Module 1: Wrestler’s spine common Injuries- Prevention exercises

Injuries in Wrestling

Wrestling is considered to be one of the most physically demanding sports among high school and college athletics. The wrestler needs to have not only strength and endurance but also technical skill to be successful. Weight control and weight loss distinguish it from most other sports. Strength and endurance are paramount to successful performance (Halloran, 2008). In a wrestling competition, wrestlers use all parts of their body to defeat the opponent. Meanwhile, the biomechanical forces applied to the athletes can cause damage in different parts of the body (Kabak, et al., 2017).

Risk factors in sports can be examined in two groups: contact injuries and non-contact injuries. Contact injury occurs when an athlete contacts with another athlete or object during competitions and training. Non-contact injuries are endogenous injuries like neuromuscular disorders. Such injuries are the focus of prevention initiatives, and managing identified risk factors plays an important role (Gonell, et al., 2015).

Wrestling injuries account for the second most frequent sports injuries after football (Centers for Disease Control and Prevention, 2006). A study on the probability of injury found that the sports with most frequent injuries are football with 10%, wrestling with 6%, handball and boxing with 3%, athletics with 1% and skiing with 0.5% probability (Sakallı, 2008). It can be seen that wrestlers rank second in terms of injury risk, because wrestling is among the sports that require enormous effort and have a high risk of injury. Similarly, reported match injury rates as high as 30.7 injuries per 1000 athlete-exposures among college wrestlers second only to injury rates among college football players (Jarret et al., 1998). According to the data from the center for injury and policy, football and wrestling are the two sports with the highest risk of serious injury to athletes (Akbarnejad & Sayyah, 2012). In a study by Powell et al. (1999) the highest proportion of injuries for which a player missed more than 7 days was for baseball (31.0%) and wrestling (32.6%), with the lowest proportions for field hockey (20.4%) and softball (22.9%).

A study on wrestling injuries that occurred during the 2008 Olympic Games in Beijing, showed a total of 32 injuries occurred in 343 athletes during the 406 matches, which is equivalent to an overall incidence rate of 9.3 injuries per 100 athletes and 7.9 injuries per 100 matches. Among the 2 styles, freestyle had the highest injury rate (10.1%), and female wrestling the lowest rate (7.5%). The overall injury rate in the male athletes was slightly higher than in the females (9.7% versus 7.5%) (Shadgan et al., 2010). Similar injury rates reported by Agel, et al., (2007). More specific they examined data of the National Collegiate Athletic Association Injury Surveillance System on collegiate wrestling over a 16-year period and found that wrestling had an injury rate of 9.6 injuries per 1,000 athlete exposures. Sprains, strains, and contusions were the most common injuries. Takedowns and sparring were the most common activities at the time of injury (Agel, et al., 2007). Takedown maneuvers also reported as the most common techniques that led to injuries by Jarrett, et al., (1998),  Pasque & Hewett, (2000) and Boden, et al., (2002). The take down position in which both wrestlers are in the standing position attempting to take the other down to the mat reported on more time as the most common wrestling situation result to injury (Strauss & Lanese, 1982; Snook, 1982). These techniques lead to out-of-control landings and cause injuries such as acromioclavicular subluxation and dislocation (Snook, 1980). Also a common mechanism of injury was a joint forced past acceptable range of motion (Kordi, et al., 2012).

Defensive wrestlers are particularly vulnerable because they are more likely to be off balance, may have one or both arms held, and have his/her opponent land on top of him/her (Boden et al., 2002). Boden et al. (2002) concluded that the position most frequently associated with injury was the defensive position during the takedown maneuver (74%), followed by the down position (23%), and lying position (3%).

In comparison between competition and practice, incidence rates are higher during competition, but more injuries occurred during practice because significantly more time is spent in practice. Competition had a significantly higher injury rate than practice but the injury profiles of these two areas showed both to be equally important. Injury percentages were similar among the 10 weight classes. The largest percentage of injuries was associated with direct contact between wrestlers during takedown (43%) (Pasque & Hewitt, 2000). Similarly, exposure data has revealed injury rates in matches to be almost 40 times those of practice (Kordi et al., 2012). Finally, Boden et al. (2002) and Snook (1982) found that the majority of injuries occurred in match competitions. However, Pasque & Hewett, (2000), reported that 63% of their injuries occurred in practice. In terms of exposure, a rate of 5 injuries per 1,000 practice exposures as compared to 9 per 1,000 match-exposures occurred. Hard wrestling during practice and the takedown position resulted in the highest occurrence of injury (Pasque & Hewett, 2000).

The incidence of injury was twice as common during preseason (matches and practices) as during the competitive season, which may reflect poorly planned attempts to quickly reduce total body weight for an upcoming season or poor conditioning. The difference between preseason and regular-season body weight in wrestlers has been reported to be approximately 10% (Pasque & Hewitt, 2000). Most wrestling injuries are relatively minor, but 26% of injuries in high school and 27% in college resulted in missing more than 3 week of wrestling (Myers et al., 2010).

Among male and female elite wrestling athletes training for the Olympic Games, most injuries were mild (59%). Occurred in the lower extremities (37.5%), followed by the upper extremities (27.4%), trunk (25.4%) and the head and neck area (9.7%) (Park, et al., 2019). Also supported that of all the wrestling injuries, those to the knee and shoulder joints are most frequent (Barroso et al., 2011; Pasque & Hewett, 2000). Jarret et al. (1998) supported that the knee is the most frequently injured body part.

Sprains, strains and bruises are reported as the most common injuries seen among wrestlers (Miller, et al., 2006). Studies have found an incidence of 2.7 to 4.2 fractures and 1.6 to 7.2 dislocations per 10 000 wrestler exposures (Jarrett, et al., 1998; Pasque & Hewett, 2000; Yard, et al., 2008). These studies were performed primarily among high school and collegiate wrestlers in the United States (Jarrett, et al., 1998; Pasque & Hewett, 2000; Yard, et al., 2008).

In a study by Yard & Comstock (2008) in FS wrestling, the majority of sprains/strains were to the lower extremity (56.8%), followed by the upper extremity (24.3%) and trunk (18.9%). In contrast, the majority of GR sprain/strains were to the upper extremity (55.6%), followed by the head/face/neck (22.2%) and trunk (16.7%). FS fractures were most frequently to the upper extremity (40.0%). GR fractures were to the head/face/neck (40.0%) (Yard & Comstock, 2008). A study revealed that Olympic-level FS wrestlers had a higher risk of injuries compared with GR wrestlers (Barroso et al., 2011).

According to a study by Myers et al. (2010) the frequency of injury in scholastic (12 – 17 years) wrestlers was approximately ten times greater than that of youth (7 – 11 years) wrestlers (Myers et al., 2010). Strauss & Lanese (1982) also found that the youngest wrestlers (8 – 14 years old) were injured at a rate of 3.78/100 tournament participants, whereas in the high school wrestlers’ the rate was 11.15/100 tournament participants. Pasque & Hewett, (2000) also found that the older and more experienced wrestlers were more at risk of injury. Varsity wrestlers comprised 44% of the study, but accounted for 60% of the injuries. This may be the result of more aggressive wrestling at that level. They also found a slightly higher rate of injury for those who wrestled year round, though not statistically significant. There was a statistically significant association with duration of practice in Agarwal & Mann (2016) study.

Increased age and years of experience, history of previous fracture or dislocation, and younger age of starting to wrestle are risk factors for fractures and dislocations among wrestlers (Kordi, et al., 2012).

Another complicating factor in wrestling is that well trained and conditioned athletes become more prone to injuries following making weight practices (Maffulli, 1992; Jlid, et al., 2013; Shadgan, et al., 2017). Weight class influenced injury severity in both wrestling styles, and lightweight athletes had higher injury rates (Park, Lee, Kim (2019)..

Spine injuries

Nearly 15% of all spine injuries occur in sport-related activities, making sports the fourth most common mechanism behind motor vehicle collisions, violence, and falls. Up to 10% of all cervical spine injuries happen in sports. The sports associated with the highest rates of spine injuries include football, ice hockey, wrestling, driving, skiing, snowboarding, rugby, cheerleading and baseball. (Kleeman, et al. 2015).

One way of categorizing the mechanism of injury to the spine is through the causal factor. Non-traumatic mechanisms of injury include overuse and overload injuries to the bone, ligaments, muscle, disc or neuronal elements. Traumatic mechanisms of injury include direct impact or indirect injuries again to all tissues that make up the spine. Muscle injuries are very frequent, and so are bone injuries (e.g. spondylolysis and spondylolisthesis) and disc injuries (disc prolapse). A special type of injury that needs to be commended on is the whiplash-type injury of cervical or lumbar spine following either direct or indirect impact mechanisms of injury. This type of injury may result in bone, joint, ligament, muscle, disc and neuronal tissue long-term histological and clinical sequelae.  The most catastrophic type of injury that may be encountered in sports is paraplegia following an injury to the thoracic or cervical spinal cord, or tetraplegia following an injury to the cervical spinal cord (Kleeman, et al. 2015).

In a study carried out by Lorish et al. (1992) in adolescent and preadolescent boys, the primary areas of injury were to the upper extremities (33%), and the neck and back (24%). Such findings can be attributed to the fact that in Greco-Roman style wrestling, most of the techniques executed in order to bring the opponent down and defeat him, involve the trunk. The consequence of such mechanical action on the opponent body will be to crash fall onto the mat, with the possible likelihood of injurious involvement of the skin, followed by extraordinary pressure on the trunk. In addition, following the landing on the mat, additional pressure is exerted to the trunk by rubbing the body on the mat, which may lead to simultaneous injuries of the skin, neck and trunk, as well.

Although rare, cervical spine and catastrophic injuries do occur in wrestling. In their retrospective review of catastrophic injuries in wrestling, Boden, et al., (2002) found that the highest incidence of injuries occurred in match competitions (80%) with a trend toward more injuries in the low- and middleweight classes. The authors examined 35 incidents that were reported to the National Center for Catastrophic Sports Injury Research over an 18-year period from 1981 to 1999. The position most frequently associated with injury was the defensive position during the takedown maneuver (74%), followed by the down position (23%) and the lying position (3%). The authors conclude that although rare, catastrophic injuries do occur in wrestling. The researchers found that athletes are commonly injured by one of the two mechanisms. In the first scenario, the wrestler’s arms are held in such a manner that he is unable to prevent himself from landing on his head when thrown to the mat. The second situation involves the wrestler attempting a roll but instead being landed on by the full weight of his opponent, causing a twisting hyperflexion, and neck injury. In 10 of the 26 takedown injuries (38%), the wrestler landed on the top of his head, sustaining an axial compression force to the cervical spine.

Lower back injuries in wrestling commonly take place during takedowns. While sparring for position, wrestlers push against each other with the lumbar spine in mild hyperextension. This extension, coupled with twisting, results in injuries. Extension against resistance, as in lifting an opponent off the mat, and hyperflexion, as in rolling, are also mechanisms that account for low back sprain or strain.

In elite wrestlers the cervical extensor muscles were more strongly developed and had a larger cross-sectional area than amateur wrestlers, judo practitioners and non-athletes. This strength enables them to keep their head and neck in a fixed position despite the opponent’s maneuvres to push both of their shoulders onto the mat to accomplish a takedown. Greco-Roman wrestlers have higher levels of cervical muscle strength/kilogram of body mass compared with freestyle wrestlers, helping them achieve manoeuvres such as the salto which involves lifting and taking the opponent down on the mat (Chaabene et al. (2017).