resistance is not excessive and exercises are done at the full range of motion, they will not reduce it.

Your problem may have less to do with stretching and more with doing too much too soon, an improper form of movements, or an improper balance of exercises.

Thomas Kurz

Question:
Your book [Stretching Scientifically] and video tape [Secrets of Stretching] have enabled me to attain a much higher performance level in my Taekwondo training.

I'm 49 years old and in good shape; stretching has always been easy for me, and I can throw high roundhouse kicks pretty easily and accurately (I am working on my Green Belt in TKD and am a relative novice to the sport). You say that muscle soreness after a workout is a sign of overworking the connective tissue in the muscles and is a bad sign. But I have sore muscles a lot after workouts. Nothing debilitating—I even seem to be making progress. But recently, I've had problems with my hip flexors and have a pain in the muscle belly that won't go away. I think this may be from doing the exercises you recommend in your book and tape. It may be that my body is just giving me less as I age. But I would like to eliminate the possibility that I've misunderstood your method and am doing something wrong. I do your dynamic stretch exercises before workouts, and feel great kicking. The next day I have a stiffness or a burn. I have backed off on all my workouts since the hip flexor (in my left leg) has begun pulling at me, and feel that rest is a good idea for it. But do you think it is all right for me to continue with the workouts you describe in your book and tape?

Answer:
Soreness once in a great while is normal (after introducing new resistance exercises not gradually enough), but being sore after consecutive workouts is not. Apparently you are not ready for these exercises or not ready to do as much of them as you do.

Do not continue workouts you are not ready for. If you do you can tear your hip flexors. So far you are getting all the warning signs—soreness, burning, stiffness, pulling or shortening (perhaps because of the hip flexor spasm).

Thomas Kurz

Question:
I'm 29 years old and I twisted my knee while playing basketball. I had a couple of weeks of swelling and soreness. After RICE [Rest, Ice, Compression, Elevation] and crutches my knee is much better, but it still can get a “tight” feeling in it, especially in the morning. I read some articles that seem to point to a meniscus cartilage tear. I also visited a doctor 2 weeks after the accident and because of no pain or irregular movement of the knee he recommended physical therapy for 2–3 weeks. My question is that if it's a tear, genetics aside, how much can cartilage repair itself? Do weight lifting, leg press, and squats help increase toughness of cartilage and are there any supplements to aid in the rebuilding process of the joint?

Answer:
Joint cartilage does not have blood vessels and its superficial portions—articular surfaces that contact each other as the joint moves—receive nutrition by absorbing synovial fluid. Synovial fluid has to be pumped in and out of the cartilage by intermittent pressure on the joint caused by weightbearing or contracting the muscles crossing the joint in the course of everyday activities and exercises. Both immobilization of the joint and prolonged pressure interfere with the adequate exchange of nutrients and waste products in its cartilage.

Whether injured cartilage is toughened by exercises or torn down depends on the extent of the damage, whether the cartilage has healed sufficiently before beginning the exercise program, and on the progression of the loads and adequate rest.

My own knee menisci were severely damaged while skiing in my youth and up to now tests of meniscus injury indicate that they are still damaged. Despite this my knees work perfectly well both while kicking and while wrestling. I use deadlifts and squats to stabilize my knees and I have progressed from very light weights to weights in excess of 200% of my body weight.

Regarding supplements I suggest you see a physician specializing in Applied Kinesiology. These physicians know tests for discovering which supplement matches best the needs of your body. A directory of Applied Kinesiology specialists in the United States is at www.icakusa.com

Thomas Kurz

Question:
My bones pop and crack when I warm up and stretch. Is this dangerous?

Answer:
The nature of noises in the joints is best determined by a competent physician.

Increased flexibility (range of motion) may cause greater frequency of joint clicking or popping, resulting from an enhanced leverage of the joint's bones.

Painless clicking or cracking in the joints themselves is harmless, especially if followed by the feeling of release of tension and by increased mobility. It usually happens when a joint is pulled or bent into a greater range of motion than usual.
There is a negative pressure in the joints. It keeps joint surfaces fitting closely. Joint surfaces normally do not touch each other. A thin layer of synovial fluid between joint cartilages protects them from rubbing against each other and there is gas (of a composition similar to air) dissolved in this fluid.

The cracking sound is caused by this gas dissolving out of the synovial fluid and forming a bubble between joint surfaces when the bones are pulled apart far enough. After several minutes the gas redissolves into the fluid. Popping or cracking of joints is not harmful per se but may be a sign of joint tightness caused by overly or unevenly tensed muscles—from an improper strength training or a neurological dysfunction.

Popping or snapping outside of the joint cavity may be caused by a ligament or a tendon catching on and then slipping over a bony prominence or by degenerative changes in the joint.

Some noises may be caused by tight muscles. For example, clicking or snapping outside of the hip joint (on the outside of the pelvis) may be caused by a tight iliotibial band and may be relieved by stretches of the hip abductors (gluteus medius, gluteus minimus, tensor fasciae latae, piriformis). Clicking or snapping to the inside of the hip joint (front of the pelvis) may be caused by a tight psoas. Muscles can become tight as a result of too much effort or too frequent exercise and not enough rest.

Another cause of sounds in a joint is osteoarthritis. When joint surfaces are diseased and the cartilage is eaten away, the ligaments and tendons crossing the joint get slack. Their slack lets them move in and out of their grooves, making popping sounds.

Loose bodies in a joint, making creaking noises particularly in the knee and hip joints, can be a result of chondromalacia (softening of the articular surfaces). This type of degeneration is accompanied by inflammation, pain, and swelling.

Kneecaps may “pop” when they snap in and out of alignment with the thigh bone as knees are bent and straightened. This may be caused by weak quadriceps. Check with a doctor if the knees hurt, swell, or get sore after working out or after walking up or down the stairs.

Clicking in the hip when extending the hip joint (as when dropping the leg after an axe kick) and adducting the thigh (bringing it back inward) after abducting it (raising it to the side while standing) may be caused by the tendon of the iliopsoas coming back over the hip joint capsule. It is not painful unless one has inflammation of the bursa (bursa iliopectinea) that lies in front of the hip joint and beneath the iliopsoas tendon. Also the tendon of the tensor fascia lata may snap forward over the greater trochanter of the femur as one makes sweeping semicircular movements with the lower limb or does squats with feet pointing out. This may indicate weakness of the thigh abductors. Such snapping is seldom painful but degeneration of the greater trochanter may result when it is experienced over a long period. To remedy this problem, strengthen the abductor muscles of the hip and stretch the tensor fascia lata—one of the abductors.

Falls or blows to the outside of the hip can damage the superficial trochanteric bursa (a sack with fluid that lies between the greater trochanter and tensor fascia lata and prevents them from rubbing against each other). Major bleeding in the bursa may result in a clot that with time will change into adhesions or loose bodies. These adhesions and loose bodies can cause inflammation of the bursa and make creaking noises during hip movement. Inflammation of the bursa is very painful, even when one is not moving. See an orthopedic surgeon or a physician knowledgeable in applied kinesiology to make sure that all is okay.

Snapping sounds from the hip may be caused by the iliofemoral ligament moving over the head of the femur during either hip flexion or abduction.

Thomas Kurz

Question:
I am 45 years old and have been training in Tae Kwon Do for 30 years. I have worked very hard to develop outstanding kicking techniques. I can do front and side splits with ease and can do them on chairs.

I have had pain in my left hip for 4 years and recently was diagnosed with severe osteoarthritis. According to my research I have three choices: do nothing and deal with the pain. It has even become difficult to walk; have a total hip replacement; have a hip resurfacing procedure.

Hip resurfacing sounds like the best choice. It is still experimental, but has several benefits. I am looking for advice and feedback from other dedicated martial artists who have had either total hip replacement or hip resurfacing. Which one is best for my situation? Are you still able to train intensely? Can you still do full splits (front and side)? Any referrals to good hospitals/physicians?

Answer:
Well, I have not had any hip surgery so I am not the best person for you to ask these questions. My hips are fine thanks to good luck (no major accidents, no congenital or chronic bone or joint disease) and rational training (right warm-ups, no static stretches before kicking, no stretching machines, no kicking marathons). Your questions can be best answered by martial artists who had hip replacements—Bill Wallace, Chuck Norris, and Steve “Nasty” Anderson, for example.

Before you decide on the operation, I would suggest you fully explore the conservative options such as Applied Kinesiology treatment and physical therapy. Joint damage usually results from poor muscle control (causes: wrong stretches, stretching at wrong time) or from imbalanced exercises. Diagnosis and treatment of poor muscular control of a joint can be very well done by Muscle Activation Technique specialist, or a physician specializing in Applied Kinesiology, or a Sports Chiropractor. Muscle Activation Technique specialists can be found at www.muscleactivation.com, Sports Chiropractors at www.acbsp.com, and physicians specializing in Applied Kinesiology at either www.icak.com or www.icakusa.com.

Thomas Kurz

Question:
I read your articles on stretching and strengthening exercises all the time. But, I have two artificial hips (although I am only 38 years old), and frequently suffer hip dislocation in my right hip during kicking exercises.

Do you have any suggestions, or tips for me to strengthen the muscles in my pelvic area that would specifically target the muscles that keep the hip joints in place?

I don't seem to have a problem with the left hip, just the right one (which is the newer implant).

Any suggestions you have would be greatly appreciated.

Answer:
I suggest that you first see an Applied Kinesiologist to find out and treat the cause of the uneven control of your hips (left fine, right dislocates). After that, your doctor (the Applied Kinesiologist) will recommend exercises for you. You may ask him or her whether the exercises shown on the video Secrets of Stretching or, if you are interested mainly in kicking, on the video Power High Kicks with No Warm-Up!, are suitable for you.

Question:
Is spat taping recommended for a healthy ankle?

Answer:
It depends on what kind of action you want to tape for. It may be fine for a football game where you can twist it while falling or for a kickboxing match where you want your ankle joints to be more rigid than normal. It is not a good idea to tape healthy joints when working out in less dangerous situations.

Tape reduces the loading on the joint and the range of motion over which the joint is strengthened so it either becomes weaker or not as strong as it could be if exercised without the additional support.

This is similar to the results of using weight belts. People who do not wear weight belts while lifting weights gain more strength in the lower back and abdominal muscles than people who do the same exercises while wearing the belts (Penn State Sports Medicine Newsletter vol. 6, no. 9, p. 3). For a person who lifts with the belt it is risky to perform a lift without one.

Thomas Kurz

Stadion Publishing Home | What's New at Stadion | What Others Say About Our Titles | Discussion Forum
Contact Us | Register to be notified of free information and new products

© 2005, 2009 by Stadion Publishing Co., Inc. All Rights Reserved. This internet site is protected by copyright. Any distribution or duplication of any of its content (text or images) without written permission from Stadion Publishing Co., Inc. is prohibited by law.