HOMB In the News
  HACA News * April 2005 * Volume 21, Issue 2
Martial Arts: Are They Safe?

By Nancy Duncan

At age 10, Jose Knight of Eagleville, Pennsylvania, became an enthralled student of kung fu. Five years later he was diagnosed with hemophilia. But Knight, an active and determined teen, didn’t allow his condition to affect his love for martial arts.

“I refused to allow hemophilia to disrupt the quality of my life,” Knight says. “We have to enjoy life and make the necessary adjustments.”Within a year Knight was competing in tournaments and within two years won the New York State Championship and the gold medal in the sparring competition. Today, at age 37, he is a martial arts instructor for children.

Knight is just one of many people with bleeding disorders who participate regularly in the martial arts to stay physically fit. It is extremely important for those with the condition to stay active – exercise builds strong muscles, which gives protection to the joints. Martial arts, like most sports, exercise and tone muscles, help mental concentration and build stamina – all of which enhance your everyday life. And contrary to what some believe, martial arts can be safe sports. “People think martial arts are dangerous,” Knight says. “Martial arts are more about a lifestyle, a respect for humankind and living things. It’s the ying and the yang of balance, along with being a fun sport and good workout.” Knight says martial arts have played an important role in managing his hemophilia.

Before You Begin

As with any type of exercise, it’s crucial that you discuss with your doctor that you are considering beginning a martial arts regimen. Your doctor can help determine what types of movements or specific activities are safe for you to engage in as you pursue these sports. He or she can also advise whether it is necessary for you to adjust your prophylaxis treatment before you participate.

It’s equally important to choose a martial arts instructor that can help adjust the movements of martial arts to make them less risky for you. Some movements in martial arts involve jumps, punches, blocks and kicks – all of which can be adjusted to be easier on those with special health conditions. The key is to use caution.

Angela Forsyth, MS, PT, with the Penn Hemophilia and Thrombosis program in Philadelphia, agrees. “You need a qualified instructor who can modify the sport based on an individual’s target joints. It’s important to protect these areas from further stress.”

Choosing a martial arts school with good instructors is a crucial element in your introduction to the sport. When deciding on a school, first ask the head instructor how the other instructors are chosen. What qualifications do they have? Do they belong to an accredited organization, such as the World Tae Kwon Do Federation? It’s also a good idea to watch a class in progress before you sign up. This will give you the best idea if you’re up to handling the rigorousness of the sport.

Which One is Right for You?

When recommending sports suitable for people with hemophilia, NHF’s publication “Hemophilia, Sports and Exercise,” divides the sports into three distinct categories based on their safety:

Category 1 – You “can safely participate in”these sports.

Category 2 – “The physical, social and psychological benefits often outweigh the risks” of injury.

Category 3 – These sports are not recommended because the “risks outweigh the benefits and the nature of these activities makes them dangerous even for those without hemophilia.”

For instance, NHF considers activities such as walking, swimming and cycling as category 1 sports. Skiing, roller blading and tennis are assigned to category 2, and more risky sports, such as racquetball, football and hockey, fall into category 3.
In regard to martial arts, NHF recommends that tai chi is the safest form and assigns it to category 1. Karate, tae kwon do and kung fu are all recommended as category 2.

According to Knight, many aspects of martial arts are based on gentle movements, relying on the mind while working the muscles and joints. Some categories of martial arts can offer a good workout with limited or no body contact. The key is deciding which type best suits you.

Tai chi.
Looking for relaxation and stress-free body moves? Tai chi master Ramel Rones, a tai chi and qigong teacher practicing in Boston, works with cancer patients and the seriously ill at the Dana Farber Cancer Center and says, “Tai chi can build physical strength, enhance the mind and spirit and energize while building bone density and strength.

“What you want to get out of tai chi is individual,” Rones continues. “Tai chi is about stillness, listening to your body, being quiet.” He advises those with hemophilia to choose a seasoned tai chi master who understands health issues.

Getting Rid of Painful Joints continued

“You want them [the surgeons] to listen to you about factor replacement and what to do if there is bleeding,” Konkle says.

The day before his ankle replacement, Burke says the doctors prepared for the procedure by ‘pouring antibiotics and factor” into him. It is routine in joint replacement – whether or not a patient has hemophilia – to administer antibiotics to prevent infection, Konkle says. While factor and antibiotic regimens vary among different sites, doctors and patients, Konkle says PCHP uses factor before surgery to normalize factor level and continues to give factor as needed after surgery to keep it in the normal range.

Total knee replacement requires the most factor. At PCHP, patients have their factor levels increased to 100% for the procedure and then kept at 50% for two weeks. After that, patients infuse before each physical therapy session, Konkle says.

For a knee replacement like Ingram’s, your hemophilia healthcare team typically starts you on legwork before surgery to exercise muscles that may not have been used, but will be needed during rehabilitation and beyond. “They make sure you can sustain the therapy that comes after the
surgery,” Ingram says.

“Up and Running”
Indeed, among the most important preparation requirements for joint replacement is understanding the need for strenuous – sometimes painful – rehabilitation after the procedure. Regaining movement takes a lot of work.

Forsyth says rehabilitation begins with several days in the hospital, after which most patients are discharged with home therapy for several weeks. After home therapy, patients are transferred to outpatient care for physical therapy that is typically required three times a week, but can vary depending on what the patient is able to do at home.

Physical therapy begins with coaching on basic movements that may be challenging after surgery, like putting on your clothes. A walker, crutches or cane may be needed for a while to get around, Forsyth says.

Then comes the functional activity training, which includes strengthening and flexibility exercises.

Rehabilitation for each joint will be different depending on what restrictions you have initially, Forsyth says. People with a new hip or knee often can walk and bear weight the day after surgery, she says, although total rehabilitation for
a knee is one of the longest, most gradual recoveries.

Burke says it took him about six weeks to walk and move around on his new knee. “But it’s how fast you want to be up and running, too,” he says. “If you can factor up every day and do the necessary physical therapy, you can shave a week off.”

Konkle says she keeps the factor levels normal for her knee patients for two weeks, then they use factor before physical therapy. Rehabilitation tends to be very intense for the first month, she notes.

While still in the hospital, Burke says he used a large rubber band-like device to move his ankle so scar tissue couldn’t form. Forsyth says some doctors may include use of a special motion device, especially for knee replacements, which gently moves the joint through a range of motions to keep it from getting stiff.

Both Burke and Ingram say they pushed hard to get up and about early, but they continued therapy on their own to build strength and flexibility, even after their formal rehabilitation was complete.

“I tell them the harder they work, the better outcome they’ll have,” Konkle says, adding that the pain tolerance in many with hemophilia is “just incredible.”

Ingram agrees. “It’s tough, but for me, and probably for most with hemophilia, it isn’t that tough because of all the pain we’ve dealt with before,” he says. “It’s like we say, ‘Okay, I can deal with this little bit of pain if it’s going to make me feel better.’ “

Ingram is happy with his results – an experience that helped him decide to have replacement surgery again. He had his right knee replaced in 2002 and will have his left knee replaced this March.

“The first five years of tai chi are based on movements with no body contact. So for those with bleeding disorders, this would be an excellent fitness activity,” Rones says. As one moves up the levels of tai chi, he explains, there can be more contact moves that can be adjusted to meet any chronic health condition.

Karate is classically made up of punching and kicking techniques. Knight cautions, “In karate your shoulders carry the weight when throwing a punch. Those with hemophilia don’t want to overextend their joints, such as elbows and knees, or you could have breakthrough bleeding.” He adds that punches are supposed to stop an inch before making body contact. “When punching and kicking, your arm should never be fully extended if you’re practicing the movements properly.”

Tae Kwon Do.
This form of martial arts is characterized by the extensive use of high-standing and jump kicks as well as punches and is practiced for sport, self-defense and spiritual development. Training in tae kwon do is carried out by learning individual techniques of kicking, punching and blocking, which are practiced in combined series of techniques in traditional sets known as hyung.

Judo is best known for its spectacular throwing techniques and also involves considerable wrestling and pinning of a sparring partner to the floor with holds, arm locks and choking techniques. Judo consists of a lot of physical contact, yet emphasizes safety and full physical activity for top conditioning.

Julie Elrod, senior martial arts instructor and owner of the American Academy of Martial Arts in Columbia, Maryland, says, “Judo is geared towards self-defense. Just inform your instructor that you have hemophilia, and kicks, punches and sweep techniques can be adjusted.”

Capoeira is a Brazilian martial art that has recently gained popularity in the US. It is both a martial art and a dance. Created and practiced by enslaved Africans in Brazil, capoeira is accompanied by drums and other percussion instruments. It is generally played in a circle with musicians and participants singing traditional Brazilian songs. The sport combines circular and straight kicks, acrobatics and takedowns. Participants “attack” without striking each other.

Hemaware, Volume 10, Issue 2, March/April 2005.



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Congratulations!!! To 4 students who got their black sashes. Sifu Brian Korty, Sifu Jose Knight, Sifu Michelle Ruppert and Sifu Walkm Pearson.
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