Spinal Overuse Injuries in the Fighting Arts: Risk Factors and Prevention Strategies

The modern understanding of “the core” and the need to properly condition it has become well known among athletic and active people, including martial artists (yes, the importance of the hips has been belabored for centuries, but the modern anatomically based concept is not necessarily the same thing). The core refers to the muscles, connective tissues and bones of the torso, yet to many it’s just the rectus abdominis (the “6-pack’).  However, the core can be more accurately thought of as the support, stabilization and movement system for the spinal column. This stack of 33 vertebrae (24 moving and 9 fixed) is connected by many ligaments and muscles, which provide oppositional tension akin to the guy wires on a tall tower.

Although the muscles of the core are often targeted (efficiently or otherwise) in conditioning exercises, the numerous articulations of the spinal column will be involved in transmitting the forces of all motion that occurs in all three planes of movement (sagittal, frontal and transverse). Conditioning the core is important and useful, but martial artists in particular place much stress on the spinal column through conditioning exercises, skill training and either competitive or training sparring/Randori etc. Overuse injuries develop over time, making them harder to notice and correct, especially in settings where training practices that aggravate them are given inflated value and encouraged with no thought to long-term injury prevention and performance. Although this post will focus mostly on striking-oriented arts/sports, it is important to note that grappling & throwing arts/sports regularly also place high compressive, torsional and shearing forces on the spinal column, and careful attention should be paid to a student’s overall conditioning and individual risk factors- particularly of the cervical spine.

Several styles of karate, tae won do and other arts place a strong emphasis on long and deep stances. The rationale given for this is typically that it will develop strong legs, although the training may involve static holding of the posture or moving in sport-derived distances, which don’t necessarily resemble the movements common to actual fighting. The front stance of these arts tends to look highly similar, and the movement dysfunctions that excessive practice may lead to are a common sight among longtime practitioners. Many long time karate or TKD stylists exhibit a lordotic posture with excessively protracted shoulders, anterior pelvic tilt (the front of the pelvis tilts down towards the feet) and hip/foot turnout. This posture may be encouraged in lordosis-prone individuals and can lead to altered muscular recruitment patterns and the accompanying reduction in performance and increased overuse injury risk (prime movers are ‘turned down’, synergists take over, movement quality and joint health suffer). The resulting muscular impairments lead to changes in spinal posture, such as increased lordosis or kyphosis. Both are naturally present in healthy spinal columns, but an excess of either creates a cycle of muscular impairment and altered joint action. Both conditions may exist singly or overlap (see Norris, 1995), and in either case are associated with predictable patterns of injury and performance deficits. Recall the image of a tower stabilized by guy wires; if one cable is slack or too tight, what happens to the other cables? What happens to the distribution of force on the tower?


Since the long stance that leads to exaggerated lordosis is often encouraged by instructors who value a particular set of aesthetic qualities, the pattern may be reinforced without correction for long periods of time. Overuse injuries occur when a joint, muscle or other component of the kinetic chain is subjected to repetitive physical stress without an adequate amount of recovery or corrective programming.If conditioning exercises reinforce these movement patterns, or if one is unable to perform exercises without the altered posture, the stresses placed on the spinal column are multiplied.

With regard to posterior element (i.e., the rear aspect of the body) overuse injuries from long stances, Zetaruk (in Kordi, Mafullli, Wroble & Wallace, 2009) advises that:

…inadequate abdominal strength, poor stabilization of the trunk, or   increased lumbar lordosis may develop low back pain by placing additional stress on their posterior elements in a front-stance position. Pain is typically  present on spine extension, but some tightness in the lumbar region may benoted on flexion. (Kordi, et al., 2009)

Ironically, it is these very muscles and structures that will be further injured through use of long stances without appropriate pelvic stabilization. These individuals will eventually show signs of Dr. Vladimir Janda’s lower crossed syndrome (as cited in Norris, 1995), in which the abdominal muscles and gluteals are chronically inhibited while the erector spinae and hip flexors are shortened and dominant. This posture inhibits the action of the gluteal and abdominal muscles’ ability to stabilize the lumbar spine and hips (Norris, 1995), altering the recruitment patterns involved in moving or executing a technique. In the case of arts that also place an emphasis on generating impulse by rotating the hips, the posterior facets of the lumbar spine are subjected to compressive and torsional forces as the anterior facets are stretched. More time spent moving in the ways that cause such overuse injuries will only contribute to the problem.

Zetaruk (2009) mentions several strategies for addressing this cluster of problems, primarily through strengthening and corrective exercise programs targeting the muscles and movements. One major intervention that can produce results is to simply shorten the length of the stance, especially in adult populations with already-developed lower crossed syndrome. De-emphasizing static stance training and incorporating more natural movement is recommended. The “appropriate” length of a stance can be a hot topic of debate and rancor in some circles, and tend to have little practical value. For this discussion, the use of the term will refer to a posture that allows one to move efficiently and freely for evasive or offensive actions without placing undue stress on any element of the lower limb, hip, pelvic or spinal joints. Regardless of the specific art or sport, if one’s forward stance is so long that posterior pelvic rotation and the maintenance of a neutral spine becomes difficult, spinal overuse injuries and accompanying overuse of the ankles, knees, hips and shoulders will develop.

As mentioned but not elaborated upon by Zetaruk (2009), corrective programming to counter these problems is necessary. A strengthening and stretching/SMR program can be created, which might include the following:

  • Regular post-training static stretching and SMR of the latissimus,  erector spinae, and hip flexor muscles; Pre training stretching and SMR as appropriate; thoracic mobilization with a foam roll before and after class, if kyphosis is an issue.
  • activation and functional strengthening for the abdominals, gluteus maximus and hamstring muscle groups before training, with an emphasis on isometric and eccentric endurance before rapid force production is prioritized.
  • Replace full situps with crunches and isometric, multidirectional planks as well as eccentric-phase emphasis crunches. Full sit ups place more of the work load on the hip flexor groups (particularly the psoas), which create more forward pelvic tilt, placing stress on the lower back and aggravating lordotic postures and the associated abdominal-gluteal inhibition.
  • Respect the need for recovery. Pay attention to how strength programming may effect skill work. Periodize your training to provide higher or lesser intensity in areas prone to imbalance, and whenever possible link it to the demands of skill training so that overuse and overload can be avoided.

For examples of the above stretches and exercises, drop one of us a line. For consultation, weekend seminars or corrective programming guidance specific to your group and practices, contact Bob or myself.

 References:

Kordie, R., Mafulli, N., Wroble, R.R. &Wallace, W.A. (Eds.) (2009). Combat Sports Medicine. Springe-Verlag, London Limited. 162-163.

Norris, C.M. (1995). Spinal stabilization 4: Muscle imbalance and the low back. Physiotherapy, 81 (3), 127-138.

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4 responses to “Spinal Overuse Injuries in the Fighting Arts: Risk Factors and Prevention Strategies

  1. Pingback: Spinal Overuse Injuries in the Fighting Arts: Risk Factors and … | Injury Prevention

  2. Pingback: Link and Commentary: Lower Back Pain and the Preoccupation With Long, Deep Stances | Fight Sciences Research Institute blog

  3. Pingback: More for the Core: Are Sit-ups Helping Your Lower Back, or Hurting? | Fight Sciences Research Institute blog

  4. Pingback: Basic Thoracic Spine Injury Prevention for Fighting Arts & Combat Sports | Fight Sciences Research Institute blog

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