James R. Andrews, MD, is a founding partner and medical director of the Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Fla. He also is a co-founder of the American Sports Medicine Institute in Birmingham, Ala. His blog adds perspective and commentary on current sport medicine initiatives and other related orthopedic news.

BLOG: Prevent injuries in wrestlers, but still maintain a competitive edge

Wrestling is one of the most ancient sports and one of the most popular sports worldwide with its different varieties, such as Greco-Roman and freestyle. Collegiate-style wrestling is dominant among high school and college teams.

Without a doubt, college-style wrestling is the most physical of youth contact sports. It allows the wrestler to use his legs and his opponents’ legs for both defense and offense. Athletes remain in extremely close contact with each other throughout the match, with the slow goal to force one to the ground.

However, wrestling is also somewhat neglected from a sports medicine coverage standpoint.

Excessive weight management

The potential for injuries in wrestling is different from other sports. The most fundamental health concern is the athletes’ weight management. A young wrestler has a distinct advantage when he is at the upper limits of the weight class, and as such, many wrestlers are right on the weight class line. The result is often a last-minute push to drop a few pounds to make competition weight.

Some commonly used techniques include intentional starvation, dehydration, attempting to sweat out extra water weight through the extensive use of saunas or steam baths. There are also more extreme and dangerous purging methods. The methods to make weight are extremely dangerous, especially when done repeatedly during the course of the season or there is a previous health risk, such as a heart condition.

Team physicians need to emphasize daily caloric requirements and balanced diet based on age, body fat and physical activity level. The younger the young wrestler is, the more vulnerable he is with this type of dangerous weight control.

Musculoskeletal injuries

Orthopedic surgeons must be aware of the risk of musculoskeletal injuries during practice and competition. “Cauliflower ear” is just not something boxers talk about in old movies. It is caused by serve bruising to the outer ear structure and can be caused by a struggle on the mat. If this occurs, the ear must be drained and wrapped in a casting material so its normal shape is maintained. Obviously, head gear helps to prevent this injury.

A problem related to the head is the prevalence of concussions. Head gear should have a frontal pad for the frontal lobes. The size and symptoms of a concussion should be recognized by a sports medicine physician at ringside and athletes need to be taken immediately out of practice or competition when a concussion is suspected. As with any concussion, wrestlers must be evaluated and cleared by a physician before returning to practice or competition. Protective mouth guards are also mandatory.

Other injures are not uncommon in wrestling. A number of wrestling holds can cause shoulder subluxations or dislocations. Unfortunately, recurrent and neglected shoulder dislocations are far too common in wrestling. Young wrestlers are extremely competitive and have a tendency to “pop” their own shoulders back into place to continue matches. From my own experience, some of the most severe shoulder injuries I have seen have occurred with wrestling.

Knee Injuries and skin infections

In wrestling, the knee takes a lot of impact as it is the body part that hits the mat most often. Inflammation of the bursa sac in front of the knee cap can cause sharp pain and swelling and bleeding. Knee pads designed to protect the front of the knee and the knee in general are strongly recommended.

Commonly injured knee sprains include the ACL and MCL. More serious sprains, isolated tears of the ACL or even multiple ligament injuries, such as a knee dislocation, require early recognition and, in most cases, surgical intervention.

The most serious health risks in high school wrestling have nothing to do with injury, but rather are the risk of skin infection. Skin infections, most notably methicillin-resistant Staphylococcus aureus (MRSA), has been on the rise in schools during the past decade. MRSA infections are particularly prevalent in high school wrestling due to skin-to-skin contact and skin-to-mat contact. Any wound should be evaluated by the coach, trainer and team physician as soon as possible so proper care can be started. To prevent an epidemic by the team, the sports medicine physician should insist that all team members follow basic hygiene practices, including taking showers before and after practices and competitions.

It goes without saying that a few simple steps can help wrestlers enjoy the sport safely. The best way to maintain a competitive edge and nurture the sport is by making responsible and smart choices on a daily basis.

James R. Andrews, MD, is a founding partner and medical director of the Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Fla. He also is a co-founder of the American Sports Medicine Institute in Birmingham, Ala. He can be reached at the Andrews Institute for Orthopaedics & Sports Medicine, 1040 Gulf Breeze Pkwy., Suite 203, Gulf Breeze, FL 32561; email: info@theandrewsinstitute.com.