..	International Ch'ang-Hon Taekwon-Do Federation HEALTH & WELLNESS DEALING WITH INJURIES IN THE DOJANG by Master Aaron Fruitstone, CSCS, NSCA-CPT, ICTF 7th DAN Wellness Committee Chairman Training injuries that occur in the Taekwon-Do dojang are inevitable. In this article we will address several types of injuries. We will first look at simple acute injuries, specifically nosebleeds, simple contusions, abrasions, and minor bleeding. Then, we will look at acute joint injuries, including varying levels of sprains and strains. We will then look at chronic overuse injuries, including tendonitis. Following, we will address head and brain injuries and profuse bleeding. *This article is intended to serve only as a guide, and proper medical care should always be sought for any suspect injury. The first aid described in the article covers a variety of injuries, and may save the life of you or one of your students. There are a number of injuries and conditions not covered in this article. I have deliberately not included respiratory and cardiac issues, nor severe bleeding and puncturing injuries, as they are beyond the scope of this article, and it is recommended that all instructors be properly certified in CPR and First Aid. SIMPLE ACUTE INJURIES: 1) Nosebleeds — Nosebleeds are caused by a number of things. They may be related to contact injuries, or may be a result of an elevation in blood pressure. Some people are prone to nosebleeds. The nose is likely to bleed profusely, but is easily stopped, assuming there is no major damage. Nosebleeds associated with disfigurement of the nose may be a fracture and should receive immediate medical attention. Always wear latex gloves when handling a bleeding individual. After ruling out a possible fracture, squeeze the nose in the cartilage area and have the injured person lean slightly forward to promote clotting. If desired, use a tissue or nasal plug, in addition to the pressure, to help stop the bleeding. Ice applied to the nose also aids in the slowing of blood flow, and will facilitate stoppage. If the bleeding persists for more than five minutes in spite of the manual treatments, seek immediate medical attention. 2) Contusions — Also known as bruises, they are generally soft tissue injuries resulting from compression from a heavy blow. There are varying levels of contusions, based on the extent of the damage. Tissue that simply is painful and discolors may be treated with RICE (Rest, Ice, Compression, Elevation) therapy and light massage. More severe contusions result in swelling, restriction of motion, and possible temporary paralysis of the affected area. Severe contusions may be immediately treated with RICE, but may require immobilization, so medical attention is recommended. Bone contusions may be severe, and should be treated with medical attention. 3) Abrasions — Caused by friction or "rugburn", abrasions are the shearing of skin against a rough surface, resulting in varying layers of skin being scraped away. Treatment for abrasions includes application of direct pressure on the wound to stop bleeding, cleansing the wound with soap and water, and treating it with an antibacterial ointment, and loose bandaging. Bandaging may be done with gauze and medical tape, and should be changed and re-treated with antibiotic ointment for the first 48 hours. A scab will form, and as the wound heals, less bandaging will become necessary. If any increase in pain occurs over 72 hours, it may be due to infection and a physician should be consulted. 4) Minor Bleeding- Minor bleeding may be caused by scratches or other mechanisms. Always wear latex gloves when dealing with any bleeding individual. Apply direct pressure to the wound and elevate it above heart level. Clean the wound with soap and water, and apply antibiotic ointment to the wound. Loosely apply a bandage, such as a band-aid over the wound, changing the bandage regularly. If swelling or pain increases over the first 72 hours, it may be due to infection and a physician should be consulted. ACUTE JOINT INJURIES: 1) Strains — Also known as "pulled muscles", strains are tearing of the muscle fibers and the tendons. There are 3 degrees of strains, each varying in severity and treatment. First degree strains are usually accompanied by some pain and possible mild swelling, but no loss of function. Stop the activity immediately upon noticing the strain. Treatment for a mild strain is RICE, with a comprehensive stretching and mild strengthening program. Second degree strains are more severe tears and are associated with more severe pain, swelling, and muscle weakness. These types of injuries should be immediately treated with RICE and a physician should be consulted to determine the extent of the tear. MRI may be necessary. A third degree strain is normally a complete tendon or muscle tear, and is marked by severe pain, disfigurement, loss of control of the muscle, and total instability. Third degree strains should be immediately treated with rice and the person needs to seek immediate medical attention. Third degree strains may require surgery to repair the damaged tissues. 2) Sprains — A sprain, like a strain, is also a tearing of the soft tissues. It is tearing of the ligaments that hold bones together, and generally occur at a flexible joint, such as the ankle, knee, or shoulder. There are 3 grades of sprain, and each varies in severity and treatment. A first degree sprain is generally associated with some pain, mild swelling, but no loss of function. Activity should be stopped immediately following any sprain. Treatment of a first degree sprain is RICE and strengthening of the joint. Second degree sprains have more severe pain, joint instability, and swelling. The recommended treatment is RICE and consulting a physician, as an MRI may be necessary to determine the extent of the ligament tear. Third degree sprains are generally associated with an audible "pop" or tearing sound, and are extremely severe. A third degree sprain is a complete tear of the ligament. Major instability and loss of function in the affected joint will occur, as will pain. RICE and immediate medical attention are appropriate treatments. Treat any severe strain or sprain with extreme caution, and seek immediate medical attention. When in doubt, refer it out! CHRONIC OVERUSE INJURIES: 1) Myositis and Fascitis — Caused by repeated movements of the muscle and fascia surrounding the muscle, respectively, they are chronic conditions that develop over time. The tissues become partially torn and irritated, and that results in pain and sometimes restricted movements. Treatment for most overuse injuries is the same. RICE, with the possible use of nonsteroidal anti-inflammatory drugs (NSAIDS), if tolerated. The most important thing to remember is to stop performing the specific movements that cause pain, sometimes for extended periods of time. Occasionally, immobilization and even surgery become necessary, depending on the severity of the condition. 2) Tendinitis and Tenosynovitis — Inflammation of the tendon attaching a muscle to bone, or the sheath surrounding the tendon, these are caused by repetitive movement that causes microtears and inflammation in the tendon. Sometimes, movement becomes restricted. Care for these chronic conditions are the same as for Myositis and Fascitis. 3) Bursitis — Bursitis is caused by irritation of the fluid filled sacs that release joint lubricant and reduce friction between the joints. It is usually caused by either acute or repeated joint compression. Bursitis almost always requires medical attention. HEAD AND BRAIN INJURIES: 1) Skull Fractures — Extremely severe, skull fracture may occur from extreme impact to point of the head. Treat any head injury as a possible brain injury, and seek immediate medical attention. Signs that include possible skull fractures include deformity, unequal pupils, discoloration around both eyes or behind the ears, bleeding or cerebrospinal fluid leaking from the nose and/or ear, and any loss of sight or smell. Do not treat the individual with any first aid unless the fracture is associated with severe bleeding. If bleeding occurs, apply light pressure on the wound with a cool cloth, except in the case of an open fracture. NO MATTER WHAT, GET THE PERSON TO THE HOSPITAL! 2) Concussions — Concussions are caused by a violent jarring or shaking of the brain resulting in immediate impairment of the nervous system. Anyone who is struck and "sees stars", has blurred vision, or experiences headaches following a blow has likely suffered a concussion. Activity following any possible concussion must be stopped immediately. Never move an unconscious individual. If a person loses consciousness, call EMS immediately! Concussions are graded in 6 grades, based on severity. A grade 1 concussion is not associated with a loss of consciousness. There may be slight confusion, unsteadiness, and dizziness. The person should not return to activity until they are symptom free for at least one week. Deterioration from a grade 1 concussion may include vertigo, nausea, mood swings, or headache, and are a sign of more severe damage to the brain. A grade 2 concussion is associated with brief loss of consciousness. Once the person regains consciousness, they will be confused, dizzy, and will be unable to walk, along with blurred vision, ringing in the ears, and headache. Memory loss from the injury is likely, and the person may not remember events up to the injury. Consulting a physician following a grade 2 concussion is necessary, as it becomes easy to develop future concussions. No activity is recommended for one month. Grade 3 concussions have extensive periods of unconsciousness, followed by retrograde amnesia. One or both pupils may dilate, the person will be sensitive to light, and may be unable to focus. Immediate medical attention is necessary for anyone who loses consciousness! Grades 4-6 of concussions are life threatening, and should be dealt with by professionals immediately. PROFUSE BLEEDING: ALWAYS USE LATEX GLOVES WHEN DEALING WITH BLEEDING INJURIES! 1) Arterial Bleeding — Spurting blood that is bright in color is arterial bleeding. If arterial bleeding is suspected and bleeding is uncontrolled, elevate the affected area above the heart, apply direct pressure to the wound, apply a mild tourniquet just above the wound to reduce blood flow, apply ice to slow the blood, and have paramedics get the person to the hospital immediately! Do not hesitate in action, as arterial bleeding may be life threatening. 2) Deep Venous Bleeding — Generally, veins collapse and stop bleeding when cut, but sometimes, when a deep vein is cut, the bleeding may be profuse. Venous bleeding will be much darker, almost maroon in color. These wounds are severe and should be treated as life threatening wounds. Treat them the same as arterial wounds. 3) Neck and Head Bleeding — Obviously, no tourniquet may be applied to a neck or head wound resulting in profuse bleeding. These are medical emergencies that may be treated with pressure on the wound (assuming no fracture) with a cloth. Call for paramedics and get the person to the hospital immediately. IN CONCLUSION: There are a number of injuries that may occur in the dojang. It is the responsibility of instructors and students to use prudence when dealing with the variety of injuries that may pop up. Always err on the side of caution when dealing with an injury, and seek the proper medical attention where warranted. Under no circumstances take it upon yourself to diagnose injury! Unless you are a doctor, you do not have that ability. Instead, be vigilant and treat injuries properly to enhance the recovery of the affected person. When in doubt, refer it out!!! BIBLIOGRAPHY Anderson, Marcia and Hall, Susan. SPORTS INJURY MANAGEMENT. Copyright 1995 by Williams & Wilkins. Arnheim, Daniel. PRINCIPLES OF ATHLETIC TRAINING. Copyright 1993 by Moshy-Year Book, Inc. Pfeiffer, Ronald and Mangus, Brent. CONCEPT OF ATHLETIC TRAINING. Copyright 1995 by Jones and Bartlett Publishers, Inc. Reproduced with permission from Mr. Aaron Fruitstone.
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