Catanese: The Medical Care of the Judoka

Apparently the medic at all the local judo tournaments, Anthony Catanese, is a 4th degree judo black belt as well as a doctor. He used to be a competitive player, with at least a degree of international travel for tournament. He wrote this book about medicine as it relates to judo. I find it useful as a competitor, but I would love for more medical professionals to read it.

Catanese distinguishes among the several types of staph infection (17) and emphasizes that all students need to shower, no joke, with soap, after every class. (22)

His description of concussive head injuries is useful enough to quote:

Concussion is a “clinical syndrome,” which means that there are no X-rays or other objective measures of its presence.... The hallmark of concussion is confusion and amnesia. The condition may last for only seconds, or it may take days to resolve. Loss of consciousness is not necessary to make the diagnosis, but it is often present whether recognized or not, even if only for a fraction of a second. If loss of consciousness is present, it is automatically a concussion. Dizziness, agitation, ringing in the ears, and ataxia (staggering), along with a dozen other neurological findings, can occur...

He then emphasizes that everybody–coaches, refs, players, bystanders–need to shut up and obey the medic who removes a player from a match due to concussion.

I was fascinated to learn that “orientations” are lost in a linear fashion: first time, then place, then person. Doctor Catanese describes his complex, intuition-based method for using that information to determine if an athlete is concussed, even if they speak a different language or are reticent.

He also notes that concussions are much more prevalent in the cold, on poor mats, and on mats placed over hard surfaces like concrete. His discussion lasts for several pages and is, I believe, vitally necessary to the judo community. (24-29)

The doctor tells a great story about choking out his partner while doing katame-no-kata for promotion. Stories about people getting choked out are inherently interesting, and if they don’t involve serious injury, are almost always devastatingly funny. (44)

I learned that asthma medications are used by many endurance athletes as a cheating method, and that power athletes like judoka are adopting the practice as well. Apparently, in order for a judoka to be allowed to use asthma medication, they need to test that the athlete has asthma by injecting them with methacholine in order to induce an attack. (112)

The author’s discussion of neck injuries, particularly with regards to drop seoinage and poorly performed uchimata, is well done. Of particular value are his repetitions of caution for evaluating someone who may have a spinal injury. (114-121)

I’d like to excerpt without comment from page 138:

Scrotal Support: There is a question with regard to what sort of underwear should be worn by a male judoka. Some judo players, and particularly some sensei, do not wear underwear at all as a result of the belief that the testicles should be free to move out of the way of injury. A male with a tight scrotum probably does not need underwear, while someone with a loose-hanging scrotum would probably benefit from tight underwear and maybe even a jock strap. The appropriate decision for the athlete is based mainly on personal comfort. This is an important piece of information that may not be available elsewhere in the literature.

I was somewhat confused by Catanese’s distinction between “warming up” and “loosening up” (210). He says that the former is about increasing blood circulation, blood pressure, and body temperature, whereas the latter is about “stretching the tendons, manipulating the joints through a range of motion, and stretching the muscles”. He states that playing cold is bad news bears and doesn’t see why judoka do so at tournament. Fair enough.

But he also states that it’s troublesome to “loosen up” before playing, because it makes the muscles weaker, and that this can be done after training or in a separate workout. This I understand if he’s talking about static stretching, but he seems to classify all pre-workout stretching as problematic. I don’t get it. (He then qualifies this whole discussion by saying that the strength loss is probably only relevant for elite athletes, so “for most athletes, it is best to loosen up and warm up together at the start of the class.” I am thoroughly confused.)

In contrast, he is very clear about strength training. His points seem to boil down to the following:

He brings the truth. Some particularly golden passages:

Strength is essential for preventing injury.... If the athlete’s neck muscles are not strong enough to hold the head stable while being thrown, he or she is prone to getting one of these [head/neck/spine] injuries. For this reason, an athlete should not be playing in a tournament until a certain level of strength and skill has been achieved.

...

Leg training is second only to core training.... A squat is the highest-quality multi-joint exercise, regardless of which sport one is playing, and it will work the spine’s entire length besides working the legs. Repetitive uchikomi like seoi nage, where the partner is lifted on one’s back, is essentially the same as doing a squat.

The most useful form of weight training in an athlete is complex, multi-joint moves. The individual isolation moves or the use of machines is probably not indicated unless it is a rehabilitation situation. While they are only calisthenics, pushups, pull-ups, sit-ups, and planks will probably suffice for strength training for a large majority of recreational athletes.... It is better to do work with dumbbells, barbells, and kettle bells. Weightlifting can be rehabilitation for the injured athlete, or it can be an adjunct for the athlete who is too weak to perform a move correctly. (214)

...

Once an adequate amount of aerobic capacity has been developed, it is time to move on to anaerobic exercise. A judo match is usually played with gripping, stalling, and bursts of attacks that occur every few seconds. To do this, the athlete really needs anaerobic training.... Perhaps only some roadwork is needed in the off season.

...

Weightlifting is an anaerobic exercise.... This wold involve repetitive maximum exertions to the point of exhaustion. This often involves taking about 60 percent of a usable weight (one rep max) and doing a certain number of repetitions and sets with very little rest in between (one to three minutes).

He also recommends track work, jogging the curves and sprinting the straightaways, four to eight times per mile, for two to three miles. (215) That sounds brutal. I also think he and my coach have a shared background for road work: they both recommend running for X number of phone poles, then sprinting for one or two, as well as stadium stairs and squat jumps.

On page 224 he relates his method for framing rehabilitative training in the mind of an athlete. It’s too long to quote in full, but he uses the analogy of starting fresh in school after a summer break, and continues:

This is a unique opportunity to build some strength in another part of the body that has been weak and that we have not been able to work on, because you have been actively competing.

...

I sometimes take an athlete and tell him that while he may have an ankle injury, his grip has really been too weak. “By the end of this six-week rehabilitation process,” I say, “I want you to be able to do three sets of fifteen pull-ups.”

...

The athlete can also be sent back to the books to learn more about the sport. I have a large collection of videos on judo. When I have an injured athlete, I give her the videos and tell her, “I want you to watch every one of these videos five times. This is going to be your training for now.” These strategies are of great help in preventing the athlete from going stir-crazy, returning to the mat too soon, and risking re-injury.

Good book. I think I’ll be using it for reference fairly often.

— David Liepmann, 26 May 2012