I am Dr Chris raynor, orthopedic surgeon and Today I’m reacting to 5 Professional Wrestling
Injuries that happened last year.
Professional wrestling is known for its theatrical and super high energy matches. Wrestlers are
constantly upping the anti as they attempt to elicit a reaction from excited audience
members. As a result, many of the moves they attempt are reckless and incredibly dangerous
if performed incorrectly. These dedicated performers are usually in extremely good shape,
and have practiced their moves over and over again to minimize the danger involved. But
performing such physically demanding tasks, while relying on precision timing with another
performer, leaves room for error. And in professional wrestling, a simple error can definitely lead
to serious injury.
Today’s intro clip was from a “Symphony of Destruction” match between Jeff Hardy
and Elias. Jeff stacks a full string section on top of Elias before performing his signature
Swanton Bomb off the top rope. Unfortunately, there is insufficient space between the table
where Elias is laying, and the metal steps at the corner of the ring. Jeff either doesn’t
notice the lack of space or is too invested in the performance to make the necessary adjustment,
and leaps into the air. As he lands, the table collapses and the back of his head collides
with the edge of the steel stair.
What could have happened? Hardy was remarkably lucky with this injury. As he fell backward
he struck his head directly onto the corner of the stair. While he was not seriously injured,
the potential for serious injury was quite high. The manner in which he struck his head
could have resulted in injury to either the head itself or to Hardy’s neck. The back
of the head impacted the step at the occiput, or the most posterior aspect of the skull.
This is a triangular shaped bone at the back of the skull with large ridges where muscles
attach. Although these features might make it resistant to impact, the sharp corner of
the stair would serve to focus the force at the point of impact, making it more likely
to cause a skull fracture posteriorly. If the force of the impact were not sufficient
to fracture the skull, it would certainly be enough to cause a closed head injury. If
mild, this would be simply a concussion, but if it were more severe, this would be an intra-cranial
bleed of some type. While some of these might resolve spontaneously without treatment, more
serious bleeds might require surgical decompression to prevent permanent injury or even death.
With the impact of the back of the head on the stair, Hardy’s neck would be forced
into flexion. This too could result in significant injury, this time, of the cervical spine.
Injuries that might result from forced forward flexion of the cervical spine could include
flexion tear drop fractures, wedge compression fractures, clay shoveler fractures, unilateral
and bilateral facet dislocations, and atlantoaxial dislocations. Any one of these injuries could
result in injury to the spinal cord and possibly even paralysis. If these injuries occurred
above the level of the C3 vertebrae, they could even result in death as a result of
disruption of the innervation to the diaphragm. Fortunately for Hardy, it was more his ego
that was injured than anything else. He was fortunate to escape with merely a cervical
muscle strain caused by the forced cervical flexion rather than quadriplegia or even something
worse.
In this second clip, Chelsea Green is booted off the side of the ring by Liv Morgan. Watch
wrestling for a few matches and you’ll know this type of attack is relatively common to
the sport. But even common exchanges such as this carry the risk of injury. Though it
is difficult to see, Chelsea Green breaks her left wrist on impact with the floor.
Green strikes the floor with her hand at her side. Although it is difficult to see, judging
by the manner in which she fell to the ground, we can anticipate that she fell with her hand
in an outstretched position, a mechanism commonly referred to as a FOOSH. This is a very common
mechanism for wrist fractures. This mechanism typically results in a fracture of the bones
of the forearm at, or near the wrist joint. As a result of forces imparted by the impact,
the fracture fragments are forced upward relative to the shaft of the forearm. This is called
dorsal displacement and it results in a deformity known as a dinnerfork deformity, as a result
of its similarity in appearance to a dinnerfork.
As a result of the way in which they develop, bones are quite resistant to compression,
a force in line with the shaft of the bone. However, they are not very resistant to rotation,
and only marginally better when bent. The FOOSH mechanism subjects the bones of the
forearm to a bending force near the level of the joint. Given that the radius takes
60% of the force that is transmitted through the wrist, it is primarily the radius that
is injured. If the force of impact is significant, then both the radius and ulna are fractured,
at times with significant displacement.
Most distal radius fractures are closed with the bones of the forearm remaining contained
within the soft tissue envelope of forearm muscles. However, on occasion, either the
impact is so energetic, or the degree of displacement is so severe that the bones pierce the skin
from the inside, and become exposed through the skin to the environment outside the body,
an open fracture. Fortunately for Green, this appears to have been a closed fracture of
the wrist. If dislpaced but stable, this could be treated with a closed reduction and cast
immobilization. However, if it was unstable, appropriate treatment would involve open reduction
and internal fixation of the fracture with contoured titanium plates and screws.
This next one is pretty scary for a moment… Johnny Gargano is slammed to the mat by his
opponent Ridge Holland. He lands awkwardly on his head, neck and shoulder and his body
crumples awkwardly under the momentum. Johnny, the ringside team, referee and announcer seem
concerned and the match slows momentarily. Off camera, the match was actually paused
until Johnny was cleared to continue by medical personnel.
Fortunately, Gargano was not seriously injured by this slam. But what could have happened
had he not been so lucky. Holland slammed Gargano in such a way that Gargano landed
awkwardly onto his head. NOrmally, a wrestler would be slammed onto his or her back with
the back taking the brunt of the impact and the head and neck avoiding injury. However,
here Holland under-rotated his opponent in the air so that rather than landing on his
back, he landed on the top of his head with his neck bent forward and to the side. This
type of impact would cause the cervical spine to be forced into combined forward and lateral
flexion. When combined with axial loading of the cervical spine, bad things can happen.
Let me explain.
The cervical spine is designed to support the weight of the head and with each of the
cervical discs able to absorb some compression, is able to tolerate some degree of axial loading
over and above that of the weight of the head itself. However, this does not mean the weight
of the head AND the full weight of a grown man as well. Axial loading of the cervical
spine with the full weight of a grown man could result in injury to cervical discs,
cervical vertebrae, and if severe even the spinal cord itself. Possible injuries could
include disc herniations or protrusions, and compression fractures or endplate fractures
of the cervical vertebrae. If forward flexion and or lateral flexion are added to the axial
loading, then even more serious injuries may result. With these additional forces further
injuries such as burst fractures, rare chance fractures, unilateral or bilateral facet dislocations,
Atlanto-occipital dislocations, occipital condyle fractures, or other serious cervical
spine injuries might occur. All of these injuries would result in structural instability of
the spine and potentially could result in neurological instability or injury of the
spinal cord as well. With an injury of the spinal cord at the level of the cervical spine,
we could expect some type of paralysis to occur. This would typically be a quadriplegia
where all four limbs are affected. Furthermore, if the injury occurred above the level of
the 3rd, 4th, or 5th cervical vertebrae motor control of the diaphragm, and hence control
of breathing might also be affected. And in case you were wondering, this is a really
bad thing and can make survival after this injury really, really challenging. Suffice
it to say that Gargano did not suffer any of these injuries, as after medical assessment,
he was able to return to complete the match.
Given the mechanism of injury, it is likely that he suffered only a cervical spine sprain,
where the ligaments of the cervical spine were stretched. Pain and stiffness, but fortunately
no no mechanical or neurological instability.
One could argue that the danger involved in professional wrestling is multiplied whenever
weapons and props are introduced into a match. Steel ladders are a WWE favourite, as they
quite literally take a match to new heights. While reaching for the belt in the centre
of the ring, Jimmy Uso’s ladder is kicked from beneath him by John Morrison. The fall
is only about 4 to 5 feet, but the falling ladder contributes to Jimmy’s horizontal
momentum and causes him to land awkwardly.
Jimmy grabs his knee immediately realizing that something is wrong. It was later revealed
that Jimmy tore his ACL in the sideways landing.
The ACL is one of the main four ligaments in the knee. There are two collateral ligaments
on the outside of the knee, and two cruciate ligaments that cross in the middle of the
knee, of which the ACL is one. The posterior cruciate ligament travels diagonally behind
the ACL between the femur and the tibia, and it stops the femur from falling off the front
of the tibia. The anterior cruciate ligament travels diagonally in the opposite direction
in front of the PCL between the femur and tibia, and it stops the femur from falling
off the back of the tibia. The ACL’s primary role is to control translation front to back.
However, because it connects the femur and the tibia tangentially, it also plays a role
in controlling rotation at the knee as well.
When USO fell from the ladder, he was falling off balance to his left hand side. When he
landed on the canvas, most of his weight was moving to the left away from the point of
contact of his left leg. However, his leg collapsed inward at the knee at the same time.
The moment that the knee falls inward while the weight is falling to the inside, a rotational
force is introduced at the knee. This mechanism is known as a valgus collapse or a dynamic
valgus of the knee. This is the primary non-contact mechanism of injury to the ACL.
USO grabs his left knee as soon as he lands on the canvas. This reaction combined with
the mechanism of injury suggests that an injury to the ACL is likely. Of course, other injuries
such as a meniscal tear or a fracture within the knee are possible, but it is likely that
the ACL is the main injury. Meniscal tears often occur in combination with the ACL tear
as a result of the combined axial load to the leg and the rotation of the knee. USO’s
injury may have included a meniscal tear, whose presence or absence would be confirmed
by MRI and clinical exam. His injury may also have included a fracture of the distal femur,
the proximal tibia, or both. Given the fact that he was able to ambulate and finish the
match afterward, it is clear that had a fracture occurred it was relatively minor in nature,
and did not preclude weightbearing. This finding would eliminate an unstable tibial plateau
fracture from the list of potential injuries. However, more subtle fractures such as subchondral
compression fractures of the femoral condyle or the tibial plateau might have occurred.
In fact, it is common for injuries to the ACL, the meniscus, and the lateral tibial
plateau to occur in combination.
Talk about the fall & ACL tear
Although he knew he was hurt, Jimmy did not recognize the extent of his injury or the
possible repercussions of wrestling on it further. He stated in an interview that he
had never really had a serious injury before and he was resistant to stopping the match
because of one. He wrestled for another 17 minutes before the bell rang to signal the
end of the triple threat ladder match that – needless to say – involved a fair amount
of jumping. It wasn’t until two days after the performance that he was diagnosed with
a completely torn ACL.
Regardless, it is commendable that USO was able to complete the match on his
injured leg. No doubt this was hella uncomfortable and unstable AF with his wonky knee. Without
an intact ACL, any lateral movement or direction change would be questionable as a result of
the resulting instability.
Normally, one would not be able to continue with vigourous activity after this type of
injury because of pain and instability, but in the event that you were able to continue,
there is ongoing risk of further injury. With ligamentous instability of the knee, any directional
change would allow abnormal movement of the joint surfaces relative to one another. This
could result in injury to other structures of the knee which could include the menisci,
the PCL, the collateral ligaments, or capsular ligaments of the knee. So generally, it is
a good idea to stop activity after you have injured your knee. Continuing activity that
involves jumping, pivoting, or direction change after this type of injury substantially increases
the risk of further injury to the knee to any of the structures previously listed. Fortunately
this was not the case.
Talk about the danger of late diagnosis + finishing the match
Subsequent exam confirmed his injury diagnosis and successful return to wrestling will require
either provisional stabilization with a rigid ligament brace or a surgical reconstruction
of the anterior cruciate ligament. If USO goes the surgical route, it will be approximately
one year before we see him grace the wrestling ring competitively again.
Ladders and other props are not the only thing that can exacerbate the risk of injury in
the WWE universe. Sometimes a pre-existing injury puts a wrestler in increased danger.
Earlier in his career, The Edge suffered a neck injury for which he would undergo surgery.
He would go on to wrestle for another 8 years before being diagnosed with cervical spinal
stenosis, and forced into early retirement.
Cervical stenosis is a condition where the space available for the spinal cord within
the spinal canal is reduced due to intrusion of some structure into the canal. This can
be a result of disc protrusion or herniation, hypertrophic bone due to osteoarthritis, or
normal bone that is displaced by spondylotic changes as the vertebrae degenerate with age.
These intrusions cause the canal to narrow and can place pressure on the spinal cord
itself or its exiting nerve roots. The spinal cord is an extension of your brain, outside
of your skull, down your back, and into your extremities. As you can imagine, your brain
does not like to be touched, and the spine is no different. Think of it as a long telephone
cable made out of jello, that contains millions of individual phone lines. If you squish the
phone cable, individual lines within the cable might have their service altered, delayed,
or even disrupted altogether. The same is true with spinal stenosis. Pressure on the
neural elements causes disruptions in the signals travelling down, and up, the spinal
cord and the various nerve roots. The consequence is altered sensation, motor function, or pain
in the distributions or areas supplied by the involved nerves. The greater the pressure
on the neural elements, the worse the dysfunction that occurs. This is not so good when your
day to day employment involves running, jumping, body slamming opponents, and being tossed
around the ring like a sack of potatoes.
Although there are a number of non-operative treatments for this problem, eventually for
some, the compression of neural elements becomes so great that surgery becomes necessary. Surgery
generally involves surgical decompression of the area where the spinal cord or nerves
are compressed. Usually, the decompression involves the removal of some of the bone in
the affected area which leads to instability of the involved segment. Talk about making
a bad thing worse. However, that is why usually the decompression is then paired with a subsequent
stabilization procedure where the unstable spinal segments are fused together to restore
structural stability. This does limit the degree of movement that can occur at that
segment, but it stabilizes the unstable area, and eliminates the compression of the neural
elements in that area. Read stiff neck, but no pain. Everything has a price.
When he retired he underwent another surgery, where doctors put 3 plates in his neck and
told him he would never wrestle again. This was in 2012… Flash forward to 2021. For
a detailed review of what procedures were performed, check out my video that covers
how Edge returned to wrestling after his extended layoff.
These are not the moves of a man who will “never wrestle again”. It took him many
years to recover from previous injuries but, for most of this match versus Seth Rollins
in September, 2021, The Edge looks to be in pretty good shape. At the end of the match,
the villainous Rollins aims for The Edge’s weak spot, administering a stomp to his neck.
The attack leaves The Edge nearly incapacitated and he is wheeled out of the arena by medical
personnel. The absence of a specific injury report following the match has led to speculation
that the injury was a story element planned to intensify the rivalry between The Edge
and Seth Rollins. Given his medical history, this could very well be a real injury… But
by the same token, it could be a well formulated plot twist designed to increase tension and
give The Edge some time off. For the sake of this video, let’s imagine that this injury
is real…
Given the pre-existing spinal stenosis and the surgeries that he has undergone, his neck
would be more stiff and less compliant when struck. This would in turn make Edge less
resilient to neck injury. Looking at the manner in which Seth delivered this attack, there
are two opportunities for injury, both causing the same forces to be applied to the neck:
first, when seth steps aggressively on the back of Edge's neck forcing him to the mat;
and second, when edge faceplants against the mat. Both moments would result in a sudden
change of direction of the cervical spine. Normally, this would be a problem for the
cervical spine, but after surgery this is much worse. The fused cervical segments are
stiff and rigid which is what protects the neural structures against compression. However,
the rigid segments are bounded by mobile segments above and below. This means that forces that
are applied to the cervical spine become concentrated and magnified in these transition zones leaving
them susceptible to more rapid degeneration and further injury from shear forces, or the
forces when two adjacent structures slide past one another. Neither of these scenarios
is good, and in an acute setting, could result if catastrophic cervical spine injury.
You know, like paralysis or even death. Yep….death. Talk about high stakes.
The visceral excitement that wrestling is able to draw out of it’s fans, is not achieved
without considerable risk on behalf of the wrestlers performing the feats. I hope I was
able to shed some light on the risks involved for those brave enough to step into the ring,
and I hope you learned something new about the incredibly fascinating human body. As
always, this has been a word from Dr. chris, not your everyday ortho.