Shoulder Stabilziation for Striking: are you Focusing on the Right Muscles?

When considering upper body striking, martial artists tend to focus on the pectoral, triceps and deltoid muscle groups, and the glenohumeral (GH) joint, which is the most obvious shoulder joint. The GH joint consists of the humerus and the glenoid fossa of the scapula (the “socket” of the shoulder blade). Since this joint is essentially like a ball resting on a shallow dish, and not a deep socket like the hip joint, ligaments and the attached muscles provide most of the stability. There are also three other joints in the shoulder complex that play important roles in maintaining stability for the GH joint, with the scapulothoracic being most prone to abuse in combative training. This joint is formed by the fibrous connection of the scapula to the posterior torso wall, which allows the scapula to glide and rotate as the GH joint requires.

The serratus  anterior and the trapezius provide the ability to adduct (pull close to the ribcage), retract, depress, and upwardly or downwardly rotate the scapulae.  They maintain alignment of the glenoid fossa  with the head of the humerus.  A strong, reasonably flexible rotator cuff group is important, but the trapezius needs to be able to provide rotation and stabilization so that the GH joint stays centered and the rotator cuff isn’t impinged. The trapezius and serratus need to work synergistically with the GH joint movers. Striking in general requires the same coupling of scapular and humeral actions that has been reported for other overhand actions  (Kibler, et. al., 2007) such as the tennis serve.

Specificity of Conditioning in Fight Activities: Basic Concepts & Application

Specificity of training is the basis on which all modern physical training rests. Briefly, to produce a desired physiological adaptation, a training program must place sufficient stress on the physiological systems in question (Willmore & Costill, 2004). In training environments this is commonly referred to as Specific Adaptations to Imposed Demands (SAID).  Adaptations to training are limited to the physiological system overloaded by the program. This includes neuromotor, morphological, hormonal and metabolic elements. Fighting activities (encompassing both combat sports and fighting/self protection scenarios) present a unique programming challenge, requiring a range of adaptations to all systems.

Basic Thoracic Spine Injury Prevention for Fighting Arts & Combat Sports

The actions of fighting arts (including combatives and self-defense systems) and combat sports place regular high stresses on the spinal column. I’ve previously mentioned the anterior-posterior compressive and shear forces that affect the lumbar spine, but not the transverse rotational (torsional) and lateral compressive forces that actions like punching, kicking, throwing and falling places on the thoracic spine. Basic fighting postures, such as a standing guard or striking can encourage thoracic kyphosis and lateral asymmetry.  Left unchecked, torso actions can become plagued by dominant muscular patterns of imbalance to one side or the other, as a result of a favored limb or ingrained movement compensations due to faulty stabilization or movement system activity. Over time these muscular imbalances  can lead to vertebral facet degradation and arthritis, disk herniations and ruptures, nerve entrapment and bone spurs (typically in the direction of excessive muscular tension), all of which translate to reduced performance.

Curvature of a healthy spinal column. Note the lateral symmetry.

A Brief Discussion on the Relativity of Skills

Ed. Note: while the examples used in the piece below relate to punching and recreational/athletic MA training, the concepts can easily be applied to all other fighting skills and situations in which they might be used.

How many ways are there to skin a cat? Or in this case, throw a punch? Among both novice and experts (and “experts”), it can seem as if there is a “right” way to perform a fighting skill, yet variations are to be found from style to style,  from individual to individual, and even from moment to moment within the same encounter. The Q & A below came out of a discussion with martial artist and CSCS Daniel Ramos (fellow ATSU Human Movement Science alum).

Using the Overhead Squat Assessment to Identify Reductions in Punching Quality

The overhead squat assessment promoted by NASM (Clark & Lucett, 2011) provides a useful evaluation of the functional status of the latissimus dorsi during a common movement (video example here). The OHS requires that both trunk extension and shoulder flexion occur simultaneously, either or both of which may be altered if the muscle has become chronically shortened and tight. When the lats are hypertonic, shoulder range or motion (ROM) is altered due to excessive internal rotation and depression of the humerus, which further affects the actions of the scapula. This can be seen when an individual’s arms habitually fall forward past the line of the torso during the eccentric phase of the squat in an OHS evaluation, which is an indication of the arthrokinematic (joint movement) compensations needed to accommodate functional ROM as the muscle attempts to maintain a shorter distance between origin and insertion (for an excellent visual of how this occurs, take a look here).

Rear view of the latissimus dorsi. Note the broad connection to the pelvis, and the insertion on the humerus. An overactive (hypertonic) lat will cause alterations in shoulder and hip function, impairing good technique by reducing strength and mobility, while increasing the chances of an avoidable chronic injury.

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.

More on Rhabdomyolysis and the Fighting Arts

This is a follow up to Bob’s introduction to rhabdomyolysis as it relates to martial artists.

Rhabdomyolysis is the destruction of skeletal muscle leading to the release of the muscular tissue components  creatine kinease (CK) and myoglobin into the bloodstream (Huerta-Alardin, Varon & Marik, 2004). These components can pose a potential serious risk to the kidneys as they are cleared from the blood stream. Rhabdo can be caused by numerous factors, and can cause symptoms ranging in severity from mild to life threatening. Classic symtpoms include muscle pain, weakness and darkened urine (ranging from pinkto cola colored). Blood tests reveal elevated serum CK and myoglobin levels. More severe cases may present symptoms such as malaise, fever, tachycardia, nausea and vomiting (Huerta-Alardin et al., 2004). In severe cases acute renal failure can result, requiring medical attention.

No More Monkeys Jumping on the Bed: TBI and Martial Arts

“Five little monkeys jumping on the bed.
One fell off and bumped his head.
Called the doctor and the doctor said,
“No more monkeys jumping on the bed.”

I like to watch boxing and the occasional MMA match (which are more and more disappointing to watch- sometimes the striking and awareness looks about as developed as something I’d see in a grade school fight) but I have to confess that I feel a certain guilt each time I tune in. Combat sports, by nature, involve heavy physical contact. In the case of boxing and MMA, the majority of that contact is directed at the head. And every time one of those guys gets hit in the head, that grey-pink stuff inside of it gets sloshed around. When watching sports, boxing/MMA bouts, and action movies, we tend to become desensitized to the fact that this sort of repeated head trauma is extremely dangerous, and is itself the cause of a serious, but often invisible injury.

As martial artists, whether traditional or non-traditional, hobbyist or competitive athlete, we are also exposed to a higher risk of concussion and brain injury. Even non-contact schools involve feet and fists moving at speed towards the head and face, and accidents are easy to come by in large classes of mixed skill levels. In a setting where moderate contact, take downs and chokes are included in free sparring contexts, the risk multiplies. Full contact striking and take downs within free sparring contexts multiplies the risk even further. However, this risk often goes unacknowledged by teachers and participants. I’ve had several conversations with high school and college aged male athletes and martial arts students who take a disturbingly cavalier attitude towards concussions and the contact that causes them- “It’s part of the sport/training”, “it wasn’t that serious because coach/the ref put me back in after I got up”, “I get knocked out all the time, it’s no big deal, I can take it” etc. Obviously, there should be no place in amateur sports participation or martial arts training for this attitude, yet it still persists in many places.

In the case of professional athletes, the stakes are admittedly different. Boxing matches and UFC fights are between individuals who have trained for this level of competition, and who presumably understand and agree to the risks inherent in competitive full contact fighting. Watching two people who are being paid to kick the living shit out of each other is a different matter entirely than watching someone get hit in the head in a martial arts class, tournament or other amateur sporting event. But a very large grey area has emerged when it comes to the long-term effects of repeatedly being elbowed, kneed and kicked in the head in a UFC style match (to be fair, full contact Kyokushin style karate matches, real Muay Thai and bare knuckle fights also produce repeated concussions, but none of these have spawned the appeal that the UFC has in the U.S.). And when one considers that droves of people are attracted to amateur practice of MMA because it is touted as being “superior” to all other martial arts, one must also wonder how much of the accepting attitude of professionals towards the contact that causes brain injury goes along with it.

The simple fact is that every hard jolt sent through that blob of tissue that we call the brain damages it. And causing damage to the brain can (or more realistically, will) negatively affect your quality of life. This animation (courtesy of the U of Penn and A.D.A.M.) is the best tool that I’ve seen for giving viewers a visual representation of what a knock to the head does to the organ inside of it. As a society, we often forget that this organ is who we are. Everything about us, from breathing and sleeping to personality and memories, happens in the brain. Everything. Damage the brain, and you run the risk of damaging some aspect of your life. And it doesn’t take much to make this damage very serious or permanent. In the case of mild concussions, this might manifest as a few days or irritability, forgetfulness or other mental disruptions. But in the case of more serious concussions, or repeated mild to moderate ones, the damage begins to add up quickly, and the after effects become more severe and permanent. A neuropsychologist once cautioned me that “with brain injuries, one and one do not equal two- the effects are synergistic and unpredictable, so two concussions might produce damage far worse than either single injury.” Better awareness of the seriousness of Traumatic Brain Injury (a term which includes concussions, but far better communicates the reality of brain injury) is slowly emerging in America, thanks to efforts by the CDC and the fact that the Iraq war has produced a terribly high rate of soldiers with serious brain injuries. Despite this increasing awareness, amateur fans of MMA-style competitive fights seem to be oblivious to the serious risk of sustaining a brain injury in such activities. Consider this remark on the topic made on a popular karate forum:

“Any sport has its dangers, some more then othrs eg boxing, kick boxing, full contact martial arts. Its (ed: brain injury) a risk the dedicated student has to take..”

This statement may be applicable to a dedicated professional competitor, but the person making it is an amateur who trains for fun. Dedication to training is admirable, but willingness to sustain serious injury in the pursuit of a fuzzy ideal of dedication is both naive and dangerous. Again, for a pro competitor in the ring, brain injury is a risk that he or she is taking in exchange for payment; but this is not the same thing as an amateur student or weekend warrior who trains without monetary compensation or medical care. As the debate over MMA vs. “traditional” martial arts rages on, we must consider the risks involved in full contact competition in this light. For that matter, those of us who engage in karate, kung fu, Judo, etc… must also consider the risks that we are willing to expose ourselves and others to in the course of our training. Occasional bumps on the head, black eyes and fat lips are one thing, and are to be expected if one engages in vigorous training that aims to be realistic. But if we keep in mind that this sort of training is a different thing altogether from what goes on in UFC (or other NHB/full contact style) matches, the line between vigorous and unacceptably dangerous is very clear. While accidents can and do happen, a group’s first priority in training is to take care of each other. If training negatively affects our health and ability to enjoy the rest of our lives, what’s the point?