Uncategorized – Page 10 – Dr. Abbate Physical Therapy

December 19, 2023December 20, 2023

Hand injuries in combat sports

Why can’t I close my fist to punch?

Anatomy: The hand is an incredibly complex network of joints (29), ligaments (126), tendons, muscle (34), bones (29) & fascia. This network allows for the manipulation of really small objects, like threading the eye of a needle, to larger objects and large movement patterns like grabbing the gi of your opponent to control them. Small injuries can turn into big problems if not taken care of, especially in the hand where tiny motions of the joints produce large motions of the bones. A loss of a few degrees of finger flexion could result in the inability to control an opponent or throw an effective punch. Hand injuries can be treated with splinting to prevent structures from being irritated, graded movement to improve healing, activity modification to allow continued practice from refraining from potentially injurious activity and finally, and surgery if the injury is severe enough to warrant it.

Injury:

Boxers Knuckle: complete or partial tear of the extensor tendon. Typically treated with splinting, casting or surgery in cases of severe instability
Metacarpal boss injury: tear of the base of metacarpal joint ligaments, often accompanied by painful bump
Metacarpal fracture: displaced fractures require surgery, non-displaced managed with casting/splinting
Bennett fracture: fracture at the base of the thumb requires surgery
Collateral ligament thumb injuries “Gamekeepers thumb” or “Skiers thumb”: disruption of the lateral ligaments resulting laxity of the joint that eventually become stiff and painful

Prevention: improving grip strength and maintaining mobility are important in combat sports to control your opponent, manipulate joints and throw punches. An athlete unable to perform these tasks without complete dedication will be at a serious disadvantage. Exercises such as farmer walks, shoulder shrugs and calisthenics bar-based movements will develop excellent hand strength.

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December 19, 2023December 20, 2023

Shoulder injuries in combat sports

Why does my back ache when standing up after Jiu Jitsu?

Anatomy: The back (lumbar spine) is similar to the neck (cervical spine) in regards to anatomical makeup. The spine is designed to provide bony support for muscles and a stable base from which the limbs can move. Nerves exiting the lumbar spine send and receive signals from the legs. A compromise in the ability of the nerve to do so can cause pain, weakness or loss of movement. Like the neck, there are two groups of muscles- those that act to stabilize (stability, aerobic, “tonic”) and those that are more active (mobility, anaerobic, “phasic”) with changing the position of the hips in relation to the ribs.

Injury: Combat sport athletes should be cautious of and take care of injuries in the lower back. Most back pain injuries involve soft tissue- tendons, muscles and ligaments. However, fractures of the pars interarticularis, herniated discs and degenerative disc disease in more seasoned athletes are typical as well. These injuries can present in many different ways. Some may have pain with movement, others may have relief with movement in certain directions. The pain might feel better with standing or worse with sitting. It is important to accurately identify what structure might be causing pain and to treat it accordingly.

It is interesting to note that a large portion of the population have herniated discs but do not suffer from any pain or limitations when training or competing.

An onset of numbness or tingling, a rapid loss of muscle strength should raise an alarm that you are suffering from a serious injury. These signs suggest that a nerve is compromised and require immediate medical attention.

Aching discomfort when standing after being in a crouched position, like newaza, can be a symptom of ligaments stretching then returning to its resting position. The tissue becomes slowly stretched over the period of time you are in that posture and then returns to resting length rapidly.

Prevention: Similar to the neck, designing a strength a conditioning program to address the different fiber types is important. As mentioned before, the back needs to brace to stabilize, and move when mobility is desired. If the underlying disc or ligaments are compromised, the exercise program needs to be tailored to both sport and pathology-specific demands. The back is quite a resilient system and is primarily designed to withstand compressive and some rotational forces. Injuries can occur when the training program focuses on a single plane and does not stress the need for rapidly changing environments. Dead lifts are a great exercise for the posterior chain (hamstrings, glutes, lumbar extensor group), but they fail to address any rotational component that you may find yourself in (throwing a punch/kick, passing guard). Cable chops would be a good addition to an exercise program to protect the disc from rotational forces that might cause tissue damage, if properly dosed.

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December 19, 2023December 20, 2023

Neck injuries in combat sports

Why is my neck so weak when I apply pressure to pass?

Anatomy: the neck, or cervical spine, is composed of 7 vertebrae (bones), bundles of nerves, a collection of muscles and ligaments, all to support the most important part of the body- your brain. The vertebrae contain “outlets” through which nerves pass through, providing the body and brain with information nonstop throughout the day and night; allows for movement so that you can see above, below and to the side of you; and provides anchor sites for muscles to attach. The muscles along the spine are generally divided into two groups: global muscles for large movements and local muscles for postural control. Global muscles (like the sternocleidomastoid) rotate and flex the neck and are usually “quiet” when standing or sitting upright and looking straight ahead. Local muscles such as the scalenes act to compress the spine to create a more stability, they are typically always “on”.

Injury: neck injuries can vary from a straightforward muscle ache that can be treated without any significant loss of training to severe neurological compromise requiring surgery. Most often injuries involving the muscles can limit your ability to look around (like looking over your shoulder when driving), may feel “stiff” upon waking and cause pain with certain movements (sidebending the neck). Muscular strains are often treated with hands on techniques and muscle re-education program.

More involved injuries involving the neurological system can cause numbness, tingling or loss of sensation of the shoulder, arm or hands. Experiencing an onset of numbness in the arm or hands can limit strength training & the ability to control your opponent. Nerve entrapment can occur at the level of the spine or at the shoulder, elbow, forearm or wrist. How and where the nerve is entrapped will determine the type and outcome of treatment. Some injuries may be resolved with conservative treatment like physical therapy and direction-specific exercises. Other injuries may require surgical intervention, as in the case of a ruptured disk that is impinging on the nerve root.

Prevention: Because the neck contains two types of muscle groups, designing an appropriate strength training program is important to maintain integrity of the cervical column. Incorporating static (non-moving) and dynamic (moving) exercises can address this challenge. Swiss balls and bands are two types of equipment to strengthen the neck musculature using the head as the primary resistance.

Exercises that should most certainly NOT be included are reverse-bridges, which add an unnecessary compression of the cervical column. Exercises that aggravate shoulder pain or cause numbness of the arms or face should be assessed by a medical professional immediately.

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December 19, 2023December 20, 2023

Back injuries in combat sports

Why does my shoulder hurt when I try to shrimp?

Anatomy: The shoulder is a complex joint, relying on the neck, thoracic spine, clavicle, scapula, glenohumeral, acromioclavicular and sternoclavicular joints to provide movement. If just one of these joints cannot move freely, there will be a loss of range of motion, pain or weakness. A weak muscle can cause impingement of the supraspinatus (a rotator cuff muscle) under the acromioclavicular joint, throwing off the mechanics of the entire arm. Reaching overhead, across the chest and behind the back can create a sharp pain in the front of the arm.

An AC joint separation is often the result of being slammed on the shoulder. An AC joint separation can usually be felt as a big “step” if you run your thumb across the clavicle to the end of the bone by the shoulder.

Neck issues can even alter how well you move the arm. Fear of aggravating your neck pain may cause you to guard the affected side and favor that side of the body.

Injury: Medical doctors or surgeons typically suggest injections in the shoulder for acute shoulder pain. As a competing athlete I would not recommend this intervention for several reasons. One, you are not addressing the underlying issue (tendon tear, nerve entrapment); secondly, the pain relief will mask any additional injury you may sustain because you cannot feel which positions or movements aggravate the problem; thirdly, the material used for injections destroy the underlying tissue, essentially degenerating the tendon.

Typical shoulder injuries might appear low grade at first and then rapidly deteriorate if not treated in due time. Pinching in the front of the shoulder when reaching overhead or across the chest might suggest supraspinatus (rotator cuff) impingement. The muscle itself is “wrung out” between two bones- the AC joint and the head of the humerus, the attachment site for the muscle. This constant pinching causes fraying of the tendon, leading to microscopic tears. The body begins to deposit fat in these tears to stabilize the area. Unfortunately, fat does not do as good a job as the original tendon for transferring force from the muscle into the shoulder to produce movement (reaching overhead). This microscopic tearing reduces the work capacity of the muscle and other muscles must compensate for poor movement patterns.

Other injuries include labral tears, AC joint separation and GH dislocations. The labrum provides stability and congruency to the shoulder joint. If the head of the humerus rides over the scapular fossa or the muscles attached to the labrum pull with too much force, the labrum can tear. This is often reported as a deep, achy type feeling across the side of the shoulder, is often very uncomfortable to sleep on and at times may feel as if the arm is “giving way” when lifting heavy weight. An AC (acromioclavicular) joint dislocation may result from landing hard on the shoulder. Sometimes you can see a visible step deformity, lose the ability to fully reach overhead or hear a “clunking” sound with certain arm movements. Glenohumeral (GH) dislocations occur when the head of the humerus is driven or stretched out of the scapular fossa (bowl-like bony part of the scapula). This can be a result of a very lax (loose) joint capsule (similar to a ligament) after the joint is excessively stretched. Grappling submissions such as the Kimura, Americana or Omoplata are perfect examples of submissions that can dislocate the GH. Once the shoulder dislocates, the portion of the capsule that is compromised may not return to its normal resting length for up to a year. This does not mean you will have pain for a year, but it might increase your risk for recurrent dislocation. If you suffered from a GH dislocation you should NOT continue to stretch out the shoulder into positions of instability. Instead, you need to retrain the muscle spindles and sensory organs (nerves that sense where the body is in space) of the joint capsule to become sensitized to positions of instability as well as develop musculature to limit the possibility of future dislocations.

Prevention: preventing shoulder injuries requires maximizing mobility while maintaining its strength, especially at the end range of movement where the joint is most likely to suffer injury (reaching overhead, behind the back, out to the side). Dumbbell and barbell exercises can help develop a solid base for shoulder strength, but it may lack the necessary components that are performed when competing. Calisthenics based exercises provide the appropriate strength and mobility with an additional stimulus for how well you control your body in unstable environments. There are dozens of calisthenic based programs out there and I have included a handful of movements and their progressions for what I consider essential for the combat sport athlete.

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December 19, 2023December 20, 2023

Hip pain in combat sports

Why does the front of my hip pinch when I’m playing guard?

Anatomy: The hip is a ball and socket joint, made deeper by a structure called the labrum. The labrum sits on the rim of the socket part of the hip and is made of soft fibrocartilage. There is a large ligament and capsule that cover the bony portion of the hip, providing stability with tension and mobility when lax. The hip is a very stable joint and contains some of the largest muscle groups in the body. Because of these large muscles, you can produce a lot of force- and fast. You can kick an opponent at a distance greater than that of throwing a punch. You can sweep to gain a tactical advantage when grappling or control their limbs to submit.

Injury: Grappling requires a balance between very flexible but strong hips. In the guard your hips are in flexion, abduction and relative external rotation (see picture). As your opponent goes to pass the guard, they may force your knee across your chest into your opposite shoulder (ex. right knee, left shoulder). This compresses the labrum, a soft, pliable tissue like rubber. If the labrum is torn it can cause a sharp pinching pain when you are caught in this position.

Another frequent hip injury is iliopsoas tendinopathy, also known as snapping hip syndrome. Long practices holding the guard position can cause shortening of the iliopsoas muscle. The shortened muscle can snap over a bony part of the top of the femur when running, stretching or exercising.

Prevention: As stated above, hip flexibility and strength are important. Mobility stretches with a band or belt will stretch out the ligaments and capsule that are responsible for arthrokinematic, or small joint movements. Strengthening exercises should consist of a mix of heavy resistance and higher repetition sport-specific movements. Stretching, foam rolling and massage should be performed after exercise to limit inhibition of muscle contractions.

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December 18, 2023December 20, 2023

Foot and ankle injuries in combat sports

Anatomy: The foot and ankle contain 26 bones, 33 joints and more than 100 ligaments, muscles and their tendons. The foot must act as both a mobile adapter and a rigid lever. Think of the difference when running on a track or beach sand. On the track your foot comes into contact with a surface of the same resilience (rubber), depth (level) and overall “feel” with every step. Running on sand? That varies based on how far you are from the water; if the sand is soft or hard packed; soft sand gives way as soon as you place your foot down. In other words, unpredictable.

The foot contains millions of nerves in the joints to relay signals about its position in space, how fast muscle is contracting and the length that ligaments are stretching. This information is sent to the spine and brain to be processed and responses can be automatic or controlled voluntarily.

Injury: Lateral ankle sprains occur when the foot is forcefully plantar flexed and inverted (toes pointing away and inward), tearing the anterior talofibular ligament. A sharp, pinching type pain may be present when you lunge or squat.

Screening for foot and ankle fractures: If you cannot place weight on the foot for five steps immediately after an injury and you have pain in one of the four locations identified in the picture, you should be on your way to have an x-ray as soon as you finish reading this sentence.

Prevention: Up to 7 times the weight of your body is supported on a single foot when running. Small injuries can quickly turn into big ones if not properly tended to. Fractures need to be casted, or operated on depending on the type and severity of injury.

Running in the sand or on a grass field is an excellent way to build the smaller muscles of the foot which help with overall stability, reducing risk for injury. Changing the elevation on a treadmill, walking backwards or sideways can assist in developing the lower leg muscles. Proper range of motion is important as well. Lack of motion in one area can lead to compensatory movements, transferring forces to a tendon or bone that would not otherwise accept it. This can lead to stress fractures or tears of the muscle-tendon unit.