Bleed Less – The Steps to Take Before Climbing in the Ring

Cuts are part of Muay Thai. A well placed knee or elbow can easily result in a profuse cut that prematurely ends a fight (7, 22). This sort of external bleeding is obvious, but there’s also internal damage; bruising and haemorrhage of various tissues within the body (17, 22) – the most consequential being the brain.

Such bleeds can have a drastic effect during the fight and adversely affect your return to regular full-bore training following the fight. There are genetic disorders that affect your ability to naturally stem bleeding (liver disease, haemophilia etc.) that are largely outside your control, but even healthy fighters can inadvertently consume or apply ingredients that make them susceptible to excessive bleeding (6). A better understanding can help reduce this risk. I’m not scaremongering, just sharing some tips that you might find useful as a Muay Thai boxer or coach.

Coagulation – Blood Clotting

When that elbow kisses your brow bone, cleaving through the delicate skin tissue, at first there’s a moment where you think you’ve got away with it – perhaps the damage isn’t too deep? Then, initially delayed, the damaged blood vessels begin spilling their contents onto the surface of the skin. The referee pays close attention – will the fight need to be stopped?

Now an internal battle rages as the blood forms clots to block bleeding and then heal the wound. This coagulation is crucial to stop blood loss, invoking cellular activity as blood platelets form a plug at the injury site, while proteins in the blood plasma kick off a chemical reaction with vitamin K and calcium, forming fibrin strands to reinforce the platelet plug with a mesh. A skilful corner team can make a big difference in stemming blood flow between rounds, but you can also affect to the outcome – if you’ve planned ahead.

Why Am I Bleeding More Than Normal?

“Blood thinners” are ingredients that lengthen the time it takes for blood to clot. There are two main types of blood thinners. Anticoagulants hamper the chemical process forming the fibrin mesh, while Antiplatelets prevent blood cells (platelets) clumping together to form a clot. NSAIDs (Non Steriodal Anti-inflammatory Drugs) such as aspirin, ibuprofen and warfarin are often prescribed by doctors to prevent clotting in patients with blood clots in their legs or heart.

It goes without saying that such medications have no place in a fighter’s regime. Coaches should be aware that fighters are highly likely to self administer such nonprescription pain killers without your knowledge, and exceeding the recommended dosage is also common (3, 9).

There are also a number of foods and supplements that negatively affect blood coagulation, containing high amounts of aspirin-like substances called salicylates, omega-3 fatty acids , vitamin E or with natural antibiotic properties (8, 16, 20). Everyone has a different level of sensitivity to these, but it makes sense to avoid consuming or applying excessive quantities of Anticoagulant or Antiplatelet substances (either individually or in combination) a week or two before a fight.

These Can Make You a Bleeder

Foods containing high levels of salicylate include tea (except fruit and camomile tea), coffee, dried herbs and spices (curry powder, cayenne pepper, ginger, garlic, paprika, thyme, cinnamon, dill, oregano, turmeric, licorice, peppermint, black pepper), some fruits (green apples, cherries, strawberries, dried fruit, raisins, prunes, cranberries, blueberries, grapes, tangerines, oranges), gherkin, canned tomato, tomato sauces and paste, fruit juices, chewing gum, honey, wine, cider, peppermints and liquorice (20).

Alcohol in general has been shown to negatively affect blood coagulation (13), but I know you’ve already forgone alcohol in preparation for your fight, haven’t you? Studies have also shown that fish oil and omega-3 increase blood clotting time (8, 16). So drop the fish oil supplement in the final week and avoid omega-3 rich fish like anchovies, salmon, tuna, mackerel, trout and herring.

Topical Creams and Lotions

It’s not just what you consume that affects how quickly your blood can clot. Vitamin E also slows coagulation, and affects blood clotting even when applied to the skin via creams and lotions – so check the ingredients on the labels. Sensitive individuals have even died from an overdose of over-the-counter sports medicines containing methyl salicylate, which if rubbed onto the skin at high enough doses can act as an anti-clotting agent and may result in serious health related issues (1, 14, 21).

This is where Thai boxers should take note. Namman Muay Thai boxing liniment contains 31% methyl salicylate, and I know we apply that stuff liberally before a fight (4 ,5). It’s recommended not to exceed 40% coverage of the body with a methyl salicylate topical cream or lotion, and to be aware of other medication that may interact negatively, such as NSAIDs (1).

Just be aware of the combination of all the elements within your control that can affect the rate of blood clotting, and try to minimise the combined affect. Coaches should try to ensure they know what fighters have self-administered to avoid negative combinations. Also be aware that female fighters are more likely to use nonpescription pain killers than male fighters (3).

Dehydration

Research shows that dehydration also increases the risk of skin tears ( 11, 18, 19). There are many reasons why fighting dehydrated is a bad idea, from both a performance and health perspective, but also bear in mind that you’ll cut easier too.

Dave Croft, owner and founder of Bradford Thai Boxing has said, “I’ve found that fighters who depleted (water) prior to a fight are more susceptible to cuts/tears than those who did not.” With dehydration of various levels being employed by fighters making weight, it’s vital that complete rehydration is achieved before stepping into the ring.

Bleed Stoppers

Vitamin K plays a major role in blood clotting, and is used to reverse the effects of blood-thinning medications (10, 15). Vitamin K is found in leafy green vegetables, broccoli and brussels sprouts, kale, spinach, lettuce, asparagus, celery, leeks, cauliflower and cucumbers. Calcium is also important in forming a blood clot (2, 12). Eggs and dairy products such as milk, cheese and yoghurt are rich sources of calcium and can help reduce bleeding. Both Calcium and vitamin K must be present in the blood to support the coagulation process, if you lack either of these nutrients then clotting will take longer than normal.

Rounding Up

Muay Thai is a full-contact activity that routinely results in both external and internal bleeding of various degrees, and exposure to blood-thinning substances should be minimised. Fighters that bruise readily in training, or suffer regular nose bleeds would also benefit from the advice in this article.

With the exception of anti-inflammatory medicines, all the other factors discussed in this article slowly affect the body’s coagulation/anti-coagulation balance over a period of time – weeks rather than days. So don’t panic, just be aware of how you my inadvertently build up and combine these various elements in the week or two before the fight.

At the vary least, coaches should educate fighters regarding rehydration and which NSAIDs to avoid, remain vigilant to self administered nonprescription medicines and be careful of the amount of Namman Muay Thai liniment applied to each fighter. With a better understanding, you can better influence your rate of bleeding before you even step in the ring.

 REFERENCES

1. Associated Press. Sports cream warnings urged after teen’s death. NBC News. Www.nbcnews.com. June 2007

2. Brass E P, Forman W B, Edwards R V, Lindan O. Fibrin formation: effect of calcium ions. Blood. Oct;52(4), 654-8 1978

3. Brewer C B, Bentley J P, Hallam J S, Woodyard C D, Waddell D E. Use of analgesics for exercise-associated pain: prevalence and predictors of use in recreationally trained college-aged students. J Strength Cond Res 28(1): 74–81, 2014

4. Datapharm. Methyl salicylate/Menthol. NHS Choices: Medicine Guides, www.nhs.uk, 2014

5. Devakam Apothecary Hall, Co, Ltd. Namman Muay Athletes Pain Relieving (menthol, methyl salicylate) Liniment. Daily Med Current Medical Information, 2011

6. Flaherty M L, Tao H, Haverbusch M,et al. Warfarin use leads to larger intracerebral hematomas. Neurology, vol. 71 no. 14, 1084–1089, 2008

7. Gartland S. Malik M H A , Lovell M E. Injury and injury rates in Muay Thai kick boxing. Br J Sports Med; 35: 308–313, 2001

8. Jones B. Fish Oil and Athletic Performance. NSCA’s Performance Training Journal Vol. 11, Iss 6: 11–12, 2012

9. Kaufman D W. Recent patterns of medication use in the ambulatory adult population of the United States: The Slone survey. JAMA 287: 337–344, 2002

10. Kurnik D, Loebstein R, Rabinovitz H, Austerweil N, Halkin H, Almog S. Over-the-counter vitamin K1-containing multivitamin supplements disrupt warfarin anticoagulation in vitamin K1-depleted patients. A prospective, controlled trial. Thromb Haemost; 92(5):1018-24, 2004

11. LeBlanc K, Baranoski S. Skin Tears: State of the Science: Consensus Statements for the Prevention, Prediction, Assessment, and Treatment of Skin Tears. Advances in Skin & Wound Care, vol 24, number 9, 6, 2011

12. Lovelock J E, Porterfield B M, Blood clotting: the function of electrolytes and of calcium. Biochem J. 50(3): 415–420, 1952

13. Mukamal K J, Massaro J M, Ault K A et al. Alcohol Consumption and Platelet Activation and Aggregation Among Women and Men: The Framingham Offspring Study. Alcoholism: Clinical and Experimental Research, 29: 1906–1912, 2005

14. Perez E, Zieve D. Methyl salicylate overdose. Accreditation HealthCare Commission, 2012

15. Rombouts E K, Rosendaal F R, Van Der Meer F J. Daily vitamin K supplementation improves anticoagulant stability. J Thromb Haemost;5(10): 2043-8. Epub 2007 Jul 31

16. Ruxton, CHS, Reed, SC, Simpson, MJA, and Millington, KJ. The health benefits of omega-3 polyunsaturated fatty acids: A review of the evidence. J Hum Nutr Diet 20: 275-285, 2007

17. Saengsirisuwan V, Phadungkij S, Pholpramool C. Renal and liver functions and muscle injuries during training and after competition in Thai boxers. Br J Sports Med. 32, 304-308, 1998

18. Stephen-Haynes J, Carville K. Skin Tears Made Easy. Wounds International, Volume 2, Issue 4, 1, November 2011

19. Sussman G, Golding M. Skin tears: should the emphasis be only their management? Wound Practice and Research, Volume 19 Number 2, 67, June 2011

20. Swain A R, Dutton S P, Truswell A S. Salicylates in Foods. Journal of the American Dietetic Association Vol. 85, No. 8, 1985

21. The Associated Press. Muscle-Pain Reliever Is Blamed for Staten Island Runner’s Death. New York Times, June, 2007

22. Zazryn T R, Finch C F, McCrory P. A 16 year study of injuries to professional kickboxers in the state of Victoria, Australia. Br J Sports Med, 37, 448-451, 2003

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