Injury Prevention in Grappling Sports - Part IIIa

Last week, we began our discussion on neck injuries.  We discussed some basic neck anatomy as well as come common mechanisms for neck injuries in Jiu Jitsu.  One major take away was that all neck injuries are not the same.  They can range in severity and which tissues are involved.  In this blog, we will begin to discuss what are some common sign and symptoms, what early interventions we can do and what preventative exercises we can do to reduce our risk of these injuries.

In orthopedics, we can usually gain a lot of information about the severity of someone's injury based on what they tell us during the medical interview.  You can also use this to determine how your injury is progressing.  Is it getting better or worse?

• Tingling and numbness - Nerves are the electrical wires that transmits or interprets sensation from our our body.  Compression of the nerves can cause those signals to be interrupted which we interpret as tingling (partial interruption) and numbness (complete interruption).   We can often tell what nerves or spinal segments are involved based on where your tingling and numbness is at.  Tingling and numbness is most often associated with disc problems or nerve root compression.  But this is not necessarily the case.  Tingling and numbness usually occur when two things are present, mechanical compression (from disc bulge/herniation or nerve root compression) AND inflammation.  This is an important point for our discussion later.  The frequency, intensity and duration of the tingling and numbness tells us a lot about how bad it is or how involved the injury is.
• Frequency, intensity and duration - how often it occurs (frequency), how strong it is (intensity) and how long it last (duration) tells us a lot about how involved the tissues are.  The more frequent the symptoms (constant versus only at the end of the day), the more intense the symptoms (can't feel anything in my hand versus pins and needles) and the longer it lasts (once it starts it lasts for 2-3 days versus 10-15 minutes) the more involved the problem is.  This is good to know as this can be a guide we can use to determine how bad our symptoms are and IF OUR TRAINING is making it worse.  If these things are getting better, you are on the right track.  If they are getting worse, then you are progressing down the wrong path and should adjust your training routine.

• Weakness - for simplicity reasons, we can look at a nerve root as being divided into into two sections, motor (wires that run the muscles) and sensory (wires that provide sensation).  The wires that provide sensation are on the front side of the nerve and those that provide motor are on the back side of the nerve.  In order for someone to experience weakness as a result of nerve root compression means that the sensory are compressed (since they are on the front side and first to get hit) and now the motor are getting compressed.  So when someone starts to experience weakness as a result of a nerve root compression, this is typically a more involved injury.  The severity of the weakness can also help us determine the severity of the injury.  Significant weakness or weakness of multiple muscles can indicate a more serious injury.  It should be clear, weakness from pain is very different than weakness from a nerve compression.  Not being able to lift your head off the mat because of neck pain may be interpreted as weakness but that is very different than not being able to hold onto a cup due to nerve compression.   It should also be clear that bilateral weakness (weakness on your right and left) is an indication of a much more serious injury that should be evaluated by your physician.  

• Pain - pain can tell us a lot about an injury and details of that pain can also tell us how the injury is progressing (getting better or worse).  
• Location - with cervical problems, it is sometimes hard to tell exactly where the injury is.  With some cervical problems, there can be radiating pain which can confusing as to where the problem is originating from.  Most of the time, you can localize this to an area of the spine or musculature in the area.  As the problem progresses (gets worse) it will be more defuse and spread over a larger area versus one pinpoint spot.  
• Severity (how frequent the pain is, how long it last and how intense the pain is at best and worst) can tell us a lot about a neck injury.  Getting a baseline of frequency, intensity and duration (FID) can let you know how the problem is progressing (good or bad).  As FID increase, this tells us that the problem is getting worse.  This can help us guide the use of ice and give an indication of how we should modify our training.  

• Range of motion - the more involved the problem, the more severe the injury, the more this will impact your range of motion.  

Obviously this is a lot of information but the intent of this is to help educate on the signs and symptoms of an injury.  It is these signs and symptoms that are a very good indication of how the injury is progressing (good or bad).  Knowing these signs and symptoms and how to interpret them will help you know better how your injury is responding to your self care (which we will talk about next week) and your training.  It is these signs and symptoms that I have all my athletes monitor on their road to recover and return to the mat. 

Next week, we will start to dive into treating some of these signs and symptoms and some preventative exercises we can do to reduce the risk for these injuries.  We hope you continue to enjoy this series and find the information valuable.  If you did, please share with your colleague and follow us on instagrm @ bjjpt_acl_guy and twitter @acl_prevention.  #ViPerformAMI #ACLPlayItSafe

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment and ACL injury prevention.  He is the founder | developer of the ViPerform AMI, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent has also been training and a competitive athlete in Brazilian Jiu Jitsu for 5 years.