“Years of rigorous athletic training have enabled the Batman not only to resist but to recover from the brutal beating that would have mortally injured most men!”

Comment in “Professor Strange’s fear dust” from Detective Comics #46, December 1940

“Wayne swaps the brace to his bad knee. Puts his weight on it—the knee bends, kicks. He sits again. Cautious…Wayne gingerly pushes a button—the brace starts to shrink tight to his leg, digging in. Wayne grits his teeth.”

From the screenplay for the 2012 film “The Dark Knight Rises”

I have been on a bit of a mission to popularize science by using pop culture icons. Mainly, I’ve used superheroes as metaphors for human abilities and limitations. In honor of “The Dark Knight Rises—the capstone to director Christopher Nolan’s Batman trilogy—the post considers the accumulation of bodily (so-called musculoskeletal) injuries in the career of the Caped Crusader. And what it means for all of us mere humans.

OK. Let’s start with the elephant in the room. Here’s the thing—being Batman is hard on the body. And contrary to the quote above from Detective Comics in 1940, years of rigorous athletic training may actually set Batman up for additional injuries!

Every time we do anything our muscles, bones, skin and other tissues experience mechanical stress (note that this has a slightly different meaning than physiological stress that comes up later) and mechanical strain. The biological tissues that make up our bodies are just like lots of other materials. With extended use they can weaken. And it all accumulates over time.

But human bodies are in a flux of rebuilding and repairing. Batman is constantly straining his body from all his training and fighting. He is also constantly getting really pummeled by the worst of his Rogue’s Gallery.

Sprains, strains and Batmobiles…

What can a real human body take before injury occurs and how long does it take to recover? These are questions that were front and center in my book “Becoming Batman: The Possibility of a Superhero”. They were also central to the way Batman is shown in “The Dark Knight Rises”, and really across all 3 of the recent movies.

And the injuries don’t have to be huge “major injuries”. Small loads repeated many times can yield injuries too. Enter “repetitive strain injury” and the concept of “microfailure”. I’ve tried to show this in the Figure.

The basic point of this figure is that very large loading events—getting crushed in Bane’s powerful arms—need only occur once to cause significant injury. Other events—repeated impacts during fighting or even the strain of training—accumulate over time so that after many repetitions an injury occurs.

Tissues that are being strained—particularly those with poor blood supplies like tendon, ligament, and cartilage—are not able to fully repair themselves before another big event. Like getting bashed around. Or even just training over and over can create repetitive strain injuries. Injury can happen anywhere on that continuum.

Muscle and bone are biological tissues that have mechanical properties that help explain some of the weird things that seem to happen to us when we are injured. In mechanical terms “stress” means forces applied to a material while “strain” means the change in length or size of the tissue to which the force is applied. Basically repeated stresses lead to strains.

If we measured the relationship between stress and strain of the bones of Batman’s body—basically any rib or vertebrae—during the “back breaking” scene in The Dark Knight Rises, we’d discover his bones would break once Bane got to a high stress which produced too much strain. This is where you would have an obvious injury of a broken bone. This means Batman only suffered a severe strain, but it was still very painful, and I don’t think Bruce Wayne would be cheered up too much by this technicality.

For somebody as busy as Batman some injuries may never recover fully. That is shown clearly in the Dark Knight Rises where Bruce has difficulty walking and uses a cane. And culminated in the scene with the knee brace described in the lead quote to this post.

Occupational hazards on the Dark Knight shift…

In the 1983 story “The autobiography of Bruce Wayne” from the Brave and the Bold #197, Catwoman has a stunned look on her face while Batman`s getting some medical treatment. She stares at his back and says “…it’s just…all this…scar tissue on your back…” The Dark Knight quips “Occupational hazard. Fifteen years of fighting will do that to a person”.

How can we get a handle on the kind of “on the job” or “occupational” injuries Batman might receive? We can get an idea by thinking of other activities that could be considered similar to the main physical demands of Batman while on the job.

Two examples of real life (and extreme) activities that include routine exposure to much of the physical demands Batman might experience in his fights are NFL football players and “ultimate fighting”. So what kinds of musculoskeletal injuries can you expect when your job shares the demands of a football playing, mixed martial artist?

In several recent medical surveys of mixed martial arts competitions, about 27% of matches were stopped because of head impact, 16% because of “musculoskeletal stress”, 13% because of neck choke, and 12% due to miscellaneous trauma. So, about 2/3 of the time significant trauma was experienced. Overall injury rate is about 29%. This is higher than that seen for boxing which is around 17%. Even in controlled realistic fighting, injuries are a serious concern. For Batman, it would be even more of an issue as there are no rules on the rooftops of Gotham City.

It’s hard to gauge the long-term effects of being exposed to these harsh occupations. Looking at NFL players provides another way to get at long term effects. In fact I used the very short average career—3-5 years—of NFL players as a way to estimate Batman’s longevity in Becoming Batman.

Skilled writer Peter King provided an in-depth expose on football players in the Dec 12, 2011 issue of Sports Illustrated. This piece was a follow up look at 39 members of the 1986 Cincinnati Bengals—25 years later—and spanned all forms of injury. But it’s the bodily injuries I want to focus on.

In the category of “residual injury” over 70% had at least one surgery during their careers with ~40% having a post-NFL surgery for an injury related to football. Thirty percent had an upcoming surgery. More than 90% of the players said that they had lingering issues arising from an injury derived from their NFL careers.

Probably the most telling “statistic” is that on average these players reported 3 parts of the body that experienced pain each day. That’s a lot of injuries and a lot of discomfort.

Too much is…too much

Living organisms—from bats to Bat-men and beyond—respond to physiological stress in a way that minimizes the effect of the stress. This minimizes the overall effect on the body. It maintains homeostatic balance. If the stress is too large or too frequent, it won’t be possible to adapt and there will be a steady (and sometimes rapid) decline.

The overtraining effect is related to this problem of “homeostasis”—or balance in the body. This is what athletes experience when they say they are “burnt out” leading up to major events like the Olympics. Hopefully they feel burnt out after their events, not before. But it doesn’t always work out like that. Mistakes in the timing of training and pre-event planning can sometimes result in being in a state of overtraining prior to the event.

When challenges to homeostasis cannot be met or are sustained for too long, biological organisms decline, and can die. This is what I’ve shown in the Figure below.

For sure the most dangerous foe that Batman has ever faced off against is Bane. In Scott Beatty’s awesome book “The Ultimate Guide to the Dark Knight”, Bane is listed as 6’ 8” tall and weighing 350 lb, official occupation “professional criminal”. Bane was born into a military prison and underwent experiments involving brain injections of a special chemical “venom”. The venom was supposed to create unstoppable super soldiers. The upshot is that Bane is not really a very nice person.

There’s an interesting thing about Bane’s strategy in the 1993 story “The Broken Bat” which was part of the extensive “Knightfall story arc” and clearly influenced the screenplay for Dark Knight Rises. Bane tries to make use of the challenge of balance in Batman’s body by making him super tired. Instead of fighting Batman more “fair and square”, Bane first breaks into Arkham Asylum. He does this to free all the prisoners.

Why does he do this? Well, because he’s pretty smart, that’s why. Bane knows Batman will go out and round up all the bad guys and gals and put them back in prison. Which is what happens. Every night. For weeks and weeks. Then, once Batman is so run down, beaten up, injured, and at his lowest ebb, Bane comes along and defeats him rather easily.

Bane faces Batman when he’s moving down the right hand side of the Figure above (the red panels). Batman’s over trained, run down, and fatigued state contributed to the serious injury that Batman was dealt by Bane.

A bad way to treat Batman’s back…kids don’t try this at home

Since we’re all about injuries right now I do have to point out something in The Dark Knight Rises. First, a preamble—I genuinely enjoyed the way the character and evolution of Batman was depicted in the trilogy of Batman Begins, The Dark Knight, and The Dark Knight Rises. I thought the take on Batman’s training shown in Batman Begins was really interesting and comment extensively on it in Becoming Batman. The Dark Knight did a great job of showing some of the human frailties and injuries. And The Dark Knight Rises showed this even more so in the accumulation of Batman’s injuries over time.

But The Dark Knight Rises, I have to tell you, also includes one of the most absurd clangers I have ever seen in a movie. It comes up in the scene where Bruce is shown trying to train himself while imprisoned in the stone “hole” by Bane. The former prison physician advises that Bruce must first “straighten” his back. This is the scene where they tie a rope under Bruce’s arms to haul him upright.

I have to admit that while I was in the theatre watching this scene unfold I thought they were going after the idea of partial body-weight supported rehabilitation. That’s where you help somebody who’s had a spinal cord injury or stroke do activities like stepping, standing, and walking to retrain the nervous system. They are too weak to stand up and move around, so the overhead harness system helps do the job of the standing up part.

I thought that I was about to witness something very cutting edge and progressive. No such luck. Bruce is next told that he has a “protruding vertebra” then “I’m going to force it back...” The next thing we see is Bruce being punched—very hard—in the back, followed by a lot of screaming and obvious pain.

I think you can probably guess that I’m going to say this isn’t a good thing to do with somebody who has a “protruding vertebra”—in which case he’d likely have a significant spinal cord injury—or even a protruding intervertebral disc (which is what I think they meant.)

So, as a result of the grievous neurological injury Bruce would almost certainly have received from the punch of the physician, he’d likely need that rope for traction and spinal decompression anyway. Overall, as both a neuroscientist with a clinical research program in rehabilitation of walking—I have a partial body-weight supported treadmill training set-up in my lab—and as a martial artist, I am not recommending this as a good approach for real life back injuries.

Batman rises above…

Overall, though, I think the most important point to take away from is to use Batman as a metaphor for our own human achievements. This comes back to the point about metaphor I raised at the beginning of this post. I often discuss this point in my presentations and it was the focus of my TEDx talk about “The Superhero In You”.

That portions of the mythologies of superheroes like Batman are grounded in reality should be discouraging. Rather, even if portions of the mythologies of human superheroes like Batman or Iron Man have any realistic grounding, it means that we can raise the bar on our own expectations and do more than we thought we could.

And rising above injuries and impediments is also a good way to think of this. It’s also echoed in many high level athletes. Back in that article in Sports Illustrated, Peter King quotes Ray Horton, age 51 who played 10 years and retired in 1992, saying “I'd do it again in a minute". Horton says that there are basically risks with everything that you do—“Firefighters have an inherent risk. Are you kidding me? To play a sport I love the whole time and to just lose a knee—guys come back from Afghanistan with no legs."

This is similar to words from writer Neil Gaiman in a story “Whatever happened to the Caped Crusader Part 2” in Detective Comics #853 in 2009. Gaiman has Bruce Wayne reflecting on his career: “The end of the story of Batman is, he’s dead. Because in the end, the Batman dies. What else am I going to do? Retire and play golf? It doesn’t work that way. It can’t. I fight until I drop. And one day, I will drop. But until then I fight.”

The message is to learn some life lessons we find in a fictional superhero from Gotham City. The lessons we see in athletes who “soldier on” after injury. In real soldiers who push themselves beyond anything we can imagine. In police, fire, and emergency services providers who are there to help us when we need. Inside of us when we do more than we thought we could.

Indeed, “The Dark Knight Rises”. And so can you. Find the bit of Batman inside yourself and use it to improve the world.

Images: Batman logo: Wikimedia commons; two graphs were created specifically for this post and were inspired by material in “Becoming Batman”.

© E. Paul Zehr, 2012