Combat Athletes & Sports Health

One summer a few years back, I started complaining to my girlfriend about my excessively itchy scalp. After inspecting it and coming to the conclusion that I had a fungal infection of the skin, she dryly commented: “I guess that’s what happens when you roll around with all those sweaty guys on those nasty mats”. (Clearly, she was referring to the different grappling sports I trained in…) Even though I argued that the “nasty mats” at my club were cleaned on a daily basis, it did not chance anything about the fact that Combat Athletes particularly (but not exclusively) grapplers are at a higher risk of contracting skin disease such as ringworm, strep and staph infections or even herpes.

The skin is our bodies’ primary barrier against the outside world. With this fact in mind, it should not be surprising, that the chance of contracting all sorts of infections rises with increased contact with potentially infected individuals. Of course, the likelihood is highest for direct skin to skin contact. That is why both popular literature as well as medical authorities have been identifying the “gladiator epidemics” herpes gladiatorum and tinea gladiatorum (=ringworm) among others. These quickly spreading infections where discovered in wrestlers in teams on any level (high school, college, olympic…). Unlike major traumatic sports injuries, these skin disease are more of an annoyance than an incapacitating factor that keeps athletes from training. And that’s really where the problems all start. Because also unlike traumatic sports injuries, having a skin disease puts your opponents in competition as well as your training partners on your team in danger of contracting the same thing you have. The resulting policies of banning wrestlers from competition if they display signs of infectious skin disease can be devastating on teams, especially if they have multiple athletes infected.

Some facts:

• Prime locations for skin infections are especially exposed areas of the upper body that are most exposed to contact with others (head, neck, arms).
• Even though herpes makes lots of people think “STD”, most cases of Herpes gladiatorum are actually caused by Herpes Simplex Virus Type 1 (HSV1), which is responsible for cold sores as well. Up to one third of athletes in wrestling programs (in the US) have been affected by Herpes gladiatorum.
• Fungus infections (aka Ringworm or Tinea gladiatorum) are actually more common in than Herpes gladiatorum.
• Even though microbes responsible for a host of these skin disease have been isolated on training mats, experts think mats have little to no part in transmission (except plantar warts!). This however should not be an excuse for gym owners to refrain from regularly clean their mats with chlorox or the likes.
• I was mainly talking about wrestlers for two reasons: due to their large numbers and well-organized athletics in schools etc. their health is being more closely monitored than other grappling sports (rugby players are often affected my similar disease as wrestlers are). Gi grapplers may be a little better off as their Gi may offer some protection from skin to skin contact, but the general precautions I will be mentioning below still apply (I have witnessed ringworm outbreaks in gyms that were exclusive to Judo and BJJ).
• It seems obvious, but I’ll say it nonetheless: despite the fact that I did not specifically mention boxing, Muay Thai, no-gi BJJ and all the other combat sports, a significant threat for the above skin infections still exists.

What to do:

• First and foremost, attempting to prevent outbreaks of skin infections is the key. This is best accomplished by not sharing equipment or towels and by sticking to basic hygiene principles (both for your body and your equipment). If there is no way around sharing certain pieces of equipment, investing in a bottle of disinfecting solution and some paper towels to wipe down materials in between uses can go a long ways (make sure to use solutions that evaporate completely so they won’t harm your skin).
• If you notice bumps, blisters, plaques (those look “crusty), reddening, itching or other weird phenomena on your own or a team mates skin, don’t ignore or conceal anything. Go to a doctor to get proper treatment and refrain from direct skin contact with others.
• For practice, it may be acceptable to use athletic tape and additionally clothing to cover up skin infections to protect others. Be diligent about making you’re to keep the athletic tape on, we all know it’s tendency to fall off during intense practices. Covering skin infections is generally not accepted during competitions.

Sources:

Adams B. Dermatologic Disorders of the Athlete. Journal of Sports Medicine 2002; 32:309-321.

King O. Infectious Disease and Boxing. Journal of Clinical Sports Medicine 2009; 28:545-560.

Kohl T, Lisney M. Tinea Gladiatorum: Wrestling’s Emerging Foe. Journal of Sports Medicine 2000; 29:439-447.

Minnesota Department of Health

Credit:

Image taken from Austin Community College Website.