Chiropractor Dr. Alexander Jimenez summarizes some fascinating injury stories in the combat game…

I was recently on holiday in Koh Lanta in Thailand, and throughout my holiday, I visited a Muay Thai training gym for two reasons. Firstly, as I’ve been fascinated with the sport for some time, having formerly handled some injuries in some fighters in Australia, it was to have a private Muay Thai training session with a few of the boxers. I was that I could use it as material. I clarified the purpose of my visit and approached the head coach and discovered a few of the interesting injury stories they’d out, and he was pleased for me to talk to a few fighters. The following are just two case studies from this fact-finding mission.

The Biker’s Elbow

The initial fighter was a seeing K1 fighter out of Holland who spent six weeks a year in Thailand. He had been a fit and healthy 25-year-old man with a history of prior knee and back injuries; nonetheless, his complaint at this stage was pain on the inside of the right elbow that made grappling through fighting and lifting weights at the gym hard.

The pain had started only a few days after his recent trip to Thailand and had been present for about five days. It had been focused around the medial epicondyle of the elbow. Any powerful gripping moves whilst flexing the elbow were shown to be debilitating. It had been affecting his coaching as some other grappling work was too painful, and he could not perform any gym movements, such as chin-ups and rowing motions. All pushing-type movements were asymptomatic.

He whined no preceding elbow pain and refused any trauma to the elbow, such as an arm lock-type situation or a hyperextension-type injury during training or fighting.

He had been tender to palpate the source of the wrist flexor muscles, which start on the elbow along, and any forceful wrist extension was uneasy. His elbow felt secure, and using a stress test. The strong grip of the hands was painless until he was put in a position of wrist extension that was complete.

I quizzed him with no history of injury and no changes to his coaching regimen. We exercised that whilst in Thailand, he traveled on a scooter — a pastime for thieves to tackle when. He’d spent plenty of time around sightseeing on the bicycle when he came.

The type of scooter he used was an automatic without equipment shifting. The accelerator is on the right side of the bars. The reasoning was because of the continuous wrist extension used to accelerate the scooter at a pronated position; the wrist flexor muscles were put in a position of stretch with constant tension due to the co-contraction of this wrist flexor/extensor group required to do this particular movement. Coupled with this was the constant vibration on the bicycle caused by the movement of the scooter in addition to the frequent potholes and undulating road typical of Thai roads. The diagnosis was an inflammatory response in the wrist flexor origin.

I made the following suggestions:

1. Regularly extend by putting the hand flat on a table with the wrist turned to supination, the wrist flexors. He was to hold this for 30-second efforts.

2. Soft tissue massage to the wrist flexor muscle group, something he could do in Thailand using the massages on offer.

3. Moderate outrageous wrist flexor exercise with a 5kg dumbbell using the forearm, put on a desk (palm upward), slowly lower the weight into wrist extension, and use the flip side to help the concentric lifting. He was to do this

4. Change the hand place on the accelerator. It was suggested he can do three distinct things to achieve this. Primarily he can flare the elbow out broad whilst riding to decrease the amount. Up to this point, he kept the elbow close to the body to perform this. Secondly, he could occasionally hold the accelerator handle on the end to keep his forearm supination position, as this requires radial deviation to quicken the bike. Finally, on stretches of the street, I invited him to undo the grip, so he utilized wrist flexion to accelerate the bicycle and to supinate his forearm.

5. Rub some topical gel.

Two weeks later, I saw him, and he maintained that the elbow pain had entirely subsided.

The Buzzing Thigh

A 30-year-old Thai local fighter had whined a six-month history of a ‘buzzing’ kind of pain on the outside of the thigh and in the calf that was the ideal region. It’d started after he obtained a hard kick to the back of his right hip. The kick was so strong that he lost the function of his right leg at the time and needed a sensation down the thigh into the foot and calf. As this occurred in training, he rested on the leg, stopped, and used the Thai concoction of heat and ointments to manage this harm. He returned to coaching a couple of days later and had been involved in several fights. He felt he had been still practical but still felt a buzzing sensation every time. He claimed that he managed to perform everything and even blows to the thigh and hip were no longer painful than normal.

On examination, he had movement in both hips; his internal rotation when lying prone was decreased compared to another side. He was able to squat and perform a single leg pain-free. All knee motions and ligament testing demonstrated unremarkably.

What was painful was a slump test on the ideal side, and this reproduced the proper-sided throat sensations he experienced with kicking. The pain was made worse with dorsiflexion of the ankle whilst in a slump position.

It was concluded that when he had sustained the blow to the posterior hip, he had bruised the subsequent hematoma, and the right piriformis muscle had created fibrosis around the sciatic nerve. Each time he had to stretch into full hip flexion with the knee extended and the foot dorsiflexed to complete a roundhouse kick, he had been effectively stretching the nerve against the port made by the scarring and fibrosis around the guts by the preceding injury to the soft tissues. This would be sufficient to give him neuropathic pain down the leg across the course of the nerve and in the superficial peroneal nerve.

I explained that removing this was frequently’ extending’ or moving the guts from the vents to try to release the nerve out of any fibrosis. I showed him how to run his gentle nerve mobilizations as a slide-and-slide method (neurological wracking) and how to hold the place on the stretch to make a sustained elongation.

He did so sitting on the conclusion of the fighting ring at a full slump position (neck flexed, spine arched into flexion), and he had been to straighten the ideal knee with the foot dorsiflexed until he felt a gentle uncomfortable tug onto the guts (felt like a buzzing down the ideal leg). This was to be achieved to this point of discomfort but not pain. I explained that if he overdid motion and this stretch, he could worsen the issue, so I invited him to underdo this and not overdo this. He had been to spend five minutes after a warm-up finishing a string of knee extensions and releasing the stretch. After a pause, continue this on/off movement for five minutes per day, and he was to stretch again.

I didn’t figure out how this was solved as this movement would take a few weeks to make a noticeable shift can expect that he would have discovered relief from his signs at some stage in the future.

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Adrenal Insufficiency