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Guest Post by:

Shane K. Woolf, M.D.
Associate Professor of Orthopaedics and Chief of Sports Medicine
Medical University of South Carolina - Sports Medicine

Thanksgiving has come and gone, and December is now upon us, which means grapplers from college to youth levels are hitting the mats. Wrestling season is, indeed, in full swing with the promise of a solid campaign ending in a championship run! As a former collegiate wrestler, I can still remember vividly this time of every season. Months of off-season cardio and weight training workouts, regular technique drills, and a dedicated schedule of summer tournaments will hopefully pay off and give the aspiring champ an edge at the respective weight class.

The other thing I remember distinctly is that wrestling season is a long battle, and one’s body is constantly stressed by the physical demands of this noble sport. Injuries and illness in wrestling can end a season and, instantly, spoil all of the hard earned off-season effort. Like athletes in any sport, wrestlers are subject to musculoskeletal injuries involving the entire body, as well as a multitude of other issues, some of which are unique to “close contact” sports.

Musculoskeletal Injury

Traumatic injuries in wrestlers more commonly occur in competition versus practice. One study of middle school athletes showed equivalent injury rates during practice and games for most sports except football and wrestling, which were higher during competition.1 Further, wrestlers are subject to an overall injury rate of 1.64 per 10,000 athletic exposures, second only to football players2 and are usually the result of direct player-player contact, unlike the cutting/pivoting types of injuries experienced by field and court athletes.3 Dislocated joints can happen, especially with complex moves and lifts/throws, but most injuries are ligament sprains and muscle strains. College wrestlers more commonly experience lacerations and cartilage injury, while high school athletes more frequently incur elbow and hand injury.4 Attentive officiating to monitor the intensity of slams to the mat, illegal holds, and potentially dangerous positions can help reduce these potential risks.

Head and Neck Injury

Dangerous holds, positions and throws also place the athlete at risk for concussion (traumatic brain injury) and neck injuries. Recent understanding of concussion management demands a cautious and systematic return to play, which can lead to time off the mat in both competition and practice. Concussion rates in wrestlers trail only football and girls soccer and are about equal to girl’s basketball.5 While not frequent, traumatic brain injury from concussion events must be considered by athletes, coaches and the medical team.

Face and Ear Injuries

Usually the result of a direct impact with another wrestler’s head, hands, knee or other body part as well landing on the mat, damage to the nose, mouth, teeth, and ears can lead to stitches, fractured teeth, lip and gum lacerations, and nasal airway obstruction. Auricular hematoma, or bleeding within the outer folds of the ear, requires drainage to avoid development of cauliflower ear.  This condition is the late effect of fibrous scarring and hardening of the hematoma and is permanent. Headgear can reduce but not eliminate the risk of ear injury when worn consistently. One study of collegiate wrestlers reported 39% of those surveyed had some degree of ear damage, 2.5x more common in those who did not wear headgear.6

Dehydration and Nutrition

Even prior to becoming thirsty, the athlete is already experiencing fluid deficit and may have already lost 2% of body weight. This degree of fluid loss, more common during intense and long practice workouts, can significantly impair cognition and performance. Coupled with the effects of compromised nutrition from misguided weight loss efforts to make a certain weight class, the athlete must be aware that top performance demands adequate nutrition and hydration. The consequences are fatigue, cramping, electrolyte imbalance (which can lead to cardiac issues), weakness, and certainly do not align with the wrestler’s goal of peak performance. I remember those days well and dreaded weigh-ins! In junior high school, my team once lost a match that we had forfeited my weight class when I did not make the cut. I was crushed, but now 30 years older and an experienced medical professional, I see the damaging health effects of extreme weight loss and dangerously low body fat. There is certainly value in optimal fitness, smart dieting with consistent, balanced caloric intake and regular hydration.

Skin Lesions

The nature of close contact in wrestling uniquely predisposes the athlete to skin tears, abrasions, and occasionally, infections. Bacterial infection, typically from Staphylococcus aureus and ringworm (a fungal rash) can be effectively treated with antibiotics or antifungals along with local care of the lesion. Recent outbreaks of Methicillin resistant strains of the Staph bacterium can be more difficult to control. The athlete must be taken out of competition until the infection resolves. Herpes Gladiatorum is a viral infection that can be more serious, as the virus causes painful skin lesions, usually on the face, neck, back, and/or trunk. This virus resides permanently in nerve ganglia where it can reactivate as recurrent lesions triggered by things like stress, UV light, skin irritation, and even certain foods. Common sense practices such as monitoring skin lesions, pre-competition skin checks, not sharing towels and gear, showering right after activity, and allowing lesions to resolve before return to the mat can make a huge difference. Coaches, parents, officials, and athletes must be aware of potential skin issues and work together to prevent spread.

Despite the risk of various injuries, some of which are unique to sports like wrestling, it is an awesome sport. I am admittedly biased, but there are few athletic activities that place such mental and physical demands on the athlete. It is an excellent sport for developing focus, strength, body control, and self-reliance. And ask any wrestler – the camaraderie of this ancient sport is just incredible! As a former 190 pounder and now a practicing orthopaedist, I encourage all parents, coaches, and officials to take care of the kids out there grappling hard. If an athlete does get injured, seek out the care of a sports medicine specialist, like those on the team at MUSC Health Sports Medicine, to get back out on the mat!

1 Beachy and Rauh, Journal of Athletic Training (2014)
2 Rechel et al, Journal of Trauma (2011)
3 Kerr et al, Clinical Pediatrics (2011)
4 Yard et al, American Journal of Sports Medicine (2008)
5 Marar et al, American Journal of Sports Medicine (2012)
6 Schuller et al, Archives of Otolaryngology (1989)

Guest Post by:

Bobby Weisenberger, ATC, PES
Head Athletic Trainer Charleston Battery
MUSC Sports Medicine

As the calendar turns to fall, Ice Hockey fans start to look to the start of a new season.  Hockey players of all skill levels are starting to hit the ice.  All of the major leagues including NHL, AHL, ECHL, and NCAA have seasons starting in October with the High School and Youth leagues following their lead.

Hockey is a considered a collision sport and treated as “high risk of injury”.  Due to the high contact nature of the game, hockey players wear a great deal of protective padding.  This padding consist of helmets, shoulder pads, elbow pads, padded gloves, padded pants that also protect kidneys, shin pads that also cover the knee, and skates.  Goalies wear helmets with full-face cages, a heavy-duty chest protector, wrist blocker and catching glove, large padded shin pads, and skates.  Due to several instances of eye injury, all of the pro leagues have mandated visors on helmets, while the NCAA and the leagues below require full-face protection.

Even with all of this protection injuries are still a major part of the game.  The most common injury in hockey are lacerations to the face caused by contact to the face by opposing players, high sticks, hitting the boards/glass, or being hit by the puck.  Ligament injuries, muscle strains, fractures, concussions, and contusions are also very common.  Many players suffer groin strains due to the specific types of movement required on the frictionless surface.  Knees and ankles are also susceptible to injury because of the heavy torque placed on the lower extremity during turning and pivoting on the ice.   Knees and ankles are also vulnerable to injury through contact with opposing players.

While some of these injuries are unpreventable, players can prevent many of them by engaging in proper training programs and proper pre practice/ pregame warm-ups.  Proper training programs include strengthening any muscles that are determined to be deficient.  Players should also be on a daily flexibility program to ensure they can function through a complete range of motion.  Pre practice and pregame warm-ups should consist of active muscle warm-up activities and drills.  Players must properly warm-up muscle groups before attempting any dynamic movements on the ice.

With the proper precautions and preparations, Ice Hockey is a great game that can be enjoyed safely at many ages.  Any and all injuries should be immediately reported to your teams Athletic Trainer and Team Physicians to ensure all injuries are dealt with in a timely manor with player safety always the main focus.

Today, experts from MUSC joined together for a Twitter chat focusing on holiday stress and tips to make it a happier, healthier holiday.

Dr. Joshua Brown, Director of Clinical Services, MUSC Weight Management Center (WMC), Dr. Constance Guille from the MUSC Department of Psychiatry and Behavioral Sciences and MUSC nutritionist Tonya Turner offered advice to help you prepare for the weeks ahead and provided some great resources for you to use after the Twitter Chat. 

We hope you were able to participate in our inaugural Twitter chat November 18 at noon.  If so, here are the links we promised you.  If not, we hope you will join us next time.  Our hashtag will be #MUSCchat.  If you missed the chat and want to learn more about the topics we covered today, check out these resources provided by our MUSC experts.

Be sure to follow:@MUSC_COM, @MUSCHealth, @MUSCPR and @MUSCPsychiatry to stay up-to-date on all the MUSC happenings.

smokingcessationWe all know that smoking is bad for us, but making the decision to quit - and sticking with a plan - is a very personal journey and one that often comes with pitfalls and setbacks. The good news is that there are more resources available than ever before - support groups, chat lines and social media outlets are great ways to start the process. Why not make this November 20th the first step in making a change and getting healthy?  

Here are some resources to help you along the way:  

South Carolina Quits
MUSC is a national leader in tobacco research and smoking cessation programs. Our team is working to provide better education and cessation resources for all of South Carolina.

American Cancer Society - Quit for Life Program
This Facebook page acts as on online support group for those on the road to being smoke-free.   

Helping a Smoker Quit: Do's and Don'ts
If you have a friend or family member who's trying to quit smoking, try and understand how hard it is. These tips can help you draw the line between being helpful and being pushy.   

South Carolina Tobacco-Free Collaborative
Formed in 2001, the TFC is a group of leading health organizations, community coalitions, and businesses in South Carolina who are committed to reducing the toll of tobacco use in our state. Their goal is to reduce that toll.   

Sign up to receive encouraging text message reminders and tips

Quit Smoking Apps
There are several apps to choose from, many offering daily reminders and motivators, cost savings calculators and a running count of your smoke-free days.  Exactly how you start your journey to being smoke-free isn't as important as making the decision to start the process.

Remember - talk to your doctor, make a plan and reach out to others for support.

Guest post by:
Emily A. Darr, M.D.
Assistant Professor of Physical Medicine and Rehabilitation
Department of Orthopaedic Surgery

Deanna Roberts, MS ATC
Department of Orthopaedic Surgery

So you've been training hard for an upcoming race and you're starting to feel an aching pain in your knee. Or maybe you're a new runner that's been increasing your mileage at the expense of a sharp pain in both your shins. Running injuries are a common part of the sport, and unfortunately, up to 82% of runners will experience one at some point in their training. Given this alarming rate of injuries, awareness of such injuries can be important in prevention, diagnosis, and treatment.

Bridge RunThe knee is arguably the most common site of injury with patellofemoral pain syndrome, AKA “runner’s knee”, affecting around 40% of runners. This is characterized by pain around and under the kneecap. Other common injuries include medial tibial stress syndrome, AKA “shin splints” which is an inflammation of the muscles and tendons of the lower leg characterized by a sharp pain, usually on the inside of the shins, Achilles tendonitis, plantar fasciitis, and IT band syndrome, which is pain on the outside of the knee that is caused by repetitive rubbing of the IT band against the outside of the knee.

Sometimes risk factors have a clear link with a particular injury, and sometimes there is a less clear link. Risk factors for which there is clear association with injury include:

  1. Increasing your mileage. Injury is more common when running over 20 and then 40 miles per week.
  2. Recent increase in training intensity
  3. Being new to running

Some risk factors which have a more loose association with injury may include:

  1. Changing your footwear or wearing improper footwear
  2. Running on harder surfaces
  3. Poor habits of warming up prior to running and stretching soft tissues
  4. Muscle imbalance and compensatory patterns

When dealing with an injury, it is best to listen to your body. Be sure to schedule rest days during your training, and take a few days off if your pain is worsening. If you are dealing with an injury that requires a few weeks of rest, pencil in some cross training days to maintain your cardiovascular conditioning. 

Pay attention to your training plan. If you notice a flare up in pain when running on the road, stick to a surface with more give like a turf field or soft track. Run on the side of the road that feels more comfortable and stick to flat courses if running up and down hills exacerbates your pain. When returning from a rest period, increase your training volume by 10% intervals to avoid overtraining and re-injury.

Can I run through an injury?

Dr. Bob Wilder’s Rules for Runners can quickly assess whether you should continue through pain.

  1. On a 10-point scale, pain during the run should be no greater than 0-3.
  2. Pain should not be severe to the point where you limp during or following the run.
  3. The long run should not be more than half the regular weekly volume.

Make sure to warm up before your run with dynamic stretching exercises that warm up your muscles and increase your heart rate. Include a cool down with gentle stretching exercises that focus on the main muscle groups worked during your run.

Running footwear has been a hot topic in recent years including minimalist shoes and barefoot running. Every foot is unique and every running style is different therefore a visit to a running store where a professional can assess your feet and help you decide on the best running shoe for you is well worth it.  Interestingly, studies have shown that when runners wear more expensive shoes promising more cushion or support, they suffer more injuries than runners who opt to wear cheaper footwear. There are no studies that show that running shoes actually prevent injury. Remember that the most important factor in finding a shoe that fits is to make sure it is comfortable when running, not just when placing it on your foot at the store.

If an injury continues to linger or worsen, see a sports medicine physician for further evaluation. He or she can provide you with a proper diagnosis and appropriate rehabilitation plan to get you back on the roads!

Running is a great form of exercise to engage in, whether it be in sport, with a running group, or participating in a color run with friends. These days, the possibilities are endless and so are the opportunities! With the proper training, equipment and rest, you too can have fun and be pain free during your run!


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