On Tuesday, we discussed the symptoms and treatments of sprains, strains, and common Capoeira injuries.  We will continue that discussion today with knee, wrist, and joint pain, more treatment and prevention, and why you should cross train.

KNEE PAIN

Repetitive movements such as the ginga and esquiva may lead to muscle imbalances or weakness if you do not strengthen the neglected muscles which support your knee.  The hamstrings and calves are often much weaker than your quads.  Over time this imbalance may lead to knee pain.

Other instances can be ligament injuries such as an ACL tear (Anterior Cruciate ligament) or PCL (Posterior Cruciate ligament) - two major ligaments in the knee that work together to provide stability in the knee. They cross each other and form an 'X' which allows the knee to flex and extend without side to side movement.  Another case may be a torn meniscus (usually knee cartilage).

Both the ACL and PCL can be injured or torn by a sudden twisting of the knee joint.  ACL tears can occur from sudden change of direction, twisting without moving the feet, or slowing down abruptly.  PCL tears are most likely to happen with impact to the front of the knee or from hyper-extending the knee.  

The meniscus which are small “c” shaped pieces of cartilage which act as cushions between the femur (thigh bone) and tibia (shin bone).  The lateral meniscus is on the outside of the knee while the medial is on the inside.  Meniscus tears are often the result of twisting, pivoting, decelerating, or a sudden impact.

If you have chronic pain, it’s best to check with a physical therapist so you can indentify the cause of your pain.

You can prevent injuries and knee pain by building overall stability and strengthening the neglected muscles along with increasing your flexibility and cross training.
 


SORE JOINTS

If you train frequently enough, you may experience some soreness or pain in your joints.  It’s essential to take the proper steps before, during and after training to reduce the chance of getting sore or pained joints.

Warm-up/Stretching – extremely important to help loosen up muscles and joints in your body to make it easier and safer to train

Correct Technique – the key is proper form so you don’t hurt yourself! If it hurts, you’re doing something wrong.  How your shift your weight makes a huge impact on how a move can affect you!

Rest – Listen to your body! You body needs time to recover and overtraining may need to injury.  You can benefit from a good day of rest and will come back even stronger!

Perform Alternate Movements – If the soreness or pain is really noticeable, stop doing the same movements.  Try to work on other techniques to give that part of your body a chance to rest and recover. Continuing to strain it will only make the situation worse.

Joint Supplements – I’m not a doctor but glucosamine supplements may help.  This is normally used by people with arthritis to rebuild joint tissue. Check with your doctor first!

Icing joints – Using ice or cold packs on sore or pained joints works really well. The ice reduces any swelling or inflammation in the area and decreases pain.

Hot Water Soak – Taking a hot bath, going to the sauna or steam room is a good way to relax the sore area and reduce stiffness and pain.

OTHER INJURIES

Other common issues that may affect your training can be wrist sprains or tendonitis, groin pulls, weak rotator cuff and a weak core.   Are you cross training to balance your workouts?  Are you working on your flexibility aside from the days you are training Capoeira?  What exercises are you doing to strengthen your weak areas?  There are always ways to improve you training and to prevent further injuries.



WRIST TENDONITIS / SPRAINS

Wrist tendonitis is a common condition characterized by irritation and inflammation of the tendons around the wrist joint.   The tendon can be injured as a result of repetitive use, overuse, hyperflexion, poor technique or weak wrists.  Wrist sprain (injury to the ligament) can occur when you slip and break your fall with your hand  - as I did when I was practicing my handstand years ago.  This can stretch the ligaments that connect the wrist and hand bones a little too far.  The result is tiny tears or a complete break to the ligament!  This will limit your ability to perform au, bananeira, queda de rins and any weight bearing activities.

As  I mentioned in the previous article, signs and symptoms of a sprain may vary in intensity depending on the degree of the injury.  You may experience swelling or tenderness in the wrist, bruising or discoloration of the skin, a pop or tear inside the wrist, a warm feverish feeling to the skin or persistent pain when the wrist is moved.

Severe sprains may require surgery to repair the fully torn ligament. This would be followed by a period of rehabilitation and exercises to strengthen the wrist and restore motion. A wrist sprain can take anywhere from 2 to 10 weeks to heal completely, depending on the severity of the sprain.



TREATMENT

Immobilize the Wrist
The first treatment step is to place the wrist in a splint or a cast. Resting the tendon should help decrease inflammation.

Ice the Injury
Ice is one of the most effective methods of reducing inflammation and swelling and promotes blood flow to the area.  You should warp an ice pack in a towel and apply to the affected area sporadically throughout the day.  Mild wrist sprain can be treated with the RICE protocol (please see previous article) while moderate sprains may need to be immobilized with a wrist splint for 7 to 10 days.

Anti-Inflammatory Medications
A pain reliever such as aspirin or ibuprofen may be helpful in the treatment of wrist tendonitis by decreasing swelling and inflammation of the soft tissues and symptoms of pain.  If the pain and swelling persists more than 48 hours, you should probably see the doctor.

Natural Treatments / Acupuncture
There are a number of vitamins and minerals which may ease pain and inflammation.  Vitamins such as Calcium/Magnesium, Vitamin C and E can increase the body's resistance to developing tendonitis.  Massage and ultrasound treatments can help encouraging blood flow and diminish numbness.  However, acupuncture is the most successful method of treatment for tendonitis in the wrist.

Acupuncture needles are inserted at or near the pain source, along with other core chi points, such as the liver (significant for blood circulation), the stomach, neck, head or ankles.  The treatment takes about 15 minutes. Between three and twelve treatments are often recommended over a period of a week or month.  Acupuncture improves circulation, strengthens tendons and reduces swelling, thus lessening or curing pain.

GROIN STRAINS/ GROIN PULLS

The groin muscles (adductor muscle group) which run from the front of the hip bone to the inside of the thigh are the muscles which bring your legs together and stabilize the hip joint.  A groin pull is an injury to the adductor muscles called a muscle strain.  When a muscle is strained, it is stretched too far.

There are different grades of groin strain:

Grade I   -   mild discomfort and usually does not limit activity.
Grade II  -   moderate discomfort, can limit ability to run and jump, swelling and bruising may be apparent
Grade III  -  severe injury which can cause pain when walking and can be accompanied by swelling and bruising, muscle fibers may be torn.



TREATMENT AND PREVENTION

R.I.C.E.
Rest, Ice, Compression and Elevate.  Please see previous article for more details.  It is important to rest following the injury to allow the muscle to heal.  Any activities that cause symptoms should be avoided.  Apply ice to the injured area the first 48 hours after injury and after activities.  Ice will help stimulate blood flow and bring down the inflammation.

Anti-Inflammatory Medications
Anti-inflammatory medications can help reduce swelling and alleviate painful symptoms. These medications do have potential side effects, and you should check with your doctor prior to starting anti-inflammatory medications.

Gentle Stretching
Stretching is helpful, but should not be painful.  Excessive stretching can be harmful and slow down the healing process.  Muscles that are stronger and more flexible are less likely to be injured.  Once the injury has healed, you should focus on increasing the flexibility of the adductors (inner thighs).

Strengthening
After injuring the muscle, it is important to regain strength before returning to athletic activities. Both the injury itself and the rest period following the injury can reduce the strength of the muscle. Stronger muscles are less likely to sustain a re-injury.  Of main focus should be the adductor and abductor muscles, pelvic stabilization and core stability.
Strengthening these muscles which help control the movement of the hips and pelvis should prevent future groin pulls from occurring.

Heat application
Gentle heating with a heating pack or pad can be used before activities to help loosen the muscles and relax the injured area. Heat treatment is best for chronic conditions while ice is best for acute conditions (first 48 hours).  As a general rule of thumb, remember to heat before and ice after

Physical Therapy
Physical therapists can be helpful in guiding treatment that may speed your recovery. Some people find modalities such as ultrasound, therapeutic massage, and specific exercises particularly helpful. You should see your physician to determine if these would be appropriate for your condition.



WHY SHOULD I CROSS-TRAIN?

Cross-training is one of the most effective ways to prevent injuries in Capoeira!  Many of the most common injuries – sprains, strains, knee issues, lower back pain, etc. can simply be avoided by staying in proper shape!  A strong core will help protect your spine and prevent your lower back from hurting while your executing your ginga or esquivas.   Developing strong and balanced leg muscles will greatly reduce the strain Capoeira places on your knees and ankles.  Strengthening your rotator cuff will greatly reduce the risk of shoulder injury from all the pushups, queda de rins and handstands.  Increasing your wrist, forearm and ankle strength will help you manage your movements more efficiently and decrease likelihood (or risk) of sprains or strains.  Furthermore, increasing your cardiovascular endurance will help you stay more focused while you’re in the roda.  The more conditioned you are, the less likely you will be winded - which often results in poor technique or the inability to recover from movements.  Sheer exhaustion can lead to injuries as well.

Capoeira is very physically demanding and joint injuries can be the price a Capoeirista pays for not meeting those demands.  The lack of training or physical abilities can also be a huge obstacle which prevents a Capoeirista from learning new moves or strengthening the old ones.  Cross training is crucial in providing a well rounded program.  This will not only help to improve your overall fitness level, but most importantly your game.  

A good Capoeirista understands the importance of incorporating a good fitness regimen to help overcome his/her physical limitations.  It is not only about training Capoeira several times a week.  Repetitive movements lead to increased risks of injuries if you neglect your muscle imbalances, flexibility, core strength and endurance.  At a certain point, our technique and ability in the roda is dictated as much by our bodies as it is our training.
Remember, no one was born an expert.  It takes a lot of hard work and dedication to overcome our weaknesses.  

In summary, all the Capoeira training will put you at risk of injury at one point or another.  It’s impossible to avoid all sprains, strains, knee injuries, groin pulls, fractures and dislocations, but you can certainly reduce your chances!  Evaluate your weaknesses and craft a manageable routine to help maintain optimal level of fitness.  Work on proper techniques to make sure you are not placing unnecessary stress on your joints.  Increase your flexibility on your inflexible areas to prevent future injuries.  Always make sure you warm-up properly to loosen up tight muscles to prevent ligament or muscle tears.   Be aware of your physical limitations so you don’t overdo it!  Give your body rest so you don’t over train!

In the case you do sustain an injury, seek prompt and proper treatment to promote rapid healing.  Consult with a physical therapist or physician if you are not sure what to do.  It’s better to be safe than sorry!

Most importantly of all, become a better Capoeirista by being a knowledgeable one!


Cindy Lai is a NASM certified Personal Trainer and runs Cindy Lai Fitness Bootcamp, a bootcamp in Central park that incorporates all the above elements and a kettlebell bootcamp on the West Side Highway for non-traditional strength training. Check out her site for more details.

Photos by Ben30, Minnaert, SuperFantastic, Muffet, Perfecto Insecto, and claudiogennari via CC BY-SA 2.0