Thoughts on martial arts injuries pre labral repair

For the last several years, I've had some on-again off-again low back pain variously diagnosed as sacral-iliac (SI) instability, or lumbo-sacral (LS) instability.  So every year I go into PT for a few weeks, straighten things out and go on with life.  This time, it was pretty clear there was a deeper root cause, and a couple of months ago, I was diagnosed with a labral tear of the left hip. By this point, everyone involved (PTs, doctors, etc) realized that the tear had been the cause of the other symptoms and that something more than physical therapy was needed to straighten things out.  An arthrogram MRI and orthopedic consult later, I was scheduled for surgery to repair the tear.

Figure 1: Looking up the leg.  The tear is the thin disconnected section on the lower left of the hip joint.

How common is this injury among athletes?  Fairly common, although it's difficult to get percentages.  Athletes who are involves in martial arts, running, dance, gymnastics, and yoga are often at risk for such injuries.  What's in common?  Either an extreme range of motion or a repetitive range of motion.  The thigh bone may then contact the outer portion of the acetabulum (hip joint socket) and create either a cam or pincer lesion which then saws through the labral cartilage.  This, in turn, destabilizes the hip and causes lower back issues.

Chinese Wushu and other martial arts are known to promote longevity due to the physical conditioning of the body, yet many participants often have to leave off practice as they get older because of injuries suffered during practice.  The two ideas are a bit hard to reconcile.  How is it that something that is so good for you can also be so bad?

An answer that we sometimes tell students is that you'll only get hurt if you're doing it wrong.  This should be rephrased to: "you'll only get hurt if you are doing it wrong for you."  In this age of large commercial schools, and competitions with compulsory type forms, we often try to bang students into a specific mold rather than finding the variation of our martial art that works for the student.  We also don't always recognize that at the extremes of competition, we place a great deal of stress on the body and it is very easy to get injured.  I remember an old wushu friend of mine, Bobby DeSario, telling me that when he visited Beijing, he noticed that many of the competitive athletes were favoring one leg or had a shin wrapped.  Even Jet Li has had a bad injury from wushu.  According to his official site (jetli.com), he tore his ACL during a split landing from a tornado kick. 

Figure 2: Not Jet Li, but the landing he should have had.  This position can exacerbate labral tears, if you've managed to get yourself one.

No doubt that some of the thrill of watching Chinese martial arts comes from the amazing things the players can do without being injured.  It's not so fascinating to watch punching when you can see someone do a butterfly twist into a split.  But you don't get something for nothing.  The more spectacular the move, the greater the risk, and the more chance you have for ending your career early.

So what is a coach to do?  Do you teach your students the fancy stuff but tell them to be really careful?  Or do you take the other extreme and tell students to stick with the traditional stuff: don't do particularly low stances, and limit jumping?  My thinking is that you take the middle road. 

1. Teach basics bilaterally including jumping.  This will keep the body more symmetrical and limit progressive instabilities in the musculature.  Knowing techniques on both sides might also be useful from a martial arts viewpoint...
2. Use the usual principals of progression in training.  If a student isn't strong enough or flexible enough, don't let them do the activity.
3. Teach students how to listen to their bodies.  Do reinforce the idea that they are not immortal, and a bit of down time now may save them a lot of down time later.
4. Log and limit high stress techniques (tornado kicks, splits, lotus kicks, twists, aerials...).
5. Despite your best efforts, a student may not be able to do a motion in a certain way due to physical limitations.  Some people (for example) have an acetabulum that will not allow for a split.  Present your students with sane alternatives to the flashier movement.

Point 4 is probably really controversial in wushu circles, partially because of the ("if you do it right you won't be hurt" mentality).  However, pitchers at the upper levels (high school, college, minor leagues, major leagues) all log the number of pitches they do.  In fact, they even do this logging in little league, and the results are pretty clear: "The risk factor with the strongest correlation to injury is pitching." (Fleisig & Andrews, Sports Health. 2012 Sep;4(5):419-24.)  This study does support the idea that there is a right way and a wrong way to pitch.

Considering the numbers of high kicks, and impact loading due to landings from jumps that occur in  our sport, not logging activities is asking for trouble.  Even when done correctly, repetitive loading on a joint or structure can cause problems. For my own part, I have not logged my own practice, although as I've gotten older, I've been better at listening to my own body.  I don't jump so much as I used to (and right now, not at all), and when I do jump, I do the bare minimum.  How then did my labral tear occur?  It's a good question.  I'm in a couple of the aforementioned risk groups.  It could be repetitive motion.  I also have had a number of groin injuries in the past.  These can temporarily (or permanently!) reset pelvic tilt and pre-dispose you to a labral tear.

In any event, I'm now looking forward to hip surgery in two days so that I can run, jump, and kick high again, just not in the near term.  Recovery will take 8 weeks to full return to activity, subject to not overdoing it after the break.  In the meantime, I'm looking forward to figuring out my crutches to determine the most efficient ways to move without stressing the hip (Crutch-fu).  And I'm looking forward to learning how to better coach from the sidelines while I'm recovering.  See you on the other side.

Northern Chinese Staff and Jogo do Pau

One interesting theme that we find in martial arts is that martial arts applications converge to some extent when presented with the same problem.  For example, if you wish to do a shoulder throw from a given position, it is likely that the shuai-jiao guys, the judo guys, the aikido guys, (and everyone else) will agree on common elements of the throw.  Not everyone will agree as to the utility of the throw, or if it is the most effective technique for a given situation, but if the throw must be done, then there are only so many ways to do it well.

The same thing applies in staff.  Staff play seems to be divided into three general types: spear type (involving lots of tip work, small circles, and thrusting), cudgel type (involving large swinging motions with either one or two hands), and double ended wherein both sides are used equally at shorter ranges.  At one point Sifu Henry Gong told me that the latter two could be called Sun and Moon staff in Chinese martial arts thinking, but, sadly, I don't recall which was which, and I've not found references anywhere on the internet.

While it is not so astonishing to find similar staff play across Japan and Korea, or across all of China, it is more striking to find such similarities between Chinese and Portuguese staff.  Yup.  You read that correctly.  Traditional Portuguese staff play, also known as Jogo do Pau, exhibits all the techniques of Northern Chinese cudgel play.  

Fig 1: Common blocking in Northern Chinese Staff, and similar block, with application from Jogo do Pau.

The origins of Jogo do Pau are debated even within its community with some feeling that the art was home grown in Portugal and in Galicia, Spain, (there are only so many ways to accomplish a goal) while others feel that it has Indian origins coming from the voyages of Prince Henry the Navigator and his successors.  

My interest in the art is more than simply running down its origin.  To my mind whether it came from India, China, or Portugal is immaterial.  What is interesting to me is that there aren't simply a few techniques in common, but rather the vast majority of techniques.  They even practice form.  Even more so, the Jogo do Pau players are versed in technique from day one.  They learn the practical application of their art through drill (not two-person form as in China).  They even teach multi-person staff defense.  I often feel that while 2 person forms are valuable, the lack of practical weapons training in Chinese martial arts is to its detriment.  Instructors either don't teach applications (because they don't know them), rely only on 2 person form, or make up drills as they go.  Perhaps such drills exist in secret (!!!) and only the chosen few in Chinese martial arts get them.  I'm not sure.  

What is clear to me is that in the many Jogo do Pau drills there are examples of the usage of *our* techniques.  These guys are not shy about sharing their knowledge and have a plethora of drills that can benefit the aspiring Longfist staff practitioner who wishes to better understand his/her forms.

You can find earlier links in this blog to some of our drilling. (More to come!)  A very clear and not terribly fancy compilation of northern staff techniques can be found in the 32 staff form.  I've included a link to this video below so that you can get a sense of the technique. 

Fig 2: 32 Staff play done in contemporary Chinese longfist styles.  Note the general techniques.

 How about those Jogo do Pau videos?  Here is a brief collection to get you started. 

Fig 3: Demo of Jogo do Pau technique, form and free sparring.

Fig 4: Some quality father (?) son time.  Note the competence of this young kid.  Also watch what happens when his dad's/instructor's staff breaks.

Fig 5: From a documentary on Jogo do Pau.  This has English subtitles.

As a final note, in this last video, you will notice the practitioners wearing sashes.  I doubt this really has significance with respect to the origins, but it is similar to what many Chinese martial arts practitioners wear.  

Enjoy, and good luck in training.

Staff Flow Drills: Part 2 - Figure 8's for Fun and Profit

When you first learn northern staff, one of the first things you practice is the figure eight.  It's an essential movement, you are told: it's for blocking, they say.  And while you might agree that you would not approach someone wildly spinning a staff in this manner, you may not be certain of how to do much more than intimidate novices with the movement in your own practice. The drill, as introduced here, focuses on one half of the figure eight and provides both defensive and offensive interpretation of the movement.

I'll start by saying that there are two versions of the figure eight that one often sees.  One is a badly done (but fast) version that is sometimes seen in contemporary wushu wherein the staff is held at a distance from the body.  This version uses mainly the arms to effect the spin with minimal reinforcing body motion.  It works great for show on thin staffs, but is much more difficult to do using anything substantial.  Anh once had me using a lead pipe to practice, and I can't imagine controlling the staff at any distance from my body. 

Fig 1: The tuck in blocking an attack.

The second version, which I am also seeing some from some of the better contemporary wushu athletes, involves a body turn and tuck and keeps a portion of the staff against the body for a fair portion of the movement.  The tuck and body contact provide reinforcement against impact when one blocks (Fig 1).

Staff Flow Drills: Part 1 - the Rollover (and some brief history)

Many years ago when I first started learning staff from my first teacher, Anh, he taught me a technique which I didn't really appreciate at the time: the rollover.  The idea was that following a high block, one could move very subtly to control the other person's staff and return the head shot via redirection.  At the time, I was disappointed in the simplicity of the form I was learning and could not see the elegance of this approach.

Starting position of rollover drill

Disappointed in the perceived limitations of Chinese staff, I put it down for a number of years before picking it up again when I started doing Contemporary Wushu.  My coach at the time, Wang Yang, a former Szechuan team member, taught me a "real" staff form.  We worked hard on figure eights, spins, flowers, cloud parries, and jumps, and my staff play got better.  I placed second in a small field at the USAWKF national tournament that preceded the World Championships in 1995. I felt really good about my staff play.  Only we didn't actually work on applications. At all.

As time went by I started playing applications of staff with more advanced students.  I found that many hadn't learned any real staff play other than the forms.  There was staff sparring in tournaments involving the use of foam covered staffs.  This didn't look at all like the movies, and even was embarrassing when some of the midieval renactors showed up and solidly womped all the Chinese martial arts guys. 

Then I started thinking more about Anh and his teaching.  His forms were never really fancy, but boy could that guy fight.  I started comparing movements from his old staff forms to movements from my newer ones.  There were a host of similarities.  Many of them involved sliding motions, or the use of bounce.  The hand positions (open or closed) became important since the hand was clearly a target in many attacks.  With my learning of Shaolin staff, it all fell together.

A successful rollover. 

The drill presented here is one which is designed to hilight the rollover, the superior guard, and the cloud parry, the later two of which can be found at the very end of Yilu Gunshu (16-step contemporary staff).  One starts as shown above.  Person A has just issued a strike to his opponent's (Person B) head which is blocked with a typical cross high block.  Person B then counters with the rollover.  If person A does not respond in time, he will be hit in the head.  The rollover consists of a simultaneous pullback to chamber with the right hand along with a left-handed inward circular motion.  The motion is similar to what is seen in Lianbu Quan.  Notice that person A has lost control of his centerline, whereas person B has covered his centerline throughout the entire motion.  To counter this, person A *must* roll his staff into a guarding position using primarily the right hand.  The left hand stays more or less where it was.

Person A rolls into a superior guard position to defend.

Person A can then redirect and attempt to attack person B's open left side using the "cloud parry".  Really, it's a lateral strike.  The rollover defense was the parry part of the movement.  In any event, the tip of A's staff circles to the back and then strikes toward B's left side in an arc.  B responds by rotating the body to the left and by assuming the guard position.  You should notice both B's open left hand to prevent getting the fingers smashed as well as the oblique angle of the staff.  That oblique angle dissipates the force of the blow and also allows the tip of B's staff to help maintain distancing as it arcs across A's centerline.

The third step in the drill.  B is in guard position.

The force of A's blow spent, B now redirects by circling the staff back and to the left and turns the motion into a downward strike to bring the drill full circle.  The rolls now reverse and the drill continues.

Final step of drill before rolls change

The power in B's blow comes from several sources: the momentum in the redirect and circling, the turning of the body, and the shifting of the stance.  Also, the hands play a roll.  Novices will often leave the right hand out of chamber.  This means that there is less of the body turn transferred into the staff, and as a result, the left arm has to do most of the work.

It is important to do each phase of this drill separately when first training it so that each partner understands the intent of each attack and how to defend against it.  It is also important to ultimately use force while maintaining control.  If your partner messes up, you should not clock them over the head.  Getting hit in the head does not teach you a lesson as we've seen from boxing and more recently the NFL.  Only go as fast as you can control.  Below is a video of the drill in its entirety.  Notice the fluidity.  One of the characteristics of Chinese martial arts is *smooth* application of power. When you start to feel control of the centerline, force in your strikes, speed, and fluidity, you are probably really starting to understand this drill. 

Landing Impact Forces Revisited

While I was at the Gait and Clinical Movement Analysis Society Conference in Cincinnati, OH a few weeks back, I saw an interesting presentation on landing impact loading titled: "The effect of plantarflexion angle on landing mechanics using a within-subjects real-time feedback protocol."  This was not the usual bit on clinical gait analysis or the study of walking and its clinical implications.  Rather it was more oriented towards sports performance and using form to mitigate injuries from landing.

It's long been known that pointing your toe, or increasing your plantarflexion results in a lower impact upon landing [1][2].  The theory is that the ankle can flex faster and thereby distribute the load to your muscles (which can take it) rather than to the skeletal system (which can't).  Dr. Jim Richards, my Ph.D. advisor, noticed that ice skaters are particularly at risk from high impacts due to the skating boot itself. Ice skates generally do not flex *at all* at the ankle and thus require that landing impacts be absorbed primarily at the knee and hip and in the bones and ligaments.  This causes all manner of mayhem in the anatomy of skaters: Tara Lipinski, an Olympic class skater, has had a number of problems in her hips and back [3].  Richards addressed the limitations in skates by developing ankle articulated ice skates in the early 1990s so that the ankle could take more of the load. Recent work has shown that these can significantly reduce loading rate on landing from skating jumps [4].

My own masters thesis work reflects the value of plantarflexion on landing.

"Jump toe tap" kick from contemporary wushu

We looked at the landings from three kicks commonly done in Chinese Wushu: the jump toe tap, the jump inside crescent (or tornado kick), and the butterfly kick.  Eight subjects who were ranked at the regional or national level were recruited to perform the jumps.  Subjects were marked up with retro-reflective markers and then filmed doing their jumps onto force plates at the University of Delaware Sports Science Lab (now the Human Performance Lab).  You can find the full results in the University of Delaware Library or selected portions in the Journal of Asian Martial Arts [5].  But the key points were that these eight subjects landed in two distinct ways: some were heel landers, and some were toe landers.  Those who landed on their heels had nearly twice the force at the ankles and knees (up to 3 x body weight) compared to those who landed on their toes (who peaked at about 1.5 body weights).

What's interesting about the recent work by Mike Rowley and Jim Richards is that it quantifies the degree of plantarflexion that is most effective in reducing joint forces [6].

From: Rowley & Richards: The effect of plantarflexion angle on landing mechanics using a within-subjects real-time feedback protocol

Rowley & Richards recruited 26 subjects, marked them up with retroreflective markers for video capture, and then had them drop from a hang onto force plates.  A feedback system informed the subjects of their ankle flexion angles which then were held as they dropped onto the force plates.  Figure 1 shows the ground reaction force (GRF) in body weights (BW), and the peak loading rate in BW*100 per seconds.  Both GRF and peak loading rates decrease as ankle flexion increases.  In these graphs 90 degrees is flat footed, so larger angles imply more plantarflexion.  Although the returns diminish as plantarflexion increases, it still seems that more plantarflexion is better.  Except that in Figure 2, we see a graph of peak support moments or joint torque as a function of angle.  Remember that with the ice skaters, the chronic injuries tended to be in the hips and lower back.  Therefore, it is desirable to decrease the hip moment the most.  The point at which this occurs is at 120 degrees.  After this, the hip flexion moment increases again. 

What this study seems to imply is that under these conditions, roughly 30 degrees of toe point (or 120 degrees of plantarflexion) will go a long way towards minimizes forces, loading rate and hip torque in landing.  Mike Rowley mentioned to me that he would be recruiting more subjects to look at this in a more sport specific way.  I don't know if he will be recruiting from the wushu crowd, but if you're interested, I can always ask.

References:
[1] Cavenaugh & LaFortune (1980)  J. Biomech 13, 397-406.
[2] Kovacs et. al. (1999) Foot placement modifies kinematics and kinetics during drop jumping. Med Sci Sports Exerc 31 (5): 708-16.
[3] Wilner (2000) Lipinski retires over hip injury. http://www.cbc.ca/sports/story/2000/12/19/lipinski001219.html
[4] Richards & Bruening (2006) Analysis of an articulated figure skating boot.  American Society of Biomechanics. http://www.asbweb.org/conferences/2006/pdfs/344.pdf
[5] Niiler (1998) Landing impact loading and injury risk to the lower legs in Chinese Wushu.  http://www.journalofasianmartialarts.com/product/china/other-practices/landing-impact,-loading,-and-injury-risk-to-the-lower-legs-in-chinese-wushu-detail-161
[6] Rowley & Richards (2013), The effect of plantarflexion angle on landing mechanics using a within-subjects real-time feedback protocol.  Proceedings of GCMAS.

A Preview of Staff Drills for Application

One of the skills our advanced students are working on at the present time is staff (gunshu).  Staff is an interesting weapon in that it has two ends and a middle.  "OK, Captain Obvious," you say, "how can this be enlightening?"  The answer is complicated.  Because of this, staff can be both very versatile, and very hard to really understand.

Consider first this traditional form

Shaolin Staff Section 1a

This type of form stresses the use of both ends of the staff and focuses quite obviously on the coverage of the centerline.

Section 4 Old Compulsory

In this case, the center line is covered more via rapid action and broad sweeping or clearing manuvers and one end of the staff is used preferentially.

What's particularly interesting is that both forms are represented as longfist-based despite their clear differences.  The first form comes from my sifus Artie Aviles/Henry Gong who learned it from Nelson Tsou, who learned it from Li Mao Ching, who (probably) learned it from Han Qing Tan.  In short, it is from the Nanjing Central Guoshu Institute's longfist curriculum.  The second form comes from the compulsory series of forms (which were largely Chaquan based) first published in 1989.  These forms contain many movements from the more basic contemporary staff sequences from the 1950s.  However, it's not clear whether such movements are purely northern staff, northern spear (which emphasizes one end over another), or some hodge-podge of technique.

In any event, it can be challenging for students to assimilate both modes of thinking: using one end of the staff vs. using both ends.  Although we make heavy use of two person forms at our school since these provide students with timing and flow elements that are needed to really understand technique, we have also found that practically, other drills are needed.

To this end, we focus first on using the staff as a long range weapon whose primary purpose is to guard the centerline.  Students are taught to use a superior guard, such as what is found in the contemporary Yi Lu Gunshu (16 step) form, and move in such a way as to keep the opponent's staff off the centerline.  In many cases, this requires only very small movements since the bulk of the body is already protected.  In other cases, when the opponent has made an opening, more complicated motion and footwork is required in order to keep the centerline safe. 

After a handful of basic blocks have been mastered, we move to three step sticking drills where one partner attacks while the other defends.  The defender attempts to neutralize the attack using minimal force and by projecting their centerline onto the opponent.  If done well, contact between staffs may never be lost!  Then after three attacks, the roles change.  Once students have really started to learn to cover their centerline under such conditions, we pick up the speed and move to a more freeform version where both sides can attack and defend as needed.  More often than not, a good defense involves a simultaneous attack. 

Below is an example of a moderate speed three step drill followed by free-form drill.  You'll note that both contemporary and traditional type techniques have found their way into the drill although in this version, primarily one end of the staff is used.  You'll also note the footwork and angulation used to maintain the centerline.  There's a reason why contemporary staff uses so much floor space.  On the other hand, you'll note that stances are not used terribly much since we're not truly beating on each other.

In some upcoming installments, I'll break things down a bit more, show how stances get integrated and how they can change the game, and show a transition to middle range technique so that both ends of the staff are more involved.  Enjoy!

Welcome to OpenSource Wushu

OpenSource Wushu (OSW) will have been around for 10 years this August, and it seemed time to actually create a blog.  Why?  Doesn't everyone have a blog?  What can you say that hasn't been said a dozen times before?

All are good questions.

The first and foremost reason for a blog is publicity.  At OSW, we teach Chinese martial arts, and we do so in a way which (we feel) is unique and brings something to the table.  We are not commercial in our attitude, and we produce students who are capable and competent.  I bring 30 years of wushu/kungfu experience with me along with a PhD in biomechanics and movement sciences, several black belts/sashes, and an International Wushu Federation Judges Certification. 

The second reason for a blog is to communicate useful information to those with an interest in martial arts.  These may be interpretations of health, fitness, and training articles that have recently come out, or they may be observations about specific stylistic elements.  We may even publish some video occasionally.  The name is "OpenSource" Wushu, after all.

Those who know me know that I'm a bit of a computer nut.  I have some strong feelings about opensource software and its utility.  I have similar strong feelings about the propagation of martial arts.  I believe strongly that martial arts are good for health and fitness and make for a good lifetime activity.  Furthermore, I feel that many schools are cultish and secretive: "sign up with us to learn the true *mystery* of our style."  If you think that keeping your techniques secret in today's age of automatic weapons is going to keep you safer, you're crazy.  My take is that many martial arts are like dying classical languages.  If you hold them too close, they die with you and that's that. 

Ultimately, good martial arts is a combination of good body mechanics, good training principles, good feedback, and listening to your body.  As time permits, I'll be posting information of interest to members of our school and the martial arts community at large.