THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 5 - MAY 2021
Pain and Injury Are Real in Professional Wrestling
What's the nation's most popular contact sport? Professional wrestling might have football in a headlock. US News and World Report estimates that 35 million viewers tune in to professional wrestling each week (1).
Though many consider the choreographed moves of professional wrestling to be entertainment and not sport, physicians who cover events, wrestlers, and an emergency department physician who sees the aftermath of kids copying the wrestling moves all contend that professional wrestling is indeed a contact sport.
James R. Andrews, MD, an orthopedic surgeon at Alabama Sports Medicine and Orthopaedic Center at HealthSouth Medical Center in Birmingham, has operated on professional wrestlers since the 1970s when performers such as Andre the Giant and King Kong Mosca wrestled at the Municipal Auditorium in Columbus, Georgia, where he worked early in his career. "I've probably treated all of the old-timers," he says. "They didn't have any care. They were lost, medically. Many were ex-athletes who came to professional wrestling already beat up from other sports injuries."
He says professional wrestlers grapple with the public's perception that their injuries are contrived or part of the act. "We're seeing more of these injuries as wrestling gets bigger, and the retired wrestlers are suffering with degenerative knees and are becoming disabled as they grow older," Andrews says.
Pro Wrestling's Impact
Professional wrestling traces its roots to turn-of-the-century strongman competitions that were held at carnivals and fairs. Though regional wrestling circuits have existed for decades, professional wrestling's current national popularity is unprecedented.
Brian Dunn, a graduate student in higher education administration at Iowa State University in Ames, is training to become a professional wrestler and has performed in two regional shows as the "heel" (bad guy) Brian Ash. Dunn says more fans, like him, are stepping into the ring. Those who hope to make it to the professional level and those just eager to live out their fantasies are learning the moves at several professional wrestling schools across the national such as Tugboat Taylor's School of Professional Wrestling in Houston and the Monster Factory in Paulsboro, New Jersey.
Dunn notes that the three levels of participation in professional-style wrestling reflect levels of training: highly trained wrestlers in national leagues such as the World Wrestling Federation, those with some training who perform on regional circuits at local gymnasiums and National Guard armories, and untrained individuals who participate in backyard leagues. (Some Web sites offer live video of amateurs performing in their backyards.) "People who are in the business discourage the backyard approach," Dunn says. "A lot of the moves require cooperation so that no one gets hurt," he says.
A relatively recent offshoot of mainstream professional wrestling is extreme wrestling, which incorporates more realistic violence—and real injuries—into the matches. In March, New Jersey's governor and the leader of the state's Assembly introduced legislation to regulate extreme or hardcore wrestling (2).
A recent Medline search produced no reports on injuries in professional wrestling. However, Dunn and some physicians who cover the events say they are seeing some patterns emerge (see "Professional Wrestling Injuries in the News," above). Gerard Varlotta, DO, as a boxing ringside physician for the New York State Athletic Commission, has also covered professional wrestling events.
Back injuries. "The major thing we see are herniated disks because of the throws and axial loading impact," says Varlotta, who is also a clinical assistant professor at the New York University Rusk Institute of Rehabilitation Medicine in New York City.
Central to professional wrestling are strategies to prevent injuries, Dunn says. One is "taking the bump" (landing on the back after being thrown) (see "Injury-Related Professional Wrestling Lingo," page 17). "You're supposed to land on the meaty part of your back with your feet planted and your hands slapping the mat to increase the landing surface area to absorb shock," he says. "You produce a sound like a shotgun going off."
Shoulder injuries. Shoulder subluxations are frequent, Varlotta notes; however, true dislocations are rare. Andrews notes that rotator cuff injuries seem to be more common than in the past.
Dunn says he injured his shoulder last year while practicing moves on a trampoline. "The shoulder impingement required 6 weeks of stretching and strengthening in rehab, and shortly before training camp I needed a cortisone injection for the pain," he says.
Rib fractures. Varlotta says that rib fractures are so common that many wrestlers don't even seek treatment for them. Dunn says rib injuries occur when opponents land on their opponents during maneuvers such as the "body splash" without tucking their knees under them to minimize the landing force. "Last December I had complete fractures of ribs 11 and 12 on my right side when I took the force of a 270-lb man," Dunn says. Misplaced opponent knees during other maneuvers are also responsible for rib fractures, he notes.
Muscle and tendon ruptures. Andrews says many muscle and tendon injuries are caused by the strength-training routines that wrestlers use to bulk up for participation. Anterior cruciate ligament ruptures are also fairly common, he says, not just from jumping, landing, and twisting, but also from the effects of past injuries in other sports.
Cervical injuries. Stingers and burners sometimes occur, but Varlotta says wrestlers who have increased neck strength seem better able to absorb some of the stress.
'Team Physician' Issues
Varlotta says from a sports medicine vantage, professional wrestlers are much like other competitive athletes. "Their concern is being able to play. I build their trust by letting them know I will do what I can to keep them playing," he says. One thing Varlotta's not likely to do is prescribe a narcotic and send them into the ring. "That's a signal that they need additional treatment," he says.
So far, there is no organization or targeted resource for physicians who treat professional wrestlers. "An injury is an injury no matter what the sport," Varlotta says. However, there are some specific diagnostic tips that Varlotta is learning through his experience with professional wrestling. For instance, monitoring degenerative spinal changes in heavily muscled patients, such as professional wrestlers, is easier with magnetic resonance imaging or computed tomography than solely with physical exam and x-ray.
Medical coverage at wrestling events seems to improve as wrestlers rise in the ranks. For example, Varlotta says that promoters at national events contract for coverage from physicians and emergency medical technicians and that leagues often employ their own athletic trainers. However, Dunn says that at the regional levels at which he wrestles, participants sign a waiver and that there is typically no medical coverage "unless," he says, "there's a physician there who's a fan." Dunn says he seeks ongoing medical care for his injuries at the Iowa State University student health service. "They take care of the athletes on campus and seem to have a better understanding of my injuries," he says.
Andrews says that, unlike other athletes, professional wrestlers seem to have shorter career peaks and aren't as likely to have contracts that cover them during injury recovery. "Once they get hurt, they have to wrestle hurt, and many push too hard during injury recovery," he says.
Reports of anabolic steroid abuse, as in many other elite sports, have plagued professional wrestling. In 1991, a Pennsylvania physician who covered professional wrestling was sentenced to 3 years in federal prison for distributing anabolic steroids to professional wrestlers, including Hulk Hogan (3,4).
Though there are no formal statistics on young people who are injured when they attempt to copy wrestling moves, at least one emergency department physician has noticed a pattern of injuries. "We saw a rash of copycat injuries last year," says John Brennan, MD, director of pediatric emergency medicine at St Barnabas Medical Center in Livingston, New Jersey. "Mainly musculoskeletal injuries, lacerations, and head injuries from throwing and flipping," he says. "The younger they are, the less they seem to realize that wrestling is choreographed."
Brennan says professional wrestling isn't the only "bad guy" in influencing kids' violence perceptions and their eagerness to act out action-figure scenarios. He says he worries about preteens and teens becoming desensitized to depictions of physical violence. "In video games people are thrown off buildings, and the opponents walk away at the end of the game," he says. "And no one is in the hospital in a halo."
Professional Wrestling Injuries in the News
A quick scan of several lay publications revealed a number of reports of injuries in professional wrestling. For example:
Sources: USA Today, New York Times, Minneapolis Star Tribune, Amusement Business
Injury-Related Professional Wrestling Lingo
Most sports have their own lingo that's privy to participants, and professional wrestling is no exception. Here are some injury-related terms along with their "translations."
Selling the move: pretending to be in pain
Shoot: real pain
Working an injury: choreographing an injury
Taking the bump: being thrown and landing on the back
Getting stuffed: getting hit harder than expected
Crowbar: an opponent who hits harder than he or she is supposed to
Sports Injury Patterns in Urban Youth
The injury surveillance study from June 1996 through June 192021 found that nearly 5% of the adolescent population experienced one or more sports-related injuries. Six sports (baseball/softball, basketball, biking, football, skating, and soccer) made up 17% of all injuries. Rates were higher for boys (84% of all sports injury events), and the most common mechanisms of injury were falls and striking against or being struck by objects. The greatest number of hospitalizations was attributed to bicycling injuries. A large proportion of head injuries was found in baseball/softball, soccer, and bicycling.
Several injuries were equipment related, including a basketball backboard falling on a player, inappropriate field conditions, and running into fixed objects during basketball. There were at least 13 assault injuries sustained during sports activities (eg, stabbing, gunshots), along with at least 30 baseball bat assaults.
The authors concluded that more efforts are needed to address the unsafe settings and field conditions that contribute to sports injuries in urban young people. They noted that separating car lanes from those used by bikers and skaters may help prevent injuries and that more education about and access to protective gear, including helmets, may enable urban young people to enjoy the many benefits of sports.
Researchers were particularly concerned about the large number of assaults during sports. The 13 assaults included 4 stabs, 2 gunshot wounds, 3 assaults with other objects, and 4 unarmed assaults. Besides 30 baseball assaults and 11 other baseball-bat injuries of unclear circumstances, there were 38 injuries that were coded as possible assaults. Though some have advocated sports as a way to keep young people out of trouble, others believe that sports competition can cause disagreements and physical aggression. They note that the results point to the need for adequate supervision, coaching, development and enforcement of safety rules, and teaching of sportsmanlike behavior.
What Makes an Energy Bar Good for Endurance?
Volunteers fasted 12 hours then consumed either four slices of white bread, a Snickers bar, an Ironman PR Bar, or a Power Bar. Each provided 50 g of carbohydrate. The subjects then had their blood glucose levels measured at 15-minute intervals for 2 hours afterward.
Blood glucose levels, which peaked at 30 minutes for the energy bars and 45 minutes for the bread and candy bar, declined steadily for all foods except for the Ironman PR Bar. The researcher noted that the Ironman PR Bar may have had a more sustained glucose rise because it had greater percentages of fat and protein than the other products; it has 40% carbohydrate, 30% fat, and 30% protein.
Trails for Walking Boost Exercise
Researchers found that in communities that built more walking trails, 40% of people with access to the trails used them and that 55% of trail walkers had increased their walking since starting to use the trail. A press release from Saint Louis University and the Missouri Department of Health says that this is the first US study to systematically examine the effects of developing walking trails.
The study also noted that women were twice as likely as men to use the trails and that people in lower income brackets were more likely to use the trails than those in higher income brackets.