Injury Prevention in Grappling Sports - Part VA

Last week we discussed various knee injuries that occur in grappling sports.  This week we are going to dive into more lower limb and hip injuries that occur. 

Hamstring Strain - As you can see from this picture, the hamstring cross both the knee joint as well as the hip joint and is comprised of three muscles.  Not only does this complex of muscles (hamstring) aid in knee flexion but also aids in hip extension.  For upper belts, a common mechanism of injury is the resistance of a knee bar.  With this position, the hamstrings is working eccentrically to resist the knee bar and is often a type of resistance that the hamstring is weakest in and therefore more susceptible to.  In lower belts, strain to this muscle can come from scrambling, pulling dela heva or spider guard.  Typically strain is felt in the posterior region (in the muscle belly) or sometimes at the origin at the ischial tuberosity (proximal hamstring tendon pictured).  There are various levels of injury to this muscle.  If there is discoloration (bruising) or balling up of the muscle, you should see a physician.  If this is painful to resistance and localized tenderness, you need to exercise caution with returning to the mats.  The guide I usually use is if you can drill or do live training without pain and control your pain afterwords with the use of ice, you are good to train with.  If you have pain during and are not able to control or prevent from getitng worse, you need to cut back. 

Adductor Strain - The adductor is really a group of four muscles (adductor brevis, longus & magnus and gracilis).  As a group, these are very commonly injured in jiu jitsu.  With pulling someone into your guard and actively resisting their trying to break your guard, you often over power the adductor's ability to resist the strain.  Doing this repetitively will eventually lead to pain when you are attempting to hold someone in your guard.  Another common mechanism of injury is when someone does a knee slide pass on you.  Both the excessive range of motion combined with the attempt to resist can add strain to this muscle.  Most of the time you will feel this in the muscle belly or at the origin of the muscle up toward the groin area toward the center of the pelvis (closer to the pubic symphysis).  Part of the reason this occurs is that most do not train their adductors and for new white belts, you are suddenly in a sport where you are having to use this all the time which can lead to over use.  Most people think that smashing the adductor on a roller or stretching it will help to prevent.  Although the stretching will help with increasing range of motion and help from a preventative standpoint, the key is to make sure to add some strengthening to your program.  This should be high reps (15-30) reps with lower weight.

Labrum of the hip - the labrum of the hip is a cartilaginous structure in the hip that provides some stability to the hip by aiding in securing the femoral head within the acetabulum.  This is commonly injured due to the excessive motion that the hip goes through with this sport as well as pressure it is under with this motion.  Going from Xpasses to knee slide pass to smash pass, the labrum is put under a lot of pressure.  When this is injured, you may feel pain up in the groin area (closer to the hip).  You may also feel pain when someone does a knee slide pass on you our as you are moving your hip around.  In some cases, you may feel a clicking or popping sensation deep in your hip.  If you experience the pain with popping in the hip, you should have this evaluated by a physician.   

As with the previous blogs of this series, we are not listing all the injuries that can occur in the hip, just some of the most common injuries. As with all of these injuries, you can prevent them and most of the time, this does not mean you have to take long periods of training off. 

Next week, we will expand this discussion to discuss what you can do to prevent these injuries.  We hope you found this information valuable.   If you did enjoy, please share with your colleagues, training partners and BJJ enthusiast and please be sure to follow us on instagrm @ bjjpt_acl_guy and twitter @acl_prevention.  Train hard and stay well.  #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,  ViPerform AMI RTPlay, 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 in Brazilian Jiu Jitsu for 5 years and complete BJJ junkie. 

Injury Prevention in Grappling Sports - Part V

Over the course of the 2 months we have been discussing various injuries that occur in grappling sports.  Specifically we have looked at neck injuries and shoulder injuries, how these injuries happen and how we can prevent them.  This week we will take at another common injury in grappling sports, knee injures and hip injuries.

When we think of knee and hip injuries, sometimes we think these primarily come from knee bars or some kind of submission.  Although they can happen this way, the majority of knee injuries in grappling sports results from a non-contact or non-submission type of situation.  Unlike neck and shoulder injuries where the main mechanism is from submission or resisting submission, 70% of knee injuries occur when going for a take down or resisting take down and remainder knee injuries from various positions in grappling.  Hip injuries, on the other hand, primarily develop from maintaining some of the positions that we do in the sport (guard) or from force new range of motion by an opponent when passing guard.  Before we talk how these injuries occur, let's first take a look at the structures that are commonly injured.

As with the previous blogs of this series, we are not listing all the injuries that can occur in the knee and hip just some of the most common knee injuries. 

Meniscus - meniscus are the cushions between the femur (upper bone) and tibia (lower bone).  There is the lateral meniscus (outside of the knee) and medial meniscus (inside of the knee).  These structures undergo a lot of stress when there is a lot of flexion (knee bend) and if any rotation at the knee occurs.  The meniscus strain increases from 50 degrees of knee flexion to 90 degrees.  Considering this is a position our knees are in a lot, it would make sense that meniscal injuries are common in BJJ with medial meniscus account for the majority of.

If you have a meniscus injury some things that may bother you or cause you pain:

• Posturing up in someone's guard  - do to the position of the knee and pressure on the meniscus
• Shooting in for single leg take down
• Shooting drills
• Knee slide pass or knee on belly  
• Pain with rising after sitting for long period of time

Usually with these injuries, your pain will be localized to the lateral or medial joint line (outside or inside) or back inside part of your knee and you can usually touch the area of pain.  In extreme cases, you may feel deep clicking in the joint or locking (bending the knee and locks up preventing you from extending or flexing the knee).  This is typically associated with a certain type of meniscus tear (bucket handle) and usually requires surgical intervention.

ACL (anterior cruciate ligament) - the ACL is the knee injury that most know about and is the one that takes the longest to heal.  The ACL is a ligament on the inside of the knee that prevents the tibia (bottom bone) from sliding forward on the femur (top bone).  The ACL is put under a lot of stress in the first 10-30 degrees of knee flexion and even greater loads when there is a component of rotation.  A majority of ACL injuries are non-contact in orientation (shooting in for take down) but can also happen when transitioning out of someone's guard or 1/2 guard or in a scramble.  Typically, you will hear a pop in the knee when the injury occurs, have some pain and will usually get a lot of swelling.  Pain will be a deep pain within the joint and not necessarily a pain that you can touch.

If you have an ACL injury you may experience pain or a sense of "instability" with the following:

• Shooting in for single leg take down
• Shooting drills
• In stand up, moving to that side 

You may also experience a lack of a sense of confidence on the effected side.  With the instability that is created once the ACL is ruptured, your body senses this instability and subconsciously you know that instability is there which adds to the lack of confidence.  If the ACL is ruptured, surgery is typically required, especially if your are to continue in the sport.  If not, the shifting that occurs in the knee due to the missing ACL will lead to early osteoarthritis.  

MCL (medial collateral ligament) - MCL (inside ligament) tears are a little more common than LCL (lateral collateral ligament - on the outside).  Referring to the picture above, this is a ligament that prevents gaping of the joint on the inside.  With a lot of the moves that we do in the sport, this ligament is put under a lot more stress than the LCL.  Although injuries can occur to the LCL, the MCL is just more common.   With this type of injury, you may or may not hear a pop in the knee when the injury occurs, pain and swelling will be localized to the inside of the knee, there may be some localize bruising and the area will be very sensitive to the touch.

Your treatment will depend on how severe your injury is.

Mild or grade 1 injuries - usually get better in 1 to 3 weeks and may only need home treatment
Moderate or grade 2 injuries - usually get better in about a month. You may need to wear a hinged knee brace and may require limiting how much weight you put on your leg.
Severe or grade 3 injuries - may require wearing a hinged brace for a few months, and may require limiting weight on the leg for 4 to 6 weeks.

If you have an MCL injury you may experience pain with the following:

• Shooting in for single leg take down
• Shooting drills
• In stand up, moving to that side 
• Bending your knee
• Rising after sitting for long period of time 
• Moving after having leg straight for long period of time

If an MCL tear is suspected, it is best to have it evaluated.  Surgical intervention is rarely recommended.

Fibular head - the fibular head (on the outside of the knee) is held in place by the posterior ligament and fibular collateral ligament.  There is also a bursa just behind the fibular head.  With some of the positions our knee get into with the foot trapped (like in opponents 1/2 guard) some of the passes we do will put stress on those ligaments.  This will usually result in sharp pain on the outside of the knee.  Although not commonly evaluated, if the ligaments have been torn, the fibular head will have more mobility with anterior and posterior translation (moving it back and forth) when compared to the opposite side and typically will cause the bursa to swell up.  This can often be missed or misdiagnosed as a LCL tear or ITBand friction syndrome.

If you have a ligament injury to the fibular head, some things that may bother you or cause you pain:

• Posturing up in someone's guard  - do to the position of the knee and pressure on the meniscus
• Shooting in for single leg take down
• Shooting drills
• Knee slide pass or knee on belly  

As stated previously this is not all the injuries that can occur just some of the most common.  Next week, we will expand this discussion to the hip since these are commonly related.  We hope you found this information valuable.   If you did enjoy, please share with your colleagues, training partners and BJJ enthusiast and please be sure to 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,  ViPerform AMI RTPlay, 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 in Brazilian Jiu Jitsu for 5 years and complete BJJ junkie. 

Injury Prevention in Grappling Sports - Part IVD

Over the course of the last several weeks, we have been discussing specific types of shoulder injuries that can occur in grappling sports.  Last week, we discussed some specific stretches we can do to prevent injury.  These stretches can be added to your routine and should be done prior to practice, drills or live rolling or competition. 

In addition, there are some exercises we can add that will also help to prevent injuries.  Before we go into specific exercises, I want to discuss how you put these into your routine.  One thing we know from the research (Soomro et al Am J Sports Med 2016) is if a "prevention program" goes over 20 minutes in duration, then compliance with that program drops off drastically.  We all know our time is very limited and adding an additional 20-60 minutes of "preventative exercises" onto your routine will many times prevent us from doing the things we know we should do.  But, what if I told you there is a way that you can add exercises to your routine that will 1/2 the time as the traditional route and when done in this fashion not only help prevent injuries but also improve athletic performance. 

In our research, in an effort to make our programs more efficient (not require high volume but still provide same training effect) we developed an approach called fatigue state training.  Fatigue state training simply uses the fatigue you create in training, weight lifting or practice to pre-fatigue the body prior to performing our preventative program.  Theoretically, we could then do less volume and still have the same training effect because you are starting from a state where the muscle is already tired.  Applying this approach, we discovered several interesting things. 

• Improved Compliance - since the program is shorter and takes less time to implement, the compliance rate with the program is much better.  This has had a dramatic impact on injury rates and team performance.  Why team performance?  In sports, better players play more and therefor are more likely to get injured.  Reduction of injury rates meant better players stay in the game longer and contribute to overall team success.
• Training Effect - by using fatigue state training, you get the same training effect with 1-2 sets that we would normally get with 4-5 sets.  We also found by training the muscles in a fatigue state, when the athlete became fatigued during play, they actually were moving better and getting injured less.  This falls under the training philosophy of specificity of training.  We trained the muscles in a fatigued state so when the athlete is fatigued this is a state the muscles are trained for so they can respond better.  
• Performance Impact - by doing fatigue state training, we found that athletes were actually performing better in the later stages of the game or competition.  So not only was team performance going up but athlete's individual performance was improving.

All of this to say, if you are going to do these exercises, you can make it more efficient, more impactful on injury rates and athletic performance if done at the end of practice.  I am also putting in some exercises that will address several links in the chain (core, shoulder, arms) instead of just pure isolation to one muscle.  This is more functional (since this is how the body works) and more time efficient (train multiple parts at one time).

*Note - some of the exercises I do with CLX.  This is a new theraband product that has continuous loops and allows you to do somethings you could not do with traditional theraband.  I have no financial relation with them but do love their products so you will see this used below*

Turkish Get Up - This is one of my favorite exercises for overall body conditioning.  Not only does this work the shoulder/upper body, core and legs, it is also a great exercise to strengthening for your escapes from mount, goon grip, etc.  There are some cues on the diagram below that you should follow to keep proper form.  When doing this, if done in fatigued state, do 1-2 sets of 10-15 reps per side.

Pull ups with a Gi- I like incorporating pull ups with a Gi or rope as this not only strengthens my shoulder girdle, arms, parascapular musculature and lats but is also a great exercise for helping me with my grip strength and explosive power for collar drags and pulling guard.

Scapular retraction with external rotation -   using the CLX, grab the middle of the band and put your hands in two loops next to each other.  With palms facing up, pull shoulder blades back and down (by bringing your chest up) and slowly rotate hands out like pictured below.  Pause at end range and slowly return to start.  Do 1-2 sets of 30 reps each.  To bring in more core, I typically do these on a ball.

Side plank with external rotation - to work the hip, core and the shoulder at the same time (which is actually very important for performance) go into a slide plank.  Holding the band as pictured here with palm up, slowly rotate out, pause and slowly return to starting position.  Do 1-2 sets of 30 reps on each side.

Side plank progression - the video below shows you a great progression for this exercise.  This uses the CLX and draws in the entire lower kinetic chain, core, scapula stabilizers and shoulder girdle.  You can do this one for a set period of time or for 1-2 sets of 30 reps.

Adding these as a normal part of your routine will not only increase your shoulder strength but also help improve performance.  We hope you continue to enjoy this series and find the information valuable.  Next week, we will start the final part of this series on knee injuries.  If you did enjoy, please share with your colleagues, training partners and BJJ enthusiast and please be sure to 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,  ViPerform AMI RTPlay, 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 in Brazilian Jiu Jitsu for 5 years and complete BJJ junkie. 

Injury Prevention in Grappling Sports - Part IVC

Last week, we concluded our discussion of certain types of shoulder injuries that can occur in grappling sports.  Keeping in mind this is not an exhaustive list, but more along the lines of the ones that we typically see.  As with any injury, if you have pain that is limiting your range of motion, waking you at night and impacting your daily activities (preventing you from combing your hair, getting dressed, working, etc) then you should seek an evaluation by your health care provider.

For those injuries that do not require medical intervention, you can attempt manage these by icing on a frequent basis and by monitoring your frequency, intensity and duration of your pain.  For more information on both these topics, please refer back to our previous blog on ice and managing pain.

As with most injuries, there are exercises that we can do to help prevent these types of injuries.  Obviously the best preventative technique is improving our Jiu Jitsu skills and avoiding getting caught in these positions but we all know, that does not happen all the time.  So whether getting put in these positions with practicing of a technique, in live rolling or competition, properly preparing the shoulders should be an important part of your training.  What does preparing the shoulders actually mean?  Ensuring that your shoulders have the full range of motion needed for the sport and the shoulder strength to participate in the sport are a critical part to avoiding injury. 

Total shoulder range of motion is a concept that has been described in the orthopedic literature for some time and is a common measurement taken in collegiate and professional athletes (baseball pitchers as an example).  Total shoulder range of motion (TSM) is the range of motion in external rotation (ER) and internal rotation (IR) when arm is at 90 degrees of abduction.  In other words, TSM = ER at 90 degrees abduction + IR at 90 degrees abduction.  It is not uncommon for the right and left to have a variance in IR or ER side to side but the total shoulder range of motion should be close to equal.

The research is clear that if you have >10 degree difference in your right TSM versus your left TSM, you are 3xs more likely to suffer a labral tear, rotator cuff tear or ulnar collateral ligament tear or UCL (elbow injury) in  (Shanley et al Am J Sports Med 2011) overhead sports.  This makes sense if you think about it.  If the range is limited and you get to the end range of motion, then other tissues then become stressed (in particular the rotator cuff, labrum and UCL).  This same concept has been applied to swimmers.  In these types of sports, the shoulder has to go through such a large arc of motion and if it is limited, it is much more likely to get injured.  This concept of TSM can and should apply to the Jiu Jitsu athlete as well.  Since our sport not only takes you into these extreme end ranges of motion, it also does this with high stress and loads applied at these end ranges, then it is imperative we make sure to include range of motion or stretches as a part of our shoulder healthy routine.  Therefore the greater total shoulder range of motion, the less stress there is to the tissues.

Considering, here is a series of stretches we can do for limitations in TSM. 

Sleeper Stretch - lying on your right side with your arm at 90 degrees abduction and 90 degrees horizonal adduction and palm facing down, using your left hand push your right hand to the floor until you feel a good stretch.  Hold that for 30 second and repeat 4 times.  Repeat on the left.

Structures stretched - posterior capsule, rotator cuff.

Kimura hamstring stretch - placing your belt around your foot, grab the end of in your hand by reaching around your back with your palm facing up.  As you bend forward as far as you can so feel a stretch in your hamstring. Keeping your hand in the position, as you extend back and ease the stretch off your hamstring, you should feel a stretch in your shoulder.  Hold each position for 30 seconds and repeat 4 times.  Do on both right and left.

Structures stretched - anterior capsule, rotator cuff, long head of biceps

Posterior shoulder stretch - start with laying on the mat with your right arm in the position depicted below.  Slowly bring your left chest toward your right elbow (effectively rolling onto your right arm) until you feel a good stretch in the posterior (back part) shoulder.  Hold for 30 seconds and repeat 4 times.  Repeat on the left side. 

Structures stretched - posterior capsule, rotator cuff

Pec stretch - standing, place your palm on the wall with elbow straight.  Slowly turn your upper body until you feel a stretch in your pec.  To add some stretch to the nerves (called nerve glides) slowly rotate your head to look over your opposite shoulder.  To increase further stretch, rotate your head and slowly raise palm off the wall while keep arm in contact with the wall.  Hold for 30 seconds and repeat 4 times.  Repeat on the left side. 

Structures stretched - anterior capsule, pec majory, biceps, median nerve & C5-C7 nerve bundles.

Adding these as a normal part of your routine will not only increase your range of motion but also help to keep your shoulders healthy.  We hope you continue to enjoy this series and find the information valuable.  Now that we have covered stretches, next week we will get into some specific exercises for preventing injuries.  If you did enjoy, please share with your colleagues, training partners and BJJ enthusiast and please be sure to 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. 

Injury Prevention in Grappling Sports - Part IVB

Last week, we discussed some specific shoulder
injuries that can occur and some of the common submissions that will lead to these injuries.  Many times, it is not just the submission position that compromises the shoulder but the resistance that we give to the submission.  Fortunately and unfortunately, these submission puts the shoulder in its end range of motion and the supporting tissues (rotator cuff, biceps, etc) in their elongate positions.  Therefore, when you try to resist the submission, the muscle is in an elongated weakened position and more susceptible to injury.  Next week, we will talk about some specific strategies to help increase shoulder range of motion (which helps in resisting submissions) and strengthening of the shoulder muscles so they are less susceptible to injury. 

This week, we want to look at two more injuries, one in the shoulder and one that is often misdiagnosed.  In the shoulder is a joint called your AC joint or acromioclavicular joint.  We talked about this briefly in our first part of this blog but this is a common enough of an injury that it is worth discussing here in some more detail. 

The AC joint is held together by a ligament (depicted in this picture).  An AC joint injury is an injury to this ligament where the ligament is torn and allows the clavical to migrate upwards.  One of the most common mechanism of injury of this ligament is a fall on the shoulder or onto an outstretched hand.  Most commonly this occurs during take down.


In the case of a takedown, this can happen on the person shooting for the takedown or the opponent.  For those shooting for the takedown, if they are shooting for a double leg takedown (as depicted here) and their head is in the proper position (head up on the inside) when they drive backwards or at a diagonal, it is not uncommon to land on the shoulder.  If this impact is more toward the top of the shoulder, the driving force is directly through the acromion and the clavical.  This puts a lot of stress on the ligamentous structures of the AC joint and can cause an AC separation.  For a classifications of AC  separations, please see our previous blog.   The other common mechanism of injury for the AC joint is the opponent that is being taken down.  Sometimes out of instinct, the opponent being taken down will reach out his arm to break the fall and end up landing on the shoulder.

In either situation, the athlete will commonly feel a sharp pain that will be localized to the small area on the shoulder.  If there is separation and depending on the grade, the athlete may see a deformity of the area.  The picture below shows two ends of the spectrum.  From a low grade level I separation to a grade III - IV.  I have included this picture so you can see what this looks like and be able to recognize this when or if you see it in the mirror. 

In the first instance, this can most likely be treated conservatively and in the second case, this individual should see a health care provider.  In either instance, use of an ice massage is very effective at reducing inflammation and pain.  For this you can purchase a cyrocup on Amazon or eBay for ~$10.  I prefer these over the metal round balls being sold in Jiu Jitsu circles and here is why.  What makes this effective is when the ice melts it forms a layer of water between the skin and the ice cube.  This conducts the cold much more efficiently than just ice on the skin or cold metal.  This means deeper penetration and colder temperatures are achieved.  This means better inflammation control.

Another injury (not in the shoulder but worth mentioning here) is a rib subluxation.  Rib subluxations primarily occur at the costovertebral joint.  This will often occur reaching around your opponent (getting an underhook during take down or something similar) and they resist you or you pull with a lot of force.  Commonly it is this outstretched position with thoracic rotation followed by maximal contraction that will cause this joint sublux.  Where you will feel this is in a pin point location in the back or upper back and you will get a sharp (sometimes debilitating) pain with a deep breath, cough or sneeze.  Inflammation reduction (ice) is important to allow the tissues to relax and allow the joint to self reduce (which sometimes it does).  If it does not, you can see a chiropractor or PT to help put the joint back in position.  The same strengthening exercises we recommend with the shoulder will help with this as well.

One common injury in wrestlers and jiu jitsu is athletes is an oblique or intercostal strain.  This happens a lot when you have your opponent in your guard and you reach for cross collar or across your midline to pull them down or when doing a bump sweep.  This injury will often occur where the oblique muscle attaches to the rib cage and will be tender to the touch at the intersection of the ribs and abdominal muscle.  This injury will hurt a lot when you sit up and when you take a deep breath or sneeze.  Due to the location of the pain and the orientation of the symptoms, this is often misdiagnosed as a rib injury.  Two very different injuries and two different treatment approaches.  It is for that purpose that I mention this here.  The key preventative technique for this injury is training the abdominals and the obliques.  High reps and preferably on an unstable surface.  I will have athletes do 8-10 sets of 10-15 reps of abdominals and obliques on a physioball to help prevent..

We hope you continue to enjoy this series and find the information valuable.  Next week, we will get into some specific stretches and exercises for preventing injuries.  If you did enjoy, please share with your colleagues, training partners and BJJ enthusiast and please be sure to 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.