•Doctor of Physical Therapy •Orthopedic Clinical Specialist •Former MMA Fighter •Brazilian Jiu Jitsu black belt
Round Kicks: Shin vs Instep How Pettis broke his foot •••••••••••••••••• This weekend at UFC 241 Anthony Pettis fought Nate Diaz and during the course of the fight he broke his foot. Pettis’s team thinks it occurred when Diaz checked a low kick early in the 2nd round. After Pettis had his kick checked he stumbled and stopped through his right kick for the rest of the fight. It appears that Pettis connected with the top of his foot. . Anatomy of the foot: 1️⃣Talocrural joint: This the talus articulating with the lower shin (tibia/fibula). 2️⃣Midtarsal joint: articulation between the talus/calcaneous and navicular/cuboid. 3️⃣Tibia/Fibula: These are the long bones that makes up the shin. Tibia is the thicker bone. Fibula is a thin long bone that assists the tibia with shocking absorption. . The most common kicks are either round kicks or front kicks. There are different philosophies and pros/cons for the different round kick options. .
Concussion Management for Combat Sports. ••••••••••••••••••••••• Concussion symptoms: * Headache, nausea/vomiting, light/ noise sensitivity, vision problems * Foggy, memory problems and difficulty concentrating * Loss of consciousness, slurred/slow speech and sluggish, poor balance * Slow to react and not oriented . Red flags (athlete should seek IMMEDIATE medical attention) * Glasgow Coma Scale 1 episode of vomiting since injury. * Pupillary abnormality. * Progressive increase of concussion somatic symptoms. * Deterioration of mental status. . The British Journal of Medicine released an updated consensus 2019 for recommendations: * If a fighter has signs of a concussion during the fight it should be stopped. Minimum suspension from training and competition: * Athlete who sustains a TKO from strikes: 30 days. * Athlete who sustains a KO without loss of consicousness: 60 days * Athlete who sustains a KO with loss of consicousness: 90 days
Case study: Assessment and Treatment for neck pain •••••••••••••••••• I started having neck pain after posting on my head during Jiu jitsu following my training partner attempting a sweep (forceful axial compression on my cervical spine). At the moment I felt a “stinger” and a jolt down my arm and my neck felt stiff and painful after class. . Assessment: cervical motion to identify potential pain triggers. In my case I had closing angle joint pain with extension and rotation. Ie as the cervical facets close something is “pinching”. This is a sign of aberrant joint mechanics and a healthy cervical spine should be able to do this motion. No radicular symptoms (pain or tingling down my arm) with cervical movements. . Treatment: 1️⃣Cervical hinge point training: this is a motor control exercise to give tactile cues to make sure each segment can move. Some segments may not move due mechanical restrictions. 2️⃣Segmental neck movements
Nasal Fractures ••••••••••••••••• In the UFC the most common fight injuries occurred to the head/face (77.8%). •Fractures = 31% •Laceration/abrasion = 28% •Bruising/hematoma = 22% •Organ damage =10%* •Unspecified pain 6% •Brain injury/Concussion =3% * *details were unspecified . Anatomy of the Nose: The nose is formed from bone and cartilage. The bridge of the nose makes up the nasal bone and cartilage extends distal to it. The septum cartilage separates the nasal cavity to create two air pathways. While most of the nose is cartilage most injuries occur at the nasal bone. . Management of nasal fractures: 1️⃣the appearance of the nose prior to the fracture. This is critical in knowing the severity of the injury. 2️⃣How the fracture occurred, specifically frontal impact versus lateral impact. “A direct frontal blow can depressed the dorsum of the nose, causing fractured bones to telescope posteriorly. A lateral blow can cause a
How Long is your Brain Vulnerable after a Concussion? ••••••••••••••••••••••• Usually most athletes who get a concussion have some symptoms that linger for a few days. Typical treatment for the athlete is to just avoid activity and rest and once the symptoms are gone they go back to playing their sport. . Unfortunately this is an out-dated method on concussion management that is potentially harmful. . Symptoms resolution may take up to 3-10 days but altered brain chemistry may take up to 22-30 days! (Vagnozzi 2010) So what is the harm of returning to play before the altered brain chemistry has normalized? During this period the brain is in a weakened state and another impact may have an accumulation affect that severely worsen symptoms (Second Impact Syndrome). . Lazzarino did a case study looking at athletes (3 were combat athletes). Almost all of the athletes suffered a mild concussion with symptoms that lasts approximately 8 days.
Are Boxing / Combat Sports Safe? ••••••••••••••••••••• Recently two boxers died due to brain trauma that occurred in the ring. With growing attention to CTE and concussions is it safe to perform combat sports? . Acute Traumatic Brain Injury (TBI): Rapid acceleration and deceleration fores on the brain. Boxing and other combat sports are NOT on the list for the top 20 sports/recreational activities requiring ER care for acute head injuries. . Chronic Traumatic Brain Injury: “Repetitive TBI is linked with dementia with a 'dose response relationship'” particularly those with greater severity of TBI and history of loss of consciousness (Ling 2015). . Risk factors for developing CTE in boxers: •>20 bouts •Older age at retirement •Longer length of boxing career (>10 years) •Genetic component NOTE: Not all boxers develop dementia or have CTE pathology post mortem despite exposure to repetitive TBI. . Signs of CTE: •Unsteady Gait
Post Concussion Return to Fighting Protocol •••••••••••••••••• In MMA concussions are common due to the prevalence of head trauma. A fighter may be suspected of having a concussion when suffering a KO, TKO and even possible if they are the winner of the fight! One does not need to loss consciousness to get a concussion. . Concussions occur following trauma to the brain that leads to an alteration of regular brain function. The brain can take up to 30 days to resume regular brain function. Additional trauma to the brain while it is in an impaired state may lead to significantly worsening symptoms that can linger. . How do you know when it is safe to return to training? . A proposed protocol (Nalepa et al 2017) for when it is safe to return to training and eventually competition specific for mixed martial arts and combat sports. The goal is safe return without risking exacerbating symptoms. . A fighter should start phase 1 after a week from initial
Concussion incidence in MMA •••••••••••••••••• There is a high correlation between repetitive blows to the head and brain trauma therefore it is reasonable to expect a high incidence of concussion in MMA. However how risky is the sport? . A retrospective study (Curran-Sills 2018) examined the incidence of concussions in MMA over a 5 year period. Of the 343 bouts (amateur/professional) observed there were 162 injuries, 101 of those injuries were reported concussions! . That is 14.7 concussions per 100 AE (athlete exposure). Each bout was categorized as 2 AE. Based on the statistic the author theorized that an MMA athlete may experience 4.4 concussions in a 10 year period. Comparison: Football (2.2), Rugby (0.8). . [IMPORTANT NOTE] This data is in regard to competition only. The rigors of training for a fight, including hard sparring, are not included. In the early days of the sports there were camps that had notoriously tough sparring. Recently
Understanding Concussions •••••••••••••••• Concussions are mild traumatic brain injuries that result from acceleration of the brain that creates shearing force. . Concussions have two phases: excitatory and spreading depression. 1️⃣Excitatory: initial phase with many typical concussion syndromes: •loss of consciousness •headache •confusion •brain fog •daze •fatigue •slurred speech •nausea •dizziness •vomiting 2️⃣Spreading Depression: Drop in brain chemical production. N-Acetylaspartate (NAA) is considered a neuron-specific metabolite and its reduction a marker of neuronal loss (Signoretti 2001). . In the second phase the brain is still vulnerable to injury even against mild impacts. Additional impact can result in a more severe brain injury. . How long does this second phase last? Most people would assume once symptoms have ceased they are ready for a return to training, however brain chemicals may not normalize until day
Understanding the danger of subdural hematomas in Boxing •••••••••••••••••••••••••••• “Acute subdural hematoma which is the most common acute brain injury in boxing, accounts for 75% of all acute brain injuries and is the leading cause of boxing fatalities (Ling)” . Sadly on 7/23/2019 Maxim Dadashev, professional boxer, died from head trauma that he suffered in the ring. The fight was stopped by his cornerman in the 11th round however his corner urged his fighter to let him stop the fight after the 9th. . After the fight Dadashev started to develop neurological signs (loss of balance, vomitting) and was taken to the ER where he was diagnosed with a subdural hematoma (bleeding in the brain) and underwent surgery to manage the injury. Sadly the damage was too severe and he lost his life. . What can we take away from this tragedy? . Sawauchi did a study looking at subdural hematomas that occurred in boxing. Boxers were
Maximizing Rotation for Kickboxing ••••••••••••••••••••••••• Two components that are key for effective striking is spine rotation and scapular mobility. In my last post I addressed scapular mobility so for this post I will address spine mobility. . When someone lacks spine mobility or motor control to use all of their range it limits their offensive and defensive capabilities. 1️⃣Generally I want to be as far away as possible while still able to hit my opponent. 2️⃣In terms of kickboxing I want a range similar for both punches and kicks to blend the offensive options. This means I need to have long punches. 3️⃣The power from striking comes from the legs and hips where the spine and arm are the vehicle for delivering the power. 4️⃣Not only does a rotated spine improve reach but it also primes my follow up attack (cross followed up with a loaded hook etc...). . In terms of spine mobility the thoracic spine is the
Serratus Anterior: Training the Boxer’s Muscle •••••••••••••••••••••• The serratus anterior, often called the "boxer's muscle", is a muscle used for punching. This muscle allows for scapular protraction which means the shoulder blade can shift forward on the ribs. This movement is important for punching because it gives you more reach so you can punch from further away. With inadequate scapular motion you lose out on a potential 1-2” of reach. . How does one train the “boxer’s muscle”? 1️⃣Scapular Controlled Articular Rotations: first someone needs to ability to isolate and move their scapula. With this exercise you take the scapula through its full available motion in all directions. 2️⃣Push up Plus: This is a closed kinetic chain exercise to train against resistance. . The intention of these exercises is to first make sure you have the muscular control and can move the scapula appropriately. Second you have to have the
Don’t fear the reaper: Should knee reaping be legal for Jiu Jitsu competition? ••••••••••••••••••••••••••• Knee reaping is a very controversial topic in the jiu jitsu community and is illegal in many BJJ tournaments, such as IBJJF. . What is knee reaping? Knee reaping is a control position where the attacker's foot crosses the hip/midline during a leg entanglement. The reason that this position is illegal is it can cause the knee to bend in an unnatural direction. . The tibiofemoral joint has 2 degrees of motion: 1️⃣Bending/straighting 2️⃣Rotating However the 3rd degree of motion which the knee can't move is side to side in the frontal plane. The thought is that when someone is starting to reap the knee that they are attempting to force the knee in a valgus moment, therefore injury can occur. The primary constraint to frontal plane motion at the knee is the MCL (knee pushed inside), LCL (knee pushed outside) or ACL
Key Points for Efficient Jiu Jitsu ••••••••••••••••••••• •Leverage •Weight distribution •Proper body mechanics All of these points will give physically weaker individuals the ability to overcome those much stronger.
What makes the temple so vulnerable? ••••••••••••••••••••• In combat sports when trying to inflict maximum damage there are two prime areas to attack: lateral aspect of the mandible or “testing someone's chin” and the “temple” . The “temple” is also known as the pterion, and what makes this area so vulnerable is it is where several skull bones interconnect. •Parietal Bone •Temporal Bone •Sphenoid Bone •Frontal Bone . Due to the nature of this arrangement it is considered to be the weakest part of the skull. . In addition to this area being weak there is also a major cranial artery that runs underneath: middle meningeal artery. . Due to the weak structure of the skull and the sensitive arterial system underneath this area is a prime area for inducing trauma to the brain. . A good example of this was at #ufcsacramento with @urijahfaber Vs @rickysimonufc . The @ufc legend needed less than 1 minute to finish his opponent after
Broken Jaws and Fighting ••••••••••••••••••• One of the most reliable ways to render an opponent unconscious is to strike them on the chin. The chin in fighting refers to the jaw. Due to a high volume of trauma expected on the jaw it is not surprising that mandibular fractures occur. . At UFC 239 @lukerockhold moved up to light heavyweight and unfortunately met the polish power of @janblachowicz . The result was Rockhold was both knocked unconscious and suffered a left sided mandibular fracture. . How often to jaw breaks occur? “When it's open, it's more vulnerable to a fracture, especially at the angle of the jaw and where it attaches to the skull by the temporomandibular joint.”- Dr. Michael Kelly D.O . Shirani looked at the career of combat athletes and found that some form of maxillofacial fracture occurred in 45.1% of athletes. Nasal (84.7%), zygomatic (12%) and mandibular (3.3%) bones were the most common compromised structures. .
Golden Rule of Wrestling: Don’t shoot with your head down ••••••••••••••••••• One of the Golden rules of wrestling that my former wrestling coach, @john galt speaking , told me was “Don’t shoot with your head down.” . @benaskren , who had wrestled in the Olympics broke the rule this weekend. In the sport of wrestling a shot is tactical movement to get to the hips of the opponent. A wrestler will have a lower stance and the classic movement is to drop their level first to get underneath then penetrate the opponent’s stance to get control of the hips. If someone shoots with their head down then the defender’s response, a sprawl, will be easier. . In fighting a wrestler has to get past a variety of strikes (punches, kicks, knees) before they can get the hips. This makes the rule even more important. If you shoot with your head down you are vulnerable to blows that you will not be able to see coming. This is where set ups are crucial. .
Dynamic Knee Valgus: How Thiago Santos hurt his knee •••••••••••••••••••••••• Last night at @ufc 239 @tmarretamma challenged @jonnybones for the belt. The contender started out strong with kicks however during the early part of the fight he threw a kick and afterwards started to hobble. While Santos was able to have a good showing the instability of his knee compromised his ability to win the fight. What did Santos do to his knee? . Dynamic Knee Valgus. Typically on a kick you open your hip and step the foot to de stress the knee. In an attempt to target Jones’s calf (really the peroneals) / lower knee Santos did not take a step which caused an over rotation of his body on a fixed knee. A combination of excessive femur adduction, femur internal rotation and tibial external rotation caused his left knee to buckle. . One of the main stabilizer of the knee is the anterior cruciate ligament (ACL). The excessive dynamic knee valgus may
How to develop FINISHING power in your Armbar ••••••••••••••••• Armbars are a complex movement that utilize the legs and posterior chain for maximum efficiency to create a hyperextension force on the elbow joint. Each muscle has a different task. 1️⃣Hamstrings (Knee flexors): Heels are pulled in as tight as possible to control the opponent so they cannot sit up and create space to escape the submission. 2️⃣Adductors (hip adduction): thighs are squeezed together to isolate the humerus to focus the energy on the elbow joint. 3️⃣Glutes (hip extension): The finishing force. The hips are raised/extended to impart the force necessary to dislocate the ulna from the humerus. . This means the posterior chain is extremely important: hamstrings for control and glutes for finishing the submission. Bridging is an excellent beginning exercise to develop motor control and has a clear skill transfer to grappling, however for strength development to occur
The Lost Art of Pinning ••••••••••••••••••••••••••••••• A key component of grappling is the ability to immobilize an opponent and neutralize their attacks. In jiu jitsu there is a hierarchy of positions. Many positions are considered superior because they grant the attacker offensive opportunities (submissions, striking) and minimize the opponent's opportunities. By keeping an opponent pinned you increase the time where you can attack freely and decrease the time you have to worry about defending attacks. . Many old school grapplers continue to use this skill, which is often referred to as the 'slow cook'. The slow cook is where the attacker drains the defender's energy. Like a video game they drain the character's lifebar before going for the finish. A beautiful example of this in modern grappler was @joshlbarnett vs. Dean Lister in Metamoris. Barnett had 20 minutes to wear down the defenses of Lister who had not been
The Danger of JUMPING closed guard ••••••••••••••••••••• There are many dangerous positions in grappling and fighting but arguably the most dangerous is uncontrolled falling body weight such as jumping to closed guard. . The danger of jumping guard is if the opponent does not or cannot catch the weight of the jumper they may land on the ankle or knee of the opponent. Full body weight flying into an opponent’s knee may lead to severe ligament rupture and/ or meniscus pathology. . This tactic had been banned in IBJJF tournaments up to purple belt due to catastrophic injuries that can occur. . This post was not designed to argue whether this tactic should be legal or not but to inform grapplers why this jump should be used very cautiously.
The Importance of Balance for Striking ••••••••••••••••••••••• Effective striking is the ability to hit an opponent without being hit. Remaining balanced at all times is crucial to effective striking. Balance is keeping your center of mass inside your base of support. When your center of mass moves outside of your base of support you are now unbalanced. . There are three reactive strategies to avoid being unbalanced: 1️⃣Ankle 2️⃣Hip 3️⃣Stepping Reactive balance is responding to a pertubation by using one strategy to remain upright. Balance for striking is anticipatory balance, which is the ability to accomplish a planned task, such as throwing a strike, and remain upright. It is not very effective to throw a punch and fall down in the process. . There are several reasons why balance is critical to effective striking: 1️⃣When unbalanced your next response has to be regaining your balance or else you will fall over.
Most Common Injuries in Jiu Jitsu ••••••••••••••••••••••••••••• While jiu jitsu might translate as “The Gentle Art” it is not very gentle on the body. Injuries are an unfortunate part of jiu jitsu, but what injuries are most common? 1️⃣Elbow 2️⃣Knee Two studies looked at how injuries occurred during competitions. Kreiswirth et al collected data from the 2009 IBJJF No-Gi World championships: Elbow: 19.4% Knee: 19.4% Shoulder: 16.1% Ankle: 13.9% Other: 32% Compared to another study from Scoggins et al who assessed injuries during several regional competitions. Elbow: 39% Knee: 19% Foot / Ankle: 14% Hand: 11% Shoulder: 11% Hip: 3% Neck: 3% . The most common cause for injury? 1️⃣Armbar. 2️⃣Falling on an outstretched arm ie a faulty break fall after a takedown (Scoggin 2014). . Professional take away from this information: Tap to armbars!: You still lose if you do not tap to a submission. Worse now you may
Common Injuries in Muay Thai ••••••••••••••••••••••• Muay Thai or “The Art of Eight Limbs” is a is a kickboxing martial art that utilizes both limbs (fists, elbows, knees and kicks) and also allows clinching or neck wrestling. What are the most common injuries a Muay Thai fighter may encounter? . In an Epidemiology study reported by Strotmeyer collected the following results (during competition): 1️⃣Bruise/Contusion: 38.7% (Gartland: Shin: 37%, Head / Face: 26%, Leg: 14%) 2️⃣Cut/Laceration: 14.4% 3️⃣Swelling/Inflammation: 13.5% 4️⃣Fracture: 12.6% (Gartland: Nasal, rib, metacarpal/Hand) 5️⃣Sprain, Strain: 10.8% 6️⃣Concussion: 5.4% . This results may not be surprising as most injuries listed are soft tissue injuries from blunt force trauma. In a study by Gartland found that the majority of contusions were to the shin, head and leg. The shins are often the initial contact for both offensive kicking and defensive
Improving Spine Mobility ••••••••••••••••••••••••••• Case study: A year ago I hurt my back in Jiu jitsu. I could still train and deadlift but my mobility was severe limited. After awhile my back pain went away but my mobility did not improve. I decided to be more diligent about regaining my lumbar motion. . The key different between these two videos is the ability for my lumbar spine to segmentally flex. Video 1: This video was a day after my injury. My pain trigger was lumbar flexion, so much that I unintentionally adopted an anterior pelvic tilt which kept my lumbar spine in relative extension. You can see that even in a fully bent over position there was minimal if any lumbar movement. . Video 2: This video while the global motion is significantly greater the important aspect is my spine now has the ability to segment properly. The goal isn’t just more movement the goal is to make each segment move. . Self treatment:
Most Common Submissions in the UFC ••••••••••••••••••••••• In mixed martial arts the ultimate goal is to disable your opponent with strikes, joint locks or strangles. In terms of submissions which ones are the the most common/highest percentage? . Data collected by @ufcsecrets looked at the last 25 years of the @ufc to determine which submissions were most common. 1️⃣Rear naked choke: 38%. This strangle variation is considered the king of chokes for a reason. 2️⃣Guillotine: 18%. 3️⃣Armbar: 15%. However I could not determine which position most of these finishes occurred - top or bottom position. 4️⃣Triangle: 7% 5️⃣Arm Triangle: 6% . The top 3 submissions accounted for 70% of all submissions in the UFC. The list goes from top to bottom for how common the submission was. . If you want to be a high percentage finisher make sure you are proficient at all of these submission options.
Highest Percentage Submissions in Grappling ••••••••••••••••••••••• In submission grappling the ultimate goal is to finish with a submission, but which one is the the most common/highest percentage? . Looking at the last 4 ADCC tournaments (2011, 2013, 2015, 2017), which is widely considered the olympics of submission grappling / no gi jiu jitsu. After compiling the data of the 115 finishes there were 5 stand out submissions. These 5 submissions made up more than 3/4 of the total finishes. 1️⃣Rear naked choke: 23%. This strangle variation is considered the king of chokes for a reason. 2️⃣Armbar: 21%. However I could not determine which position most of these finishes occurred - top or bottom position. 3️⃣Heel hook: 14%. This leg attack had more finishes than all other leg locks combined. 4️⃣Guillotine: 12%. 5️⃣Triangle: 10%. . If you want to be a high percentage finisher make sure you are proficient at all of these
Understanding Shin conditioning ••••••••••••••••••••••••••• Muay thai fighters are notorious for having “shins of steel” and use their shins simultaneously as weapons and shields. How do muay thai kickboxers develop such strong shins? . ⭕️Physiology of cortical remodeling: Wolff's law states that bone tissue will adapt to stress placed on it. In the case of muay thai repetitive stress from kicking and checking will cause microtrauma to the tibia. The microtrauma is similar to what happens to muscle tissue when someone lifts heavy weights but at a much slower rate. When microtrauma occurs osteoblasts/osteoclasts are sent to the site to address the physical stress. Osteoclasts breakdown the damaged bone tissue while osteoblasts deposit new bone. When the bone mass reforms the bone will have increased density at the site of stress. . How to incorporate in your training: The most important lesson is to stress the bone
Controlled Articular Rotations: The Purpose of CARs ••••••••••••••••••••••••• What are controlled articular rotations? CARs just look like silly joint circles, what is special about that? Controlled articular rotations are a @functionalrangeconditioning concept that have many different functions. . 1️⃣Joint “Flossing”: What is the point of dental floss? To clean / reach areas of your teeth that are not easily assessable. CARs do the same thing for your joints. Full joint motion helps to preserve the health of the joint. 2️⃣Joint Assessment: A health joint should have full pain-free motion in whatever ranges the joint can move. If one is unable that gives you an idea that maybe you need to address your joints. If someone has “pinching” or some kind of block it is an indicator that you may need to see a healthcare professional / @functionalrangerelease as the aberrant joint motion needs more than just training. Never
Biomechanics of the Armbar ••••••••••••••••• The armbar, arguably the most iconic technique in grappling, is a submission that involves hyperextension of the elbow joint (humeroulnar joint). While there are two other joints around the elbow region: 1️⃣humeroradial 2️⃣radioulnar joint . the humeroulnar joint is the primary joint involved in elbow extension. After years of grappling many martial artists may lose a bit of range, but the average person should have about 5 degrees of hyperextension. . There are a variety of structures that limit hyperextension: 1️⃣muscle 2️⃣ligaments 3️⃣the bony articulation of the humerus and the ulna. 4️⃣The joint capsule is connective tissue that wraps around all three joints and is supported by ligamentous structures. . The primary ligament to limit excessive extension is the ulnar or medial collateral ligament (not to be confused with the MCL in the knee), particularly the anterior fibers