Global Training Report
or Not to Punch
By Roberto Pedreira
"Teeth often make an involuntary
inoculation of bacteria into skin during fist fights. The hero’s
decisive punch can then bring him knuckle sepsis as well as victory” (The Pathogenesis of Infectious Disease
by C.A. Mims, 3rd ed.,
Academic Press, 1987, p. 12.
Everyone understands that the
power of a punch comes from a combination of mass and motion, rather
than the rigidity of the striking implement (although that can certainly
affect the sort of trauma inflicted). This is basic physics and most
martial arts are based on physics (1).
Sometimes though, you just want
to close your fist and smash someone's face(2).
It feels so much more satisfying. But if you succumb to this temptation,
you will probably regret it. The brain is a jelly-like
substance. That's why the skull is hard. Because the skull is hard,
punches are usually aimed at the softer spots on the face. If you hit
the chin on the button, most opponents will drop. But the button is a
small spot and people who are being attacked frequently try to get out
of the way. Chances of actually hitting that precise target and at just
the right angle, are not high, unless you are a very good boxer (in
which case, you wouldn't risk injuring a hand would you?)
It is reasonably probable that
if more than a few bombs are dropped, one is going to land on your
opponent's teeth. That isn't going to be fun for him. But it could be
fatal for you.
The bacterial population of the
average human mouth is roughly 1-10 million organisms per milliliter of
fluid or gram of scrapings. It is among the "buggiest" parts
of the body (More precisely, the mouth is composed of various
micro-environments, each supporting a different mix of microorganisms.)
Most are strict anaerobes, meaning they flourish inside tissue (rather
than on the surface). Broken teeth are sharp. The skin over the metacarpophalangeal
joints (the knuckles) is thin.
All the liquids of the body contain anti-microbial defense factors,
especially blood, but the blood supply to the hand is poor, because the
fingers are operated by a system of cords (tendons and ligaments)
attached to muscles in the forearm, that move them by contracting.
(Unlike muscles, tendons and ligaments are cartilage and do not require
much oxygen, which is also why they heal slowly).
Most common pathogens found in
clenched fist injuries are exactly the same ones that are found in the
human mouth: Viridians streptococci, S. aureus, Bacteroides sp.
Fusobacterium sp., peptostreptoccoci. Eikenella corrodens. Teeth tend to inject the organisms into joint capsules and bone. Once they
are in, they are very hard to get at to kill or contain with
antibiotics. If the entire bone becomes infected, the treatment can be
unpleasant indeed, including removal of part or all of the appendage. The good news is you aren't going to
die. The bad news is you might not have two hands anymore. And
unfortunately, wounds of the hand and foot are more likely to become
infected due to many tendon sheaths, fascial planes and compartments
that promote persistence and spread of the microorganisms which can
come not only from your victim's mouth, but from the surface of your own
skin as well.
A wound left untreated for
three hours has a potential bacterial proliferation of more than
1,000,000 organisms/gram of tissue. Presence of even large numbers of
organisms (up to 100,000 per gram of tissue) doesn't necessarily mean
there is an infection, but in the case of high risk sites like the
hand, joints, and bones, the potential complications are so
serious (extensive tissue destruction and gangrene) that if bites and
contamination with saliva are involved, most doctors will advise a 3-7
day prophylactic course of antibiotics whether there is clinical
evidence of infection or not.
If you have erythema
(redness), pain or tenderness, swelling, heat, and pus, then you have an
infection. That means there are a lot of microorganisms where they
normally wouldn't be and shouldn't be. They will continue to double
approximately once every 20-120 minutes, limited only by physical space
and nutrient supply. You are eventually going to wish you hadn't punched
that guy after all. Your body will fight back. Fever is an attempt to
create a temperature that inhibits the growth of the bugs. But it also
causes tissue and organ damage and if high enough long enough can
scramble your brain cells. You will also feel "unwell" and won't want
to eat. That isn't good because you'll be consuming 13 % more energy for
every 1 % increase in body temperature. When you are malnourished, your
immune system can't produce adequate numbers of T Lymphocytes, which
increases your risk of infection and the severity of the infection when
Obviously, all the
time you are laid up in bed, you won't be in the academy training.
There are several
other outstanding reasons for not punching someone with your closed
fist. One is the high probability of breaking one or more of the 27
bones (all small) in each hand. For the same reason bacteria are hard
for your immune system to get to, the bones heal slowly--poor blood
The human hand is a marvel of
natural design and served its evolutionary purpose by way of the
survival possibilities opened up by precise manipulation of objects
rather than as a substitute for a blunt force weapon. Here is an outline
of the anatomy of the human hand.4
Another reason that will be obvious to
any grappler is that with an open hand you can do much more to control
A final reason, but no less important than the
others, is that in western cultures that are under the sway of linear
logic, a closed fist is perceived as threatening, as a prelude to
aggression (whereas in some other cultures, it is used to signal
emotional involvement and commitment.) Try this experiment for yourself.
Simply walk around and do what you normally do, but do it with your fist
closed. Notice the reactions you get. People will give you a bit more
space, and your girlfriend and mom will look at you funny and ask you
what you are angry about. Why does this matter? (5)
If for some reason you get involved in the American criminal justice
system you will find out fast.
Gates, Robert H.: Infectious
Disease Secrets. Philadelphia, Pa: Hanley & Belfus. 1998.
Harvey A. McGehee, Johns, Richard J.,
McKusik, Victor A., Owens, Albert H., and Ross, Richard S.:The
Principles and Practice of Medicine (22nd ed.). Norwalk, Conn:
Appleton & Lange. 1988.
Hoppenfield, Stanley.: Physical
Examination of the Spine and Extremities. Norwalk,
Connecticut: Appleton & Lange. 1976.
Mims, C.A.:The Pathogenesis of
Infectious Disease. (3rd ed.). Academic Press, 1987.
Schlessinger David Mechanisms of Microbial
Disease. Baltimore: Williams &
Tortora, Gerard J.: Principles of
Human Anatomy (5th ed.). New York: Harper & Row. 1989.
(c) 2001, Roberto
Pedreira. All rights reserved.
Revised November 25,
Revised January 1,
Updated January 7,
Updated October 14,
1. Most, but
not all: some are based on gullibility and wishful thinking.
2. Full Instructor
(and shooto fighter/stuntman/actor) Chad
Stahelski made this comment once during an afternoon class at the
Inosanto Academy, circa 1994. Chad has since leaped to Hollywood
success as one of the masterminds (writer/director/etc.) behind one or
more of the John Wick movies. Roberto hasn't seen any of the
series and doesn't plan to. Nothing against Keanu Reeves but really,
come on. Instead, keeping it real, he recommends Enter
the Dragon and The Chinese Connection.
According to a 2007 review, "simple lacerations of the hand"
(not involving nerves, tendons, bones, or large blood vessels) seem not
to benefit significantly from antibiotics in the absence of manifest
It is assumed however that basic wound care management has taken place,
which ideally means a visit to a clinic or ER. The crucial distinction
is whether the superficial wound has become infected or not. For open
fractures, prophylactic antibiotics is still recommended (http://www.thennt.com/nnt/antibiotics-for-open-fractures/).
4. Outline of
the Anatomy of the Human Hand
Muscles that move wrist, hand, and
Flexor carpi radialis
Flexor carpi ulnaris
Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus
(extensors and supinators)
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digiti minimi
Extensor carpi ulnaris
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Bones of hand
Hand = carpals (8), metacarpals (5),
and phalanges (14)
Proximal = (from lateral to
medial) scaphoid, lunate, triquetral, pisiform
Distal = trapezium, trapezoid,
Heads of the metacarpals are the
27 muscles in hand and fingers (8 of
them in thumb). Innervated by median, radial, and ulnar nerves.
6 dorsal tunnels transport extensor
2 palmar tunnels transport flexor
tendons and arteries, nerves, and veins
5. In most jurisdictions,
simple assault is a crime. Assault is merely an attempt to inflict
injury. The attempt does not have to be successful (in any case, the
definition of injury is not precise and will have to be decided by legal
professionals--for which service you will pay in time, money, and
stress). Raising a closed fist in many jurisdictions can be regarded for
legal purposes as an assault--an "offer" to inflict injury, as
it were. This can be enough to get you arrested, spend time in custody, have to engage a lawyer, and spend time in court. You don't have
to actually hit or hurt anyone for this to happen. Being embroiled in
the legal process itself is the punishment. Now, if you punch someone,
and manage to "inflict injury" (which can be almost anything
and can happen accidentally as a consequence of your punch), you will
have additional problems.