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Manipulation vs mobilization for treatment of neck pain

Manipulation vs mobilization for treatment of neck pain

Cervigogenic headache (CGH), or headaches that are present with neck pain, can be successfully treated with exercise and joint manipulations. The treatments are generally safe, effective, and last up to 3 months. A noticeable improvement in headache intensity, duration and overall disability was demonstrated in this study. 

Cervicogenic headaches are defined by three criteria

  1. Unilateral headache at least once/week over the past 2 months
  2. Neck pain before, during or after the headache
  3. Pain aggravated by movement or specific postures of the neck

This study recruited 110 people with CGH and divided them into two groups: (1) neck manipulation and (2) joint mobility with exercise. The researchers obtained a baseline of headache frequency, intensity, duration; disability; and medication use. Follow up measurements were taken at 1 week, 4 weeks and 3 months after the intervention. 

The findings demonstrated a significant improvement in headache intensity and disability of both groups, with the manipulation group experiencing superior results. At 3 months, 30% of the manipulation group and 4% of the mobilization/exercise group continued to experience complete resolution of symptoms. Neither group reported adverse events, suggesting that the techniques were safe.

In conclusion, there are safe and effective treatments for CGH that reduce intensity, duration and overall disability. Receiving manipulation in addition to strength training and mobility exercises, appear to have superior results than strength training and mobility alone. These improvements were demonstrated up to 3 months after a course of treatment. In this study, participants received 6-8 sessions over 4 weeks. 

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Cervicogenic headache and posture

Cervicogenic headache and posture

Poor posture has often been associated with the development or experience of neck-dysfunction related headaches (cervicogenic headaches or CGH; cervico= neck, genic= arising from). Previous studies have been inconsistent in their findings. This may be due to poor subject selection, limited number of participants or measurement error. In children, there has been consistent research demonstrating that forward head posture is more likely to be associated with the onset of neck-related headaches.

However, studies of the adult population were inconsistent in their findings. The current study this article discusses, demonstrated that for every 1 degree increase in general cervical lordosis, there was an 8% increase in experiencing headaches related to neck dysfunction. 

Cervicogenic headaches are defined by three criteria

  1. Unilateral headache at least once/week over the past 2 months
  2. Neck pain before, during or after the headache
  3. Pain aggravated by movement or specific postures of the neck.

Cervicogenic headaches are not the same as tension-type headaches or migraines. Other factors that may contribute to CGH include altered muscle tension, altered proprioception (perception of head or neck position) and hypersensitivity of the joint or disc. 

This study looked at measurements taken by x-ray to see if there was an association between bony alignment (posture) and presence of CGH.

The study found that for every every 1 degree increase in general cervical lordosis (GCL), there was an 8% increase of experiencing CGH. Other measurements were similar between those who did and did not experience headaches.

The researchers concluded that although their findings with x-ray imaging demonstrated a consistent association between cervical lordosis and CGH, other information may be provide additional benefit in the diagnosis and treatment of this condition. This may be neck range of motion, joint mobility and alteration of muscle tension. 

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Concussion Assessment: Neurocognitive Testing

Concussion Assessment: Neurocognitive Testing

Concussions may present as a wide range of symptoms. Among these include a change in walking and balance. Specifically, a slower gait and greater side-to-side sway are evident in those experiencing concussion symptoms. Cognitive ability is affected as well, with slower response times to mentally demanding tasks. 

Physical therapist often assess athletes experiencing concussions. Standardized testing usually includes postural and cognitive capacity independently. Meaning, one test for posture/balance, and another test for cognition. The issue with this approach is that life requires both high cognitive power coupled with a responsive postural system. Testing these two systems with a single assessment may provide distinct advantages over independently sourced ones. Currently, no standardized protocol exists. This current article will describe the advantages and disadvantages of dual-task testing. 

 

In this research study, 24 articles were reviewed. Articles were included in the review if they met the following criteria: age 16-64, testing done within 72 hours of concussion, with retesting several days and months post-injury. Dual-task testing includes cognitive and physical domains. The cognitive tests reviewed include spelling a 5 letter word backward, subtracting 7’s starting at 100, reciting the months of the year backward, the Stroop test, the visual Stroop test, Brooks spatial memory task and reaction time. These cognitive tests were performed at the same time as a physically demanding tasks- usually walking. The studies looked at cadence, step length and side-side sway. 

The authors found that with dual-tasks testing, lateral sway was present post-injury and up to 1 month, before returning back to normal at 6 months. However, the average “sway” was less than 1 cm, making it very difficult for a clinician to pick up by eye sight alone. Adults typically slowed their gait, whereas teenagers did not. 

Cognitive testing demonstrated more errors and slower responses, lasting up to a year post-concussion. This was evident in both teens and adults. 

Future research should focus on standardized testing protocols to improve assessment methods and outcomes. Additionally, a “baseline” (pre-concussion) is required in order to make sense of concussion testing at time of injury. 

Conclusion: concussion testing can be challenging and the results of a single examination alone may not always help a clinician determine return to sport. Both clinicians and athletes need to be vigilant with testing protocols and tradeoffs with individual tests. Dual-task assessment for concussion appears to be a means for functional testing.

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Screening for Headaches, a Physical Therapy Examination

Screening for Headaches, a Physical Therapy Examination

A large portion of the population will experience headaches at some point in their lives. About 17% of these are classified as cervicogenic headaches, or headaches originating from the neck. Physical therapists can be instrumental in screening out more serious issues as part of a comprehensive evaluation. This article describes a physical therapy examination and decision to refer a patient to the proper medical provider.

Physical therapy examinations measure neck range of motion, neck strength, presence of muscle tension and neurological screening. In this article, the author describes a 23 year old female patient experiencing right sided, pounding headaches for the past 2 years, with symptoms usually peaking at noontime, and often associated with excessive fatigue. Upon examination, the therapist noted hypersensitive neck muscles and an onset of neurological symptoms (numbness of the toes) with certain neck tests. The patient was referred back to the medical doctor for follow up evaluation and imaging. 

Upon examination by the medical doctor, the imaging demonstrated Klippel-Feil fusion of the neck. Klippel-Feil fusion is when 2 or more neck joints are fused. This is often associated with additional abnormalities including cardiovascular system, facial asymmetry, hearing loss, spinal cord issues, spina bifida and cervical stenosis. The cause can be attributed to excessive movement at the time of ossification (bone hardening) of the cartilage-like dens (see picture). This results in impingement of the spinal cord or vertebral artery due to a change in joint mechanics. 

The patient was treated with physical therapy with relief of symptoms including headache intensity, neck motion & strength, but not headache frequency. 

Conclusion: Physical therapy is a safe and effective treatment for headaches and neck pain. Physical therapists can safely screen patients for more serious underlying condition, and refer out to appropriate medical professionals if need be. 

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Dry Needling as an Intervention for Tinnitus, Headaches and Neck Pain

Dry Needling as an Intervention for Tinnitus, Headaches and Neck Pain

Tinnitus, or “ringing in the ears”, affects 10-15% of the population. It is described as an “auditory sensation in the absence of a corresponding external stimulus” or ringing in the ear without a noticeable cause. Causes may be multifactorial, essentially alter the rate of firing for nerves, and resulting in maladaptation over time. 

Somatosensory tinnitus occurs when there is dissonance between the somatosensory and auditory systems. Stimulation of these nerves change how the neurons fire, leading to “non-sound driven” sources, altering the perception of loudness in the environment. As mentioned above, the causes may be multifactorial. These include head or neck trauma, bruxism (teeth grinding), change in muscle tension, chronic head/neck or shoulder pain, and association with poor posture. 

Cervicogenic somatosensory tinnitus (tinnitus arising from neck related impairments) are associated with neck pain, poor neck flexibility, a change in tinnitus with head or neck movements and neck muscle tenderness. 

This article discusses the treatment of a 41 year old female diagnosed with occipital neuralgia. The patient experienced headaches, neck pain and tinnitus after being involved in a car accident 20 years prior. The ringing in the ears was made worse after loud concerts, experiencing stress, the onset of headaches and with prolonged positions (driving). 

The patient was previously treated with radio frequency nerve ablation with symptom relief for 6 months. However, the tinnitus returned, and the patient sought treatment by a physical therapist. 

The examination demonstrated normal neck movement and strength, but hypersensitivity of the upper and mid-neck muscles, reproducing the headache and tinnitus. 

Physical therapy treatment included 12 sessions of thoracic manipulation and dry needling of the neck muscles. The patient reported a significant improvement of symptoms (headaches, tinnitus and neck pain) after treatment and at a follow up 1 year later. 

Here are the patients findings. They demonstrate a consistent improvement in symptoms with physical therapy treatment. At the 1 year followup, the patient reported an onset of tinnitus with attending live concerts only. 

Conclusion: physical therapy can be an effective treatment for chronic tinnitus, headaches & neck pain. Dry needling, manipulation and exercises, can reduce the adverse events typically seen with medication use. Physical therapy is a safe and effective option for people experiencing headaches, tinnitus and neck pain.

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What is Brazilian Jiu Jitsu?

What is Brazilian Jiu Jitsu?

Sport

The sport component of BJJ can be thought of as a series of movements against an opponent with the intent of scoring points or submitting them. Scoring points is based on competition style rule set. Points are generally attributed to take downs, advancing to a dominant position and submission attempts.

With the point system, take downs, guard passing, mounts and back takes demonstrate that the athlete has a clear positional advantage. Once in a more dominant position, submission attempts are made in order to make a decisive victory. In the case that no submission was made (time ran up), the athlete with the most points wins. Submissions are achieved when an opponent verbally or physically “taps”, to signal that they surrender. 

Submissions include joint manipulation or chokes. Joint manipulation places the opponent in such a way that a joint will be damaged to the extent as to render that specific body part incapable of defending or attacking. This usually means ruptured ligaments or acute damage of other soft tissues (meniscus, labrum, cartilage). When the defending opponent experiences pain, they will tap and the match will end.

Chokes are designed to occlude (cut off) the blood supply to the brain, thus rendering the opponent unconscious. Use of the limbs and/or gi can achieve this end. In sport jiu jitsu, the opponent ought to tap to prevent from passing out.

Self-defense

BJJ is also a very effective form of self-defense, even in cases where the opponent is much larger or stronger. The task of the defender is to position themselves to minimize damage to themself in addition to gaining an advantage to secure a submission. Similar to sport jiu jitsu, self-defense necessitates the use of submissions to end the fight. There are no “points” other than survival. Controlling the aggressor is the ultimate goal, with preservation of your own body to survive the encounter. 

Once a take-down is initiated, the fight ends up on the ground, where the defender can use gravity (top position) or their legs (bottom position) to attack. The asymmetry created by gravity (top) or the difference in leg strength versus upper body strength (bottom) can create a clear tactical advantage to someone well-versed in jiu jitsu. The goal once both combatants are on the ground is to immobilize the opponent. Similar to sport-JJ, the attacks are very similar: joint locks and chokes. 

While smaller sized defenders can attempt to gain an asymmetrical advantage, there is an obvious limitation to how much of an advantage can be gained. In the case of someone weighing 120 pounds fighting a 260 pound person, the absolute strength of the 260 pounder will more than likely have an advantage regardless of the positioning of the 120 pounder. For example, the larger individual may be able to pick up the lighter person and simply spike them onto the ground, knocking them out or perhaps paralyzing them. The tactical approach of the lighter person may very well be to limit this exposure.

Jiu Jitsu is arguably the best form of self-defense, as most fights end up on the ground. Well placed punches and kicks can thwart or injury an attacker, but those attacks are generally useless when on the ground (unless you’re on top). Even the bare minimum of jiu jitusu, learning how to control an opponent to stop an attack, can be extremely useful for smaller or weaker individuals.

 

Biomechanics

When fully assessing how to gain an asymmetrical advantage, there are a few things to consider. If we take the example of two combatants of equal stature (height, weight and experience), we can immediately see that minimizing energy expenditure and maximizing mechanical leverage is the first and foremost goal. A poorly conditioned cardiovascular or muscular endurance system will fail to “win” even if the athlete is brilliant and talented. The lack of a mechanical advantage will most likely result in a failed submission attempt. 

A well-conditioned cardiovascular and muscular strength/endurance system will allow an athlete to continue to move towards a better position despite having exerted a tremendous amount of energy to match an opponent of equal stature. This can be extremely physically and psychologically demanding, as the end result of a failed movement can place the athlete once step closer to a submission, or points scored against them. 

Having a better understanding of how to create and manage mechanical advantages can preserve energy to further create an asymmetrical environment. Think about it this way- if you had to only exert 5% of your force to gain a positional advantage, but your opponent had to exert 55% of their energy to defend that movement, you will clearly “wear them out” in a short amount of time. This will greatly increase the likelihood of a submission. Very often, mechanical advantages are intuitively understood by somewhat experienced grapplers.  

In summary, a well-condition athlete with the requisite knowledge of “mat sense” can begin to dominate an opponent to work towards a submission. Let’s take a closer look at how mechanical advantages are gained. With the goal of maximizing submission completion and minimizing risk, we can look at the body as a system of levers, fulcrum and forces to achieve this aim. To have a better understanding of this system, we will review the three types of levers, how fulcrums function, and the minimal application of force to create positional advantages. 

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Levers in Jiu Jitsu

An example of a class 3 level in BJJ is a scissor sweep from guard. The opponents contact point on the floor (foot/knee), the force is your contact on their body, and the load is the pull/drag you create on their upper body.

If you are a keen observer, you will notice that load and force are somewhat interchangeable. Since the class of levers applies to both the attacker and defender positions, the mechanical advantage is dynamic. Additionally, the fulcrum needs to be well-placed in order to gain this advantage. To add more complexity to the issue, the fulcrum can be moved along the lever arm to adjust location of force application.

Other observations include both the attacker and defender act as levers. In the arm bar example above, while the defenders arm is a class 1 lever, the attackers body is behaving like a class 3 lever (blue arrows, gold text). The fulcrum is the attackers shoulders (wheels of a wheelbarrow), the effort is the hips (bucket of wheelbarrow) and the load (handles of wheelbarrow) is the defenders elbow.

The majority of attacks utilizing lever arms is fairly well understood in jiu jitsu. In no-gi, limbs provide mechanical advantages; in the gi, we can use tools (the gi), to create a lot more advantages. The way I like to think of the gi as a tool is to minimize the number of limbs it takes me to control the maximum amount of my opponents limbs. For example, if you control an opponents lapel in the Worm guard position, you can use a single hand to manage their posture (upper body), hips (center of gravity), knees and ankle.

Similar attacks and defense with the lapel can be made in standing, top or bottom guard. The best use of the gi will free up your hands and limit your opponents movement. 

To recap:

  1. There are three classes of levers
  2. Levers provide mechanical advantages
  3. Mechanical advantages allow for more opportunity to score or submit

The goal of jiu jistu then, is to gain a tactical advantage over your opponent while minimizing risk and maximizing reward. The more you’re able to control your opponent and the less of your body you need to use to do so, the greater the advantage.

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An example of a type 2 lever in BJJ submissions is an omoplata. Force is applied at the wrist/hand, load is applied to the shoulder (as close to the joint as possible) and the fulcrum is the shoulder joint.

An example of a class 3 level in BJJ is a scissor sweep from guard. The opponents contact point on the floor (foot/knee), the force is your contact on their body, and the load is the pull/drag you create on their upper body.

If you are a keen observer, you will notice that load and force are somewhat interchangeable. Since the class of levers applies to both the attacker and defender positions, the mechanical advantage is dynamic. Additionally, the fulcrum needs to be well-placed in order to gain this advantage. To add more complexity to the issue, the fulcrum can be moved along the lever arm to adjust location of force application.

Other observations include both the attacker and defender act as levers. In the arm bar example above, while the defenders arm is a class 1 lever, the attackers body is behaving like a class 3 lever (blue arrows, gold text). The fulcrum is the attackers shoulders (wheels of a wheelbarrow), the effort is the hips (bucket of wheelbarrow) and the load (handles of wheelbarrow) is the defenders elbow.

The majority of attacks utilizing lever arms is fairly well understood in jiu jitsu. In no-gi, limbs provide mechanical advantages; in the gi, we can use tools (the gi), to create a lot more advantages. The way I like to think of the gi as a tool is to minimize the number of limbs it takes me to control the maximum amount of my opponents limbs. For example, if you control an opponents lapel in the Worm guard position, you can use a single hand to manage their posture (upper body), hips (center of gravity), knees and ankle.

Similar attacks and defense with the lapel can be made in standing, top or bottom guard. The best use of the gi will free up your hands and limit your opponents movement. 

To recap:

  1. There are three classes of levers
  2. Levers provide mechanical advantages
  3. Mechanical advantages allow for more opportunity to score or submit

The goal of jiu jistu then, is to gain a tactical advantage over your opponent while minimizing risk and maximizing reward. The more you’re able to control your opponent and the less of your body you need to use to do so, the greater the advantage.

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We can manipulate the effort (muscular force), fulcrum placement and to some degree, the load (opponents weight, or force) to create an asymmetrical advantage. The fulcrum is best understood as the point of contact that will “break” on an opponent. 
An example of a type 1 lever in BJJ submissions is an arm bar. Force is applied at the wrist (effort), with the fulcrum at the elbow and the load applied at the opponents shoulder. 

An example of a type 2 lever in BJJ submissions is an omoplata. Force is applied at the wrist/hand, load is applied to the shoulder (as close to the joint as possible) and the fulcrum is the shoulder joint.

An example of a class 3 level in BJJ is a scissor sweep from guard. The opponents contact point on the floor (foot/knee), the force is your contact on their body, and the load is the pull/drag you create on their upper body.

If you are a keen observer, you will notice that load and force are somewhat interchangeable. Since the class of levers applies to both the attacker and defender positions, the mechanical advantage is dynamic. Additionally, the fulcrum needs to be well-placed in order to gain this advantage. To add more complexity to the issue, the fulcrum can be moved along the lever arm to adjust location of force application.

Other observations include both the attacker and defender act as levers. In the arm bar example above, while the defenders arm is a class 1 lever, the attackers body is behaving like a class 3 lever (blue arrows, gold text). The fulcrum is the attackers shoulders (wheels of a wheelbarrow), the effort is the hips (bucket of wheelbarrow) and the load (handles of wheelbarrow) is the defenders elbow.

The majority of attacks utilizing lever arms is fairly well understood in jiu jitsu. In no-gi, limbs provide mechanical advantages; in the gi, we can use tools (the gi), to create a lot more advantages. The way I like to think of the gi as a tool is to minimize the number of limbs it takes me to control the maximum amount of my opponents limbs. For example, if you control an opponents lapel in the Worm guard position, you can use a single hand to manage their posture (upper body), hips (center of gravity), knees and ankle.

Similar attacks and defense with the lapel can be made in standing, top or bottom guard. The best use of the gi will free up your hands and limit your opponents movement. 

To recap:

  1. There are three classes of levers
  2. Levers provide mechanical advantages
  3. Mechanical advantages allow for more opportunity to score or submit

The goal of jiu jistu then, is to gain a tactical advantage over your opponent while minimizing risk and maximizing reward. The more you’re able to control your opponent and the less of your body you need to use to do so, the greater the advantage.

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Levers in Jiu Jitsu

A well-condition athlete with the requisite knowledge of “mat sense” can begin to dominate an opponent to work towards a submission. Let’s take a closer look at how mechanical advantages are gained. With the goal of maximizing submission completion and minimizing risk, we can look at the body as a system of levers, fulcrum and forces to achieve this aim. To have a better understanding of this system, we will review the three types of levers, how fulcrums function, and the minimal application of force to create positional advantages. 

In first class levers, the fulcrum is between the force and the object to be manipulated. Examples in the real world include seesaws, crowbars or a hammer to remove a nail from a piece of wood. 

In second class levers, the fulcrum and levers are at opposite ends with the manipulated object between. Examples include wheelbarrows and doors. 

In third class levers, the fulcrum is at one end, force is applied in the middle and the manipulated object at the other end. Examples include sweeping or hitting a baseball with a bat.

We can manipulate the effort (muscular force), fulcrum placement and to some degree, the load (opponents weight, or force) to create an asymmetrical advantage. The fulcrum is best understood as the point of contact that will “break” on an opponent. 
An example of a type 1 lever in BJJ submissions is an arm bar. Force is applied at the wrist (effort), with the fulcrum at the elbow and the load applied at the opponents shoulder. 

An example of a type 2 lever in BJJ submissions is an omoplata. Force is applied at the wrist/hand, load is applied to the shoulder (as close to the joint as possible) and the fulcrum is the shoulder joint.

An example of a class 3 level in BJJ is a scissor sweep from guard. The opponents contact point on the floor (foot/knee), the force is your contact on their body, and the load is the pull/drag you create on their upper body.

If you are a keen observer, you will notice that load and force are somewhat interchangeable. Since the class of levers applies to both the attacker and defender positions, the mechanical advantage is dynamic. Additionally, the fulcrum needs to be well-placed in order to gain this advantage. To add more complexity to the issue, the fulcrum can be moved along the lever arm to adjust location of force application.

Other observations include both the attacker and defender act as levers. In the arm bar example above, while the defenders arm is a class 1 lever, the attackers body is behaving like a class 3 lever (blue arrows, gold text). The fulcrum is the attackers shoulders (wheels of a wheelbarrow), the effort is the hips (bucket of wheelbarrow) and the load (handles of wheelbarrow) is the defenders elbow.

The majority of attacks utilizing lever arms is fairly well understood in jiu jitsu. In no-gi, limbs provide mechanical advantages; in the gi, we can use tools (the gi), to create a lot more advantages. The way I like to think of the gi as a tool is to minimize the number of limbs it takes me to control the maximum amount of my opponents limbs. For example, if you control an opponents lapel in the Worm guard position, you can use a single hand to manage their posture (upper body), hips (center of gravity), knees and ankle.

Similar attacks and defense with the lapel can be made in standing, top or bottom guard. The best use of the gi will free up your hands and limit your opponents movement. 

To recap:

  1. There are three classes of levers
  2. Levers provide mechanical advantages
  3. Mechanical advantages allow for more opportunity to score or submit

The goal of jiu jistu then, is to gain a tactical advantage over your opponent while minimizing risk and maximizing reward. The more you’re able to control your opponent and the less of your body you need to use to do so, the greater the advantage.

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Aerobic Considerations in Combat Sports

Aerobic Considerations in Combat Sports

Strength and conditioning for combat sports requires a proper evaluation in order to best prescribe an aerobic exercise program. This provides the best case scenario for minimizing overtraining, reducing risk of injury and improving weaknesses.  While there has been robust research on strength, power and agility, measuring aerobic fitness in combat sports is slightly more complicated.

As an athlete, coaches facilitate you learning new technique or improving on current ones to better develop the skill set to win a fight. Not good at guard? Lets drill that. Take downs a little weak? Take an extra 10 minutes after class to improve them.

Similarly, exercise prescription for improving cardiovascular ability needs a proper assessment first, then implementation of a plan specific to your needs.

In traditional “field” sports like football or soccer, it is very well known how much time will be spent sprinting, jogging and resting. In combat sports, there is a high degree of variability. Several factors needs to be considered with each individual athlete- how they fight, what their strengths and weaknesses are, their opponents style of fighting, their “gas tank” and how much power they can develop to control an opponent.

Let’s review the different variables that make up aerobic capacity.

  1. Mechanical efficiency
  2. Maximal aerobic capacity
  3. Metabolic thresholds
  4. Anaerobic capacity 

Mechanical efficiency can be described as an athletes capability in executing a specific technique with proper form. Sure, you have a great single leg in the first minute of a match, but what about in the last 30 seconds when you’re down by 2 points? Mechanical efficiency can make or break a fight. Currently, only a few assessments are capable (and validated) for measuring mechanical efficiency. 

Maximal aerobic capacity is described as the oxygen uptake based on aerobic metabolism. While there are validated tests for measuring VO2 using treadmills and bikes, few tests exists for combat sport-specific activity.

Metabolic (anaerobic) threshold can be described as the highest intensity of exercise sustained for a period of time without lactate accumulation. Lactate accumulation is one factor that limits muscle force production. Several tests exist for general and sport-specific activity. Think of this threshold as the point when you get “gassed out” when scrambling. 

Anaerobic capacity is the maximal amount of ATP resynthesized via anaerobic metabolism. ATP can be thought of as the “currency” of muscle contraction. This is usually high-intensity, short duration activity. Several tests exist for general and sport-specific activity. Think of anaerobic capacity as how much power or strength you have at a given point in your match. 

As you can tell, creating a specific test, or battery of tests to effectively measure these variables to develop a conditioning program can be quite challenging. While general testing exists, sport-specific tests for combat athletes is not always very well defined in the literature. 

My intuition tells me that while an athlete can subjectively describe where they are on the aerobic capacity spectrum, the objective measurements of these characteristics needs to be combat-sport specific when prescribing conditioning programs.

Test selection identifies a certain characteristic in combat sport athletes, attempting to differentiate between physiological capacity or sports performance. 

Low sports specificity tests include the 1RM, maximal isokinetic strength, counter-movement jumps, squat jumps, 40-m sprint, 30 second continuous jump, repeated contractions on an isokinetic dynamometer, Wingate testing, repeat-sprint tests and maximal aerobic capacity testing. 

While these are great for strength and aerobic assessments, the findings do not necessarily translate to how well an athlete can perform within the context of a sport. For example, a BJJ athlete may have a 1 RM bench twice that of his opponent, but if his gas tank only lasts for 20 seconds in a match, the opponent can just wait until they’re tired before capitalizing on their lack of muscular endurance. 

Sport specific assessments include exercise circuits and simulated combat with a live opponent. Exercise circuits like burpees, press-ups, throws or striking may appear sound, but the validity of these tests need to be elucidated. For example, performing burpees for 2 minutes straight may demonstrate a full body, explosive-type movement typically seen in combat sports, but it may not accurately reflect the technical or tactical demands an athlete requires during a match. Even repeated-bouts of burpees, like performing 30 seconds of movement, then 20 seconds rest, does not account for “active rest” that would typically occur in a match. Similar limitations exist for sport-specific movements like throwing, takedowns or striking. Simulated combat presents the closest assessment- since a live opponent will be actively defending or attacking, keeping the pace as close to competition as possible. With simulated combat, one tradeoff is differences in fighting styles between athletes. 

So how can we improve our assessments and interventions? 

The first is developing an assessment protocol to accurately address the 4 determinants of aerobic function we described in the beginning of this video. This will help the strength coach to identify opportunities for growth with the athlete. Second, we can properly prescribe exercises, and perform the necessary reassessment after a predetermined amount of time. 

One interesting approach a patient of mine spoke to me about was strategizing based on energy level when fighting and is position-specific. For example: if the opponent has good standing game, but weaker ground game, and there’s plenty of gas in the tank- then the focus will be on take downs and ground work. If on the bottom, with half a tank, then the focus will be on defense, waiting for an opportunity to capitalize on. In this way, energy system dominance can be managed while still considering tactical issues. The benefit to this approach is its utility- it encompasses technical, tactical and conditioning components.

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Anaerobic Testing for Brazilian Jiu Jitsu

Anaerobic Testing for Brazilian Jiu Jitsu

In the previous post we discuss factors that comprise to aerobic capacity and then we looked at what tests are available to measure aerobic capacity. Now, let’s turn our attention to BJJ specific metabolic demands and a performance test to measure anaerobic capacity. 

Anaerobic capacity can be thought of as the work capacity of muscle without the presence of oxygen. This system is generally limited to higher intensity, shorter duration work (<2 minutes), and requires rest to replenish energy stores. An athletes anaerobic capacity is determined by the presence of Type II muscle fibers (muscle trained to work in the absence of oxygen), hormones, neurological stimulus, and efficiency clearing metabolic waste. Blood lactate is an indicator that muscles are producing work via anaerobic metabolism. 

Studies of competitors at BJJ tournaments demonstrate RPEs about 13-17 (hard to very hard), HR ranging between 148-182 and blood lactate between 4.8-11.3. This shows that BJJ is a highly aerobic sport with a heavy reliance on anaerobic metabolism. 

Previous research on the work:rest ratio in BJJ places it at about 6:1. This means that for every 6 seconds of activity, there is 1 second of active rest (maintaining, not advancing a position). While this may provide an average “baseline”, it may not be specific to every athletes style.

 

In this BJJ anaerobic assessment, the athletes are to perform a butter fly sweep (sitting on the mat, feet placed between the partners groin, hands clasped behind their back; the athlete being assessed then rocks back, elevating the partner before returning to the starting position) for 1 minute straight and a 45 second rest. The total number of repetitions are counted in each round, and 5 rounds were completed. 

The researchers compared this to simulated BJJ matches lasting for 10 minutes. 

The researchers found a strong correlation between measurements of blood lactate (an indicator of anaerobic metabolism), with heart rate and RPE ranges similar to competition.

The authors concluded that the butterfly sweep is a good indicator of anaerobic performance when 4 rounds of 1 minute and a 45 second rest was assessed. 

On average, there was an 18% difference between number of sweeps completed in the first and fourth rounds of this study.

So, if you’re planning on engaging in a conditioning program, the butterfly sweep assessment can be used to measure your anaerobic performance. The protocol calls for performing 4 rounds of 1 minute of sweeps withs 45 seconds of rest. Baseline testing and retesting at regular intervals can provide valuable information and help guide your training program.

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What is PT?

What is PT?

What does it help with?

Physical therapy is a mode of treatment that addresses functional impairments. For sports physical therapists, these impairments usually include injury to the neurological or musculoskeletal systems. Injuries often result in loss of movement, muscle weakness, or avoidance of sporting activity that aggravates the pain. Athletes often discuss pain and fear of training or competing as their primary concerns. 

How does it “work”?

Physical therapy begins with a formal examination and evaluation. This includes history taking, movement assessment, systems evaluation and discussion of the examination findings. Based on your specific injury or condition, the physical therapist will develop a plan of care based on agreed upon goals. These can include things like running (football, soccer players), jumping (volleyball, basketball) or weightlifting (power lifters, crossfit). It is important you discuss what your goals are with the physical therapist; the reasons why you’re seeking treatment, and the level of activity you want to achieve. These goals should be specific (I can participate in 45 of the 60 minutes of play), measurable (I can now run for x miles), achievable (I want to get back to my 6 minute mile for cross country), relevant (catching a pass in football) and time bound (I want to achieve this in 2 months, before competition season). 

What you should know (treatment options)

There are several treatment models available within the context of physical therapy. These skill sets vary from therapist to therapist and may only be available in specific states. Some treatment options may be injury or sport specific, some may work well for your teammate, but not very well for you. The aim then, is to match your injury with the skill set of the therapist. Some treatment options include manual therapy (joint mobilizations, massage), dry needling, stretching, cupping or strength training (resistance, aerobic fitness). Usually a combination of the above mentioned treatments are required to get you moving in the right direction. It is best if you discuss these treatment options with the therapist after your evaluation. Treatment options should always consider what you prefer (given that it is effective) and what is available (your PT has the skillset). 

What to expect (improvements in dysfunction)

Seeking treatment from a physical therapist should always be done with a specific goal (or goals) in mind. Are you going to therapy because you have knee pain when you squat? Do you find yourself avoiding squatting and now have to substitute exercises, resulting in difficulty in other athletic activities? While pain management ought to be discussed, so should activity modification. Oftentimes, I advise patients to modify their current training while we teach techniques to manage pain. Just like learning a technical skill in sport, so too, should you be learning how to independently manage pain to improve function. While “hands on” therapy helps, creating a plan of care with independent exercises builds confidence that you are capable of managing pain. This sets the athlete up for success. What happens if they’re traveling to a different country and you have no access to hands-on treatment? Get on that home exercise program! You should expect consistent improvement in pain, dysfunction and confidence with sporting activities. Communication with your therapist is very important! Discuss where you’re at now and where you want to go. Discuss your timeline, how often you train, what type of training you engage in, length of training sessions, how often you compete, what the demands of competition are, how you communicate with coaches etc… All pieces of the puzzle should be considered. An effective therapist is one that pays attention to what YOU need as an athlete. 

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