Grappling Injuries Rehabilitation Strategies

Grappler’s Guide to Understanding Injuries

Injuries happen in all walks of life, particularly for athletes. An important concept to understand is how your body recovers and the phases of tissue healing.

Phase 1: Inflammatory (Day 0-6): Following the injury your body will start the process to repair the damaged tissue. This results in an altered chemical state as your body sends chemicals to the injured area. Why do you have pain and swelling? Chemicals sensitize the area to remind you to avoid aggravating it more. While excessive swelling is bad the initial swelling is your body starting the process to heal.

Phase 2: Proliferation (Day 4-24): The damaged tissue is in the process of being repaired. Repair does NOT mean healed. Following the injury your body is haphazardly connecting the points to repair the damaged structure. This initial connection is much weaker than the original uninjured tissue.

Phase 3: Maturation/Remodeling (Day 21- 730): The tissue is repaired and your body is remodeling the weak tissue to return to its prior state.

These numbers are dependent on the tissue that was damaged and the circulation in the area.

Healing times based on the tissue that was damaged.

A common misconception with injuries is that when you no longer have pain then it is healed right? The most common predictor of an injury is previous injury, likely because the athlete returned when they no longer had pain, instead of following a thorough rehabilitation cycle. Clinicians, coaches and athletes have to respect tissue healing times of the structures damaged.

Understanding ligament injures:
In regards to combat sports most joint locks stress connective tissues (ligaments and the joint capsule). Example: following an ankle sprain or in the context of Jiu jitsu following a foot lock injury (ankle lock, toe hold or heel hook).

If it doesn’t hurt how has it not healed yet?
“Remodeled ligament tissue is morphologically and biomechanically inferior to normal ligament tissue [and], ligament laxity results (Hauser, Dolan 2011).”

How do ligaments heal? Just like muscle they heal via appropriate stress so adaption can occur.
1. Pain free ROM: “Motion causes an increase of blood flow to the affected joint, providing the damaged ligament tissue with nutrients and metabolites necessary for tissue repair and healing. Under loading conditions, cells within the ligament detect tissue strains and respond by modifying the tissue (Hauser, Dolan 2011)”. Personally I used controlled articular rotations in a pain free range. Gradually expanding the range (which may take days/weeks depending on the severity of damage).
2. Isometric contractions: “Repetitive loading on injured [ligaments and tendons] has profoundly beneficial effects including enhanced cellular synthetic and proliferative effects, increased strength, size, matrix organization and collagen content of ligaments and tendons (Hauser, Dolan 2011).
Initially perform isometric contractions in neutral and gradual expand into end-range. This way the ligaments can be safely stressed for adaption to occur.

Key points to take away:
1. If you interfere with the healing cycle then healing will be delayed.
2. Often the damaged structure will repair, even if you do not do anything.
3. Tissue repair does NOT mean the tissue is healed. The tissue may not be 100% as it was before.
4. This is why a proper rehabilitation program is so important. Pain inhibits motor function. Tissue damage interferes with strength. No pain does not mean you have functional movements. If you rush or ignore the proper steps you can develop dysfunctional movement patterns and/or compensatory strategies which may lead to more injuries later or chronic injuries that do not go away.

What should you do when you get injured?
When dealing with an injury your job is to maximize tissue healing. The original acronym PRICE is perhaps outdated, I personally prefer POLICE.
Protect. Optimal loading. Ice. Compression. Elevation.
1. Protect: Keep the area safe so you can let your body heal without additional unnecessary stressors.
2. Optimal loading: This is where good rehab professionals come in, tissue responses to stress and you want to stress the damaged tissue appropriately. Early care is often pain-free motion and end-range isometric holds.
3. Ice: the heat vs ice debate, which to use? For acute injuries I prefer to use ice for managing pain. I do not feel that ice interferes with tissue healing but I also do not feel it reduces swelling.
4. Compression: This is my preferred way to manage swelling. Get a comfortable compression sleeve or compression bandage that you can wear for prolonged periods.
5. Elevation

See a healthcare professional. The body can heal without help, but it does not necessarily heal correctly. Your body does not care what you used to be able to do or what your goals are, all your body wants to do is connect the pieces. Improper Healing may lead to weak new tissue which may develop into compensatory responses.

Don’t let an injury become a chronic problem

References:
Hauser, Ross A., and Erin E. Dolan. “Ligament injury and healing: an overview of current clinical concepts.” Journal of Prolotherapy 3.4 (2011): 836-846

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