Sports Medicine Rehabilitation
Sports medicine and rehabilitation has taken on
greater importance in boxing today. The issues of injury prevention,
education and conditioning of athletes, and the treatment of injuries-
fractures, dislocations, intracranial bleeds are of major importance
within the sport of boxing.
Proper assessment and treatment of boxing
injuries require an understanding of boxing specific musculoskeletal and
The value of an inter disciplinary approach to
boxing to include physical therapists, massage therapists, certified
fitness trainers and nutritionalists is important to the approach of
providing comprehensive health care to the boxer athlete.
The mission of sports rehabilitation is to rehabilitate the injured boxing
athlete beyond the resolution of symptoms in order to allow a medically
safe return to the sport and prevent further injury.
The ringside physician is a physician licensed in medicine who has a broad
understanding of common boxing injuries as well acute emergencies.
Ringside physicians are presently participating on a voluntary basis.
role of the ring physician is to ensure the participant safety and ability
to perform in this contact sport. A background in sports medicine is an
attribute for a ringside physician.
The preferred physician should be a medical doctor
or doctor of osteopathic medicine and have proof of a current medical
license as well as medical malpractice insurance. He should be able to be
in good standing at a local hospital and familiar with the nearest
hospital emergency room to the boxing arena.
Communication between the
local emergency medical trauma team and the ringside medical staff is
critical in managing acute life-threatening injuries.
Boxing injuries can be divided into two basic types- those resulting from
acute trauma and those resulting from chronic repetitive microtrauma. Each
type of injury has certain specific characteristics and findings that are
associated within the evaluation process.
The difference between acute and chronic injuries lies in the fact that
acute injuries occur from a one-time event and are easily recognizable,
whereas chronic injuries usually present as a gradual onset with
increasing symptoms. In the chronic injuries, the exact timing of the
onset of injuries usually less exact since symptoms may be more widespread
and may be initially easily overlooked.
For both types of injures rehabilitation is an important process that
promotes healing and restoration of functional capabilities. Principles of
Rehabilitation There are three major phases that exist in the
rehabilitation process: the acute, the recovery, and the maintenance
The goal of rehabilitation includes the return of tissue healing,
maintenance of fitness, resolution of the injury cycle, and restoration of
functional endurances and flexibility to return back to the sport.
In the acute phase of rehabilitation modalities
should be used to reduce the signs of acute inflammation and injury.
Modalities such as ice, heat, hydrotherapy, electrical stimulation work to
decrease the swelling and facilitate tissue healing. Anti-inflammatory
medications, splinting and surgical treatment are all utilized in this
phase of rehabilitation.
Recovery Phase of Rehabilitation
The recovery phase is often the most lengthy and most involved phase of
rehabilitation. Emphasis in this stage shifts from resolution of
clinical symptoms to restoration of function. Anti-inflammatory medication
and physical therapy modalities are use much less frequently and assume a
more adjunctive role.
Appropriate tissue loading is the major modality
that is used in this phase. As tissues regain their integrity, flexibility
is increased and strength improved through isometric and isotonic
exercises and then isokinetic rehabilitation.
Isometric exercise increases strength quickly essentially through no
movement, (i.e., pushing against a wall). The disadvantage of isometrics
is that strengthening does not occur through the full range of motion,
therefore flexibility and conditioning are not promoted.
Isotonic exercise promotes muscle conditioning
through movement. Calisthenics and weightlifting are common examples of
isotonic exercises. In isotonic strengthening, muscles are loaded with
increasing increments to promote both strength and endurance.
The disadvantage of isotonic exercises is that these exercises are not
specific in promoting cardiovascular fitness.
Isokinetic exercise promotes strengthening and flexibility through a range
of motion for which a maximal force is given at every point within this
range of motion. Isokinetics frequently involve specialized machines that
match the strength through every degree of motion. This form of
strengthening and exercise is very effective for it provides a constant
load on the muscle allowing the athlete to achieve the highest level of
An adjunct to isometric, isotonic and isokinetic exercise strengthening
program is aerobic fitness. Aerobic exercises improve cardiovascular
fitness by increasing the heart rate, which promotes positive
physiological changes on the cardiovascular and respiratory systems.
Aerobic exercise should be targeted for a minimum of 15 minutes to
increase the heart rate within the desired target training level. In
addition to modalities and exercise, the therapist may add to their
rehabilitation, regimen using assistive devices.
Taping, braces and splints are frequently utilized
in acute trauma. Therapeutic massage has also been utilized as a modality
in acute injuries. Massage has been shown to be beneficial in improving
the stretching of tendons and connective tissue providing relief of muscle
tension and spasm. Massage enhances muscle recovery from intense exercise
as it improves muscle blood flow.
Recovery Phase of
The recovery phase is usually the longest and most involved phase of
rehabilitation. The emphasis of this phase is the resolution of clinical
symptoms and restoration of function. Within this stage, anti-inflammatories
and modalities are much less frequently utilized.
As recovery of muscular tissues is achieved, strength and flexibility are
the focus of the rehabilitation. Concentric and eccentric muscle
strengthening as well balance are emphasized.
Maintenance Phase of
The maintenance phase is the final phase of rehabilitation and helps
prevent future injury. In this phase, the athlete is prepared to return
back to his level of athletic performance. Simulated activity within
the sport's specific motions should be evaluated for any weaknesses and
strength, lack of flexibility or pain.
Protective equipment should be used to prevent any
recurrent or new trauma during this phase of rehabilitation. Criteria to
return back to athletic ability and training should be strict and include
the following components: no pain, full range of motion, strength being
equal on opposite sides, strength balance within the expected norm for the
sport, and a completion of the functional interval progression of
Acute Exacerbation of Chronic Injury
Acute exacerbation of chronic injury is difficult to distinguish from
acute injuries. An athlete may assume that the injury was completely
healed and then, through activity, have an acute exacerbation. It is up to
the healthcare practitioner to differentiate between a new trauma and a
re-aggravation of an underlying chronic condition.
Treatment of the acute
episode overlying a chronic problem involves the same recovery phases as
acute injuries. Identifying specific anatomical or physiological trauma is
more importantly the key to minimizing the degree of permanent injury.
Common Boxing Injuries at Olympic and Amateur
A 15-year record of injuries and illnesses of amateur boxers at the Untied
States Olympic Training Center in Colorado Springs was reviewed by Dr.
Timm, et al. (2). Although there were significant differences between the
frequency of injuries and illnesses collectively, the serious injuries
represented only a relatively small percentage (6.1 %).
The most common involved the upper extremity
representing 25%, second most common were head and face injuries,
representing 19%, third were lower extremity injuries, representing 15%
and finally spinal column injuries representing a 9% incidence.
study, followed by Dr. Timm, found the most common injury was a contusion
representing 24.90/0, followed by muscle strains representing 20.8%, joint
strains 17.5%, tendonitis 9.2%, concussion 6.1 % and fracture 4.9%.
The probability of injuries recurring is great if
the athlete returns prior to completing rehabilitation. In order to ensure
a safe recovery, five criteria should be met before participating in full
physical activity: I) Absence of pain; 2) Full range of motion at the
injured area; 3) Normal strength and size of the injured area; 4) Normal
speed and agility; 5) Normal level of fitness.
Absence of pain
In the acute phase of injury, pain usually disappears within a few days
for a bruise or minor sprain. For more serious injuries, the pain may
remain for days or weeks. The main goal of rehabilitation is to resolve
pain, reestablish normal range of motion, strength and
power and muscular endurance at the site of injury.
Full range of motion
Musculoskeletal injuries reduce range of motion at the joint. The more
severe the injury, the greater loss of range of motion. As soon as the
athlete is able to move an injured area, the athlete should be encouraged
to progressively increase the range of motion until normal range is
In regards to appropriate stretching over
the past two decades, many experts have advocated prolonged stretching
anywhere from 30 seconds to 20 minutes for what was termed the optimal
stretch. For years, this prolonged static stretching technique was the
However recently, studies have shown prolonged static stretch
greater than five seconds actually decreases the blood flow within the
tissue creating localized ischemia, increased lactic acid buildup and
With appropriate isolated interval stretching, full range will eventually
return. When an athlete can move the injured muscle or joint through its
normal range, strengthening exercises should begin.
Muscle strength and size
After an injury, muscle disuse or atrophy occurs from splinting, wrapping,
and resting the affected muscle groups. As a result of disuse, muscles
become smaller and weaker than they were before the injury. Strengthening
of the injured muscle group should be done conservatively and with
weighted increments. Weights should be incorporated to a level of pain
tolerance. If the weight utilized creates significant pain levels, then
one should return back to a lighter weight for the strengthening program.
Assessing full strength and size is best when
compared to the uninjured area on the opposite side of the body. When both
areas are equal size and strength, then the athlete may progress to the
next phase of recovery, which is competitive practice.
Speed and agility
Once the athlete has regained full strength through the entire range of
motion, he is ready to return to practice competition. Returning to
practice, the athlete progresses with the intensity and duration of the
activity. It is important for the trainer to specifically monitor
and observe the previously injured body part. When an athlete can move at
a pre-injury speed and agility, he is potentially ready to compete again.
Level of fitness-conditioning
Fatigue and injury have a strong relationship. When an athlete becomes
fatigued, his skill performance is reduced. Concentration becomes more
difficult, and reaction times slow down. As the athlete's judgment becomes
impaired, faulty decisions are made which
result in injuries.
One of the final phases of sports medicine and
rehabilitation is to improve performance and conditioning. The
conditioning program is designed to minimize fatigue and potential for
injury. Similarly, coaches and trainers must be aware that athletes will
engage in intense, frequent practices and bouts. They athletes require
time off. It is possible to over-train and cause, rather than prevent,
Injuries caused by overtraining are at an increasing proportion
within all sports injuries. Signs and symptoms of overtraining and
potential for injuries include: .elevated resting heart rate .chronic
muscle soreness .poor performance .higher incidence of injury .longer time
to recover from injury Warm-up.
The body responds optimally when proper
physiological responses are coordinated. The body requires a controlled
warm-up period to prepare itself physiologically with optimal body
temperature, increased blood flow and neurosensitization. This
physiological response promotes greater tissue pliability with more
effective and efficient neuromuscular functioning.
Muscles in the body tighten during periods of inactivity following hard
work. To minimize muscle stiffness and the soreness, 20 minutes should be
dedicated to adequately cool down at the end of the practice. A gradual
reduction of activity (the reverse of the
warm-up procedure) facilitates removal of the body's waste products
associated with intense muscular activity.
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Copyright © 2004 - 2012Taras V.
Kochno, M.D. All Rights Reserved
Board Certified in
Physical Medicine and Rehabilitation