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.