CASE STUDY – AC sprain during jiu jitsu
•••••••••••••••••••••••
While training jiu jitsu, my training partner @hapdiesel, was swept and landed directly on his shoulder. This mechanism of injury may result in a acromioclavicular joint sprain/separation.
.
Common symptoms are :
1️⃣pain with overhead movement.
2️⃣pain with the arm hanging at rest.
3️⃣shoulder compression/lying on the affect shoulder.
4️⃣Small bump/protrusion.
.
Management strategy: ⭕️Protect – You have to keep the area protected during the initial phase of tissue healing. One strategy is taping the joint to assist with static stability while the ligament is compromised. .
The open packed position for the AC joint is the arm hanging at the side. This means the joint is more mobile and puts unnecessary strain on the remaining structures. Using a sling to unweight the shoulder helps.
.
Luckily for my training partner I was on the mat when the injury happened so I was able to quickly diagnose the injury. Next rehab phase is optimal loading.

Shoulder Connection: How to protect your shoulders in grappling
•••••••••••••••••••••••••
Shoulder connection is the kinesthetic awareness of using your scapula to help stabilize your shoulder.
.
Grappling arts are designed to exploit the weaknesses of the human body, one in particular is the shoulder. The shoulder (glenohumeral) is a mobile joint which means it is not very stable and thus at risk for injury. “The joint by joint approach” is a concept originated by Mike Boyle, who notes that the joints of the human body alternate with mobility and stability. If the glenohumeral joint is a mobile joint the closest most stable joint is the scapula (scapulothoracic joint).
.
Shoulder connection: Scapular retraction, which effectively connects the shoulder to the trunk thus giving significantly more stability. As I explained in a previous post the shoulder does not have to be locked down and back, especially for overhead motion, instead the scapula needs to be active and slightly retracted.
.
Positional Injury prevention:The arms are often outstretched on takedown attempts (double leg / single leg), especialy when shooting from too far away. During this scramble the shoulder is exposed to injury from a heavy sprawl on the back of the shoulder. By engaging your scapula during this outstretched position you can give your shoulder additional stability to prevent injury. In addition to reducing injury this also allows the grappler to maintain control of the leg or hips to try to finish the takedown.
.
Posture: Often from standing or from the ground an opponent may attempt to pull the arms to unbalance you. Often the weakest link in this situation is the shoulder. By connecting your shoulder to your trunk you give yourself the additional stability necessary to avoid the unbalancing technique.
.
Grappling is hard enough on your joints, by using proper biomechanics you can give your shoulder the advantage to avoid future injuries!

Using science to improve your ankle lock defense
•••••••••••••••••••••
The ankle lock is one of the earliest leg attacks that a student will learn. The first defense to this attack is ‘the boot’. The ankle lock is a submission where the attacker bends the ankle to try to dislocate it (plantarflexion + anterior translation). Therefore the defense is to curl their foot up (dorsiflexion). This defense is only a temporary solution as the attacker will create much more force with their lat and glut muscles compared to the defender’s tibialis anterior.
.
⭕️How to improve your foot: Irradiation. .
The intention of irradiation is motor activation of similar muscle groups to improve the motor activation / strength of the intended muscle. The human body has patterns of muscle synergies: in this case – dorsiflexion, eversion, knee flexion and hip flexion. These muscle synergies work well together. By attempting to contract them all simultaneously it will make your tibialis anterior muscle stronger. This makes your boot much harder to break. This neuro trick buys you even more time to clear the attacker’s controls to escape the hold.
.
Try this trick to see if it makes your ‘boot’ more difficult to break.

Finger taping: Injury prevention for BJJ
_____________________________
Establishing the proper grip is integral to initiating offense in grappling arts, specifically those where jackets are involved such as brazilian jiu jitsu, judo and sambo. Many matches are won based on who is able to achieve their intended grips to allow for the throw, choke or guard pass. Because grips are so important it is not surprising that many grapplers have a history of finger pains and aches.
.
Anatomy of the finger: There are three joints of the finger:
1️⃣ metacarpophalangeal joint (MCP joint)
2️⃣proximal interphalangeal joint (PIP joint)
3️⃣distal interphalangeal joint (DIP joint)
The joints involved with grip injuries are often the PIP and DIP joints. The volar plate and collateral ligaments help to stabilize the PIP and DIP joints. The volar plate is a ligament on the front of the knuckle to prevent hyperextension and the collateral ligaments are on the sides of the joint to prevent side bending. Most finger injuries begin with damage to these ligaments: sprains which mean the ligaments are stretched or have partial tears. If the ligament ruptures then dislocations can happen.
.
Post-traumatic osteoarthritis: With repetitive stress, multiple sprains and/or dislocations the joints will begin to develop arthritis. Signs often begin with stiffness, general aches and restrict movement. As the arthritis progresses there will be increased laxity/instability followed by limited mobility. In the later stages you may notice enlarged joints.
.
Taping strategy:
1️⃣X taping: placing an X on the front of the finger helps to stabilize the volar plate and prevent finger hyperextension.
2️⃣Buddy taping: taping one finger to the other helps to stabilize the collateral ligament and prevent side bending.
.
To watch the full video with sound click on the link in the profile.

Got sciatica?
___________________________
Sciatica is overused term to describe what people feel when they get shooting pain down their legs. Nerve pain can either be due to nerve root compression or peripheral nerve entrapment (often sciatica). Let a healthcare professional diagnose the problem I’ll give you a strategy to address the problem.
.
What to do?
1️⃣Find your pain trigger: bend forward, bend backward, bend to the side and rotate. This lets you know what motions cause more nerve pain or pain that moves further down your legs.
2️⃣Commonly a trigger for worsening symptoms occurs with forward bending. If this is the cause a common intervention that can reduce symptoms is the opposite direction: extension/backward bending.
3️⃣Exercise: The prone cobra / prone press up. Maintaining a position of being on your elbows or hands (whatever you can tolerate). Often rapid repeated floppy push ups may irritate the spinal facets so perform 10×10 second holds and re-assess for any changes. ❗️If symptoms worsen or progress STOP. If you notice a change keep performing until symptoms plateau. .
‼️Do not panic and rush for a MRI. As a healthcare professional I don’t treat that the images shows, I treat what I find. People often have worse prognosis after hearing the results of imaging because it makes them feel ‘damaged’. The problem is just because the images show a defect it does not mean it is the cause of pain. .
Make sure to see a healthcare professional who can confirm the diagnosis and address any contributing factors to your symptoms.

Back Pain? What to do when you throw your back out
______________________________
“Throwing out your back” or acute back pain can be crippling and significantly affect your day / week. Everything seems to hurt: getting up, tying your shoes, moving, everything. What should you do? ❗️These strategies are to minimize pain and improve motion- let a medical specialist diagnose the issue.
.
Here are some methods to help you reduce your pain.
1️⃣Determine your pain triggers: it is important to determine exactly what motions cause pain. Bend forward, bend back, bend to both sides and rotate. Once you figure out what motions hurt you should avoid them. Most people with back pain have hard time figuring out what hurts. If you keep picking a scab it won’t heal. Your job is to avoid irritating the sensitive area FOR NOW. In days/weeks when your symptoms calm down you want to re-Introduce these motions.
2️⃣Gentle pain-free motion: Once you figure out what moves hurt your next job is to move in the other ways that don’t hurt. This helps de-sensitize the system and reminds your body that it can move in certain ways without pain.
⭕️Cat cow Exercise: on your hands and knees move your stomach up and down. Isolate movement to the spine. Complete 10 cycles of pain free motion.
3️⃣Activate your core: Pain inhibits motor activation. Therefore you want to make sure you can re-activate your core in a pain-free way. While laying on your back bring your knees to your chest and push just enough until you feel your abs turn on. Start out with 10 second holds and build up to 30 seconds.
4️⃣Movement: Walking, biking, swimming. Whatever way you can without hurting do it. .
✅I recommend seeing a healthcare professional. See a physician if it is required by your insurance but if you can get in quick to see a PT or chiro do it. You want to make sure this does not become a chronic issue. Back pain is the number #1 cause for disability. Even when you are out of pain I would recommend seeing someone so you have strategies to avoid this from happening again.

Developing core stability : Pallof press
____________
To improve core stability and to strengthen your abdominal muscles you must develop the ability to resist force. By preventing movement you create a stable base. These muscles are designed for anti-motion. Developing proximal stiffness creates distal mobility. .
Exercises for developing stability:
⭕️Pallof press: hold a mobility band and step until there is tension. Press forward.
Variations: ?️alter your base of support: half kneeling or tall kneeling. ?️Progression: add a forward press + lift the band up.

Improving punching power with a strong core: ‘Stirring the pot’
___________________
“The ultimate exercise for the ultimate fighter!” Dr. Stu McGill, renowned researcher in spinal biomechanics. ‘Stirring the pot’ is an exercise he recommends specifically for MMA fighters to develop the anterior chain and core stability. .
How does core stability help a fighter create more power? There are three phases of a strike:
1️⃣Ground reaction force of the lower extremities pushing off the ground.
2️⃣Trunk rotation.
3️⃣Velocity of the upper extremity.
This movement requires optimal sequencing these of steps while minimizing force loss. Micro-movements of the spine may sap energy that could be used for the desire task: a punch. ‘Stirring the pot’
⭕️Exercise: maintain a plank position on a stability ball with your feet shoulder width apart. Maintain an abdominal braced neutral spine and make circles with your arms/shoulders.
?️Repetition: 2-4 rotations clockwise and counterclockwise. Approximately 10 seconds. ?️Sets: 4-6. As you improve motor control and stability gradually increase the shoulder movement to create larger circles without compensations. .
“Proximal stiffness enhances distal mobility and athleticism”(McGill 2014)

How to crankproof your neck – Part II
__________
Jiu jitsu is a martial art where there is a high chance of having a neck injury because so many attacks target the neck. In my last post I discussed the factors that can help reduce the risk for neck injuries. One important factor is having adequate neck mobility. There are several factors that may limit optimal mobility: tissue extensibility (muscle, fascia etc…), Atlanto-occipital joint (C0-C1), Atlanto-axial joint (C1-C2), lower cervical segments (C3-C7) and thoracic segments.
.
If vertebral segments have limited joint mobility than the segments above or below will be forced to compensate. This means they will take up the slack and be forced to move too much. These hypermobile joints are the areas at most risk for injury because they will move if someone is trying to force the neck in a position it should not be in. To reduce the risk for injury if you improve the mobility of those hypomobile segments then the other segments will not be at a higher risk of getting injured.
.
Test for optimal cervical flexion motion: Touch your chin to your sternum. You should be able to reach your sternum without pain, compensation or excessive effort.
.
Self-cervical spine mobilization (Sustained Natural Apophyseal Glides) to restore proper cervical motion to C3-C7. When your cervical spine flexes the facet joints open. This mobilization assists with this process. As you actively flex your neck forward you can put your fingers under the spinous process (bony knobs in the middle of your spine) and apply a firm pressure at a 45 degree angle (pressure towards your eye). After you perform 6-10 movements you progress down towards the next segment. Realistically you want to find the segments that feels “stuck” and focus your attention on them.
.
Focus on pain-free motion. If a segment hurts with pressure start with the segment below then re-test the one above. Often the segment hurts or is tender because it is the hypermobile segment.
.
Re-test to see if you have any improvements (Improved range and/or decreased pain)
.
Following the mobilization you want to retrain your neck to be able to actively use the newly gained range.

Post op Phase 3 – Normalize gait
__________
Post op arthroscopic surgery day 5 – with my weight bearing restrictions removed I can work on trying to walk normal.
.
This will be the most challenging part of my rehab due to my primary complaint pre-op, which was mechanical catching with walking. My knee would catch just prior to full knee extension. This caused me to have an asymmetrical step pattern and reduced toe off. My limping would get significantly worse after exercise, specifically jiu jitsu. This developed a habitual limp. Now that the loose body is removed I have to work on voluntary control of proper heel strike and toe off. .
Hopefully when I’m cleared for jiu jitsu I won’t have to hobble out of the gym anymore.

Phase 2 – Regaining motion
______
After an injury having reduced range of motion is a common complaint. It is important to determine the limiting factor whether it be: tissue length, myofascial restrictions, instability, joint hypomobility or swelling. .
In my case I’m post-op day 2 following a scope so my reduced range is because of inflammation in the joint. One of my favorite ways to improve knee flexion range of motion is eccentric isometric. .
Slowly descending to my pain-free bottom squat position and holding. This allows me to improve proprioception in the joint, regain strength and stability at the end of my current available range.
.
When working with patients with knee dysfunction one of my discharge goals is for them to be able to squat with their femur below horizontal so I am ahead of schedule! I still have some work to do as a jiu jitsu athlete I need to be able to sit on my heels with my full body weight.

Rehabilitation: Post-surgical Phase 1
____________
Post-op Day 1: this was a fairly simple arthroscopic surgery to remove a large loose body. While there was evidence of significant osteoarthritis in my patellofemoral joint my complaint was mechanical catching from this piece of cartilage floating around in my knee.
.
Phase I of rehab: PRICE or POLICE?
Most people have heard the acronym PRICE, however I prefer one coined by @liftersclinic, P.OL.I.C.E: Protect. Optimal Loading, Icing. Compression. Elevation.
.
Optimal loading vs. rest: Yes you want to avoid excessive loading but you do want to load, what does that mean? Right now that means active gentle pain-free motion to restore range of motion. Stationary bikes are a great option as it is partial weight bearing to minimize stress but also allows you to move the joint.
.
Quad atrophy: Atrophy of the quadriceps muscle group is very common post-surgery. Arthogenic muscle inhibition is subconscious feedback inhibition to the muscle to reduce pressure on the joint. Even with simple surgeries the muscle can atrophy extremely fast. Quad sets are a great way to restore muscle activation. Once you can do a proper quad set and lift the leg without any lag, also known as “extensor lag” , you can progress to focusing on the single leg raise for quadriceps strengthening. In the video I use my unaffected leg to demonstrate what it should look like.
.
Managing swelling: In my professional opinion compression is the best method of reducing excessive swelling. While there is some controversy about ice vs. heat when there are acute injuries, or in my case post surgical, icing is a good method of decreasing pain and swelling.
.
Next phase is restoring range of motion and strength. The final phase is return to sport.

Bridging: a fundamental movement in jiu jitsu
___________
In jiu jitsu and ground fighting you must understand how to bridge properly to escape inferior positions. There are several intentions of bridging in jiu jitsu:
1️⃣unbalance: when your opponent is in a dominant postition they are free to attack with submissions or strikes. By unbalancing them they must regain their balance before they are able to attack again.
2️⃣create space: when escaping inferior positions you need to create space so that you can move your body away.
.
To accomplish both of these tasks you need a powerful bridge but also must be stable so that you can remain in an good position to transition.
.
The single leg bridge is an excellent exercise and drill to address this. By performing this exercise on 1-leg you increase the gluteus medius activation. This muscle is essential for developing stability and hip balance strategies. To make your bridge as powerful as possible make sure you are using your gluteus maximus. This is your primary hip extensor muscle, instead of relying on your hamstring muscle group. While the hamstrings will activate they are primarily a knee flexor and act as a secondary hip extensor. Prior to initiation make sure your heel is closer to your butt and pre-contract your glutes.
.
This exercise is identical to the movement you will perform thousands of times in your jiu jitsu lifetime.

The best exercise for grapplers
_______________
The Turkish get up is one of my favorite exercises, especially for a grappler. This exercise has been described as “loaded yoga” because you have to move up and down while loaded with resistance.
.
1️⃣Returning to the feet: This exercise is especially important for grapplers because it teaches them how to get up when someone is trying to hold them down. While the resistance point is not exactly the same there is a very similar principle.
2️⃣Assessment: This exercise is a great assessment tool because it is a whole body exercise you can find weak points or movements that need further attention.
3️⃣Shoulder stability: By maintaining a load overhead at various angles it is great for developing shoulder stability and strength.