Mechanisms of soft tissue injury
No one likes to be sidelined because of an injury, but having some basic knowledge of your condition can help get you back training as quickly as possible. It is useful to know what in particular caused your problem, so that you can determine the steps needed to get you back in the game, and to prevent you from becoming injured in the first place.
In general, there are four basic causes of mechanical tissue damage. Of course, things can become much more complicated; however the following will go a long way in helping you understand your particular issues.Trauma
This is perhaps the most evident of them all. Trauma is characterized by its quick and obvious nature. Examples of this happen all the time during training. In grappling, you tapped just a little too late and that armbar tweaked your elbow. Or you reached out during a takedown and cranked your wrist.
The force must be clearly proportional to the injury, and the extent of the damage is known almost immediately. The amount of swelling, bruising, and pain will indicate how bad off you are. This also means that if it seems that your pain is out of sync with what just happened, you are probably right. “I bent over to pick up a sock, and my back went out” is not trauma! Rather, it is most likely due to a complex series of factors which are detailed below.
Overuse
Overuse problems are often confused with a repetitive stress injury. The definition of overuse is distinguished by a relatively fast breakdown in tissue, because of the introduction of a stress that the structure is not equipped to tolerate.
The cause is a distinct change in your “environment”, whether that is a new sport, or a new pair of shoes. The change can be easily identified and the symptom appearance is nearly immediate, usually within a few days, and sometimes as soon as a few hours (as anyone that overdoes it in their first weight training session can testify!). A common example is adding an extra day of training when your body is just not up for the extra stress. Perhaps you are getting just enough rest and recuperation on your regular off days from training, and you are not able to tolerate the extra work. If you ignore these symptoms of the “new ache” in your shoulders, or the shin splints that you haven’t had since you ran track in high school, you may be setting yourself up for long term problems. Overuse can then progress toward the chronic injuries that can plague dedicated martial arts practitioners.
Repetitive Stress
Repetitive stress injuries are formed by a slow buildup of irritation to a tissue. These injuries are very common in committed trainees who practice their techniques or drills again and again, in the quest to improve. An example is the carpenter who works for years and years without difficulty, yet now notices a lingering pain that is worsening. When questioned he may recall that there was a gradual deterioration in his performance. But the slow deterioration can be difficult to notice until the pain becomes too much to ignore.
An illustration in our pastime is working the heavy bag hard for many rounds, week in and week out. Initially we feel an ache in our shoulders which comes and goes. But some months later, we notice that ache lingering longer than it has before, and perhaps appeared when we hoisted that bag of groceries.
What causes this? Perhaps an illness, or even just the passage of time, which brought strength levels down for a bit while the person continued on without any decrease in the volume of his activities. A good way to prevent this is to have a good variety in our training, avoiding repeating specific movements again and again without change.
Exhausted Adaptive Potential
Our bodies’ adaptive potential is defined as our ability to tolerate the various stresses in our daily activities. This is distinct from overuse or repetitive stress, in that the underlying problem is generally not at the area of our pain. It arises from a particular cascade of events from a past trauma that appeared to heal and resolve. Yet what we don’t see is that the body did not heal the issue, it instead compensated by changing certain other structures away from the compromised body part. These adaptations gradually cause the problems with which we now find ourselves.
The true cause is often far removed from the site of pain. This has been described with the concept of “Victim vs. Culprit”. The victim is the local site of your pain, while the true culprit can be at a different location altogether. The cause of these compensations is what needs to be addressed rather than just treating the symptoms at the site of pain. The hard break-fall you took on your back some months ago that got better after a couple of weeks, may have subtly changed the posture of your neck. Even though you had no pain in your neck after the incident, you now notice this pain which “came out of nowhere”.
A complex example can be found in the variety of causes for tennis elbow, otherwise known as lateral epicondylitis (the inflammation of the forearm extensor tendon group that attaches at the elbow joint). The simplest explanation is an overwork/use of those extensor muscles. Why that might be the case can be significantly more complicated. One elaborate reason is that of a previous neck strain which irritates a nerve root. This irritated nerve root is then unable to provide a normal signal to your wrist extensor musculature. These weakened electrical impulse may then cause a dysfunctional muscle contraction. This decreased force of contraction makes the muscles less capable and the tissue cannot withstand the external forces acting upon it. This can be a difficult concept to grasp. The easiest way to look at this is to think about the weak spots in your physical make-up. Are your shoulders a little tight? Do you have trouble bending backward, or bridging up? Is your neck stiff when you turn to the right? These issues can create problems elsewhere in your body, and make you more vulnerable to injuries during your training. Identifying and working on your problem areas can help prevent bigger problems in the future.
Conclusion
As has been outlined above, injuries can come about through a wide range of causes. If you would like to reduce your likelihood of injury then I strongly encourage you to familiarize yourself with the four major causes that have been covered in this article. Once you get a handle on these causes you may then be able to take measures decreasing your chance of injury. Reducing exposure to trauma may mean wearing the proper protective gear. Overuse and repetitive stress may be warded off by varying your training schedule and intensity levels. And, making sure your body’s adaptive potential remains functional, requires taking care of your deficient points with proactive stretching and strengthening. Applying a little bit of thought into your training regimen can go a long way in reducing those injuries that can take us away from the fun in training.
*The identification of mechanical tissue damage taken from a seminar with Erl Pettman, PT, MCSP, MCPA, FCAMT. Shoulder Girdle Pathology Secondary to Spinal Dysfunction, December 2001, Vancouver, B.C.
Jarlo Ilano, M.P.T. has been a Physical Therapist since 1998.
He lives in Honolulu, Hawaii and is a certified JKD Unlimited Instructor.