Kicking and Hip Injuries

[Kenpodoc]

I recently Heard that Mr Palanzo is recovering from hip replacement surgery. I know that Mr Liles has also had Hip placement surgery and that Bill Wallace has had his hips repaired. Does any one know if anyone has looked at the incidence of hip injuries in Kickers in the Martial Arts. Are there any credible reviews of this topic and any well documented means of avoiding problems in the future?

Jeff

 

[Bill Lear]

I recently Heard that Mr Palanzo is recovering from hip replacement surgery. I know that Mr Liles has also had Hip placement surgery and that Bill Wallace has had his hips repaired. Does any one know if anyone has looked at the incidence of hip injuries in Kickers in the Martial Arts. Are there any credible reviews of this topic and any well documented means of avoiding problems in the future?

Jeff

I know that Mr. Hawkins had hip replacement surgery too. As for the answer to your question... I dunno.

:idunno:

 

[The Kai]

I think any activity engaged in for extended period could lead to hip problems. Kickers more at risk? Probably, but runners tend to wear the hips out at a earlier age (From what I've seen)

 

[Seabrook]

There hasn't been much written in terms of published literature that specifically addresses the impact of martial arts kicking and hip injuries....interesting....

I think Steve "Nasty" Anderson also had to have hip replacement surgery but don't quote me on that one.

Jamie Seabrook
www.seabrook.gotkenpo.com

 

[Touch Of Death]

There are two kinds of kicks. Kicks that take a whole beat to perform and kicks you insert between the beat (minor moves or jabs). The latter will cause the practitioner less damage, however so will it cause less damaged to your opponent unless well timmed and placed. As we grow older, one would hope to rely less on kicking for combat success.
Sean

 

[distalero]

Just google-ing around I found http://nutrition.ucdavis.edu/olympics/Sports/mart.htm which is a (long) listing only, of related (maybe not specific) studies. (One is on "Judo-joggers itch"; don't want that ).
By the way, if I remember correctly, Mr Liles had back problems early on (and still managed to kick up a storm); perhaps there was a progression in injury?

 

[Kenpodoc]

Thanks for the responses. It seems to me that the better kickers are develping more than their share of problems. If that is really true it would be good to know if certain kicks cause worsening injury. I had always felt (without good reason) that stretching could help prevent hip injuries but Bill Wallace was one of the more limber people in the world and he blew his hips. In fact I now hypothesize that the stretching and looseness required to kick high well may actually lead to worsened joint trauma and increase your rick of injury. (I have no proof of this either. But, Osteoarthritis if the knees has demonstrable improvement and decreased progression if increas the strength of the opposing muscle groups and "tighten" the joint.)

This line of reasoning makes me wonder if we should actively discourage high kicking.

Jeff

 

[TigerWoman]

That's interesting in that I have been striving to kick higher. I am pretty limber, almost in full splits either way. I have just come back from a workout at noon where I did a hundred double low high sidekicks and my hips are aching, like a burn feeling not the glutes either. I already have knee issues which I am trying to keep tight. I also did 100 squats for that. It certainly helps keep the tracking right. I am trying to do more workout without my knee brace to work my ligaments and muscles more without that aid. TW

 

[KenpoTess]

If it causes pain or discomfort don't do it is my motto

Bill Wallace's trademark being his Kick.. most likely contributed from years of over use.

We kick to the head all the time.. when the opponent is on the ground .. No higher than solar plex is necessary for me.. bladder, groin, and knees are best targets I find. kicking hard targets may jam joints.. and if you're one of those die hard kenpoists who revel in kicking.. drills or what have you.. consistent motion in hip joints may cause some damage down the road.
I, myself already face bone issues and can feel the 'titanium cage' in my lower spine move when I do left legged kicks.. so guess what.. I don't do em

Just my thoughts

~Tess

 

[Kenpodoc]

Tiger Woman - My comments are just conjecture. For all I know TKD students get fewer hip problems because of the way they train. I do think it's an important question. I'm not sure we'll easily find the answer.

KenpoTess - I'm with you. I con't have the hardware in my back but the injuries are there and not always easy to ignor. I emphasize and work on lower kicks.

thanks,

Jeff

 

[KajuMom]

I think any activity engaged in for extended period could lead to hip problems. Kickers more at risk? Probably, but runners tend to wear the hips out at a earlier age (From what I've seen)

I came to martial arts 3 years ago (at age 35) with hips that have been subjected to years and years of long distance running. I still do an easy run 3 times a week, pain free, but high kicks definitely cause pain in my hip joints.

I was also an avid mt. biker for many years and that led to a definite lack of flexibility in my legs and hips. I consider it a miracle that I am even able to kick to the solar plexus and a kick to the head...? Well, I can dream, can't I?

 

[Doc]

I recently Heard that Mr Palanzo is recovering from hip replacement surgery. I know that Mr Liles has also had Hip placement surgery and that Bill Wallace has had his hips repaired. Does any one know if anyone has looked at the incidence of hip injuries in Kickers in the Martial Arts. Are there any credible reviews of this topic and any well documented means of avoiding problems in the future?

Jeff

This question has come up before in the past, and we had a rather lengthy discussion on the topic. To rehash a bit in what I said previously, The kicks as many perform them are anatomically incorrect, and I have see across all styles a necessity for hip replacement surgery after a period of time. The fact this is commonplace among Kenpo practitioners is even more disturbing, in as much American Kenpo is not even known as a “kicking style.”

Simply, basics in all categories have eluded those who instruct, but kicking basics are probably the most damaging to the body (absent poor execution of basics getting your butt whooped), and Kenpo Teachers have always “borrowed basics” from other disciplines. I have often heard of Kenpo students taking TKD to improve their kicks and even vice versa to improve hands.

Ed Parker never really taught basics after a fashion, taking us back to the conceptual execution of most of the material. The majority of Ed Parker’s black belts were transplants from other teachers and styles, bringing their own understanding of “basics” with them and essentially taught them “their” way.

When Parker first came to the mainland and did teach basics, they were flawed and represented the heavy Okinawa / Japanese influence of Kenpo in the islands. Early “Kenpo” was essentially Okinawa-Te and Okazaki jiu-jitsu with the Chinese Influences brought by Chow.

Chow and Emperado did not do these improper kicks and neither did Parker, but the cross-pollination effect and influence of absorbing information from other disciplines, also brought many of their flaws and improper basics as well. Early video of Parker will verify this very straight forward linear like execution, with a hint of greater Chinese influence yet to come.

The "knife-edge sidekick" as an example, as well as other high kicking methods is a product of the Okinawan/Japanese and Korean Arts and is not represented in the traditional Chinese Martial Sciences. Nor are they seen in Ed Parker’s Chinese Kenpo roots, and they are one of the biggest culprits in the damage to hip flexor muscles and tendons that stabilize the “ball joint” hip socket relationship.

Parker never did these kicks improperly above his waist when he understood why he should not. Ark Wong and Haumea Lefiti stopped that when he first came to Southern California.

Parker told me personally, "... all those guys will have hip surgery one day." speaking about some of the "fancy kickers" as he called them. That came true across all styles and you can add, Chuck Norris and America's Hap Ki Do pioneer Sea Oh Choi to the previously mentioned, along with a multitude of practitioners whose names would be unfamiliar.

Over time, how, and where you kick and stretch has a huge impact on the hip flexors. Parker’s personal interpretation of Kenpo has all the kicks that are anatomically correct, and Parker himself ceased performing any that were not and never had hip problems. Being "limber" and being capable of certain kicks does not mean your kicks are being done properly and that, over time, you are not doing significant damage to your joints.

The "proof is in the pudding" when well-respected and "knowledgeable" practitioners from many different styles ultimately injure themselves significantly. When extremely limber athletes in other activities rarely have hip problems, it suggests perhaps the methodology is flawed and knowledge of proper execution is missing. The passing of knowledge in modern American Martial Arts of all types is seriously flawed and without knowledge present beyond, "do it this way because I say so." with very little demonstrable knowledge to explain to a student eventually "why" it should be done a certain way.

The answer to the question is not even the height of the kick, but as always, "how" it is performed. No matter what we do, it always seems to come back to the basics of "how," which "conceptual" Kenpo has never taught because "how" has never been a part of its design, according to its progenitor.

It was never supposed to be "right," only "right for you" as quickly as you could possibly get there and it worked. But as we see, it is seriously flawed over the long term.

 

[Kenpodoc]

Doc,

Nice response and fits well with my preconceptions. Anatomically I'm sure that many of the kicks now taught significantly stress the cartilaginous component of the hip. Your comments on Mr. Parker fit my observation from the video I've been able to watch. Of course my problem remains finding out how to do these kicks safely with out reinventing the wheel. I'll try to do a better job of searching the previous discussion and thanks for having the patience to reitterate your previous statements.

I spend much of my day taking care of both the healthy and feeble elderly. I know that if I manage to live to old age that the former have far more fun. At 48, my 70's no longer seem so distant and as a father I want to try not to steer my far more resiliant children into bad habits.

With utmost respect,

Jeff

 

[Ceicei]

So how should kicks be done that would not stress the hips?

- Ceicei

 

[Kembudo-Kai Kempoka]

So how should kicks be done that would not stress the hips?

- Ceicei

I've kept my mouth shut, but you asked for it...

We rented a video-flouroscopy (VF) unit a couple years ago, and taped the open and closed chain joints in motion during the performance of basics. VF is ongoing X-ray...instead of a snapshot of a millisecod in time, it's watching TV. It's a several minute x-ray, used in physical medicine to either giude injection procedures, or to evaluate the movement of jonits for abnormal soft tissue findings. For example, someone beig taped in VF walking on a treadmill with a ruptured ACL on the right...the right knee will look very different, with an unatural "hitch" in it during gait, compared to the left. We were curious about some very specific things, relative to some concerns about biomechanics that had come about during a lecture on the effects of cumulative trauma sports injuries (i.e., guys who run wrong, swing their bat wrong, serve a tennis ball wrong, etc.). So we taped the hips and knees during specific types of kicks, the lumbar spine and thoraco-lumbar junction during lower extremity basics (kicks, small foot maneuvers, etc.), the shoulder during specific movements with the potential to create wear and tear for martial arts enthusiasts (reverse punches, upward blocks delivered to the side vs front, and backnuckles delivered to the side vs to the front). We also trained the VF on the cervical spine at the shoulders and base of skull while subjects from kenpo, kajukenbo, TKD, and boxing performed 5-10 repetitions of moves. We taped it, then analyzed the heck outta the tapes. I wish I had them still; I'm sure someone could make a PC friendly file of them, and we could post them here for all to see. But, to the point.

Front kicks are about the only kick that can biomechanically be done safely to chest height. Side kicks and roundhouses -- kicks delivered to the side of the body -- should not be delivered above the level of the belt; ideally, no higher than your own bladder (anatomically just slightly lower than the articulations of the hip joint). Doing so either 1) places more stress on intra-articular and peri-articular tissues than they were meant to have, or 2) requires accomodation and compensations at other places in the body (i.e., knees, spine at lumbo-pelvic junction, others) which create a whole set of injuries on their own.

We are designed to step high and reach forward with a foot, then pull the ground we gained to us (relatively)...the gluteus max, hamstrings, sacrospinalis, contralateral adductors, and some buncha other muscles come into maximum play with actions similar to walking up a hill, or stairs, or reaching far forward in a sprinting stride, then recoiling the leg back to the body to take the ground you covered in the forward stretch phase of the running gait. A front kick is akin to placing your foot on the hillside up in front of your thorax, then changing your mind about going uphill and bringing it back down again. For someone who takes many high steps covering lots of ground (i,.e., hikers, etc.), the flexibility is there to allow this motion to normalize within the complexities of the hip joint and pelvic nutation/counter-nutation rhythems.

Aside from the un-natural movements employed in martial arts, when, in the course of hunting and gathering, do we whip our leg out to the side, higher than our head? It is not in the natural repetoire of human motion. We can force it, but the price is compression of tissues that do not like to be compressed.



Dig out Snells, Grays, Rohen & Yokuchi, or some other basic anatomy text (I copied some pics from the web, but can't figure how to place them). Look not only at the complex structure of the hip joint itself -- giving up flexibility for stability, and holding that stability in place through a twisted set of very tough ligaments and connective tissue structures -- but also at the relationships of the femoral head in the acetabulum, particularly in relationship to the fovea capitus (little hole in the ball part of the ball and socket hip joint).

There is a ligament & accompanying blood vessel that feeds the hip, and communicates through this tiny hole in the head of the femur, within the joint capsule of the hip itself. The fibrous capsule of the hip is twisted to maintain an optimal strength-tension curve relationship, providing stability to the hip joint while facing the correct parts of the femoral head to the articulating surface of the acetabulum (the ball in the socket). Superficial and deep muscles that cross the hip joint support it further in specific planes of motion. There are hip flexors (muscles that move the thigh forward or pick the knee up towards the sky out in front of you), hip adductors and abductors (some that sway the leg away from you at the hip, and some that sway it back to you); extensors (butt muscles that lift your heel rearwards); and external and internal rotators (allowing you to turn your toes in, or out).

"Pure" movements will consist of one or more of these motions, preferably not combining more than 2 sets of motion. I.e., hip flexion with external rotation (iliopsoas, with assistance from some of the deep 6 and piriformis, plus either gracilis or sart...can't recall specifically, been too long and am too lazy to fetch a reference)...the motion used in picking your leg up, and stepping forward with it towards a front twist. There are no natural combinations for picking your leg up and out to the side, straightening it, then elevating it to chest level or above. It's made possible by the assistance of abdominal and lumbar lateral flexors (i.e., quadratus lumborum, others), and by a quick contraction of major external rotators (gluteus medius), complemented with a counter contraction of hip flexors and thigh extensors (psoas, sartorios, quads, etc.). This combination of possible, but unnatural, motions essentially forces the femoral head to engage in an infero-lateral glide within the acetabulum. Not possible as a true movement, so hip flexion takes over and, at the last moment, pulls the ball rearward in the socket to allow for the forward relative movement of the kicking leg (in the roundhouse), or the snapped-forward movement of the hip joint when a side kick is delivered to 8:30 or 3:30, since the hip jonit wil not allow for straight lateral elevation to a true relative 3:00 or 9:00 at high altitudes.

Muscular anatomy is what the thing is. Biomechanics is what it does. The muscles listed at the top of the chart are for internal or external rotation...obturator niternus and externus, superior and inferior gamellus, quadratus femoris, gluteus minimus, and piriformis. The closest muscle to lateral elevation is the tensor fascia latae...only about the size of a silver dollar, and clearly not designed to carry the full weight of the limb into lateral elevation.

On VF, there is a violent snapping of the hip in the joint, starting on one path, then being suddenly and forcefully yanked in another. This places undue stress on a number of structures:
1. The fibrous hip capsule
2. The articular hyaline cartilage of the hip joint (a slick, shiny surface joints are supposed to glide over)
3. The artery & ligament as they communicate through the fovea capitalis
4. The sacroiliac ligaments on both the ipsilateral and contralateral sides relative to the kick, but more on the ipsilateral side
5. The lumbar discs and zygoapophyseal joint capsules of the bottom three spinal articulations.

I guarantee that, after only one year of high kicking in any of the planes other than a front kick, and even there higher than your own sternum, you will start having cracks in the articular surfaces of the hip joint; stress injuries (sprains & strains) to the fibrous hip capsule & assisting musculature, annular fissures to the bottom 2-3 lumbar discs, facet joint damage to at least the bottom three articulations of the low back, and tissue degradation within the hip joint itself secondary to compromised blood supply. Additionally, I have seen the before and after x-rays of the hips of guys who have spent about a year of training in kicking arts (most specifically, TKD & Thai, as well as "match-style" kenpo). There is an early degenerative change visible on plain film x-ray called a "sub-chondral cyst". Basically, this is where a rough load was placed on the joint, and a tiny fracture occurred in the plates between the different levels of cartilage & bone, causing some hyaline cartilage -- the smooth, glassy stuff -- to get pushed under pressure to the area just beneath the outer shell of main bone; like a piece of carpet getting pushed under itself. On x-ray, it looks like intermittent bubbles along the articulating surfaces of the hip joint. It is an early sign of advanced degeneration. A bad thing. It means the biomechanics of the hip have been compromised, and with every step, the wear and tear on that joint is greater than it would have been without the cysts. On film, it's like seeing 45 year old hips in 25 year old men. All from kicking high.

It ain't just a theory, folks. Many years ago, some fringe nutjob made a connection between smoking, and lung cancer. It started with the simple observation that smokers got it a lot more than non-smokers. Then for years the tobacco companies denied it, while thoracic, cardio and lung surgeons knew better. Kicking high in any plane is a bad idea. Here's the early warnings; time will show more of this surfacing as the effects of age are exacerbated by the effects of poor kicking habits. But we'll never get the funding the medical community got for cancer research, so we need to listen to subtler signals and signs. Tess feels it in her cage, because the pelvis and hips can't get there without enlistnig the back for help. People feel it in their knees, because with the stability of the hip joint compromised, somebody has to hold your ridiculously imbalanced butts up off the floor. (incidently, also causes knee damage, by placing increased stress on the menisci in the knees via semi-membranosis, plantaris, and other muscles that go from hip to knee and foot/ankle/foreleg to knee). The hip joint and low back joints on the side of the kicknig leg take a beating, while the knee of the supporting leg takes one.

In short, if you value the idea of orthopedic surgery at a younger-than-necessary age, keep on high-kickin. In TKD? switch your focus from kicking high, to kicking hard at a lower elevation. Especially if you're a woman. The cards are already stacked against you for hip and bone health problems; why add to it? And if you're a man? Well...weren't all the pioneers and seniors mentioned earlier men? No one is immune to the effects of crappy, unwise biomechanics. It may look good and feel great when you do it, but it's a bad idea. I walk like an old man with a load in his pants because of the damage I did to my own hips and low back, training to kick high, fast & pretty. I used to be able to throw 100's of high repetitions in training, and could smack plenty-o-folk in the head while sparring without tipping my head back (the classic compromise made in TKD to help get the leg higher). With a 2nd ni TKD, I spent lots of time training jump spin kicks. I used to watch Gil Kim, from Hwarang-Do, do his...sucker would graze the cieling tiles with near vertical spreads. I decided I wanted to be able to do that, and actually got close. Now, I can barely throw 10 proper kicks knee-high before my back starts screaming at me. Then, it takes about 3 days of advil megadosing before I can walk in some semblence of normalcy. I gotta find some old photos or video so Doc doesn't think I'm just fibbin about having been able to kick, once.

Preventive medicine = Is it bad for you? Then stop it.

Regards,

Dr. Dave

 

[Doc]

See, you're going to have people thinking I'm crazy again. Anyway, I believe you can still kick, I just won't let you kick incorrectly. That's why we do all that indexing.

Once again someone asks "how," as if you can really teach someone "how" on the internet, or video, or in a book, or ....

See you Saturday. Be prepared to spend some time learning and applying Index Set #1.

 

[thepanjr]

wow hip injuries are bad , i feel srry for mr hawkins even though i don't know that guy

 

[distalero]

Nothing like a little knowledge on the subject; what a GREAT post! This allows any and all to print it off and take it to their respective schools (gonna be some discussion out there ).

 

[distalero]

And by the way, that statement I made in another thread about the application of science to MA? I now stand corrected (in several senses of the term ).

 

[Soulman]

Dr Dave,
thankyou for such a great posting, please keep sharing your knowledge with us!

soulman