AISTS MEDICINE PODCAST #65
How did Ma Long recover from a knee injury and become the world table tennis champion?
In 2018, the World Table Tennis Federation introduced a new ranking that drove top players to participate in even more events. Ma Long is considered a victim of this change. He was diagnosed with severe medial collateral ligament (MCL) injury shortly after its launch.
Learn how Ma Long managed to recover from the injury and win the world championship again the following year. And what PRICE means in this context.
This AISTS Sport Medicine podcast is created by AISTS Class of 2019 Myungwon LEE and Min JUNG under the supervision of Professor Boris Gojavonic, MD.
Min: Hello everyone! My name is Min, and today, we are going to discuss on Ma Long’s left knee injury case in table tennis especially on what type of injury he had, how he recovered and returned to win the 2019 world table tennis championships in Hungary in April. Partnering with me on a panel today is Mr. Myungwon Lee.
Myungwon: Thank you Min and hello all! Moving right into the topic, we encountered a severe chronic injury case with Ma Long, the top ranker and a star player in the world of table tennis today, due to, in correlation with, the intention to force athletes to participate in a lot of tournaments based on a new world ranking system in place at the International Table Tennis Federation, or in short, the ITTF, since January 1st 2018. What is this new ranking system and why is it so striking that causes an athlete’s injury like Ma Long?
Min: The main objective for the announcement of this new system is to simply create more media engagement opportunities for the ITTF. The top rankers are then put into a position where they are forced to participate in most of all levels of competitions out there in order to earn accumulated points that affects their rankings during the entire year, instead of choosing which competition they wished to participate in which was the case in the past before the new ranking system.
Ma Long, the Olympic and world champion of table tennis, became a victim and had to endure a severe left knee injury he had since the 2016 season.
Myungwon: So Ma Long had a Medial Collateral Ligament or MCL injury. The MCL is a flat ligament on the inside called medial of the knee that connects the lower leg bone called tibia to thigh bone called the femur. This MCL injury is known to be a common injury for all types of athletes but more exposed to contact sport like football. It could be as short as weeks and as long as months but usually up to 4 months. But according to scientific research by Ebadi and Gunay in their analyzing the types of injuries observed in table tennis, the “constant knee flexion” of “musculoskeletal injuries are common” (Ebady & Gunay, 2018). How could, then, a non-contact sport like table tennis get this long-term injury as 8 months?
Min: Yes, it is true that a non-contact sport like table tennis causing MCL injury is “atypical”. But we need to point out that he started table tennis since 5 and entered competitive table tennis at 15. We also know, there are 2 types of injury classifications, which are acute and chronic. With Ma Long as a living evidence case, this long-term injury is possible due to an “overuse” and repetitions of sudden twist movements of the knee, leg and foot over the years. The stress and fatigue on the knee for Ma Long was tremendous which fell under the chronic injury.
Myungwon: To add, according to Kondric 2008’s research, points out the issue of “abrupt assymetrical” twist and “excessive rotational torques” all accumulates to the players’ “overuse” of the knee (Kondric et al., 2008). Ma Long is known for this table tennis signiture technique move called “forehand looping drive” which requires a raging movement from one side to the other, a careful training is required in order to increase flexibility in the movement and hopefully reduce the chance for any foot or knee twisting injury. Ma Long, a right hander, stores the energy from right half of the body and then exerts in a very quick motion with full energy release with a twist of the waist, and foot turning outwards putting tons of pressure in such a short period of time, on his knee facing and turning to left side of the table.
Min: Based on Ma Long’s record, he had more than 930 matches including both singles and doubles matches he competed since his 2001 debut. The number probably increased more significantly in 2018 due to the new ranking system. No wonder why his inside left knee MCL had worn out.
Myungwon: Definitely. The gradual stretch of the MCL from the inside of the knee eventually ended Ma Long’s season completely in 2018. Having forced himself to participate even more competitions with the injury in order to keep his number one ranking streak in the world, the injury was unstoppable.
Min: However, that did not stop Ma Long’s career. From coaches, family, athletes to medical staff, they were all well integrated as one team to support each other for Ma Long’s rehabilitation. While his former coach announced his knee injury as more severe than it first looked, it did not require a surgery.
Myungwon: Correct. Usually, MCL injuries are non-surgical treatable and so was for Ma Long, it was a wise decision from the entire squad to miss out the rest of 2018 season and did what is best for the MCL injury, to rest without moving and ice, with the help of medical rehabilitation and fitness training that strengthens his leg muscle and knee flexibility.
Min: From his defeat and exit on August 2018, he sat out until March 2019. That is almost 8 months. According to Professor Torbjørn Soligard from IOC, this repeated cycle and inadequate recovery of knee injury could be associated with other pain such as patellofemoral pain on the front kneecap. For Ma Long, he had to stop from other economic activities in order to regain his long-term glory and waited until his full recovery along with proper leg and mental training. No one was sure at the time when and how well he would recover at which level. However, we see he is now even stronger than ever as a competitor, with strengthened and conditioned muscle support around a knee, returning in a heroic fashion to win it all at the World Championships this year.
So what can we learn from Ma Long’s case?
Myungwon: So, while this injury is not imminent at first, it could cause chronic injuries such as Ma Long’s left knee MCL injury. It might not be easy to prevent but can prolong as long as a player runs proper training program with correct skills of foot positioning for better knee twist flexibility.
So the lesson is, like Ma Long, when there is a hint of an injury, be sure to remember P.R.I.C.E., or PRICE, as kinesiologists promote. Protect, rest, ice, compress and elevate your knee. Consult with a team how far you can push and play.
Last but not least, some of the strengthening exercises that Ma Long used include – “short-arc extensions” which you sit or lie down, put a rolled-up towel underneath your leg to support and help keep your leg up in the air for couple of seconds. Another one is “stationary bicycling” as Ma Long regularly did with low tension setting of the bike with a seat high enough so the leg is straight down the stroke with less stress on the knee.
So that is all for today. Thank you Min and everyone who joined our podcast today!
Min: Thank you!
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