Grappling Injuries Rehabilitation Strategies

Shoulder Injury from falling: AC sprains and grappling

Have you ever hurt your shoulder after being thrown overhead or taken down? In grappling martial arts, your opponent may succeed in taking you to the ground, but what happens when you land improperly on your shoulder?

The shoulder complex is made up of several joints:
1️⃣Glenohumeral joint
2️⃣Sternoclavicular joint
3️⃣Acromioclavicular joint
4️⃣Scapulothoracic “joint”
All four are involved in overhead arm motion. The acromioclavicular, or AC joint, is most likely what will be affected by a fall on your shoulder.

The AC joint is a gliding joint, meaning that it is predominately flat, and that ligaments are the primary constraints that protect against separation. The ligaments involved in preventing excessive inferior-medial translation, or downward motion, are the superior and inferior acromioclavicular capsular ligaments. The coracoclavicular ligament may help, but it is usually a secondary constraint to this movement, and is typically only involved in severe falls.

So So what does all this mean to grapplers? When you are swept or thrown and end up landing on the tip of your shoulder, a massive amount of force is put on a thin band of connective tissue. This band will likely not be able to effectively absorb the impact. The resulting ligament stretch or tear is called an AC sprain or, in more severe cases, an AC separation. When you do a break fall properly, the impact of your fall is spread to the back of the shoulder or scapula, allowing you to ‘roll’ with the movement, so the top of the shoulder doesn’t end up absorbing the full impact.

Minor injuries to the AC joint can be asymptomatic and heal quickly. If it does not, however, a common sign of an AC injury is a large bump on the top of the shoulder as the joint heals slightly out of position.

This video is a clip from a grappling match between Gilbert Burns vs Gregor Gracie. As Burns slams Gracie, he lands improperly on his shoulder and isn’t able to continue. Gracie confirmed that he suffered a Type II AC sprain from the fall.

Common symptoms of AC sprains / seperations :

1️⃣pain with overhead movement.
2️⃣pain with the arm hanging at rest.
3️⃣shoulder compression or pain when lying on the affected shoulder.
4️⃣Small bump/protrusion on the top of the shoulder.

Management strategy:
Protect: You have to keep the area protected during the initial phase of tissue healing. One strategy is taping the joint to assist with static stability while the ligament is compromised. The open packed position for the AC joint, where the joint is most loose, is the arm hanging at the side. This means the joint is more mobile in this position, putting strain on the stabilizing structures. Using a sling helps to unweight the shoulder and take the stress off the injured ligaments.

Optimal loading: The primary impairment caused by an AC sprain is limited shoulder motion and pain; therefore, the goal is to restore full range of motion. Controlled articular rotations (CARs), a concept of Functional Range Conditioning (FCR) is a method that allows you to explore the complete range of the isolated joint. Not only do CARs help maintain joint health, but they can be used as a diagnostic tool to detect limitations and pain. Complete a full PAIN-FREE circle with 20% muscle contraction (video was 2x as fast as actual CAR).

The AC joint’s job is to work in conjunction with the sternoclavicular joint to assist the scapula with upward rotation. This is what allows the arm to reach overhead. As a result, scapulothoracic CARs are key for early rehab of the AC joint. Once the painful ranges are detected, isometric holds can be used to properly load the joint to allow for adequate tissue healing.

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