How do you interact with treatment providers who are unfamiliar with martial arts following an injury?

Question

Related: Is there a mathematical model of how much force is applied to joints during various tae kwon do activities?

I recently got a fairly serious knee injury (fully torn ACL which will require surgical repair). One rather alarming aspect of the recovery process for me is the fact that none of the medical professionals I've seen (orthopedic surgeons, physical therapists, etc.) seem to have any particular knowledge of martial arts or the specific demands they put on the body. That being the case, I'm seriously concerned about whether I can trust their recommendations on what kind of a treatment plan is appropriate, and when it's safe for me to go back to martial arts (tae kwon do in my case).

That being the case, how can I help to ensure that my treatment providers' recommendations and treatment plan are suitable for martial arts? Are there resources that I can point them to?

Alternatively, if I wanted to just find a physical therapist who was familiar with martial arts to begin with, how would I go about doing so? Where could I look?

Answer 1

I was in a similar situation a few years ago, when I had a complete rupture of my right Achilles tendon. I was fairly lucky in that I had a medical group on my insurance plan that also caters to the local professional sports teams, so they had a really good grasp on what might be needed for that kind of a repair on an athlete other than an average joe. It starts with the surgeon, so if you can find one that consults/works with local sports teams, that is a big step.

My first visit with the physical therapist, I took videos of my form and sparring, and showed them to him. While they are not familiar with martial arts, they have extensive training on body mechanics, and they can look at the movements and know what kind of stresses they will create. In my case, part of the form involves jumping backwards from the front foot landing on the back while executing a kick. He looked at the landing and said "Yeah, you won't be doing that move for at least a year." Knew nothing about the form, but could tell what kind of stress would be on the area.

Show the therapists your form (Even if it is instructional videos), show them sparring, whatever you compete/practice, give them as much information as you can. They can look at the mechanics, the stresses, and work towards a full recovery goal with that in mind.

Answer 2

ACL tears can end athletic careers. Although treatment has improved over the years, there is no guarantee that you can fully recover from an ACL tear. In your previous question, I linked a news article about how the medical field discovered a new ligament in the knee in 2013, which partly explained why some ACL surgeries are successful and some are not. There is still much to learn about ACL recovery; this recent study about return-to-sport testing indicates that current methods do relatively well for in the knee in question, but are correlated with increases in injury to the other knee!

With the severity of this injury, the first job of the medical professionals is to make sure you can perform basic activities such as walking or running. I have personally had only minor knee injuries (grade 1 sprain), but even the minor sprain could create enough instability to make walking difficult. I have friends with ACL tears whose knees can dislocate during physical activity. Restoring a basic level of usage is obviously necessary to practicing tae kwon do. In this context, I don't understand why you are concerned about whether the treatment plans are specifically tailored to martial arts.

After you finish with the non-athlete version of recovery, you can start to worry about tae kwon do. It's possible it is never safe for you to return to tae kwon do, or at least not as you were practicing it before. Jumping, spinning techniques tend to be bad for knees.

As for finding martial-arts-specific physical therapy expertise, I suggest:

1. Ask in your martial arts community for recommendations. You are not the first person to get hurt, and this should give you pointers for whom to (not) see.
2. Call some physical therapists and just ask. Physical therapists know other physical therapists, and unsurprisingly they tend to be an active bunch.

Answer 3

Ouch. I've been nursing a knee injury the last 30 years which was never treated properly and I'm not able to run.

I agree about being able to show them the form, consider getting a friend to come along to demonstrate something rather than just using video, as that lets the provider move around them and repeat the move with variations to judge fully how the body moves.

I don't think surgical and neurological specialists don't need to be expert in the field but can evaluate from seeing the range of movement (more below).

For physiotherapy, I would urge you to get someone familiar with treating athletes. I have been lucky enough to find one who is a regular traveling physio for tri-athletes. So, when asking about their experience, ask if they have regular teams or particular clients. Physio knowledge of how people respond when healing and particularly safe ranges of movement is more dependent on experience. It's not just about understanding the anatomy but from a lot of experience on how people react to different treatment and a longer-term view of wellness.

I recommend taking up Tai Chi as soon as you can move enough to do it. Not only will the gentle loading help, it may dramatically improve your healing (I've actually healed a minor torn meniscus which at the age of 55 was told I was too old to expect to heal and that surgical repair wouldn't be attempted).

My woeful hand story

Many years ago I started learning double broadsword. That includes a figure-8 twirling move which I couldn't sustain for more than a couple of minutes with my left hand.

I was extremely lucky that the instructor was a qualified doctor who, on examining my hand, diagnosed ulnar nerve problems based on the loss of sensation and particularly the withering of the muscles around the thumb. She had a list of four neurologists for me within a week and a warning to treat it as urgent.

The neurologist walked me through a long description of habits (sitting with head propped up on hand and elbow fully bent being a bad one) and especially training.

I demonstrated for him one of the quarterstaff drills I used to repeat 200 times every morning and he went noticeably pale. He said if you were trying to design an exercise to damage the ulnar nerve it would look just like that. The combination of twisting motion as you fully close the arm (dropped elbow) and pulling the hand back to the shoulder is like putting a couple of vice grips on the nerve either side of the elbow and stretching it.

Oh, and also doing heavy weight curls all the way to the shoulder is nearly as bad.

So the combination of experience and observation paid off!

Answer 4

Speaking from personal experience (I had a right ACL tear from >10 years ago)

Medical professionals differ in opinion. I've had orthos tell me to give up martial arts; strengthen other muscles to compensate; and surgery.

I went the surgery method (but it was delayed for 2 years as I was too young and there was just not enough information back then)

That 2 years delay cost me in terms of competitiveness advantage as I was at my peak (21 years old). I also gained almost 10 kg after the injury as there were not many sports you can do with an unstable knee.

My advice to you is, have the surgery. Even if you don't recover 100%, whatever you gain is still more than if you were just going to go the non-surgery method. I couldn't go back to Taekwondo after the surgery, and I changed my style to Kyokushin Karate (it had high kicks too). The knee was good for at least another 10 years after my surgery, but in the past 1 year, both knees are showing signs of wear and tear. But the surgery got me another 10 good years. Now I'm 40 and I can't really train as hard even if I had good knees.

On a brighter side, one of my students recently tore his ACL too and he took the surgery option. The method used has changed since I last did it, and his recovery period (up and walking about with no limp) was only 1 month vs my 6 months.

You've got to depend really on yourself for treatment plans and recovery options. The therapists are there to guide you on proper form, but there's really nothing they can teach you that you cannot look up on the internet.

Also get a good brace and knee guard even when the knee feels good.

Good luck!