Health Issues in Wrestling: Skins infections and concussions rate among the top five concerns

Editor’s Note: Matt Doyle is the Director of the Athletic Training Outreach Program for University of Iowa Sports Medicine. From 1999 until 2011, he provided athletic health care for the University of Iowa wrestling team. This is an expanded version of the Q&A that appears in the Feb. 8, 2012 printed edition of WIN magazine.

Matt Doyle

WIN: What are the top five health concerns in high school and youth wrestling?

DOYLE: No. 1 and what is always on people’s minds, when it comes to wrestling, are the types of skin infections and preventing skin infections that wrestlers would have.

Concussions are another hot topic. With wrestling, it’s not the most common injury that we see. But it’s a very important topic and we are learning to manage them more effectively and it’s changing the way we have to look at it. We are doing a better job educating people about concussions and you are seeing more (athletes) taking time off and it’s appropriate that they are held from competition.

Next there would be weight control and nutrition issues. That includes proper nutrition and basic diet, maintaining a healthy weight and competing at the appropriate weight class. A lot of kids are into supplements and thinking about how much money can I spend to get a supplement here or there, where actually they can maximize their performance simply by getting basic nutrients at the right time and the right volume.

Then there are the increasing injury rates in youth sports in general and preventing specific injuries common to youth wrestling. Upper extremity injuries like elbow dislocations and shoulder injuries are much more common as there are more mismatches (at that age group) and probably more kids who are not physically developed, with strong and stable joints in their upper extremities.

If you look at adolescent and youth wrestling injury data, the parts of the body where injuries occur are similar to Greco-Roman wrestling, probably because there are more lifts and throws and more upper-extremity injuries, compared to high school and college folkstyle wrestling where there are more knee injuries.

The fifth health issue deals with preventing wrestling specific problems like cauliflower ear, knee bursitis and other common wrestling injuries.

WIN: Is there enough prevention out there or is the wrestling community doing more rehab of injuries?

DOYLE: There are always going to be injuries and follow-up care, but people can always do a better job with injury prevention. Every year, you have new kids who start wrestling and their parents are new to the sport as well, so that’s a constant area that we need to address. There is information available for people who need to be educated but it needs to be made available and parents need to look for it.

WIN: What should the role of a parent be?

DOYLE: Parents know their kids and what’s best for them, but they need to learn more about the sport of wrestling and guide their kids. They should be aware of what their kid’s interest is. Are parents pushing them too much? Do kids want to do this year round? Also, most parents don’t know everything about care and prevention of injuries. They need to find resources and talk to other parents who’ve had kids to make sure they are taking in the right information to make the right decisions for their children. They should also talk with and evaluate coaches or even offer assistance to help create a safe and healthy environment.

WIN: When did health issues become important in high school sports?

DOYLE: I’m sure these issues have always been important, and as athletics continues to grow in importance to people we also learn more and more in medicine, and now we are able to train people with specific knowledge in these areas. The profession of athletic training is only about 60 years old. Before that, there were managers and coaches, and probably nurses and doctors who had an interest in sports. But we didn’t start training people specifically to manage health issues in sports and exercise until more recently.

WIN: Regarding skin infections, can the sport of wrestling ever be skin infection free?

DOYLE: I don’t think so. We can really do many things to prevent them, but the nature of wrestling is that it is a contact sport so you are going to see more of it in wrestling than other sports.  And with the trauma from wrestling there is going to be skin wounds and scratches where there are opportunities for germs to cause infections. At some point our immune systems break down but if there is good nutrition, proper rest and recovery, and good personal hygiene we can really decrease the chances of having problems.

WIN: Is there any product made that can totally eliminate skin infections?

DOYLE: No. Most of today’s products serve a purpose and help decrease the chance of infection. There are ones to clean the environment. You have to think about the locker room surfaces, the wrestling mats and the equipment wrestlers wear. All those things need to be cleaned on a routine basis and you need to have a plan in place.

Coaches know they need to have clean mats for their athletes, but they also need to think about the person-to-person contact and enforce good personal hygiene. Everyone has to follow a routine of showering after practice, washing their gear appropriately, and washing your hands throughout the day.

There are simple and basic products available to do all these things but they all have a role and have to be used correctly.

WIN: MRSA (Methicillin-resistant Staphylococcus aureus) really became a hot topic in high school wrestling a few years ago when the state of Minnesota lost much of its season because of an outbreak of this skin infection. Have high school wrestling programs done better in dealing with skin infections since then?

DOYLE: I think so. Every year that goes by, we learn more what we should be doing. There have been more guidelines to follow and more rules created based on our new knowledge. For example we now know specifically how many days (infected athletes) need to be treated with the appropriate medicine; and how many days they have to be restricted from contact before they can practice again. Also, the NATA (National Athletic Trainers’ Association) put out a statement last year, which was very thorough and described all the common types of skin infections in sports. It has guidelines on identifying, treating, and preventing skin infections, and recommends environmental cleaning routines, screening procedures and educating athletes ahead of time on hygiene issues.

WIN: Some people will say wrestling has been going on for a long time. Why are skin infections such a concern now?

DOYLE: The MRSA issue is something that wasn’t there before. It’s a staph bacteria and we’ve always had that.  But this type of bacteria acts on the body a little more quickly and it’s often unrecognized so it becomes a more severe and more critical type of medical problem. This staph infection has become more resistant to some treatments. For example, penicillin will not affect that organism. Whereas the old staph infection might have been a boil or abscess on the skin and can be quickly treated, this infection will move quickly into deeper tissue. This infection doesn’t only occur in wrestlers, it is often referred to as community acquired and can happen to anyone where there is the proper environment and crowding and contact. It can be easily treated and prevented but people need to know about it.

WIN: Regarding concussions, is this another problem that has been ignored in the past? For example, Jake Deitchler (the 2008 Olympian and Minnesota college wrestler who recently gave up wrestling because of his problem with concussions) said he first dealt with concussions when he was seven years old.

DOYLE: If you had to ask me what the common injuries are in wrestling, concussions would be low on the list. But right now concussions are a hot topic in all sports. We have learned there are more long-term consequences to ignoring treatment of concussions. If you don’t restrict these people, they are more easily concussed again. If they have a history of repeated concussions, this can lead to further problems.

WIN: Since not every high school athletic program has an athletic trainer on site, what can a high school coach look for in determining a concussion?

DOYLE: Many states have now passed some legislation to help guide people in this situation. The state high school athletic associations have information for coaches and provide checklists as far as what common symptoms are and what to do anytime anyone has any of those signs. First and foremost they need to be removed from practice and checked by a medical provider with experience treating concussions. A coach who has been around athletics and reads this information can have a pretty good idea if there is something abnormal.

And this is even more important with youth wrestling, because their brains are developing and they don’t respond after an injury the same way as an adult brain would, and may need to be treated differently.

Also, a lot of people ask, ‘How do you know for sure?’ We now define concussion differently than we did in the past, we don’t grade concussions, and return to play criteria are more formal, so it can be a complex process. But the simple thing to remember is anyone who is even suspected of having a concussion should be evaluated by a health care provider who is knowledgeable about concussions.

So if you notice any abnormal behaviors after a kid gets hit in the head, take a moment to check them further. Often times I just start to talk with someone and look them in the eye, and if you know them well and how they normally should respond, you have a pretty good inkling right away. Then you know you have to ask some questions to see if they are oriented to where we are, what period is it in the match, what’s the score in the match, who did we wrestle last week.

Even if they get those answers right, if they are slow and really have to think and look around to get their bearings, you can tell that they are not acting normal. And of course even complaining about a headache is a sign. A person just needs to take some time to look up the common symptoms and most importantly if they even suspect a person has a concussion they should get them examined.

WIN: Regarding youth wrestling, the number of kids involved is growing. Wrestling does not want to scare parents away from having their kids wrestle. What are things that can be done to protect these kids? For example, should there be a limit to the number of matches a kid wrestles?

DOYLE: You have to look at the supervision of the tournament. Who is organizing it? Who are the coaches? Who are the officials? I do think that children are pretty resilient. They can handle quite a bit of activity, especially if they have been practicing and gradually building up to that. Limiting the number of matches would not be as important as teaching all kids the proper rules for safe participation. For example you can’t slam a wrestler or put an illegal hold like a full-nelson on a kid and injure their neck. Officials need to be aware of kids’ positions and the coaches need to make sure they are teaching these kids the proper skills.

WIN: Is there a misconception about young people; that they are supposed to be flexible and not susceptible to injury?

DOYLE: They aren’t as susceptible to some injuries, but the thing about youth wrestlers is that they aren’t just small adults. They are still growing and developing, their growth plates haven’t closed, and they will have different types of injuries than adults. For example, where you might see a ligament injury on a college wrestler, it could actually be a growth plate injury in a young kid, which needs to be X-rayed and seen by a physician. It can affect growth and development long term.

WIN: Many of the coaches who work with the youngest kids are not certified as high school coaches, who have some formal training in dealing with health issues. A lot of these coaches are just parents. Should some standard be established for anyone working with kids, especially those who are looking to participate and may not belong to a club?

DOYLE: That is a difficult question, because you definitely want educated and knowledgeable coaches working in the sport, but it is also difficult to get enough people to coach at all levels. There are organizations that are discussing youth sports injuries and what can be done to help in these areas. The NATA recently hosted a Youth Sports Safety Summit in Washington D.C. that brought together concerned groups to address health issues in youth sports. Another effort called STOP (Sports Trauma and Overuse Prevention) Sports Injuries is a campaign initiated by the American Orthopedic Society of Sports Medicine and provides injury prevention resources for athletes, coaches, parents, and healthcare providers.

WIN: Is overuse the biggest reason for injuries?

DOYLE: Probably not in wrestling. It’s more about getting kids in bad positions or someone getting picked up and put down or a knee gets twisted or do they fall on their arm in the wrong way. So trauma injuries are more common than overuse. Sports where kids participate all year round, repetitively moving the same way would lead more to overuse injuries. Wrestlers can fall into that if they are repetitively doing the same movements or running and training improperly.

WIN: In talking about weight control, it seems like we must also talk about weight training. Wrestling is a sport where we match up athletes at the same weight and the question wrestlers must ask: do they go down to a lower weight by cutting weight or do they go up and increase their weight training to compete at a higher weight?

DOYLE: When you are talking about youth wrestling, you have to be aware that kids are growing and developing. Nutrition-wise, you really have to be careful about limiting calories. It’s an interesting problem, because if you look at society, we have a problem with obesity. The majority of kids need more physical activity and they don’t have good nutrition. So the first issue is you need all kids to eat healthy foods and amounts that are appropriate for them, so improve their diet

WIN: When you talk about diet, you don’t simply mean lose weight?

DOYLE: When I talk about diet, I’m talking about the proper nutritional intake. A lot of people will talk about going on a diet, which means to restrict and lose weight.

WIN: When should wrestlers start weight training?

DOYLE: The better question to ask is how can I safely introduce the young athlete to strength training? I think it is OK to introduce weight training in young athletes and the junior high age groups, just to teach them techniques and not to stress their bodies. They don’t have the hormones to benefit from it but they can learn routines and techniques and healthy habits.

WIN: Why should young wrestlers weight train if they will not receive the benefits?

DOYLE: There are benefits, but just not the benefits most people are probably thinking about. You are going to find some debate about what age group athletes should start, but you have to start at some point and they need to learn the techniques to properly perform the exercises and not injure themselves. They need supervision. They can’t simply walk into a weight room and start picking up weights and do it correctly. They need to learn the right types of lifts and they can do repetitions, or start off with push-ups and body-weight type activities. You are not putting them underneath barbells with huge amounts of weights. It may be an empty bar. It is important to have someone with knowledge, supervision and interest in maintaining the safe atmosphere.

We do need to remember that there are kids growing up on farms that are scooping and hauling things and doing weight training their whole lives. We just have to structure it in a different way and kids need to learn how to do this. You don’t want them to do it incorrectly and injure themselves. Eventually, they can make adjustments as they mature and will be developing muscles from their strength training.

WIN: Is there any data out there to suggest how big one’s child will get?

DOYLE: In general, you can look at growth charts as kids are growing and developing. Other than that, without looking at X-rays in a doctor’s office and looking at growth plates and how much time they have to grow, a lot of it is common sense where you look at parents and relatives, which is not an exact science.

WIN: Can pediatricians help with parents developing young athletes?

DOYLE: Yes they are very good resources but it can also depend on their background and interests. Some of these issues are very specific to sports medicine. If they have not had experiences in those areas, they may not be the leading experts in that field. But they do need to be part of the team. If a person feels like this is outside their level of expertise, there are other people who can be consulted. Half of our primary care sports medicine physicians here are pediatricians.

WIN: Regarding cauliflower ears, there are some high school tournaments where kids are not wearing headgear. Some people are tired about things being over legislated, but shouldn’t there be more common sense in wrestlers wearing headgear.

DOYLE: Some of the coaches we have today grew up not having to wear headgear and don’t enforce wearing the headgear and don’t feel like it’s an important issue. Whereas I can say the last four years of working with Tom Brands (at Iowa), we enforced wearing headgear in practice. The number of hematomas that I had to drain went from 10-15 in a season to maybe one or two.

WIN: Does wrestling deal with the problem that cauliflower ears are looked at as a badge of courage; if you have a cauliflower ear, you are truly a wrestler?

DOYLE: Definitely. People want to be identified as a wrestler. They don’t think it’s a big deal and don’t like headgear. It’s really a discipline issue. People should just get used to it because they aren’t going to win in competition without it. Initial injuries to the ear can become infected, and then you have a worse problem. The changes to the outer ear and can produce a significant deformity and functional loss of hearing, especially if the canal of your ear changes. I remember there were guys on the team who could not listen to their music because they could not get their ear plugs in their ears. Also wrestlers with deformity tend to have a lot of ear infections since their ears don’t dry out well after showering.

I would think that most coaches would not want their wrestlers to miss one day of practice because of an infection or ear pain when it is something that could have been prevented. People need to do everything they can to maximize their practice time and performance. Injury prevention is really about discipline, getting the right amount of sleep, having your proper protective equipment in place for example. It’s all about living the right way. There are many lessons that kids can learn from participating in wrestling if people do things right. Wrestling can help a kid learn about dedication and discipline that will help them throughout life.