First Aid For Fighters: Torn Toenail

by Meredith & Doc Dill

More for the injury journal:

After months of 'breaking in" savate shoes that were a bit small on my right foot (my right is a half size bigger than my left, whatever, I'm not the only one), my big toe turned black. This was unattractive but not too upsetting since I have the nail polish option. It was already starting to grow out, so I didn't pay much attention to it. Then one day when I was sparring, I threw a roundhouse and my partner stuck out his elbow. He wasn't wearing elbowpads and my toenail split in half horizontally. I'd like to mention that I WAS wearing my savate shoes at the time. So currently I'm applying neosporin and trying to keep the remainder of the nail on the toe with bandaids.

Doc Dill says:

Ouch! Busted toenails hurt like a bitch!!

Well, ideally you should trim the broken part to prevent moisture accumulating and developing a fungal nail bed infection. Neosporin to keep it from drying out and cracking and preventing a bacterial infection. Cover it to protect it and wash it twice a day thoroughly trying it. In a couple of months the nail will grow out and you'll have beautiful tootsies once again.

Wash Your Clothes!

by Meredith

Wash your shit.

Just because you're about to get it all sweaty again does not justify dragging a stinky gi out of the laundry and wearing it in to class to burn the nose hairs off of your fellow students. I always keep an extra gi and shirt in my locker. If you're one of those that sweats profusely (you know who you are) and you plan on working out before class or taking more than one class, by all means, bring an extra shirt to change into. Especially if you're going to be grappling. Or kickboxing. I hate kicking someone and then having to drag my foot along the floor afterwards until I wipe off their sweat and regain traction. Just bring an extra shirt. For me.

Also, wash your knee and elbow pads and handwraps. I've been guilty of letting this go too long once before and man... was it embarrassing. But I made up for it this Saturday when I was about to grapple and my partner asked, "What fabric softener do you use? You smell great!" And, yes, he was a heterosexual male.

Just wash your stuff. It makes for good hygiene and good neighbors.

Doc Dill has the following to add regarding the sorts of things you might find growing in your nasty old gear.

Yep, [keep your gear/clothing clean] and you reduce the chance of passing on or contracting an infection. Things like impetigo, pseudomonas, etc. Worse is getting an antibiotic resistant bacterial infection like the MRSA or the "flesh eating bacteria." You wind up in the hospital on IV antibiotics, which leave you with a good chance at permanent dizziness. It's not all that hard to contract either. So stop the stink!!! Wash your SHIT and don't try and cover it up with bad cologne either. That just makes you smell like an 80 yr old incontinent with a bad nose.

CC licensed image from Handforged.

Mailbag! How hard do you have to punch someone to give them a concussion?

Q. How hard do you have to punch someone to give them a concussion?

Doc Dill responds:

As my instructor used to say, "you don't have to hit someone hard, you have to hit them right to knock them out."

Basically you need to jostle their head. The "button" is considered the chin. if you hit the chin with enough snap that the jaw slaps shut hard or the whole head jerks down then up or twists sideways suddenly, you will probably knock them out. Think of it this way, you want to shake the ketchup from the bottom of the bottle to the neck. so you jerk down, then up suddenly, making the ketchup in the bottle travel opposite the direction of the bottle. Same thing with the head. You want that little brain bouncing around inside that skull like a walnut inside the husk until lights out.

For more information about knockouts, brain trauma and concussions, see:

Is it a concussion?

What's in a knockout?

CC-licensed photo by Arriba

First Aid for Fighters: Stupid Shoulder Injury

by Meredith & Doc Dill

It was time to take the stupid family Christmas picture. I began to trundle down the stairs yelling over my shoulder for my cousins to follow me. I slipped. My left hand instinctively latched on to the railing and didn't let go although the rest of me fell. (This would have been cool had I been falling off a cliff or something cool like that.) After a couple of hours, it became clear that this was not just a minor strain. I couldn't live my arm above my waist without pain in my shoulder. Really I couldn't move it much at all. I iced it and took tons of Advil and when I got home two days later, a P.T. worked on it. It felt much better after that, but it still gets 'tired' when I work out and feels 'delicate' when I do certain things. I.E. after throwing a couple of hard jabs into a focus mitt, I get that 'this minor discomfort is a warning' kind of mild pain. I've been avoiding grappling and throwing hard left hooks.

Doc Dill says:

Well a couple of things could have happened here. Overhead injuries like the kind you describe happen in sports to pole vaulters and gymnasts. In those sports you are trying to lift or hold body weight with one or both arms in extreme flexion. A little too much extreme flexion or a ballistic move like you did (falling with a sudden recovery) and something's gotta give. Three possibilities come to mind: 1) acromioclavicular joint separation (separated shoulder), 2) rotator cuff strain, tear or compressive injury, or 3) torn labrum. Number three is bad and will only get better with surgery if you're lucky. Luckily these are rare. Number two is serious but unless it's a complete tear you can avoid surgery. Number one hurts more than the other two and takes a long time to fully heal but is relatively a minor injury. How do you tell the difference?

Well, 1 will hurt when you touch the end of your collar bone or if you grab the collar bone and try to wiggle it hard. 2 will be painful in the resisted "empty can" position. if a complete tear you will have no pain and be unable to resist at all.* In 3 you will most likely have pain with movement and a feeling of slippage as if you're shoulder wasn't attached right or a painful arc where everytime you move through a motion it hurts only through the same portion of the motion. Whattaya do? Well ICE then strengthen the scapulo-thoracic musculature and retrain scapulo- thoracic rhythm which I'll cover in another article.

* Empty can position fists in front of pockets arm rotated so thumbs point down, flex shoulder so arms are lifted on angles lower than shoulder height, as if emptying pop cans.

First Aid For Fighters: Is it a Cauliflower Ear?

Doc,

I got earholed. Now my ear hurts. I hope it's not cauliflower ear. What can I do about it?

First off, is the pain in your ear canal or the external ear? If it's the external ear you prolly have a hematoma and should get it drained.* I waited too long and had to have a surgical irrigation and drainage. Essentially opening the skin removing the clot, sewing it up and smashing the ear with a hard dressing. the cartilage of your ear gets its nutrition from the skin. if you get a clot under the skin one of two things happens. 1: The cartilage thickens and twists giving you a cauliflower ear. Looks like a pig chewed on it. 2: The cartilage can die, rot and you have your ear removed. Bizarrely enough, this looks worse that the chewed up ear.

If the pain is inside your ear you may have a serious problem, especially if you can't hear very well. You may have an infection or the bones (ossicles) in your hearing mechanism may be dislocated. either way go see an ENT doc. (Ear, Nose, Throat or otorhinolaryngologist).

* Why We Not Hit Hard? recommends that you see a trained professional to have your ear drained. Don't let your buddy do it. Don't let your buddy's wife do this, unless she does it for a living. Just working in a hospital doesn't count. Maybe your wrestling coach, but if he's smart, he'll tell you to go to a doctor. Having your ear drained is a simple, quick and terribly painful procedure. But it's better than the alternative which is to walk around with a giant cauliflower ear. Regardless of what the other guys in the gym say, girls don't find it attractive. We've done studies.

CC-licensed photo by daviddeferro. Yes, that's Alessio Sakara.

Mailbag! Why are blows to the back of the head illegal?

Q. Why is it illegal for boxers to punch each other in the back of the head?

Doc Dill says:

Because you can kill them. Seriously, spinal cord injury or fractured skull.

First Aid For Fighters: Is it a concussion?

Doc, I got rocked in class, but I'm pretty sure I don't have a concussion. How long should I wait before training again? I don't want to take the risk of making things worse by going back too early. Also, I get a headache when I hit the bags too hard (especially crosses and elbows). Is that a warning sign?

Doc Dill responds:

Dude, how do you know you don't have a concussion? You have all the symptoms; headache especially with impact and dulled thinking, or are you always this stupid? Sorry, I have a case of diarrhea and am really crabby.

Anyway, you may actually have a cervical strain or sprain. In English that would be a neck stran or sprain. Both can cause those symptoms. A strain is a muscular injury a sprain is a ligamentous injury. Both cause pain and spasm. High cervical muscular spasm impinges the greaer and lesser occipital nerves and can cause pretty severe headaches. This is easy to determine. Push with your fingers into the hollows in the base of your skull at the back of your head. Slide them around until you are pushing on a very tender area. If that feels like your headaches it is most likely the cause. mash the areas and ice them for relief. Then improve your posture. Your ear should be in line with your shoulder and hip.

Poor posture makes you over use these muscles and contributes to the tension.

In case you missed it earlier, Doc Dill isn't actually a doctor. Take his advice for what it's worth, but consider talking to someone with the appropriate credentials.

First Aid For Fighters: Cramping Hands/Forearms

Doc, My hands and forearms are all tight from making fists (I think my new bag gloves are to blame, but probably the way I wrap my hands as well). Anything I should do differently besides getting new gloves? Exercises to stretch things back to the right spot?

Doc Dill says:

Well, first off let's try and improve your discomfort. So ice, compression and elevation to decrease your swelling and improve blood flow. An NSAID, like ibuprofen, would also be a good idea. Massage and stretching to improve the suppleness of the tissues. To stretch, bend your wrists as far as you can in both directions and hold for 5 to 15 seconds. Repeat several times. Rest and especially no lifting or striking for 1 to 2 weeks.

Now, let's talk about the reason this happened. Most likely a multifactorial cause. Overuse being the most likely culprit. You need to learn to relax your fists except at the moment of impact. You may be wrapping your wrists too tightly or improperly and impairing blood flow. Also if you are working the bags a lot try not hitting the heaviest bag all the time. Work on snap and speed and lay off the pounding especially if you have a tendency to pound the bags a lot. Hitting hard all the time can do a lot of harm to your wrists and elbows and really does not improve your fighting ability. All in all the problem is usually self limiting but if it lasts too long make sure you see a good hand specialist.

In case you missed it earlier, Doc Dill isn't actually a doctor. Take his advice for what it's worth, but consider talking to someone with the appropriate credentials.

Mailbag! Is it bad to get hit in the side of the head?

Dear Doc Dill?

Is it bad to get hit in the side of the head?

A. Hell no! It's great to get hit in the side of the head! Which side is the question. Dumb f***!*

* Believe it or not, that response was sarcastic. Why We Not Hit Hard is hard-pressed to think about when it might be good to get hit in the head, although to be sure, there are worse places to be hit in the head than the side.

Take home lesson: try not to get hit in the head.

Wear your damn cups

by Meredith

This article is a 'mate' (if you will) to Mike's Wear a Damn Cup article below.

Ladies. Wear your chest protectors, PLEASE.

I know all the reasons why you might not want to. I put it off as long as I could, personally. I didn't want to look all 'busty' while I was working out. I liked the flatness of the sports bra. "It hasn't been a problem so far." "I never get hit there." Suck it up. I did.

My new favorite place to plant a thrust kick is square in the chest of my opponent. And you know how it is, we're all moving around, sometimes things don't hit square. I'm sick of feeling guilty for landing a good shot on a partner who wasn't wearing the proper equipment. I don't care if you're big or small. I'm a 32C, so I'm right there in the middle. What, it doesn't hurt you? Too many hits to the chest can cause damage. We don't want breast cancer do we? No. No we don't.

For more impact, here's what Dr. Dill says:

Lumps, scarring, deformation can all be the result of continued trauma to breast tissue. This can make detection of tumors more difficult resulting in more mammagrams and potentially more surgical procedures than would normally be expected. "Protect the girls!!"

Also, these babies can be an advantage! Ever grapple a guy in class and manage to put your full weight on him in a cross body position? Generally they will yelp or squirm if you're wearing your boob armor! Personally, I wear the turtle shells. I landed a shovel hook on a girl wearing that full torso stuff and hurt my thumb. A lot. Like, I had to stop.

So wear your shields. I'm not going to feel bad for kicking/punching your girls anymore.

And another thing, this can go for both sexes, don't go live if you forgot your mouthguard.

The one time I made a guy's lip bleed during a grappling class, I felt really bad. Until I realized he wasn't wearing a mouthguard. By choice. I mean, c'mon. Don't we all like our teeth? Especially during something like grappling where you never know where things are going to land half the time.

If you forget it, then let your partner know, and just drill. Sit out during anything live. Obviously the same goes for boxing and kickboxing. I get very annoyed when someone forgets their mouthguard, and then it's ME who is handicapped by not being able to punch them in the face. This happened once on my end, and I told my partner I wouldn't punch her in the face either since she couldn't punch me. Fair's fair. But what a drag when you were counting on all out sparring. At least offer to sit out and time until someone wants an easy round. Go work the bags.

What's in a Knock Out? [First Aid for Fighters]

Doc Dill:

I can't find any definitive evidence on what a knockout is and what happens when you do get knocked out. The best I can do is:

1. You get hit in the head, your head goes in one direction, but your brain stays mostly in the same place.

2. The cerebrospinal fluid can't keep a buffer between your brain and your skull, so your brain goes "boink."

3. When your neck muscles kick in and try to stabilize your head and/or your neck goes to the end or the range of motion, the brain goes in the opposite direction, bouncing off the other side of your skull.

3.5 This may be repeated a couple of times until your head comes to rest.

4. ??? A large number of neurons fire simultaneously and overload your senses and/or arteries that supply blood to your brain are cut off and/or something else entirely ???

5. You fall down.

That sound about right, or does an actual explanation exist somewhere?'

What's going on?

Thanks,"

by Doc Dill

It's called a concussion. 2 types. coup and contra coup. Coup is a brain injury on the same side of the head as the blow received. contra coup is on the opposite side.

A knockout is simply a "bruise on the brain." You can suffer a concussion even if you never lose consciousness.

You get hit and your brain can get bruised. doesn't matter which side. you will have symptoms. Headache, dizziness, nausea and/or vomiting, difficulty walking,seeing,hearing, memory loss and /or confusion. The longer they last doesn't mean the worse it is. Unconsciousness is bad, especially if it occurs after the initial "knockout." Vomiting is bad. Bleeding from the ears is really bad.

The effects of concussion are cumulative. That is, the more "knockouts" one suffers the more likely permanent symptoms will occur and these are not good. memory loss, psychiatric disease and personality changes are quite common due to brain injury. This is because your brain doesn't heal and restore function like other body parts. Areas of brain lost are permanently gone.

Prevention is key. Get better defense!! If you are rocked or knocked out take time off from getting hit. If you are on medication that prolongs bleeding time, like coumadin or frankly even aspirin or ibuprofen, you are at risk for an inter cranial hemorrhage which is far worse than a concussion. Above all if you lose consciousness vomit, bleed from the ears or have a headache that lasts, you should see a doctor and get a proper workup.

If you are one of those guys who thinks "it's no big deal i get dropped all the time and i am still ok," maybe you should try tennis.

In case you missed it earlier, Doc Dill isn't actually a doctor. Take his advice for what it's worth, but consider talking to someone with the appropriate credentials.

First Aid for Fighters: Don't Blow Your Nose!

Q. I heard a couple guys in the gym talking about why a boxer shouldn't blow their nose during the fight. Sounded like the silliest thing in the world to me, but it seemed like the most obvious thing in the world to them. Especially as we get to the winter, I get runny noses while sparring all the time. Am I going to explode my head if I blow it?

A. If a boxer has a fractured orbit or a select few other facial bones, blowing your nose can force snot, blood, bacteria and air through the fracture (assuming it communicates with the nasal sinuses) under the skin or worse into the cranial cavity. this can be potentially life threatening. Frankly, blowing your nose in general is rather unhealthy as you can force material into your middle ear quite easily.

The condition is called "subcutaneous emphysema" or air under the skin.

In case you missed it earlier, Doc Dill isn't actually a doctor. Take his advice for what it's worth, but consider talking to someone with the appropriate credentials.

First Aid for Fighters: Itchy noses and MRSA scares

Dear Doc Dill,

Every now and then when I get popped in the nose, I notice it itching more than hurting. This happens with certain people more than others. Do I just need to tell them to clean their gloves, or do I need to worry about MRSA?

Karl Malden

Well you actually have asked 2 questions, Karl. The first “My nose itches when hit.” Well that’s easy. It’s probably just a histamine release caused by capillary destruction due to the blow to the nose. Other causes could be an underlying case of Rosacea, also known as adult acne, although it is not acne at all. It’s an immune system disorder characterized by a red rash on the face and nose exacerbated by trauma foods and other irritants. It’s the cause of the giant bulbous nose ala W.C. Fields and your namesake. It is unlikely but could be an allergy to something on your partner’s glove. Like cat urine or leather conditioner.

The second question is “should I fear MRSA?”

Methicillin Resistant Staph Aureus is a variant of stap aureus that was caused by the overuse of antbiotics. Blame all those friends of yours who get an “antibiotic” every time they get a cold. If you work in a hospital or frequent hospitals or nursing homes you are more susceptible. If you have an immune system disorder like AIDS you need to be extremely careful. The rest of us should just use normal everyday hygiene precaution. Wash your hands disinfect your gear and let it dry regularly. Wear clean clothes especially to work out in. If you get cut, clean it and cover it. Change the bandage regularly and if it starts getting red and oozing pus go to a doctor.

MMA rats and wrestlers are much more likely to get Impetigo than MRSA. Those high school kids that got it are likely getting exposed to it somewhere else like visiting gramma in the nursing home and bringing it to school. Children are slobs and carry germs like petrie dishes. In my World they would ALL go away to boarding school until they are 18.

DD

In case you missed it earlier, Doc Dill isn't actually a doctor. Take his advice for what it's worth, but consider talking to someone with the appropriate credentials.

First Aid for Fighters: Deep Thigh Bruising

by Meredith & Doc Dill

This one's pretty simple. I was sparring with a guy who was bigger and more experienced and got nailed in the left leg with three Thai kicks in rapid succession. My leg was killing me for days after, but no bruise showed. It happened to be the same leg with my injured ankle which was not quite healed. And it also happened to occur one day before a three day Savate seminar I was attending. I wrapped it up during the seminar and tried to avoid getting kicked there. And the next time I went with the guy who had kicked me I moved the entire time. My left leg is now a little shy, which I'm not sure is a bad thing.

Doc Dill responds:

Thigh bruises are potentially very serious. There are two areas of the body, the bicep and the quadriceps that have a tendency to turn accumulated blood, called a hemotoma, into bone. This is called myositis ossificans. This happens a lot to football players who cut down their thigh pads so they can run more freely.

Martial arts practitioners are particularly susceptible for reasons other than the obvious constant impact. In martial arts in particular there is a bit of quackery healing going on. All of the Ancient Asian Secrets applied by well meaning but ignorant “healers” should be avoided. Use only well known and preferably licensed practitioners. I do know a few trusted non-licensed “healers” but always use caution when seeking treatment. Both the biceps and quadriceps should NEVER be massaged after a deep bruise. This furthers the chances of developing a bony growth in the muscle.

This bone is both painful and debilitating. Surgical removal is the usual way of dealing with it although there are Physical Therapists in New York State that do iontophoresis with acetic acid to dissolve the heterotopic bone. I have seen radiographs before and after and the results are encouraging.

Basically lots of ice, gentle range of motion without pain, compression with ace wraps and protection from impact for several weeks is the way to deal with a deep thigh or bicep bruise. Good luck in your training.

Dr D

In case you missed it earlier, Doc Dill isn't actually a doctor. Take his advice for what it's worth, but consider talking to someone with the appropriate credentials.

First Aid for Fighters: Not So Stupid Ankle Injury

by Meredith & Doc Dill

Thumbs and shoulder being healed, it was time for leg and feet injuries. I hurt my ankle during a footwork drill. This was before I wore shoes to class regularly and my foot just rolled to the side and my leg stayed upright. I fell down instantly because I knew it was bad. I started swelling up right away and I had to take the rest of the class off and ice it. I iced it all night and it hurt so very very bad. I limped to work the next day with an ankle brace and iced it every hour for twenty minutes and wrapped it in between. It hurt. At first I didn't tell anyone about it aside from those in the class where I had hurt it, and wore a brace and shoes to classes and iced it afterwards. The icing got easier in the weeks that followed and as it felt better I iced it less. General consensus was that it was fractured. I took six weeks off from grappling class, wore shoes to every class, with an ankle brace (which I still sometimes do) and if live grappling ever occured in regular classes during that time, I took care to warn my partners off of ankle locks.

Dr Dill says:

Ankle injuries are very common in most sports. Sounds to me like you handled the “First Aid” part pretty well. Rest Ice Compression and Elevation or RICE is the mantra given to most musculoskeletal injuries. Now here’s the troubling part, many ankle “sprains” on further examination, namely radiographs, or x-rays in the parlance, are shown to be ankle fractures. So much so that emergency medicine, especially “sports” medicine, say to assume all ankle sprains are fractures unless proven otherwise. Most sprains feel much better for walking around in 3 to 5 days. Longer than that and I would suspect a break. By the way there is no difference between a “fractured” bone and a “broken” one.

Anyway recovery and rehab is about the same for sprains as non-displaced fractures. Initial healing takes about 2 weeks then gentle stretching or range of motion begins. Strengthening and kinesthetic rehab starts next and progresses for 4-8 weeks.

The retraining of joint position sense (kinesthetic training) is the key to preventing serial or recurrent sprains. This can be done in literally dozens of ways. Make sure to walk on different slopes and surfaces. Pay attention to your foot, don’t wear an ipod. Do heel and toe raises. Also raise up on the inside and then the outside border of your foot. Get to the point that you can walk around on the borders of your feet. BUT Pay ATTENTION to avoid respraining your ankle.

Ankle supports are good if you use good ones. Like the Aircast, or Sweedo lace up ankle brace. The elastic ones are useless, except to keep compression on if they have a tendency to swell. If you are having trouble go see a physical therapist for advice and or a treatment program. They are truly the experts at rehabbing injuries. Take good care of those feet. They are the foundation of your body. Ignore them and the rest crumbles.

Dr D

In case you missed it earlier, Doc Dill isn't actually a doctor. Take his advice for what it's worth, but consider talking to someone with the appropriate credentials.