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)