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Working With Combat AthletesSports that involve fighting are among the most challenging and stressful—not to mention dangerous—competitions.Combat athletes compete in many different sports. While some—such as wrestling, boxing, and karate—have been practiced for hundreds or even thousands of years, others, such as mixed martial arts (MMA) and Brazilian jiu jitsu (BJJ), are new to the scene. (The term "combat sports" describes a competition whose essence consists of direct combat between 2 competing athletes.
Similar to athletes in other pro sports—as well as to tactical athletes, including military personnel, police, and firefighters—combat sports athletes' continued employment relies on their physical performance and, ideally, avoiding injury. However, the physical demands of combat sports mean that injuries occur more frequently than in other sports. In MMA, for example, a number of studies have found an injury rate of 24-29 per 100 fight participations.
Both women and men compete in combat athletics. Women compete in judo in the Olympics as well as at other levels; MMA fighter Ronda Rousey was an Olympic judo bronze medalist before transitioning to MMA, where she won the UFC (Ultimate Fighting Championship) women's bantamweight championship. Holly Holm was a professional boxer and kickboxer before defeating Rousey to win the UFC bantamweight championship. Amanda Nunes, the current MMA bantamweight champion, started training in karate at age 7 and pursued training in boxing at the age of 16. She holds a black belt in BJJ and a brown belt in judo. In fact, many women combat athletes have practiced multiple martial arts.
Physical therapists work with these athletes focus on minimizing injuries, addressing those that do occur, and extending the careers of the athletes.
We analyze technique and identify the sources of the movement problem from the individual, then complete manual therapy, stretches, strengthening, and neuromuscular reeducation, and build back up into reintegrating appropriate movement into the specific problem area to maximize performance.
While conditions and injuries for combat sports athletes can vary, the most common injuries are rib injuries, thoracic restrictions, lower back pain, knee pain (frequently meniscal or at the iliotibial band or medial region), hip impingement and pain, ankle sprains, elbow hyperextension (often among "newbies" to their sport, she says), postconcussion headaches, and chronic whiplash.
We can also see a lot of shoulder impingement syndrome (SIS), which frequently occurs because the athletes have been taught to protect their chin while throwing jabs by "putting on a hoodie"—bringing their shoulders up and forward, as if shrugging into a jacket.
Many of these patients stay in 'fight stance,' continuing to cover their chin as they go to their [daytime or salaried] jobs, and the anterior tipping of the scapula will frequently, over time, cause partial supraspinatus tears if not addressed, For these patients, my first goal is to fully normalize thoracic mobility, costal mobility, and cervical mobility through manual interventions. Ribs 1-4 are very frequently restricted in these patients. Soft tissue work and stretching instruction usually is needed."
It's also important to assess lumbar and hip mobility and lumbopelvic stability, as many of these patients are using their upper body to power their punches instead of rotating through their hips and pelvic girdle, and incorporating their whole body in delivering the strike.
Regarding chronic injuries, Lou sees a lot of low back and shoulder pain. Each fighter is different, but a large contributing factor I've seen is from the fighter's posture—rounded shoulders, pitched forward—compounded by the dominant patterns in specific types of combat sports such as wrestling, judo, and jiu jitsu.
In the realm of MMA, the most common injury location is the head and face—predominately the nose, eyes, and jaw regions. This is followed by the lower extremities and then upper extremities.
The upper and lower extremities tend to follow distal to proximal locations with regard to higher injury rate,The hand typically suffers a higher injury rate, followed by the elbow and then the shoulder. The lower extremity follows the same pattern, with the toes having the highest injury rate, followed by the ankle and then the knee. The research shows this across multiple studies.
Combat Sports & Terminology in BriefHere are brief summaries of some of the sports and terms mentioned in this blog .
Boxing, both amateur and professional, involves attack and defense with the fists. Boxers wear padded gloves and generally observe the code set forth in the Marquess of Queensberry rules. Matched in weight and ability, boxing contestants try to land blows while attempting to avoid the blows of the opponent. A boxer wins a match either by outscoring the opponent—points can be tallied in several ways—or by rendering the opponent incapable of continuing the match. Bouts range from 3 to 12 rounds, with each round normally lasting 3 minutes.1
Brazilian Jiu-Jitsu (BJJ) is a martial art and combat sport that teaches a smaller person how to defend himself or herself against a larger adversary by using leverage and proper technique. The Gracie family, founders of BJJ, modified judo and traditional Japanese jujutsu to create the art. It contains stand-up maneuvers but is most known for its ground-fighting techniques. Gaining superior positioning—so one can apply the style's numerous chokes, holds, locks, and joint manipulations to an opponent—is the key in BJJ.2 Fights may be won by submission or by points awarded by the referee.
Chokes are submission moves that apply pressure to the neck, cutting off blood to the brain. A player who does not "tap," or submit, will lose consciousness.3
Joint Locks are moves that apply pressure to a joint and push it in an "unnatural" direction (ie, locking an arm and forcing an elbow backward). This restricts an opponent's movement and/or causes him or her to submit due to pain and/or potential for a hyperextension injury or broken bone.
Jujutsu is a Japanese martial art and method of close combat for defeating an armed and armored opponent while using no weapon or only a short weapon. Because striking an armored opponent proved ineffective, practitioners learned that the most efficient methods for neutralizing an enemy took the forms of pins, joint locks, and throws. These techniques were developed around the principle of using an attacker's energy against him or her, rather than directly opposing it.4
Karate developed out of martial arts forms practiced on Okinawa, an island now part of Japan. The word karate is Japanese for "open hand" (kara means open and te means hand). Te signifies that the main weapon is the body. Instead of an arsenal of swords or guns, the "karateka" cultivates a personal arsenal of punches, kicks, and deflection techniques. Kara relates to the psychology of karate. Karatekas are open to the world around them, making them better equipped to handle any attack.5 Historically, and in some modern styles, grappling, throws, joint locks, restraints, and vital-point strikes also are taught.
Krav Maga is a tactical mixed-martial art/combative and self-defense system that combines boxing, judo, jujitsu, and aikido. It was developed for the Israel Defense Forces and Israeli security forces. The primary goal, to neutralize a threat as quickly as possible, governs all the other principles of Krav Maga. It consists of strikes, holds, and blocks. The fighter looks to combine an offensive movement with every defensive movement.6
MMA (Mixed Martial Arts) is a full-contact sport that allows a variety of fighting styles to be used (including martial and non-martial arts techniques). Striking and grappling techniques, either standing or on the ground, are permitted. The early years of the sport saw a wide variety of traditional styles, but it is now common for fighters to train in multiple styles, creating a more balanced skill set.7 A competitor may win by submitting his or her opponent (forcing the opponent to concede the match), knocking out the opponent, prompting a referee stoppage (technical knockout), accumulating the most points from the judges, or causing an injury that results in a doctor's stoppage.
Muay Thai or Thai boxing is the Thai national sport. In Muay Thai, competitors fight standing as in Western boxing, but elbows, knees, and kicks strikes are allowed, with the only protection being the gloves. An important part of this fighting style is the clinch (standing wrestle).
Kenneth Mauck, MPT, MS Lead Physical Therapist
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