Are you an MMA fighter or coach who’s looking to learn more about MMA’s most common injuries? With A Quick Reference Guide to MMA Injuries you will be able to identify and recognize several types.
Mixed martial arts and their component practices include boxing, wrestling, Brazilian Jiu-Jitsu and Muay Thai. Athletes are driven by the need to participate in tactical and technical training to develop a strong base and improve their skills.
Most injuries suffered by MMA athletes typically occur during training. Half of the injuries reported occur in the face, hands, nose and eyes. The most frequent lesions are skin lacerations, followed by fractures and concussions.
In this Reference Guide I will speak to the most common injuries that I see in training and competition.
It is especially important for combat sport athletes to take proper care of their eyes. It is recommended that they undergo yearly dilatation to detect subtle changes that may result in permanent, lifelong complications if not addressed in a timely manner. Blows to the head can cause early onset glaucoma (due to increased pressure on the optic nerve); cataracts (clouding of vision over the lens blocking light entry); corneal abrasion (contact with foreign object, possible infection); and retinal detachment, holes or tears (loss of peripheral vision, onset of floaters).
There has been an explosion of research regarding the assessment, treatment and effects of concussions. Concussions occur from a blow to the head and can be linear (forward/backward; think of throwing a jab or cross to the front of the face) or rotational (spinning; think of a hook or roundhouse kick to the side of the head). Linear acceleration causes bruises of the brain, disruption of blood flow to the cerebellum (responsible for balance) and nerves damage in the brainstem (area responsible for breathing, sleeping). Damage from rotational blows may stretch and tear the veins, resulting in nerve damage and bleeding out.
Special consideration need to be taken when there is arterial bleeding (very difficult to stop, typically spurting blood) or exposure of an underlying nerve. Facial skin that has not been damage before is typically 20% as strong pre-injury at two weeks, 50% by 5 weeks and is about 80% as strong 10 weeks out. Controlling blood loss is imperative for both the fighter and the opponent. Gushing blood from a wound can cause vision to be impaired. In a fight, the cutman should have the appropriate equipment to control bleeding and swelling, especially around the eye.
Stoppage of a fight may be due to a deep laceration around the orbit or the vermillion border of the lips. Exposure of underlying nerve can result in permanent damage if not treated immediately and properly. Additionally, post-fight care should include cleaning of debris and foreign particles from the wound to prevent infection. Infection control includes use of sterile bandages, changing of bandages when necessary, maintaining a clean wound and limit training that might reopen laceration
Oftentimes there is more than one part of the knee that is damaged. The “Terrible Triad” includes an anterior cruciate ligament (ACL), medial collateral ligament (MCL) and medial meniscus tear. This can significantly complicate surgery, rehabilitation and return to sport as less than 50% of all athletes undergoing knee surgery will not return to sport (although it may be due to reasons other than them not having a full recovery, like lack of interest). Less than half of the athletes that do return to sport, do so at their pre-injury level of skill. That means that more than 50% of those returning to sport post-op will have a weaker knee.
The hand is an incredibly complex network of 29 joints, 126 ligaments, 34 tendons and their muscles, 29 bones & thick ligament-like fascia. This network allows for the manipulation of really small objects, like threading the eye of a needle, to larger objects and large movement patterns like grabbing the gi of your opponent to control them. Here is a short list of hand injuries that I often see:
- Boxers Knuckle: complete or partial tear of the extensor tendon. Typically treated with splinting, casting or surgery in cases of severe instability
- Metacarpal boss injury: tear of the base of metacarpal joint ligaments, often accompanied by painful bump
- Metacarpal fracture: displaced fractures require surgery, non-displaced managed with casting/splinting
- Bennett fracture: fracture at the base of the thumb requires surgery
- Collateral ligament thumb injuries “Gamekeepers thumb” or “Skiers thumb”: disruption of the lateral ligaments resulting laxity of the joint that eventually become stiff and painful
Typical shoulder injuries might appear low grade at first and then rapidly deteriorate if not treated in due time. Pinching in the front of the shoulder when reaching overhead or across the chest might suggest supraspinatus (rotator cuff) impingement. The muscle is “wrung out” between two bones- the AC joint and the head of the humerus, the attachment site for the muscle. This constant pinching causes fraying of the tendon, leading to tiny tears. The body then begins to deposit fat in these tears to stabilize the area. As you might guess, fat does not do as good a job as the original tendon for transferring force from the muscle into the shoulder to produce movement (like pushing your opponent to set them up). This small tearing reduces the work capacity of the muscle and other muscles must compensate for poor movement patterns.
Neck injuries can vary from muscle aches (getting out of bed in the morning, but relief after moving around) that can be treated without any significant loss of training to severe neurological compromise requiring surgery (numbness, tingling or significant weakness of the arms or legs). Most often injuries involving the muscles can limit your ability to look around, may feel “stiff” when waking up and cause pain with certain movements, like slipping a punch. Muscular strains are often treated with hands on techniques and muscle re-education program. More serious injuries may require consultation with an orthopedic or sports medicine physician.
Combat sport athletes should be cautious of and take care of injuries in the lower back. Most back pain injuries involve soft tissue- tendons, muscles and ligaments. Fractures, herniated discs and degenerative disc disease in more seasoned athletes are typical. These injuries can present in many different ways. Some may have pain with movement, others may have relief with movement in certain directions. The pain might feel better with standing or worse with sitting. It is important to accurately identify what structure might be causing pain and to treat it accordingly
Grappling requires a balance between very flexible, but strong hips. In the guard your hips are in flexion, abduction and relative external rotation. As your opponent is passing the guard, they may force your knee across your chest into your opposite shoulder (ex. right knee, left shoulder). This compresses the hip labrum, a soft, pliable tissue like rubber. If the labrum is torn it can cause a sharp pinching pain when you are caught in this position.
Foot and ankle Injuries
Ankle sprains occur when the foot is rolled under the body, tearing the ligament that connects the ankle to the foot. Lunging and squatting may cause this area to “pinch”. Ankle sprains typically cause the feeling of “giving way” when working your stand up game, or occasional misplacing of the foot because your brains processing of where your body is in space is disrupted.
Pain along the outside of the elbow, right on top of the radial head where the muscle mass attaches into, is called lateral epicondylagia (formerly known as epicondylitis). With tendon damage, the inflammatory phase lasts about a week and thereafter the tissue begins to heal (now no longer an “-itis”). In some injuries the tissue being laid down to replace the torn tendon is not as strong. This can lead to fraying of the tendon and fatty deposits in an attempt to stabilize the area. The fraying reduces the total amount of strength the tendon can handle. The fatty deposits alter the proper line of pull when the muscle contracts. All this being said, when you go to grab your opponents gi, wrist or leg to control it, pain hits and suddenly you cant squeeze as hard.
If you want the extended version with tips on how to prevent these injuries download The Ultimate Guide to Major MMA Injuries by Dr. Abbate.
Dr. Abbate has committed his professional career to studying all aspects of combat sports with a focus in injury prevention and rehabilitation. His broad knowledge in nutrition, strength and conditioning and psychology provides a strong foundation for athletes to refer to for support. If you are a coach or athlete in Miami, Florida and are concerned about an injury you may have sustained, Dr. Abbate is eager to provide support and care to keep you in the cage or on the mat.