Nutrition in Combat Sports

160 M. Zetaruk
the heel and provides some support for training. Ice may be applied to alleviate
pain, and pain-free training should be encouraged, particularly in the early stages
of treatment. A home exercise program directed towards stretching and strengthening
the gastrocnemius – soleus complex is beneficial, [35] and may help to reduce
recurrences. There is a risk of recurrence as long as the apophysis is open.
10.5.2.4 Injuries to the Extensor Mechanism of the Knee
Extensor mechanism injuries are commonly encountered in young martial artists.
Kicking and jumping techniques place these tissues under stress, leading to
Osgood-Schlatter Disease (OSD) and Sinding–Larsen–Johansson syndrome (SLJ).
These apophysitides present with pain over the tibial tuberosity (OSD) or over the
distal patellar pole (SLJ). [34] OSD is frequently associated with significant localized
swelling over the tibial tuberosity. The typical age of presentation of OSD
(10–15 years) is slightly higher than that of SLJ (10–12 years). [35]
Physical examination typically detects focal tenderness over either the tibial
tuberosity (OSD) or the distal patella (SLJ). Although swelling is frequently
present over the tibial tuberosity in OSD, SLJ is not usually associated with localized
swelling. Both conditions may produce pain with passive flexion of the knee
or with resisted extension of the knee. In more severe instances, there may be pain
with active extension against gravity. Patellar maltracking and tightness in the
quadriceps muscles may contribute to these conditions.
Initial management is directed towards reduction of pain, as well as secondary
swelling and inflammation that may be present. Regular application of ice, and
restriction of aggravating activities such as jumps, kicks, and running, may be necessary
to settle symptoms. The formal kneeling position common to many martial
arts may place undue pressure on a swollen, tender tibial apophysis, and may need
to be avoided. [36] A strap may be used to limit traction on the tibial tuberosity in
OSD. [34] Patellar stabilization braces may be used in both conditions if patellar
maltracking has been identified. Home exercises are usually directed towards
stretching of the quadriceps.
10.5.2.5 Medial Epicondyle Apophysitis
Repetitive traction of the forearm flexor muscles on the medial epicondyle apophysis
results in medial elbow pain in young judoka and wrestlers. [36] Grappling with an
opponent or gripping of the opponent’s uniform in order to perform throwing techniques
may contribute to medial epicondyle apophysitis. This injury presents most
commonly between the ages of 10 and 14 years. [36]
Physical findings typically include focal tenderness over the medial epicondyle apophysis,
pain with valgus stress of the elbow, and pain with resisted flexion of the wrist.
Plain radiographs may be normal or may show delayed development of the ossification
center. [34]