Injuries in Iaido
by Kim Taylor
The information presented here comes from several sources but one of the best is the book "Sportshealth" by W. Southmayd and M. Hoffman Quick Fox, 1981, New York. This is a well written book including many anatomical diagrams and, more importantly, rehabilitation methods.
Since the main factor (other than inertia) keeping a student from Iaido practice is injury, a basic understanding of cause and treatment is needed. The information presented here comes from several sources but one of the best is the book "Sportshealth" by W. Southmayd and M. Hoffman Quick Fox, 1981, New York. This is a well written book including many anatomical diagrams and, more importantly, rehabilitation methods.
ACUTE INJURY
An acute injury is one that is acquired immediately, an injury such as a muscle strain or a cut. In Iaido strains are not quite as likely as in some other budo. There is certainly the danger of cuts and, in partner practice, some chance of bruising and even concussion.
GENERAL PRINCIPLES
The general method of dealing with an acute injury is contained in the acronym RICE. This stands for Rest, Ice, Compression and Elevation. This is mainly for sprains and strains but will also work for cuts and bruises.
REST: Stop what you are doing. The first thing needed is to rest the injured part. Don't make a small injury a large one by continuing to exercise. You must give it a chance to heal.
ICE: When a body part is injured fluids are dumped into the area to fight any infection that might occur. The fluids will dilute any toxins and flush them from a wound. They also carry disease fighting factors such as white blood cells. To allow these cells to get to the wound the tissues and blood vessels become more permeable which in turn allows more fluid to be accumulated in the injured area. All of this is fine if there is a wound, but if the injury is a sprain the fluid is of little use except as a splinting mechanism. The ankle or wrist swells up so that you can't move it. While this might seem to be a good thing, in actual fact it can slow down the healing process drastically. This excess fluid will impede repair of the tissue since good blood circulation is now impossible.
By applying ice to an injury as soon as possible the fluid buildup in the injured joint is prevented. Circulation is maintained and movement is preserved.
COMPRESSION: Wrapping a sprained joint with an elastic bandage also helps to prevent swelling. Care must be taken not to wrap so tight as to impede blood flow.
Compression is also the correct treatment for cuts, up to and including major lacerations of arteries. Apply a clean bandage or cloth to the wound and apply pressure to stop the flow. Keep the pressure on as long as needed. Tourniquets are highly discouraged as even the blood loss from a severed limb can be stopped by enough direct pressure.
ELEVATION: Lifting an injured part up higher than the heart will also help to drain the area. (It also helps to reduce blood loss.)
This treatment should be continued for at least two days, then motion and exercise follow. Rehabilitation will be described at another date.
The following are some of the acute injuries encountered in Iaido practice.
CUTS: Even an Iaito can give you a fairly good stab wound. Compression directly over the cut will stop the flow in most cases. It is not generally recommended, even on major arterial cuts, that a tourniquet be used. Direct pressure on the wound is much more safe and practical, if the bleeding cannot be stopped no matter how much pressure is applied, direct pressure on the artery further up the limb may be tried. If you bandage a cut and it soaks through the wrappings, simply apply more wrapping, don't remove the first layer or you will disrupt the clotting process.
Since the mineral oil on the blade seems to prevent healing of the small stab wounds that you accumulate during training, washing the injury well under running water is recommended before the bleeding is stopped to get rid of this oil.
In the extreme case of actually losing a finger or part thereof, stick it back where it belongs and wrap it in tight, then get to a hospital as fast as possible. It is truly amazing what they can sew back on these days. If the finger is completely detached, wrap it in clean gauze and wrap in plastic, then pack it on ice with yourself to the hospital.
BROKEN BONES: Although not likely during solitary practice, some bones may be broken during partner practice with bokuto. The most likely breaks would be to the fingers with some possibility of skull fractures. A complete fracture is one where the bone is severed while a stress fracture is one where it is only cracked.
If a bone is broken, the general rule is to splint it as it sits. If it is in an awkward position and you must straighten it, make it parallel with the other limb, while applying gentle traction. This will usually do no further damage. Fingers are relatively easy to realign and can be splinted to another finger. If the bone has broken the skin, don't push it back in, cover the wound, circle the bone with clean packing and then apply pressure to stop the bleeding. Don't apply pressure to the bone but to the tissues around it. Always get a broken bone attended at the hospital, even if only a finger, otherwise you may end up with a non-functional grip.
A concussion is a result of a blow to the head that bruises the brain. It is hard to distinguish between a concussion and a fractured skull, the initial symptoms are similar. Since, in most cases of concussion, you do not lose consciousness or become disoriented, it is always a good idea to get checked out for any blow to the head that makes you feel a bit fuzzy. Even a small skull fracture will cause bleeding and swelling in the brain case, this can lead to permenant damage and sudden death. All head injuries should be checked out by a physician. Head injuries can be cumulative, there are cases in Japan of students taking multiple breakfalls, each of which presumably involving a slight bump of the head, who suddenly collapse and die as the brain becomes concussed.
Shin and heel fractures are possible when working on a wooden floor in bare feet. It is also relatively easy to fracture the kneecap. In all of these cases it is important to give the fracture time to heal before resuming practice, injuries that heel improperly will hinder practice for years after they should be forgotten.
BROKEN TEETH: Collect the parts and get yourself to a dental surgeon, these can often be re-inserted into the sockets and cemented back in place. (its a good idea to transport the bits in milk).
DISLOCATIONS: There is some risk of dislocating fingers and toes but not much else in Iai practice. To reduce a dislocated finger or toe pull straight out from the base. The thumb is a little trickier, requiring a slight outward motion. Once the finger is back in place an immediate reduction in pain should be felt. Sometimes the finger may not be quite straight or a small broken piece of cartilege may be caught in the joint. These should be examined by X-ray.
BRUISES: Bruises are fairly common in any sport, including Iaido. The knees can be bruised by striking the floor with too much force. Hands, arms and ribs can be bruised in bokuto practice. The hands can also be bruised simply by gripping the Iaito with excessive force when tired. All bruises should be iced and elevated to reduce the swelling.
DEHYDRATION: This is a serious problem that may be happening without your knowledge. Dehydration in itself is a problem but it can also be a trigger for other injuries.
In the summer months it can get very hot in the dojo. If the training discipline says that students must practice with no breaks for several hours, they will soon get dehydrated.
You should actually drink every 15 minutes or so during hard exercise. The best fluid is cold water, not sport drinks or soda pop. You don't usually need to replace body salts unless undergoing long term and severe exercise. Salts in the water will impede absorption and warm water stays in the stomach longer. Drink before you actually feel thirsty, when you're thirsty you are already in water debt. Load up on water before practice and get water during practice if permitted. (Instructors...permit it!)
The effects of dehydration include a loss in blood volume and an increase in salt concentration. Less water means less sweat as well as less blood volume to pump heat to the surface. This means that your core temperature will rise. Sweating over a long time will cause your blood salt levels to drop.
As your core temperature rises you become subject to heat exhaustion, with too little blood volume you can't cool the muscles and they overheat. If you are dehydrated you may get heat cramps. These are a result of a poor salt balance, lack of blood to muscle or in some cases a pinched nerve.
One sign of a lowering blood volume is orthostatic hypotension or a dropped blood pressure when you stand up. If you sit in seiza for a while and then stand, the blood will move into the legs and not to the head. This makes you dizzy. Curiously as you get into better shape and your heartrate slows down this problem may get more severe.
In the more severe cases of dehydration you may get heatstroke. In this case there is not enough blood volume to properly cool the brain. Some of the signs of heatstroke are burning muscles and difficulty in breathing. The air begins to feel hot, as does the body. When the temperature reaches 105 Fahrenheit the head hurts. Then very quickly comes a ringing in the ears, spots in front of the eyes, and then a loss of vision. At this point the student will usually pass out and often has convulsions.
As soon as possible you must hose these students down with very cold water. It is critical that you get the body temperature down as soon as possible. When they have recovered you must continue to watch them since the temperature often goes up again.
The solution to this problem is water, drink more.
CHRONIC INJURY
It is much more usual in Iaido to acquire a chronic, rather than an acute injury. The repetitive motions of kata practice will encourage such conditions as carpal tunnel syndrome which is an inflammation of the tendons at the wrist, and tennis elbow to name two that most of us have probably encountered.
In the case of chronic injuries the same acronym RICE is also the key to treatment. In this case it stands for rest, ice compression and exercise.
REST:
These problems are due to wear and tear on the body. Give it a
chance to repair itself by taking a break. This means not doing
the specific motion that causes the injury. It does not mean stop
exercising. By "cross training" you elevate your heartrate,
helping to flush out swelling, and get blood to the injured areas
while not stressing them further.
ICE:
Ice is applied to the injury to reduce the swelling that
accompanies and is often the cause of the pain and reduced
motion.
COMPRESSION:
Strapping an injury to prevent swelling is usually not called for
in chronic injury but some compression can relieve the pain by
providing support to fatigued tissue as in taping the wrist or
elbow. Taping is done to allow you to play with an injury and is
usually not part of a rehabilitation program unless you are in
the rest period.
Compression is also applied in the form of therapy as in deep massage or trigger point erasure.
EXERCISE:
After the swelling is gone and the injury starts to heal it is
most important to exercise the weakened parts. If this is not
done then it is almost guaranteed that the injury will reappear
as soon as you begin practicing again.
As you perform repetitive and stressful exercise it is usually the smaller, support or stabilization tissues that give way first. If you continue to practice you will begin to favour the damaged parts and your form will change. This will put unfamiliar stress on other parts and these in turn may fail. It is rarely more advisable to work through an injury than to rest and allow it to heal.
Chronic injuries are usually caused because you are not allowing enough recovery time. The muscles should be allowed time to rebuild, and not be subjected to continual stress. When building strength you must allow time for the support tissues to catch up with the muscles. Tendons, ligaments and bone grow somewhat more slowly than muscle. They are however, built up in exactly the same way as muscle, by applying resistance. In strength training you are also improving the support structure around the joints. This becomes very important if you are performing inefficient motions such as rising from Iai Hiza which can put tremendous stress on the knee.
It may be difficult to stop practice since it will seem that you are never improving. Remember that you are, and allow time to recover. Most of the chronic injuries do disappear with time (as the body adjusts) so have patience and don't give up.
Here are some of the specific injuries associated with Iai practice, from the more or less mild to the serious. They can all prevent good practice.
BLISTERS AND BLOODY HANDS:
With either a new student, or a new handle there will almost
certainly be blisters. Blisters come from a rubbing across the
skin, the lower layers of the skin are fixed while the upper rips
away as it is twisted. The situation is helped along by moist
hot skin (sweat) which tends to soften the tissues. Nylon
wrappings on the handle instead of absorbent cotton will
exaggerate the problem. With a bokuto, varnish instead of oil as
a finish means that the wood has no absorbing power and no
lubrication. This causes friction and wet hands. One solution is
to apply talcum powder.
The proper treatment of blisters is to try and keep the top layer in place. Poke a hole in the side of the blister with a sterile needle, push out the water and then tape it down tightly to allow the skin to re-fuse.
After a blister has been formed and the student keeps practicing it usually rips off. This results in bloody hands and a wound into which the salt sweat is leaking. Wash it well and cover it with sterile gauze or an adhesive bandage if it is small enough. Allow it time to heal before picking up the sword again.
If, while practicing you notice a red spot on your skin, place a small bit of tape directly on top. This way, the handle rubs on the tape rather than your hand. The heat buildup from friction can also be countered by applying ice to the area.
A simpler solution to blisters is to reduce the amount of movement of your hands on the handle. Continual adjustments of the hands simply allow more openings for an opponent.
CALLUS BUILDUP:
When you begin practicing Iaido, callus usually builds up, and
then goes away, leaving smooth but tougher skin. In some people
however, it just keeps building up. In this case you must trim
it or risk having it rip off in a chunk. Soak, then polish it
with pumice stone.
Since much of the time spent practicing Iai is spent in seiza on a hard floor, the tops of the feet often develop what looks like a "ganglion". This is a thickening of the skin that is the same as that under the feet. In some cases there may also be some bone thickening which is called dorsal exostosis, usually with a thickened skin as well. This happens most often in people with a bony protuberance on the top of the foot. This callus can often cause problems with dress shoes. More importantly, when you practice the callus can be driven into the foot and this may sometimes trigger circulation problems.
MUSCLE STIFFNESS:
Muscles that are stiff after exercise are not too much of a
bother, but several muscles can become stiff while doing Iaido.
This is often caused by fatigue and can include the muscles of
the hand. When this happens the control of the Iaito is lost and
practice becomes dangerous. If the hands become sore and weak,
stop for the day.
The lower back can also become sore during practice. This can be caused by excessive curvature of the spine while trying to hold the back straight. Instead of curving the back try stretching the spine upward to keep the back vertical. This will enlist the stomach muscles as well as the back. If there is poor flexibility and strength in the back this can also lead to soreness. Problems in the lower back are often a result of spasms in the muscles of the neck, upper back or the hamstrings. The back can often be released by bending over as if to touch the toes and just hanging for a short while.
A stiff neck is a common problem as the student tries to hold the head still and the back straight. Again, flexibility and strength is the key.
MUSCLE CRAMPS:
A "charly-horse" is a spasmed muscle. This is caused by lack of
oxygen or energy in the muscle, poor salt balance, damaged muscle
tissue which creates "trigger points", or nerve damage. They
usually respond to squeezing and massage. One of the most painful
of these little devils happens especially to the left foot when
sitting in Iai Hiza, the planter's fascia across the bottom of
the foot can go into spasm while you are sitting on it. For all
of these spasms stretch the muscle out as fast as possible and
when it passes, take a break and drink some water.
MUSCLE PULLS:
It may not seem that there is enough work being done in an Iaido
practice to pull a muscle. If you think this way shame on you for
not working hard enough. One area that does become susceptible to
pulls is the groin. By maintaining strict posture, perhaps
holding the breath unwittingly, using opposing muscle groups in
the legs for stability and then lifting the whole body weight
with widely spread feet, the groin can be damaged enough to feel
like you've just herniated yourself. Let it rest.
FINGER JOINT DAMAGE:
When you stop the Iaito at the bottom of a cut you are subjecting
the fingers to tremendous sideways stress. This is not a normal
stress on the joints and can cause irritation. It is difficult to
tape fingers and maintain control of the sword so the best way to
deal with this problem is to allow the damage to heal.
BONE IRRITATION:
By continual grinding of the knees on the floor, a periosteum
inflammation can be set up. This is a swelling in the sheath
around the bone which is exposed near the knees. This type of
irritation is one of the forms of "shin splints".
The feeling that it is more spiritually pure (read macho) to practice Iai on a hard floor without kneepads will usually get you a very short career in the art. Several top Sensei will not allow students to practice without kneepads any more because of the drop out rates that result in both beginners and in seniors that develop damaged knees. It is safer to assume that Iai was meant to be practiced on tatami, on grass, or with shinguards (ie. kneepads).
NERVE DAMAGE:
Any time you spend long hours doing repetitive motions there is
risk of nerve damage, especially in the hands where the nerves
are near the skin. Another exposed area is the top of the foot,
sitting in seiza on a hard surface can cause loss of feeling in
the foot. The cure is to rest the part until the nerves recover.
BURSITIS OF THE KNEE:
It is quite common in Iaido to develop "housemaids knee".
Scattered around the knee are 14 sacs or bursa. They can be
irritated by repeated blows as when one kneels without proper
control. The swelling can occur over two or three days. To
correct the problem you must reduce the swelling. Apply ice 3
times a day, for 20 minutes, for 2 days. Most adults can take up
to 6 aspirins a day to reduce inflammation. Aspirin is still one
of the most effective anti-inflammatories we have.
BURSITIS OF THE HEEL:
Inferior calcaneal bursitis is an irritation of the bursa between
the heel and the heel pad. If you slam the heel down instead of
the whole foot when stamping, it is quite easy to irritate the
bursa.
TENDONITIS:
Most "arthritis" is actually irritation in the soft tissues of
the joint itself and not a problem with the bones. It is just
simpler to call it arthritis and prescribe pain killers. In Iaido
the joints most susceptible are those of the wrist, hand,
fingers, knee and hip.
The knee is especially vulnerable since Iaidoists are constantly doing deep squats and finishing with a shock almost directly on the tendons. They are sitting down in seiza. Another motion that creates ideal conditions for tendonitis is Iai Hiza. The outside of the left knee is stretched about as far as is possible and then part of the body weight is placed on it. The rest often goes sideways onto the ankle.
With beginning students it is important not to go for perfect form right away. Leaning forward to rise will relieve a lot of the stress on the knees when moving out of seiza. Wait until the knee tendons are strengthened enough to raise the entire weight of the upper body at full stretch. This is what they must do when rising with a straight back. Just sitting down in seiza can be enough to damage tendons if it has never been done before.
The same methods should be used when starting to work from Tate Hiza. In this case the knee is not only bent but often twisted as well. If you try to rise using only this left knee great damage can be done. By leaning forward slightly you can transfer some of the stress off of the left knee and on to the right leg.
In all cases, work up to the correct form gradually so that the tendons can keep up with the muscular demands put upon them.
Some Iaidoists develop a bump on the top of tibia right where the patellar tendon joins the tibia. In children of 10-16 years this form of tendonitis is called Osgood-Schlatter's disease and is due to a slight tearing away from the bone. It is supposed to happen only in growing people but Iaidoists without kneepads can also damage this area enough to cause the problem.
Tennis elbow is common at some point in Iai practice. The right hand is used to stop the cut and this puts great stress on the muscles of the forearm that run up and join the humerus. The pain is usually felt as an ache near the outside of the elbow. It can also be transferred (referred) down to the wrist giving the impression of a problem there. This syndrome is quite responsive to deep massage and trigger point techniques and seldom persists as the forearms become stronger.
Another place where tendonitis is felt is in the Achilles tendon. There is often some pain here which goes away as the muscles warm up. The best way to deal with this is to strengthen the tendon by exercises for the calf muscles. Another important point is to make sure that the calves are well stretched out before each practice.
When practicing with bare feet the student often develops shooting pains on the bottom of the arch. This is usually planter fasciitis, tendonitis in the membrane over the bottom of the foot. Since this membrane moves over the heel and up the calf, stretching the calf will help prevent the problem. Not slamming the heel down onto the floor will also help, use the whole foot.
THE SHOULDER:
The right shoulder can begin to suffer from repetitive motion
problems, especially in the area of the A-C joint due to the
stress on the front of the joint as the shoulder is thrown
forward, for example, when replacing the sword in the saya.
Rotator cuff tendonitis, also called swimmer's shoulder, is a
common problem for those who use their arms above their heads a
lot and the prescription is at least a week of rest after icing
for twenty minutes at least twice in order to get the swelling
down.
Almost all tendonitis will respond to RICE but there are some other methods that can also help speed up the healing process. The main objective is to promote blood flow to the injury and to keep the damaged parts moving in their proper range. This will help prevent the joints from freezing as they heal.
In later articles we will go into rehabilitation techniques and the prevention of injury. Right now however it should be pointed out that the author is simply a Jock and not an MD. Those readers out there who are doctors may wish to comment further.