Monday, September 2, 2019

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. 

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