A ‘clack’ on my shoulder
This afternoon I had to rush to my karate class because I was late again. When I got into my car and sped off, I reached out for the buckle above my right shoulder. Suddenly, I heard a loud audible ‘clack’ coming from my left shoulder. I thought I would have worsen my shoulder bursitis. Miraculously, there wasn’t any pain but I felt having better mobility and greater degree of movement. Before this, I could barely lift up my left arm to touch the other shoulder without assistance of my right hand, and the movement would be slow. Now, I can lift up my left arm to touch the other shoulder at will. Of course, I still feel a little sore on my left shoulder.
Anyway, I was very much worried about my shoulder. I was so afraid that I would need a surgery. Thank God that it is improving now.
Shoulder bursitis
I had shoulder pain since March. Initially, it began at my left shoulder after waking up one morning. The pain was not too serious until recently (for the past two weeks), I had lousy sleep. Both of my shoulders were aching and often woke me up in the middle of the night. I thought it was some kind of spraining and it would go away after good rest with less training. But it seems to self-exacerbate. The pain was getting more intense every night.
Last night, I read articles about shoulder bursitis or rotator cuff injuries and treatment. After reading these articles, I decided to give it a try. I applied Fastum gel (Ketoprofen) on both shoulders. Guess what? I had the best sleep ever since March. I woke up early this morning without any pain.
Fastum is used to relief localized pain of arthritis, rheumatism or sports injury. I should have acted earlier.
On and off, I had been doing some wauke spontaneously while I was thinking or working on some programming problems. Some kind of off-my-mind of physical activities after sitting in front of computer for too long. I guess it was the effect of banging my head on the keyboard and I lost sense of safety. Without doing proper stretching, I performed wauke with speed and force as in a counter attack situation. That could have torn my muscles or tendons on the bursa and I overlook the seriousness of the pain. How insanely I was!
Alright, now I am on Ketoprofen and I am going to apply it for the second time. Hope my shoulders will recover in a month or two.
Another case of sub-standard health care
I wrote an article about sub-standard health care provided by government hospital sometime ago. Read it here. Today, we experienced another with our friend, Richard, who had a terrible accident last night.
We were going to grandma’s to help prepare the CNY eve dinner. It was about 1100+ when we arrived at the general hospital. Richard’s leg had been plastered without any surgery. LA and I were shocked and we got further details of what the specialists said from Richard. He told us one female specialist said he needed a surgery and the other male said no need surgery. WTF! What specialists were they? Were they qualified? I doubted.
We confirmed with a few friends who worked in hospital and they told us surgery was necessary to repair bone fractures. The earliest surgery the general hospital could schedule for Richard was next Thursday. It would be 10 days after his accident! WTF! He could have infection and had his leg amputated! We quickly provided him options to seek professional medical treatment in private hospital. He was concerned with insurance claims and the medical expenses. Private health care is many times more expensive than government hospital. I helped him to sort out some insurance doubts and advised him to decide quickly because today was CNY eve and there would be followed by two public holidays and weekend. Charges could be double or triple in operating theater and medical fees.
We waited until about 1645 and he finally called me that he had decided to seek professional medical treatment at private hospital. Without any delay, LA called her ex-colleagues in private hospital and arranged an ambulance and informed the doctor to standby.
By 1730, he was transferred to Putra Specialist Hospital and was under Dr. Ramu’s care. Surgery was scheduled at 2100 and after the CNY eve dinner, I went to see him at around 2000. Richard’s parents had gone home for dinner and he was alone. Poor Richard. I could understand his loneliness and fear as I had experience a surgery in 2006.
Before 2030, the nurses came in with an OT wheeled bed. They changed him. He was too embarrassed to get naked in front of the female nurses (his first time in front of female 
a virgin I supposed 
) He finally submitted to the sweet persuasion of the nurses. There gone his virginity! LOL. I accompanied him to the OT waiting area. That’s the furthest I could go. I comforted him and saw him being pushed into the OT. I went home and called to inform his parents.
I called his sister around 2350 and she told me Richard was soundly asleep and had not waken up after the surgery. I was relieved to hear he was fine after his surgery. Get well soon, my friend.
Most Unfortunate
Richard, my ex-classmate and best friend, were back from Singapore for the CNY on Sunday. He called me on Sunday night and Monday as well but I wasn’t free to go out with him for a tea. So, tonight while taking dinos downtown for a spin, an idea sparked and I called Richard to find out his whereabout and thought we might go for a drink.
He was shopping at MP and Carrefour. We made an rendezvous at 2145. We went many places in the car to look at CNY decoration in the old town. Then we were at Melaka Raya and I called Richard to change our rendezvous place to Hotel Equatorial. We waited there and many cars and motorcycles had passed by but Richard was nowhere to be seen. The kids were getting boring and started to make lots of noises. I decided to leave but no long after we left the rendezvous place, my phone rang. It was Richard. He told me he met an accident. First I thought he was joking as he used to be. But I heard his jumpy voice and I knew it was not funny. He was behind MP and we rushed to the vicinity.
When we arrived, he was sitting by the road side. He was on motorcycle and a car recklessly knocked him down. I went to understand the situation and to take a look at his condition. Using my knowledge in sports science and sports injuries, I examined his wounds and his right leg. He told me his leg was broken but some youngster who appeared to be the friends of the driver and were St. John members told me his leg was fine and not broken. What a stupid and ignorant youngsters!
Richard had some abrasion on his arms and legs. Not much of concerns. I examined closely and carefully his right leg and I found some swelling began to develop around and above his ankle. I touched and pressed gently and asked him if he felt anything. He told me it was numbed. That further reaffirmed my findings and I told him he had broken leg. I concluded his top part of fibula and the lower part of tibia were broken. I quickly called an ambulance and then came two policemen on motorcycles. One of them went to direct traffic and the other stopped beside to see what happened. I told him it was an accident and the victim had broken leg. This policeman took his own sweet time and he did nothing but standing there to look. I told him to radio the ambulance to reinforce my report. He still took his own sweet time to unbuckle his crash helmet, put it down in the basket, and stood there. I asked him why wasn’t he take any action and he ignored me. When I questioned him the second time, he told me to be patient. I raised my voice a little bit and told him the victim had broken leg and was suffering and he needed immediate medical assistance. He still took his own sweet time. My anger increased and I took out pen and paper and started looking for his ID number on his uniform but his safety jacket had covered his uniform and the ID number. I wrote down his motorbike registration number and he quickly began to radio back to headquarters. What kind of policeman was that? Worst, at the end of the incident after Richard had been sent to the hospital, the two policemen encouraged the driver and my friend’s family to settle outside so that no troublesome paperwork. I told him with a stern voice that we were going to lodge a police report.
After Richard had taken his motorbike which was parked behind MP, he was en route to rendezvous with us. Suddenly, a car came from behind him, passed him and suddenly turned left to go into a parking without signaling and looking at the left rear looking mirror. BANG! The driver was a young college going boy after his form five so he must be about the age of 18 or 19. A new and inexperienced driver with friends in his car talking and cheering away. When they spotted a parking, he endangered Richard.
The driver and his friends (girls and boys) admitted it was the driver’s fault while talking to me and Richard’s sister and mother. We encouraged him to file a police report. I was the one to lead them to the police station. Sadly, this young boy changed his mind under the influence of his friends (maybe) and his family. He did not admit his fault and stated that the motorcyclist (Richard) overtook his car from left rear. I wonder where is his conscience? I wonder if he can sleep and eat well?
My three boys are fascinated by ambulance and they like to see ambulance when we spot one on the road. This time, they had gotten the chance to seean ambulance taking an accident victim to the hospital. They saw the medical officers taking Richard up to the ambulance in a wheeled stretcher and rushed him to the hospital with siren. My boys had seen what an ambulance should do. But I guessed, today was the most unfortunate day for Richard.
After I sent them home, I went to the General Hospital to see if there was anything I could offer. I waited until he was ready to be warded. His leg was confirmed broken and he was really worried. When we (his sister and I) met the doctor in the ward, I asked to see his X-ray. That confirmed my findings. One fracture on the top part of his right fibula and two fractures on the lower part of his right tibia.
Nicotine may ease Parkinson’s symptoms?
In my previous post, Sparring – The Medical Implication – Part 2, I mention about the potential risk of Parkinson’s Disease (PD) from head injuries. I came across an article about Nicotine may help ease Parkinson’s symptoms. I re-post the full article and the original article can be found here.
Nicotine may ease Parkinson’s symptoms: U.S. study
Thu Oct 25, 2007 1:21am IST
By Maggie Fox, Health and Science EditorWASHINGTON (Reuters) – Nicotine may help ease some of the debilitating and uncontrollable tremors and twitches caused by Parkinson’s disease and its treatment, researchers said on Wednesday.
Monkeys given a nicotine-laced drink before drug treatment for Parkinson’s showed a 50 percent reduction in movements associated with the treatment. They showed a 35 percent drop in the movements, known as dyskinesias, when given the drink after treatments.
The finding, to be published in the Annals of Neurology, suggests it may be possible to improve the lives of patients who have very limited options.
“It may be the only drug that is useful for reducing dyskinesias without making Parkinson’s disease worse,” Maryka Quik of the Parkinson’s Institute and Clinical Center in Sunnyvale, California, who led the study, said in a telephone interview.
Parkinson’s disease, which affects more than 1 million patients in the United States, is marked by the death of brain cells that produce dopamine.
Dopamine is a neurotransmitter, or message-carrying chemical, associated with movement. Drugs can delay symptoms for a while but there is no good treatment and no cure.
The main treatment, levodopa or L-dopa, itself causes the abnormal involuntary movements after a time.
For years, researchers had noted that people who smoke and who drink coffee seemed to have a lower risk of Parkinson’s, and some research has suggested that nicotine might protect brain cells and nerves in some way.
Quik said her team’s findings appear to uncover a separate effect of nicotine.
The researchers caused Parkinson’s in rats and then in monkeys by damaging the area of the brain where dopamine is made. They gave them a soft drink with nicotine before and after administering levodopa.
“Not only is nicotine neuroprotective, it protects against L-dopa-induced dyskinesias. The two effects are exclusive,” Quik said. Nicotine did not appear to interfere with the beneficial effects of L-dopa.
Her team is now working with companies that make nicotine-like drugs to work up a trial in people.
The key is probably chemical doorways into brain cells called nicotinic receptors, Quik said. Drugs that work to affect these more precisely than nicotine does might also work better and more safely in people.
Nicotine patches are available over-the-counter for people who want to stop smoking but Quik did not advise that Parkinson’s patients try them.
“It is very important to work out the proper conditions and the proper dose,” she said.
© Reuters2007All rights reserved
This does not mean smoking cigarettes is good for health. The study suggest that, Nicotine, one of the chemical content in tobacco may help to relieve Parkinson’s symptom and the study has yet to confirm its effectiveness. Let’s wait and see. I hope it really can help those who have been suffering from PD.
Sparring – A medical implication – Part 3
To continue from previous topic here and here. Now, let us focus on injuries in children. Children suffers greater risk of injuries than adult because they are in their tender growing age. Children and adults share the same risk for injury of the bones. However, child’s bones are subject to a unique injury called growth plate fracture. Growth plate fracture requires immediate medical attention because long-term consequences may include limbs that are crooked or of unequal length.
What is growth plate?
Growth plate or physis is an area of developing bone tissue often near the ends of long bones (such as femur), between the widened part of the shaft of the bone or the metaphysis and the end of the bone or the epiphysis.
The long bones of the body do not grow from center outward, instead, it grows at each end of the bone around the growth plate. The growth plate is the last portion of the bone to ossify or harden, which causes it susceptible to fracture. Because muscles and bones develop a different speeds, a child’s bones are weaker than the surrounding connective tissues or ligaments.
When a child is practicing free sparring or jiyu kumite in sports karate (or Tae Kwon Do) for example, the constant body bouncing introduces stress every each time the child landed on the ground. This may cause or retard the growth of the bones by injuring the growth plate. The child’s bones may become crooked due to the repetitive stress which the bones have to withstand.
Excessive kicking motion will further weaken or injure the already weak connective tissues or ligaments mentioned earlier. Take mawashi-geri or roundhouse kick for example, when the child misses the target, his/her leg will snap in the air. Without hitting a target, the momentum of the kick cannot be transferred and thus snapping of the leg will injure the knee by absorbing the momentum of the kick. All these injuries are long-term.
Children’s bones heal faster than adult’s. This gives two important consequences. First, it is important for a child with injury to see a doctor as quickly as possible to receive proper medical treatment before it starts to heal. Ideally to see an orthopedic particularly if manipulation to align the bone is necessary. Second, the immobilization period required for healing is shorter than adult.
Risk Factors
Who is at risk?
- Children near the end of their growth period are particularly vulnerable compared to children of other age.
- Boys’ risks are twice the girls’.
- More than one third of growth plate injuries occur in competitive sports.
- About 20% of growth plate fractures occur during recreational activities such as biking or skateboarding.
Are you willing to subject your children to such injuries for participating sparring or kumite and suffer long-term effects for their entire lives?
Sparring – A medical implication – Part 2
My post “Sparring – A Medical implication” has caught attention of some of my blog readers and they have sent me feedbacks regarding my post. I am not a medical doctor but I have followed every medical articles regarding sports injuries and diseases (sports injury related) very closely and have made contact with some sports medicine researchers who are doing their Ph.D. in well known medical university in the U.S.
My posts will certainly create some controversies among karate-do practitioners, instructors or coaches, parents and other groups. My intention does not mean to inflict any contention or harm to karate training as I am a karate practitioner and coach myself. My intention is to realize people’s awareness of the potential injuries and the after-effect when our body begin aging.
In part 1, I mentioned vaguely how an injury like bruises and thrombosis can seriously affect our health. In this post entry, let’s take a look at the type of injuries we can get from karate training.
Before I start to elaborate types of injuries obtained from karate training, let me emphasize on one thing. One argument is most likely to come from the mouth of those karate coaches/instructors will be “With proper training and strengthening of the physique, injuries can be avoided…”. This can be a very selfish statement to protect their coaching income. Even the Olympic sportsmen and sportswomen can sustain injuries during their training or while competing. Remember, they are pro!
For modern competition oriented karate training, the sparring (jiyu kumite or free sparring) uses bouncing motion to distract opponent and also to position body into maneuver for attack. This repeating bouncing motion during training and tournament causes overused injuries. These overused injuries are caused by repeated, microscopic injuries to a part of the body.
Many long distance runners experience overuse injuries even after years of running. For road runners, the surface is hard and sometimes uneven, and the running movements are repetitive. In addition, there are usually both up- and downhill elements, and these increase the stress on tendons and muscles in the lower leg.
The bouncing motion in karate sparring (kumite) has the same effect of running. Although there is cushioned floor mat, but karate kumite exponents perform without proper footwear. This induces pressure onto both feet and legs every time they land and bounce off the mat.
They are most likely to suffer:
- Achilles tendinitis – The Achilles tendon (the tough sinew that attaches the calf muscle to the back of the heel bone) is most likely to be damaged if performing repeated bouncing motion in kumite. The injured Achilles tendon feels tender when squeezed between the fingers. Pain is usually at its worst in the morning and improves with walking. Vigorous exercise will increase the pain for a bit, then improve it.
- Lumbar strain – The standard weightlifter’s injury can also occur in sports that involve sudden twisting of the back, such as kumite when the athletes trying to maneuver into attack or out of attack or performing mawashi geri (roundhouse kick). Sudden lower back pain appears with twisting. It may seem fairly minor for an hour or two, but carrying on the exercise will usually bring a sudden deterioration with extreme pain and back spasms.
- Metatarsal stress fracture – The second to fourth toes are vulnerable to breakage if you push off with your toes when bouncing and maneuvering into or out of an attack during kumite. Army cadets doing running and marching drills are likely to suffer stress fractures during training camps. Dancers, gymnasts and kumite exponents experience stress fractures because of frequent jumping. The front of the foot starts hurting during exercise, and the pain usually stops when you finish. With each subsequent bout of exercise, the pain appears earlier and earlier, and gets steadily worse. The fracture can take up to three months to fully heal.
These are the injuries which effects can be seen or felt immediately during or after training. Whether the injuries have been completely treated and healed professionally, the problems are most likely to emerge again when our body begin to age.
Another injury which gives the most terrible effect is head injury. It is not surprising that head injury is common in karate kumite and other sparring events. It is estimated that when a martial art exponent gets a direct blow to the head it is like being hit by a 12lb padded, wooden mallet travelling at 20mph!
Being hit on the head can cause fractures to the bone of the head and face and tissue damage in the brain. A blow can damage the surface of the brain, tear nerve networks, cause lesions, bleeding and sometimes produce large clots within the brain.
Famous boxer, Mohd Ali, who suffered repeated head traumas over his professional boxing career, is suffering from Parkinson’s disease (PD).
Quoted from Wikipedia:
Past episodes of head trauma are reported more frequently by sufferers than by others in the population. A methodologically strong recent study found that those who have experienced a head injury are four times more likely to develop Parkinson’s disease than those who have never suffered a head injury. The risk of developing Parkinson’s increases eightfold for patients who have had head trauma requiring hospitalization, and it increases 11-fold for patients who have experienced severe head injury. The authors comment that since head trauma is a rare event, the contribution to PD incidence is slight. They express further concern that their results may be biased by recall, i.e., the PD patients because they reflect upon the causes of their illness, may remember head trauma better than the non-ill control subjects. These limitations were overcome recently by Tanner and colleagues,[45] who found a similar risk of 3.8, with increasing risk associated with more severe injury and hospitalization.
The human brain is contained in the skull and is suspended in some fluid. An impact to the head can set the brain into forward and backward rocking motion, smashing itself onto the skull wall. This is the cause of concussion. The impact may cause internal bleeding causing tiny to large blood clots in the brain. This may also cause thrombosis in the brain. Repeated head trauma can reduce the size of the brain and surface grey matter become thinner. The ventricles within the brain enlarged because of the decrease in the brain’s white matter. All these increase the vulnerability to natural aging of the brain and diseases of the brain. Kumite exponents may suffer Parkinson’s and/or Alzheimer’s disease.
It is not necessary to have a knockout with a direct or indirect (with head protective gear) blow to the head to traumatize the brain. As quoted above, those who have experienced a head injury are four times more likely to develop Parkinson’s disease than those who have never suffered a head injury. The risk of developing Parkinson’s increases eightfold for patients who have had head trauma requiring hospitalization, and it increases 11-fold for patients who have experienced severe head injury.
Imagine traumatized the brain of a young child or adolescence and how they can develop Alzheimer’s and Parkinson’s disease when they begin to age. There are many medical cases involving people of young age who suffer Parkinson’s disease. One of them is Michael J. Fox, who has a young on-set of PD at the age of 29. The cause of his PD is not known, of course.
Would you like your child or yourself to suffer PD in young/old age? Would you compromise your health or your child’s health for the one-minute glory receiving a medal on stage? Would you compromise your health or your child’s health for displaying the male chauvanism during training and tournament? You decide your own or your child’s ultimatum.
Research on Sports Injuries
After reading many articles about sports injuries, kinesiology and other sports medicine related articles, it spurs my interest to know more about the medical implication of sparring (or kumite) in competitive martial arts such as karate-do. The injuries in children are most misunderstood amongst parents and martial arts instructors.
A lot of this medical knowledge has been known thousands of years ago by the Chinese martial artist without any sophisticated medical equipment. Today, we have all resources to learn about these injuries but people ignore the facts and the potential harms. Why? Read more about the medical implication on sparring here.
Sparring – A medical implication
Last year, I wrote an article about injuries in karate. You can find the article here.
Many modern martial arts practice free sparring between two persons. In karate, free sparring or jiyu kumite, like many modern contact martial arts, such as Tae Kwon Do, Muay Thai and many more, are practiced widely as one of the training regime to strengthen physically and mentally and also often training for tournament. Free sparring events have been fabulous attraction. We can see sparring events are divided into three major age groups, children, teenagers and adults. In some sports martial arts such as TKD, protective gears are used to protect torso, shins and knees. But none can provide absolute protection from injuries.
Very often, we can see these tournament ‘fighters’ have got bruises on their limbs and sometimes on their bodies and heads. These bruises are actually internal hemorrhage where blood vessels have ruptured and cause bleeding. Together with the hemorrhage, there could be thrombosis or formation of blood clot along the wall of a blood vessel. Thrombosis can cause many medical complication, such as infarction and may also cause cancer over time when the thrombus is not cleared up by our body immune system. These medical complication will usually cause some other illness later in life which is difficult to trace back to the cause or injury suffered from a tournament many years ago.
In children, sparring is a very dangerous activities and extremely hazardous to their health. Children’s bones, joints and tendons are very soft and still in formation. An injury may cause serious health problem later in their lives.
IMHO, free sparring should not be practiced in martial arts as it causes destruction more than strengthening good health. Sparring is an evolved form of male chauvanism and the product of capitalism of commercializing tournament. Commercialization has become a key for a martial art to continue to survive in this capitalism world. Without a tournament, there will be no handsome income and publicity for the martial arts organization. Tournament has also become an instrument for marketing oneself and one’s training school if he has won many titles which highly sought after by ignorant and naive people.
Martial arts should be practiced in a non-violent way which encourages only growth and strengthening of oneself and partners. Sparring encourages violence and initiative to attack rather than defense which is contrary to the concept of olden martial arts teaching.
Injuries in karate
Another interesting topics we (Robert, his wife and I) discussed on last Wednesday evening was injuries. Robert and Minnie were concerned about injuries in karate because karate did not use protective gears such as body and head guard during kumite (sparring) session.
During kumite training, students only wear hand gloves and mouth guard. In a tournament, hand gloves, mouth guard and shin and instep guards are required. No body and head guard is required as in Tae Kwon Do.
This makes the couple concerns about their daughter safety. In my coaching experience, I have not encountered any serious injuries other than some bruises and sprained fingers. I personally experienced lots of bruises and sprained fingers and legs. I had a torn adductor longus (go from pelvis to the thigh bone) on my left thigh about 3 years ago. It was a self inflicted injury. I did not warm up enough before I executed an ushiro geri (back kick). It took me 3 weeks to recover and the next 8 weeks not to do any kicking during my training.
I found an interesting article about a study of injuries in 5 major martial arts. The research was done by Dr. Zetaruk, Pediatric Sports and Dance Medicine Program, Children’s Hospital of University of Manitoba, Canada in collaboration with Violán of University of Barcelona, Spain and Zurakowski and Micheli of Children’s Hospital, Harvard Medical School, Cambridge, MA, USA. The result of the study is very interesting and it shows that tae kwon do has highest injuries rates:
The rate of injuries, expressed as percentage of participants sustaining an injury that required time off training a year, varied according to style: 59% tae kwon do, 51% aikido, 38% kung fu, 30% karate, and 14% tai chi.
There was a threefold increased risk of injury and multiple injury in tae kwon do than karate. Subjects 18 years of age or older were at greater risk of injury than younger ones.
Martial artists with at least three years experience were twice as likely to sustain injury than less experienced students. Training more than 3 hour per week was also a significant predictor of injury.
Compared with karate, the risks of head/neck injury, upper extremity injury, and soft tissue injury were all higher in aikido, and the risks of head/neck, groin, and upper and lower extremity injuries were higher in tae kwon do.
No sex differences were found for any of the outcomes studied.
CONCLUSIONS: There is a higher rate of injury in tae kwon do than karate. Different martial arts have significantly different types and distribution of injuries. Martial arts appear to be safe for young athletes, particularly those at beginner or intermediate levels.
Here is the full article.
Perhaps, it is time for people to realize that karate is safer and switch to karate. It can be very difficult for ignorant and obstinate people to accept this true fact and partly because of their ego not to admit.
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