Craig and Jason discuss Nicky Ryan’s knee injury and hypothesise about structures potentially injured given the mechanism and immediate footage post match.
They also discuss the anatomy, mechanism of injury and management pathways for posterolateral corner injuries that they have commonly seen in BJJ practitioners, soccer players and rugby league players.
We know the feeling. You’ve been training solidly, competing well and things feel like they’re coming together (finally!).
Until that moment amongst a heated roll, that you lose your base and land smack-bang on the point of your shoulder.
You have an immediate reflexive wince of pain. You feel like someone stuck a knife into the point of your shoulder and your arm ain’t moving very far away from your body.
It definitely doesn’t like you moving the arm across the body and it may even look like a little speed hump at the end of your shoulder.
Welcome to the acromioclavicular joint, the notorious AC joint in contact sports like BJJ. This is the joint that lies between the end of your collarbone and shoulder blade and acts as a strut to stabilise the shoulder/arm complex.
These AC joint injuries are classified into 6 different types according to the commonly used Rockwood Classification:
Management of AC joint injuries follows the general principles of all ligament injuries and will be dependant on the grade (type) and the end goals of the individual.
As a general rule, surgical intervention may be indicated for type 4, 5 and 6 AC joint injuries and type 3 injuries that do not respond to non-surgical management.
Like all injuries, the rehabilitation and exercise or loading exposure will vary from person-to-person. As a general guide, initial management begins immediately and aims to minimise bleeding and swelling and treatment aims to:
promote tissue healing
prevent stiffness
protect from further damage
strengthen shoulder musculature to provide dynamic stability.
Isometric strengthening exercises can be started as soon as pain allows and usually begin close to the body with a progression plan to move away from the body as the body undergoes it’s natural healing response to injury.
We usually look for no AC joint tenderness and full pain-free movement as a starting point for starting the conversation about returning to sport.
We like to see the completion of a full rehabilitation program that focuses on restoring full function and strength of the entire shoulder complex, as well as a graded return to rolling that may involve light drilling and flow rolls initially, with an increase in exposure as the shoulder adapts to the additional stress loads of training.
Full return to training will be individual-specific and criteria driven.
Keep Rolling!
Photo: Peter Hinton (http://hintonzone.smugmug.com) Southern Cross Jiu Jitsu Academy
Craig at Winter Cup 2018 - Sydney Uni
We know the frustration when injuries happen as a consequence of this healthy addiction.
As battling white belts at Flow Physio Co we need any extra edge that we can get.
We like to take a proactive approach aiming to maximise performance and we would like to share this with you to keep you rolling.
With the growing popularity of BJJ and grappling in Sydney and with minimal information available locally, we have decided to put together a series of blog posts, videos and exercises that aim to help you improve performance on the mats and minimise time spent off the mats due to injury.
We understand the time constraints so we want to provide simple research based strategies for you to use.
Today, before we get into talking about specifics on the mats we will discuss three areas to address off the mats that can have a big impact on performance and injury risk.
These are especially important to BJJ but are important to all sport and physical endeavours:
“Sleep is the greatest legal performance enhancing drug that most people are probably neglecting”
- Professor Matthew Walker.
It is generally advised that the optimal sleep duration for adults is 7-9 hours and for adolescents it is 8-10 hours. Sleep can also be supplemented by napping with good effect. (1-2).
Sleep is important for growth hormone release and muscle protein synthesis aka repair, adaptation and growth of muscles and connective tissues. Learning and memories are also consolidated while we sleep.
Studies on athletes have found measurable improvements in athletic performance and skill execution when sleep duration was increased and significant declines in performance with lack of sleep (1-2). Other research has shown significantly higher rates of injury as the hours of sleep per night decrease (3).
In a sport as mentally demanding as it is physically, this can be the difference between submission or having your opponent ending up in full mount.
Strength training has many benefits for athletic performance including:
Increased speed
Agility
Power and efficiency
Reducing injury risk
Strength training alone has been shown to reduce the risk of overuse injuries by 50% and acute/traumatic injuries by 30% in a systematic review of 26 000 participants (4 & 5).
So not only will your game be stronger and more explosive but it will keep you dominating for longer.
Whether you are trying to sneak in an extra couple of classes or have recently had a time off the mats for a well deserved vacation, any spike or drop in the short term vs long term workload can be linked to the likelihood of suffering an injury (6).
Consistency is important; long term high training loads make us more resilient to injury. Therefore, high work loads in themselves are a good thing, as long as we progressively load to that point allowing the body time to recover and adapt (7).
*For those wanting to get a little more technical. Every exercise session you do over the course of a week can be easily measured by multiplying the session time (mins) by a score out of 10 (rate of perceived exertion ie. 0=asleep, 10=max effort) and each session to calculate the weekly total. To reduce the likelihood of injury it is advised to not progress exercise loads by more than 10% per week and remain in the sweet spot of training loads (more on this in a later post) (6).
References:
https://www.mickhughes.physio/single-post/2017/05/26/Sleep-Injury-Performance
Simpson NS, Gibbs EL, Matheson GO. Optimizing sleep to maximize performance: implications and recommendations for elite athletes. Scandinavian journal of medicine & science in sports. 2016 Jul 1. PubMed PMID: 27367265. Epub 2016/07/02. Eng.
Milewski MD, Skaggs DL, Bishop GA, Pace JL, Ibrahim DA, Wren TA, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. Journal of pediatric orthopedics. 2014 Mar;34(2):129-33. PubMed PMID: 25028798. Epub 2014/07/17. Eng.
Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British journal of sports medicine. 2014 Jun;48(11):871-7. PubMed PMID: 24100287. Epub 2013/10/09. Eng.
https://www.mickhughes.physio/single-post/2016/03/27/Load-Management-Part-1-Overuse-or-Underprepared