wrestlers with limb deficiencies: a descriptive study · authors & acknowledgements authors:...
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Wrestlers with Limb Deficiencies: A Descriptive Study Mike Baria, MD/MBA
State of the Science Symposium: Adaptive Reconditioning for Wounded, Injured and Ill
Veterans
June 5, 2015
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Authors & Acknowledgements
Authors: Baria MR, Terry MJ, Driscoll SW, Andrews KL, Soma DB,
Prideaux CC
Citation: Wrestlers with Limb Deficiencies. Am J Phys Med Rehabil. 2015 Apr 16
Special thanks to Dr. Ralph Gay for manuscript review & Nick
Ackerman, CP Director of Prosthetics at American Prosthetics and
Orthotics (IA)
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Financial Disclosures
Archbishop Moeller High School (Cincinnati, OH) provided funding
for participant remuneration
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Introduction: Definitions
Our study uses the terms ‘impaired’ and ‘non-impaired’ in lieu of
‘disabled’ and ‘able-bodied’
Consistency with WHO definitions
Best descriptors
Our study uses the term ‘limb-deficient’ for both amputations and
congenital limb deficiency
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Introduction: Limb Loss in the Military
According to the Army Office of the Surgeon General, there were
1,286 amputations in Operation Iraqi Freedom, Operation Enduring Freedom and other unaffiliated conflicts1
935 were considered ‘major’ limb amputations
Only 105 continued as active duty, reserves or were Fit for Duty
50% were caused by IEDs
77% Army, 19% Marines, 2% Air Force, 2% Navy
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Limb Loss in the Military: What’s the
Burden?
The Military Extremity Trauma Amputation / Limb Salvage (METALS)
Study 2 reported
38.3% had a positive depression screen, 18% had a positive PTSD screen
34% were not working, active duty or enrolled in school
38% involved in rigorous sports / recreation
Many struggle with emotional health and have difficulty re-initiating
their social and vocational roles
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Toward a Solution
In addition to foundational rehabilitation services, sports (competitive or
recreational) can help improve functional independence, mental and physical
health, and self-efficacy3,4
Common sports for limb-deficient athletes include track, swimming, sitting
volleyball, sled hockey and wheelchair sports
Though these are excellent options, each of them requires adaptive equipment
and / or competition against similarly impaired peers
My personal observations suggested that wrestling presents a unique opportunity for limb-deficient athletes by integrating them into standard
competition against non-impaired athletes
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Background
The wrestling community has consistently seen limb-deficient wrestlers
compete against non-impaired peers
No adaptive equipment, accommodations, or disability classifications
Examples
https://www.youtube.com/watch?v=c5W4RZq1NRg
https://www.youtube.com/watch?v=Ri8kx2yEPMI
https://www.youtube.com/watch?v=4isX2EMMg08
From our best observations, competitive equality between the wrestlers is preserved
There are numerous success stories of limb-deficient wrestlers
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Dustin Carter (Hillsboro, OH); 40-3 senior year record
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Nick Ackerman (Simpson College); DIII NCAA Champion &
Hodge Trophy Winner
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Rohan Murphy (Penn State)
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Kyle Maynard (Collins Hill, GA): High School State Champion
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Zach Anglin (Bayfield, WI): State Tournament Qualifier
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Anthony Robles (Arizona State): DI NCAA Champion
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Background
Despite this success, wrestling has not yet been integrated into
common athletic considerations for limb-deficient athletes and
participation remains isolated
Not found in any text, paper or website for impaired / amputee athletes
Wrestling is just not commonly considered for limb-deficient athletes
But maybe it should be
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Aims
Since the rehabilitation, adaptive sports, and amputee communities
have limited awareness of wrestling as an option for limb-deficient
patients…
The primary goal of the study was to survey wrestlers with limb deficiencies to determine if wrestling is a safe and positive athletic
option for limb-deficient athletes
If safe and positive, we hoped to raise awareness of the suitability of
wrestling for these athletes
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Study Design
Questionnaire-based descriptive study using a nationally distributed
electronic survey after receiving IRB approval
Inquired about demographics, limb loss etiology, achievements, quality
of life, barriers to entry, residual limb and musculoskeletal (MSK)
problems
Inclusion criteria: 5 years old and up, minimum 1 year wrestling
experience, limb deficiency at or proximal to the transradial / transtibial
level
Descriptive statistics used for analysis; Fisher’s exact test used to examine residual limb complication risk factors
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Results: Demographics n=16 (50% response rate)
Gender Male: 16
Congenital vs. Acquired Congenital: 9
Acquired: 7
Age at Acquired Amputation (years) Median: 6
Range: 1-15
Acquired Etiology Traumatic: 4
Infectious: 3
Limb Deficiency Level Below Knee: 9
Above Knee: 5
Below Elbow: 3
Accomplishments
NCAA Champions 2
NCAA Tournament Qualifiers 2
Collegiate Wrestlers 7
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Results: Wrestling-related residual
limb complications
Rate 50%
Complication Type Total #
Skin breakdown 6
Residual Limb Pain 5
Swelling 2
Phantom Pain 2
Infection 1
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Results: Musculoskeletal Injuries
Significant injury defined as any injury that withheld the athlete from
competition
6 / 16 reported at least 1 significant musculoskeletal (MSK) injury
MSK Injuries by body region
Shoulder: 2
Elbow: 1
Low back: 3
All lower limb deficiencies
Knee: 3
*One respondent accounted for 4 injuries, while the others each had only 1
injury
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Results: Training habits 9 used a prosthesis for cardiovascular / strength training
None used a prosthesis for wrestling training or competition
1 used modified grips for strength training; otherwise, no adaptive equipment needed
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Results 100% indicated that wrestling had a ‘very positive’ impact on quality-of-
life
95% reported a ‘very positive’ impact on physical health
87% reported no difficulty finding acceptance with teammates,
coaches and competitors
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Discussion: Competitive Equality
Limb-deficient wrestlers can and do succeed against non-impaired peers
without the need for accommodations or adaptations
No other sport boasts this degree of competitive equality
Competitive equality is likely fostered by the weight class system & nature of the
sport
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Discussion: Competitive Equality
Because of the weight class system, whatever mass is absent from the limb is
redistributed to the torso and intact limbs
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Competitive Equality or Competitive Advantage?
Basic concepts can guide our discussion
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Competitive Equality or
Competitive Advantage?
Consider the wrestler with a lower limb deficiency
Upper body likely stronger than opponents: relative, not absolute, advantage
Missing a lower limb means an entire array of techniques are unavailable to
that athlete
Basic attacks requiring a powerful push-off, trips and throws
Mat mobility is challenging
These wrestlers must cope with and overcome significant challenges to be
competitive
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Discussion: Injuries Residual limb complications seem common
Direct end bearing and shear forces
Complication rate of 50% warrants educating & monitoring the athlete;
meticulous skin care is a priority
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Discussion: Injuries
MSK injury risk
For ‘all injuries’, rate was 38% all-time compared to 50% injury rate per
season in a large cohort of high-school wrestlers5
Wrestlers with lower limb deficiencies may be predisposed to low back
injuries
Altered biomechanics and their kinetic chain
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Discussion: Injuries
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Discussion
Wrestling was a markedly positive experience
Barriers to entry are low, allowing for easier integration
No special equipment, financial investment, personnel training or
adaptive needs
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Limitations Selection bias
Small sample size
No female participants
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Conclusion
This study suggests that wrestling is a safe, positive athletic
experience that provides the unique opportunity for competitive
equality between limb-deficient and non-impaired athletes
Wrestling should be integrated into the common athletic
considerations for athletes with limb deficiencies
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Future Directions: Research
Detailed, prospective assessment of injuries
Specific etiologies
Motion analysis for injury prevention and optimizing training
Prospective study of mental and physical health outcomes
Preventive strategies for residual limb complications
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Future Direction: Participation for
Military Amputees
Two groups: those with a wrestling background and those without
For those with experience, options include:
Post-college, join local sanctioned USA Wrestling club, help at local HS
http://www.teamusa.org/usa-wrestling/membership/athletes/find-a-club
If they plan to attend college, contact coach at the school
For those without experience, no clear opportunities exist
Local clubs may work, but not suited to new adults
Military programs are for elite level
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Future Direction: Participation for
Military Amputees
Start a wrestling reconditioning program specifically geared towards
veterans with amputations
Need mat space and a coach
Contact myself or USA Wrestling: [email protected]
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Freedom and Operation Enduring Freedom. Congressional Research
Service. CRS report for Congress. March 25, 2009.
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Amputation / Limb Salvage (METALS) study: outcomes of amputation versus
limb salvage following major lower-extremity trauma. J Bone Joint Surg Am.
2013 Jan 16;95(2):138-45.
3. Fiorilli G, Iuliano E, Aquino G, et al. Mental health and social participation
skills of wheelchair basketball players: a controlled study. Res Dev Disabil.
2013 Nov;34(11):3679-85
4. Pepper M, Willick S. Maximizing physical activity in athletes with
amputations. Curr Sports Med Rep. 2009 Nov-Dec;8(6):339-44
5. Pasque CB, Hewett TE. A prospective study of high school wrestling
injuries. Am J Sports Med. 2000 Jul-Aug;28(4):509-15
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