Here's What Every Submission Grappler Needs to Know About Injury Management.
How to Use Heat/Cold Therapy
šKey Points
If you have a serious injury that requires medical attention call 911 or go to the hospital.
The most common musculoskeletal injuries in submission grappling include knees, ribs, and shoulders.
For musculoskeletal injuries that involve your limbs AND do not require immediate medical attention you want to use ice during the inflammatory phase firstāļø, and then apply heatš„ once inflammation resolves.
š°In this issue
In this issue weāll go over the most common injuries in grappling sports, weāll review some of the various mechanisms of injury including an overview of the inflammatory response and stages of tissue recovery, and weāll discuss the effect of heat and cold when applied to the injury site.
š¤Most common Injuries
The incidence rate of injuries among BJJ athletes is VERY high and varies depending on the study.
McDonald et alĀ reports a 12-month injury incidence of 85.7%.
Moriarty et alĀ reports a 6-month injury rate of 59.2%, and
Hinz et al 3-year injury incidence rate of 68.8%.
These studies looked a different cohorts during different time intervals and had different definitions of what exactly constituted an āinjuryā - hence the differences. But regardless of the exact details, the point is that injury rates in BJJ are very high, and therefore, chances are that sooner or later you are going to be dealing with your own - if you havenāt already.
One of these groups performed a cross-sectional study of 1140 BJJ athletes which aimed to quantify the 3-year incidence of BJJ-related injuries. They showed that the lower extremity (45.7%) and upper extremity (30.2%) are the predominant sites of injury, with the knee joint being the most common (27.1%).
Not surprisingly, the most common mechanism of injury are submissions (29.7%) and takedowns (26.4%). Here is a summary of the entire data-set from that paper:
And here is a breakdown of the data by specific type of injury:
Some additional interesting facts:
Most injuries occur during sparring (77.6%) - but this figure is likely related to time and frequency athletes spend sparring vs. competing.
While lower belts tend to get injured in training, higher belts tend to get injured in competition.
Other statistically significant risk factors for injury include:
Competing regularly
Older age
Higher belt rank (surprisingly)
š©¼What Happens When You Get Injured
The exact cellular and molecular response to musculoskeletal injury depends on many factors including the exact mechanism of injury (for example bruise vs fracture vs sprain), the timing of the injury (for example acute event vs a chronic issue), the anatomic location of the injury (superficial vs internal vs joint space), and the tissue type (muscle vs tendon vs cartilage), among many others.
In very general terms, when an injury occurs, whether it's a bruise, a fracture, or a sprain, our body initiates a very well-orchestrated response aimed at restoring tissue functionality as soon and as much as possible:
Cellular Response: Immediately after the injury, various types of cells activate and come into play, like an emergency crew. Red blood cells and platelets take care of any clotting that may need to occur to stop bleeding. The cells that make up vessel walls relax and become permeable to increase nutrient exchange and traffic to the injury site. White blood cells rush to the scene to clean up debris, dead cells, potential infections, and send signals that trigger inflammation at the site.
Inflammation: You might notice some swelling, redness, and heat around the injured area. This is inflammation in action. Think of it as your body's alarm system. Inflammatory cells arrive on the scene, releasing chemical signals that increase the metabolic rate, attract even more helpful cells, and continue the repair process.
Molecular Signaling: Molecular signals are like text messages between cells. These signals tell other cells to start repairs. When you have a fracture or torn ligament, cells in the area receive these messages and start the process of mending the damage. These processes may include things like cell migration and proliferation.
Tissue Repair: After the initial mess is dealt with, it is now time for the builders to step in and initiate the reconstruction process. Cells called fibroblasts work like construction workers. They lay down a scaffolding of collagen, a tough protein, to create a framework for new tissue. This is the body's way of temporarily and rapidly patching things up.
Remodeling: As time goes on, the body continues to fine-tune the repairs. Specialized cells break down the excess scaffolding and replace it with stronger, functional tissue, that resembles what was originally there. When this process is unable to be fully completed due to the magnitude of the injury, a collagenous scar from the previous step remains in place. Scars are by definition, non-functional tissue.
Pain and Healing: Throughout this whole process, you might feel pain. Pain is actually a signal to the brain that evolved with the objective of protecting the injured body part and speeding up recovery. Pain is basically the body's way of telling you to take it easy and let it work. It's also a reminder to protect the injured area while reconstruction takes place.
š„Heat Vs Coldāļø
Adequate therapy selection is important for a timely return to the mats. Both heat and cold are a practical and inexpensive, easy-to-use treatment for injuries and pain. However, it is oftentimes easy to forget which choice provides the most benefit at any particular point in time post-injury. Here is a quick summary that offers some clarification:
The previously described phases of the injury response roughly correspond to the following phases of healing:
Inflammatory phase (0 to 72 hours after injury)
Reparative phase (72 hours to 3 weeks after injury)
Maturation/remodeling phase (3 weeks to 2 years after injury)
šØInflammatory Phase (0 to 72 hours after injury)
š«Avoid Heat ā Heat therapy should be avoided during the inflammatory phase of healing because heat increases swelling, inflammation, vasodilation, and blood flow. In combination, these are all detrimental to the inflammatory phase. Read more about this here.
Instead, focus on PRICE: Protection of the injured area, Relative rest, and decreasing swelling through Ice, Compression, and Elevation. More here.
Cold therapy should begin immediately postinjury and should be used during the rest of the inflammatory and early reparative phase - up to seven days after injury, to decrease pain and swelling. The benefits of cold therapy intervention during these early stages are well-established and have been demonstrated via MRI and include decreased pain, decreased swelling, and increased range of motion. See study here.
āļøHow to apply ice: For optimal results, ice application should begin immediately postinjury. Apply ice packs for 20 to 30 minutes (either continuously or in 10-minute intervals with 10-minute breaks in between) directly on the skin. Three to four times per day should be enough, but ice therapy can be applied every hour - the more frequent the application, the better the results. The optimum temperature range for reduction of cell metabolism without causing cell damage is 10 to 15Ā°C. More info here.
š ļøReparative phase (72 hours to 3 weeks after injury)
This phase begins after the initial inflammation is controlled, swelling decreases, and the injured site can be moved with little to no pain.
During this phase, both heat and cold therapy should be used as adjuncts to stretching exercises. The best thing to do is to warm up the muscles before stretching with passive heating modalities (hot packs, hydrotherapy, ultrasound) to enhance the beneficial effects of stretching exercises, and then apply ice to the tissues in a lengthened position to increase range of motion. More info here and here.
ā³Maturation/remodeling phase (3 weeks to 2yrs after injury)
During this phase, the new collagen and matrix fibers that were deposited during the previous phase get further organized and increase their strength. Heat and cold therapies are not as important during this stage. Instead, emphasis should be placed on rehabilitation because the application of excessive force will disrupt the immature tissue, but at the same time, if insufficient force is applied, the tissue will not reorganize properly and will fail during the application of strong forces once you return to sports activity. Its a balancing act.
š©¹Chronic Conditions:
š„Heat therapy: Heat therapy may be used before exercise or in chronic conditions caused from old injuries or even arthritis where recovery is slowed by restricted muscle or joint motion. Localized heat application helps relieve pain and reduces joint stiffness and muscle spasms, making it useful when muscles are tight.
ā ļøLastly, the use of both heat and cold can cause further injury when used in excess - either extreme temperatures or prolonged periods of time. Always follow the instructions of the products you are using and use both in moderation.
Disclaimer: This content is provided for educational purposes only and should not be construed as medical advice. Always consult with your primary care physician (PCP) or a qualified healthcare professional before making any changes to your lifestyle, diet, or exercise routine. The information presented in this article is not intended to diagnose, treat, cure, or prevent any disease. Individual results may vary. The author and publisher of this article are not responsible for any adverse effects or consequences resulting from the use or application of the information provided. Please use your own discretion and judgment when implementing any suggestions or recommendations.