Years of hard-core training drills may be doing more harm than good at this point -- and a crippling overuse injury may be in your near future, says an orthopedic surgeon specializing in sports medicine.

I recently saw a fit 74-year-old patient who’d practiced wing chun and tai chi chuan for many years. He came to me because of shoulder pain that was bothering him during the performance of his everyday activities. Even doing slow tai chi forms was problematic because he couldn’t raise his arms above his shoulders anymore. He feared he’d no longer be able to practice or teach his arts.


His X-rays revealed significant shoulder arthritis — so much so that the bone was eroding. My concern was that if he continued putting stress on his shoulders, he’d soon have a permanent disability that affected every aspect of his life. It was difficult to advise him to stop training, but his condition was so severe, I couldn’t let him act in a way that would further the deterioration.

The patient informed me that he’d trained old school all his life. He’d punch a concrete wall every day, and he had knuckles to show for it. To strengthen his bong sao, he’d tie weights to his arms before working out. He said he did these and similar exercises up to three times a day. That raised many questions in my mind:

  • Did his workouts cause his current problem?
  • How much abuse can the human body tolerate before structures start to break down?
  • How should martial artists regulate their training intensity?

Unfortunately, there are no simple answers.

Shoulder Injuries: Overview of Arthritis

Shoulder arthritis occurs when the cartilage on the humeral head (ball of the joint) and glenoid (socket) wears out. In severe cases, the joint space is lost, and the bones grind against each other. There are several causes of shoulder arthritis, including trauma, inflammation (e.g., rheumatoid arthritis), a large/massive rotator-cuff tear and primary degeneration.

No matter the cause, the end result is loss of joint functionality. People with the problem usually feel pain and stiffness. The pain can be mild and associated only with activity, or it can be noticeable even while resting and may wake a person at night. Stiffness also becomes a problem with everyday activities; sometimes it’s so severe the person can’t reach the top of his head or back. 

Diagnosing Shoulder Injuries

Shoulder arthritis is diagnosed after a physician obtains a history, performs a physical exam and reviews the X-rays. Initial treatment involves pain management with analgesic and anti-inflammatory medication, lifestyle modification to avoid activities that aggravate the condition and gentle stretching exercises to avoid progression of the stiffness.

Treating Shoulder Injuries

Painkillers may control the pain enough for the person to continue training. Martial artists will often try to tough it out, ignoring shoulder pain and opting not to use medication. That’s ill-advised. The condition can worsen, and the pain can become so severe that training is impossible.

If the pain cannot be controlled with medication, cortisone may be prescribed. It’s a strong anti-inflammatory that’s injected into the joint. The main risk, albeit a low one, associated with the treatment is infection. The injection should be performed via sterile technique, preferably in a clinic at a hospital. The duration of relief varies. Some patients report lessened pain for a year or more, while others say they notice an improvement only for a few weeks. On occasion, people find no pain relief at all.

Another type of injection, called viscosupplementation, is designed to lubricate the joint. Why does that help? Because arthritis also entails the “drying up” of the joint, meaning that the normal fluid that circulates in it is lost. Therefore, supplemental lubrication can provide relief — according to studies, it’s usually a short- to medium-term duration. It may be delivered as a single-dose injection or in multiple doses, often three given at one-week intervals.

Dealing With Shoulder Injuries

If one of the aforementioned treatments helps manage the pain, the afflicted person will want to resume training. I usually advise my patients not to engage in intense workouts because excessive force placed on the shoulder can worsen the condition. I then explain the importance of daily stretching and range-of-motion exercises to counteract the stiffness. The goal, of course, is to prolong the life span of the joint by slowing the deterioration. 

If nonoperative treatment fails, surgery may be required. The definitive treatment is shoulder replacement. That involves removing the arthritic surfaces of the joint and replacing them with metal and plastic components. After such a procedure, I always advise against any martial arts practice. Some surgeons, in fact, will perform a shoulder replacement only on sedentary elderly people.

If the patient elects not to have a shoulder replacement, an arthroscopic procedure may be an option. This minimally invasive surgery can address all the non-arthritic causes of shoulder pain (e.g., bone spurs) and improve range of motion. However, it won’t alleviate all shoulder pain and is usually beneficial only for those with mild to moderate arthritis.

Returning to my patient: His arthritis is so bad in both shoulders that the only viable solution is shoulder replacement. However, he insists the pain isn’t severe enough to warrant that. I told him he should stop all training. I still think about the effects of hard training over extended periods and how it can lead to a breakdown in the anatomy. Yes, such training can facilitate impressive displays of strength and power, but you need to think about the potential long-term consequences. If you don’t moderate your training now to preserve the integrity of your shoulders and other joints, you may not be training at all in the future.

About the author: Robert Wang, M.D., is a Fellow of the Royal College of Physicians and Surgeons of Canada. He’s an orthopedic surgeon specializing in sports medicine.

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In the martial arts, we voluntarily subject ourselves to conflict in a training environment so we can transcend conflict in the real world. After all, we wouldn't knowingly train in a style that makes us weaker or worsens our position. The irony of all this is that we don't want to fight our opponent. We prefer to work with what an opponent gives us to turn the tide in our favor, to resolve the situation effectively and efficiently.The Japanese have a word for this: sabaki. It means to work with energy efficiently. When we train with the sabaki mindset, we receive our opponent's attack, almost as a gift. Doing so requires less physical effort and frees up our mental operating system so it can determine the most efficient solution to the conflict.In this essay, I will present a brief history of sabaki, as well as break down the sabaki method using Miyamoto Musashi's five elements

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"Unlike karate training outside a combat zone," Cpt. Yoon explained, "it is important here that the troops be able to turn their techniques into devastating, bone-crushing blows. There is no place for mild strikes in combat when a VC is trying to push a bayonet into your stomach."

For that reason, the compound is peppered with makiwara punching boards, and the Korean Tigers spend much time conditioning the weapons of taekwondo. Also, throughout Vietnam there are plenty of sandbags, which are used to protect all kinds of constructions. They make excellent striking bags for a karateman.

The next unit in the schedule is to display free fighting. The commander again explains that this form of fighting is used to test the Tigers' skills against one another rather than to demonstrate the actual methods of close-quarters combat, as a fight on the battlefield is nearly always over in an instant.

The sparring matches are exhibitions of technique and control. Perhaps the only recognizable difference between these and matches held in tournaments is the consistent power the soldiers put behind their blows and their concentration on hard taekwondo techniques rather than elusive ones.

Against Weapons

At last, a final group prepares to show what happens when an unarmed Tiger meets a VC with a knife or a bayonet fixed to his AK-47 rifle. Two pairs of soldiers stride to the center of the hard-dirt arena, face the commander and render a snappy salute. Then they fall into a four-man square and await orders.

Sgt. Lee barks a command, and the best of the best explode into action. One gladiator leaps for a knife that has been thrown into the arena. He jams it, hard, at another, who violently kicks the striking hand and jumps shoulder height, scissoring the attacker's neck and tumbling him forward onto the unyielding ground with a crash. The knife spins away.

Meanwhile, another black belt catches a rifle with a fixed bayonet that is thrown to him from the sidelines. With a guttural shout, he lunges for his opponent. The defender spins to the left, brings his knee sharply inward against the weapon and rolls the attacker onto his own shoulder while tearing at his windpipe. It's over in seconds.

The couples repeat the performance again and again, smashing full tilt against each other. Every time, the attacker thrusts hard with his weapon. It's just less than miraculous that the practice doesn't turn into a blood bath.

Korean Budomen

Initiated as the Capital Infantry Division, the Tiger Division was activated on June 20, 1949, in Seoul with the mission of providing security for the capital. It was charged with additional security of the 38th parallel in Ongjin in September of the same year. When the Korean War began on June 25, 1950, the division began to prove itself in heavy fighting during battles at Ahn-kang and Kyung-joo along the defense line of the Nakdong River in the southeastern part of the country.

Following the successful Inchon landing by Gen. Douglas MacArthur's forces, the division penetrated deep into the North across the 38th parallel, overrunning enemy strongholds and advancing close to the Korea-Manchuria border. As their ability became recognized, the division was committed repeatedly and saw the armistice signed while fighting at the front in the spring of 1952. They captured more than 9,920 enemy, killed more than 91,000 and seized more than 31,000 weapons. As a result of their valor, the division was awarded five ROK Presidential Citations and a U.S. Presidential Citation, an ROK National Assembly award and 42 other plaudits.

After the armistice, the division had already been dubbed with the Tiger laurel and was deployed along the front line of the central part of the Korea DMZ. They remained under continued training and constant combat readiness.

Upon approval of the National Assembly, the division was directed to combat in the Republic of Vietnam on August 20, 1965. Three separate elements arrived at Qui Nhon on November 1 after four weeks of preliminary training. That month, it received its tactical area of responsibility, which consisted of 1,400 square kilometers in Binh Dinh Province in central Vietnam. The division's general mission objectives are to protect travel routes, military installations and facilities within its TAOR and to assist the Republic of Vietnam in its pacification plan by eliminating Viet Cong in the area and helping the people rebuild their destroyed homes.

Since 1965, the Tiger Division has stabilized security within their area to an impressive degree. The TAOR itself has expanded from 1,400 to 3,800 square kilometers. As of mid-June, the Tigers had killed more than 9,000 enemy, captured nearly 3,000 and counted 4,500 defectors, as well as seizing nearly 4,000 weapons.

All this leaves little room for doubt about whom historians will count as the true elite of Vietnam combat. In the ranks of the VC and the NVA, mention of these ferocious Koreans brings shudders to the comrades. Even as he fights those from North Vietnam and the Viet Cong, the Tigerman knows that he has full command of his body and his mind. When he's faced with hand-to-hand combat, he need not rely only on the ferocity of his rifle to equalize the score. He can hammer out punches with machine-gun rapidity or swing a full-flogging kick with sufficient force to gain the advantage. When a man is trained in karate, or to be more specific, taekwondo, he's ahead of the game and the Viet Cong, that crap-shooting armada of insurgent forces, and the crack North Vietnamese troops who come to do battle. They know full well that the Tigers with their taekwondo as well as armaments are tough to beat.

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The roots of taekwondo are in Korea, and for the ROK GIs who enter the Tiger ranks, the intensive routine of training in the martial art is strictly par for the course. No doubt every Tigerman hopes to use his martial arts training sometime in a tournament as well as he does in combat. That's the dream of every GI in the ROK division.

The Tigers, under Maj. Gen. Lew Pyong Hyon and with taekwondo's Capt. Yoon, have been making headlines throughout the world. They are the only troops, it's been said, who fight fire with fire, who use guerrilla techniques and ambush techniques in much the same manner as the Viet Cong. In a war such as this — where the boundary lines are questionable, where there is no front line and where your neighbor can turn into your enemy — such techniques are indispensable. Thanks to the hand-to-hand techniques and the combat-karate emphasis of this militia, the odds are clearly shaping up in the Tiger Division's ledger. Thanks to taekwondo, the Tigers are smashing the enemy with no holds barred and, if anyone doubts it, plenty of contact!

Read Part 1 of this article here.

text by Jack E. Swift

(This article first appeared in the November 1968 issue of Black Belt.)

Scene: A group of soldiers is gathered for a bull session. The subject under discussion is the Tiger Division of the Korean army. The soldiers are engrossed. One, a lean, tanned GI, pushes back his beret, squints into the darkness and looks out to see a mountain of burning embers.

"We were on recon operations in southern Binh Dinh Province," he explains. "One night, we caught the sounds of a skirmish. My squad leader held up his hand and when he smiled, we knew we were in for some action. As we approached the area, we were a little surprised that there was no small-arms fire, but we could hear a lot of guys yelling.

"When we got there, it was an unbelievable sight. Here were those Korean troops in close-quarters combat with what must have been superior forces, as there were [Viet Cong soldiers] all over the place. I've never seen so many broken necks and caved-in ribs in my life. We helped clean up what was left."

So goes the legend, and just in case you're casting a cynical eye as to the Tiger Division's aptitude in the use of martial arts, the record speaks for itself. If there was ever a primer on combat karate, these troops would write it. In two grueling periods daily, every troop in the Tiger Division trains in the taekwondo method, the official karate of Korea.

At one time, there were many factions, but in the past year or so, they've all been absorbed by the International Taekwon-Do Federation, with its headquarters in Seoul. In fact, with the Koreans, and even in many areas in Vietnam, taekwondo is synonymous with karate. Numerous Vietnamese do not even understand the word "karate" — but mention taekwondo and their faces light up with recognition.

Way of Life

At Qui Nhon, division headquarters, visitors are surprised to see sparkling white uniforms — and a sea of black belts — virtually in the middle of a combat zone. While on actual operations away from their base, the Tigers work out in field gear, but at the training center, everyone wears a gi and keeps it as immaculate as any other military uniform.

On the left side of the gi, each person wears the proud division emblem of a roaring tiger. On the other side, if he's an instructor, the soldier wears a black insignia of a fist with white dots above indicating how many degrees of black-belt rank he holds.

Commander of the massive taekwondo corps of the Tiger Division is Capt. Yoon Dong Ho, himself a third dan. But the rugged, intelligent captain is no armchair commander. He's on hand daily at the dirt arena, watching the troops go through their paces and often teaching a special class of officers.

Capt. Yoon is responsible for the official taekwondo training of more than 15,000 Tiger troops in Vietnam. Although popular belief holds otherwise, there are actually more than 200 black-belt holders in the Tiger ranks. Of them, three are fourth dan, 29 are third dan, 57 are second dan and 115 are first dan. There are roughly 600 red belts and 2,300 blue belts, as well as 9,000 troops holding degrees of white belt. Approximately 2,900 men recently began their training in Vietnam. Many of these, of course, already hold rank they won in Korea.

Deployment

Each element of the Tiger infantry arriving in Vietnam goes through intensive schooling at Qui Nhon. The 26th of these classes began in July, to run just over a month. The sessions lead off with classical techniques under the direct supervision of Sgt. Jun Jae Gun, head taekwondo instructor for the Meng Ho in Vietnam. Sgt. Jun, one of the division's tough trio of fourth degrees, displays a certificate signed by Gen. Choi Hong Hi, International Taekwon-Do Federation president.

When a trooper is promoted in Vietnam, however, he's awarded a military certificate of training by his supplement company commander, who acts as a representative of Lt. Col. Jai Chun Ko, division field commander. All promotions are recognized by the federation. In cases of promotion to the higher grades, however, special recognition is often meted out. For example, Sgt. Kim Duk Ki was recently awarded his third dan by Lt. Gen. Chae Myung Shin, field headquarters commander for all ROK Forces in Vietnam.

"The major objective of our formal taekwondo classes," asserted Cpt. Yoon, "is to take the minds of our troops and replace civilian thinking with military spirit and fierceness. 'Tiger' is the nickname the division has been tagged with because of the fierce nature we have demonstrated in combat. We intend to live up to it."

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Cpt. Yoon reinforced that statement with an impromptu demonstration of his own favorite techniques. Choosing a brawny trooper with a bayonet, the captain rushed him, parrying the weapon with an onslaught of power strikes with the elbow, palm, heel and fist. He ended with a forearm strike to the windpipe, which he explained is effective when one wants to silence the enemy quickly.

Key elements in hand-to-hand combat, the commander explained, are attacking the weapon directly or the hand that holds it while simultaneously attacking the most vulnerable spot within reach, then pressing the assault to keep the enemy off-balance while finishing him.

Field Testing

Stressing physical fitness in preparation for the application of these techniques, Cpt. Yoon said his troops rely heavily on powerful, smashing blows against the smaller Viet Cong and North Vietnamese Communists. He explained that the enemies are often undernourished because of their long treks from the North and therefore may fall easily under a strong attack.

"One particular situation where we encounter hand-to-hand fighting," Cpt. Yoon said, "is when the VC hide in bunkers and Tiger patrols do not have heavy weapons available to blow [the bunkers] apart. In such a case, the troops simply go in after them. The VC stand little chance against my men in close-quarters fighting."

In addition to the training of their own infantry, Tiger taekwondo instructors teach U.S. and Republic of Vietnam soldiers, as well as other Allied Forces infantry soldiers. Presently, some 1,250 Vietnamese and 150 U.S. soldiers are being taught by the Tigers at Qui Nhon alone. At other installations throughout South Vietnam, the Koreans teach their art to Allied Forces and Vietnamese civilians of both sexes and all ages.

There are scores of Korean black belts who are not members of the Tiger Division but who teach taekwondo to the local troopers and civilians. Many of these men belong to the larger White Horse Division. Especially in populated places such as the Tan Son Nhut Air Base–Saigon area, taekwondo has become as popular as baseball is to Americans. Today, self-defense is serious business to the Vietnamese, as no one knows when a VC terrorist squad will break into his home.

The Tiger Lair

Several miles away from the main training area on the Qui Nhon Air Base where the new arrivals hold classes, the Tiger instructors have their own compound, carved out of the verdant Vietnam countryside. Bordered on two sides by mountains and banked by the South China Sea, the encampment nestles into a serene and clean-smelling natural cradle, somehow out of place amidst the turmoil of war. The site has never been successfully attacked, and no one remembers the last time even a single mortar landed within the perimeter.

The perimeter itself is defined by roll upon roll of barbed wire, machine-gun posts and sandbag-reinforced bunkers. When not actually leading class, the instructors perform most of their military duties wearing their gi, often barebacked in the all-pervading heat. Somehow it doesn't seem quite right to see a fierce fighting man carting pails of water for the makeshift shower or spreading rolls of concertina wire — until you recall how budo masters of ancient times made their charges perform menial tasks before they would be accepted. Perhaps this accounts in part for their dedication and the respectful attitude the troops invariably display.

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Cpt. Yoon decides to review the instructors' training methods, so he has the select corps organize into a squadron to demonstrate their prowess. Sgt. Lee Jin Ho, whose official title is post instructor, leads the formation. They fall swiftly into ranks. The commander steps forward and receives the squadron's salute, then turns the command over to Sgt. Ho.

At a signal, the Tigers break ranks and rush into new formations with precision reminiscent of the Roman legions. The first squad is directed to show taekwondo forms. They snap through the kata in coordinated pairs, demonstrating the adroitness that can only come from military discipline. The forms are technically the same as classical Korean karate but are executed with the confident power of soldiers who have seen what their stuff can do to a man.

The next group forms behind a line of boards, bricks and tiles. Stacks of four and five bricks, up to 15 tiles and four 1-inch boards lie before them. The unit is called to attention, salutes again and assumes a ready posture. Sgt. Lee barks a command, and a dozen heads, hands and fists smash into the solid objects. Not a single one remains unbroken.

Read Part 2 here.

text by Jack E. Swift

(This article first appeared in the November 1968 issue of Black Belt.)

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