Top Five Tips for Combat Athletes from a Physiotherapist

1. Do not neglect strength training.

What’s the best way to avoid injury? Being strong. Injuries occur when the capacity of a tissue is surpassed by a single force/stress or an accumulation of force/stress. Strength is not only the ability to overcome a resistance, but it’s also the ability to dissipate force/stress. Many martial artists would rather spend their time focusing on skill training, while neglecting strength and conditioning training. A meta-analysis compared strength training, balance training and stretching on the effectiveness to reduce injuries. The results show that strength training significantly reduced both sport injuries and overuse injuries. Balance training demonstrated a mild reduction in injury while stretching did not demonstrate any protection against injury (Lauersen 2014). Don’t neglect strength training; it will help mitigate future injuries.

2. Understand the mobility requirements for your sport.

How much mobility does a combat athlete require? “You need as much range of motion as your sport requires with a small buffer (Spina 2020).” I often see athletes attempting to do things with their body without the necessary mobility. Doing movements without adequate mobility forces compensatory patterns, which will eventually lead to overuse injuries. In the last tip I mentioned that stretching does not help reduce injury; let me explain why. That study looked at general stretching, as opposed to working on the specific areas where an athlete requires enhanced mobility. Second, stretching promotes flexibility, which is the ability to passively move in a certain range. If you have passive mobility but not the active control in those ranges, it means you won’t be able to actively absorb the accumulation of stress that occurs with your sport. Mobility is the ability to actively move in a certain range. If you can actively move in a certain range, then you have the ability to develop strength and absorb stresses in that range.

Common combat sport positions that require enhanced mobility: head kicks, high guard, inversion.

• Head kicks: To throw effective high kicks one requires a decent amount of hip abduction, hip internal rotation and posterior thigh (hamstring) tissue extensibility. Without adequate hip mobility the athlete will be forced to compensate at the spine / pelvis OR may be putting excessive stress on the hip capsule.
• High Guard: High guards in jiu jitsu, such as rubber guard, require hip external rotation, hip adduction and hip flexion. Without adequate hip mobility the athlete will be forced to compensate at the knee.
• Inversion: The act of inverting requires thoracic, cervical and lumbar flexion. Without adequate thoracic flexion the athlete will be forced to compensate at the cervical spine, putting excessive load on the neck. This becomes even more dangerous because the cervical spine was not meant as a weight-bearing structure.

How do you know if you have enough mobility for your sport? It would be a good idea to get assessed by a qualified healthcare professional or coach who understands the demand of your sport.

3. Movement is the key to joint health.

How do you keep your joints healthy? The key to keeping an articulating joint healthy is movement. Training inherently stresses the body, which causes microtrauma to your joints. This stress will accumulate as fibrotic (scar) tissue. Movement of the joint assists with transportation of nutrients and helps to minimize the accumulation of aberrant fibrotic tissue. Loss of range of motion in a joint is often due to this accumulation of fibrotic tissue, disuse, or injury. If you do not move an articulation through its full range of motion, your body will not use its resources to maintain that range of motion. Injury will lead to pain, and pain may cause an athlete to avoid moving in a certain manner. This again results in disuse, that eventually results in loss of range of motion over time. It’s a good idea to take every joint through its full available pain-free range of motion each day, to maintain range of motion and to facilitate the transport of necessary nutrients to maintain a fully functioning joint (Bricca 2017).

4. Understand load management.

Everything an athlete does puts stress on their body, from strength and conditioning and skill training, to various life obligations. The accumulation of stress negatively affects the body. How does an athlete recover quicker and reduce this stress? Load management is a concept to allow one’s body to adapt sufficiently to the demands of training. In the older model of combat sports, an athlete did “fight camps” to prepare for a competition, then take time off between competitions. That athlete would go from not training hard at all to multiple training sessions a day, while on a caloric deficit to make weight. The athlete ends up training significantly more with less resources, which can be a disaster. It would be wise to gradually increase the volume of skill training and strength work to allow your body to adapt. This gradual approach allows the body’s capacity for stress to gradually increase and minimizes overloading the body, to allow the body to recover sufficiently.

5. Address your injuries so they don’t become lingering issues.

Injuries are an unfortunate consequence of the rigours of training. Many athletes go into competition with some level of pain or injury, but don’t you think your performance could be better if you had less injuries or less pain? Most athletes end up retiring because they’ve accumulated so many injuries, which take their toll on the athlete’s performance to such a degree that it’s no longer worthwhile to compete.

Athletes are not great at seeking medical attention from healthcare professionals when they have injuries. Small acute traumatic injuries or minor overuse injuries are often ignored, as they will heal with “time and rest”. In many cases this is accurate, your body will heal, but healing is not always this straightforward. When overuse injuries are ignored, they go from acute injuries to chronic lingering injuries, which are much more difficult to treat.

Typical timeline of a combat athlete: An athlete will start out inexperienced, but with a fully functioning body. Through rigorous training or competition they start to develop injuries. They may ignore some small injuries, so now their body is operating at slightly less than 100%. Their skills develop over time, but their body starts to gets worn down as well. Due to chronic injuries, the athlete is forced to modify their training routine or change their fighting style. There comes a tipping point, where the athlete’s injuries outweigh their skill and experience. This is the point at which many athletes consider retirement.

As a medical professional, it’s my opinion that if an athlete sees a physiotherapist, they minimize the chances of an injury becoming a lingering problem. They may also have the opportunity to address biomechanical faults or movement deficits that may predispose them to overuse injuries.  The goal of a physiotherapist is to make sure that your body can do what you ask it to do. Working with a physiotherapist has the potential to improve not only the fighter’s performance in competition, but also the longevity of the fighter’s career.

References:

1. Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2014). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British journal of sports medicine, 48(11), 871-877.
2. Spina, Andreo. Functional Range Systems, functionalanatomyseminars.com
3. Roos EM, et al. Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of osteoarthritis. Arthritis Rheum. 2005.
4. Bricca A, et al. Impact of a daily exercise dose on knee joint cartilage – a systematic review and meta-analysis of randomized controlled trials in healthy animals. Osteoarthritis Cartilage. 2017.

Dr. Mike Piekarski is a doctor of physical therapy who resides in Northern California. Mike is also a board-certified orthopedic specialist, a brazilian jiu jitsu black belt and a former MMA fighter. To read more from Mike check out his website www.doctorkickass.com or check out his instagram @doctor_kickass .