Injuries in Brazilian Jiu Jitsu (Part 3): Getting back on the Mats Following an Injury
Scenario: you’re two weeks out from a knee injury while training Brazilian Jiu Jitsu (BJJ). Initially, you felt a “pop” after the knee was forced into an awkward position while sparring. You stopped training and shortly after as your body cools down, the pain begins rising. You limp out of the gym and back home in frustration wondering what to do next. Luckily, there isn’t much swelling around the area, the pain is there but doesn’t affect your sleep that night, and you attempt to keep it moving lightly until the next day. You don’t feel any popping or clicking but it does feel a little unstable and it’s especially uncomfortable when walking or attempting to bend it fully. At this point, you decide to go see your local physical therapist for further evaluation and help building a plan to move forward.
This situation is unfortunately extremely common in the world of BJJ. Knee injuries are some of the most common things my athletes come in for. I’ve also experienced a few of these frustrating evenings myself after sustaining partial tears to my LCL, MCL and meniscus (all separate incidents) throughout my 9+ years of training. In my last article, I discussed some ideas on when it may be necessary to seek emergency medical care following an injury. These are very important to rule out any red flags and make sure that you receive the appropriate level of care for your injury. Remember, err on the side of caution and If you are ever unsure of what to do next or feel you cannot appropriately handle the situation alone, seek medical advice. After determining if you should seek medical care, I then discussed some initial goals following an injury such as: managing pain, early mobilization, regaining your range of motion (ROM), and maintaining strength throughout the rest of the body. If you haven’t checked it out, click here to read more!
Continuing on with this scenario, you’ve now been focusing on these initial goals over the last few weeks. The pain has improved immensely, your range of motion has improved but it still isn’t back to “normal” or at least comparable to the non-injured side. You definitely have lost some strength, but performing more simple exercises like bodyweight squats and lunges have been getting easier. You brought up with your physical therapist that your goal is to get back to training BJJ and you’re hoping that you can compete at a big tournament in six months. So where do we go from here? From the point of struggling with simple bodyweight movements to getting back into competition mode, fully prepared for the intensity of regular hard sparring and eventually stepping onto the tatami to test your skills against a game opponent.
A lot needs to happen between these two moments in time. This is the bulk of the work that I do as a physical therapist. In our BJJ community, this stage is often where I see the most mistakes made. Athletes attempt to rush through this phase too quickly and without a gameplan jump back into training without having a clue if their body is actually prepared for the task. Every single individual is different, from the injury that they sustained to the ability and rate of recovery within their body. This means that an individualized and tailored plan is extremely important if you want to maximize your results, safely and effectively get back to your training. Going through a cookie cutter rehab program and rushing back into training is a great way to end up back in the same position that you started with. As great as all of the “rehab” exercises or “bulletproofing” programs you see on instagram or Tik Tok, remember that these may not be specific to what your body needs to fully heal and recover.
As we proceed through this next stage, here are some things to keep in mind that will help guide your recovery:
Continue with pain and edema management:
As the acute inflammatory process ends (fairly early on in the process) and your body transitions into the proliferation or repair stage, the pain will begin to improve and dissipate. Continue to monitor and adjust your activities as needed based on these pain signals.
We want to begin with early mobilization very quickly following an injury but within pain tolerance to make sure we protect the injured area while the repair stage progresses.
If intermittent swelling or edema continues to occur, this is a sign that factors in your rehab program may need to be adjusted. These may include: range of motion of exercises, intensity or resistance, and overall total volume.
Improving Range of Motion and Mobility:
From the initial goals of early mobilization and on, you’ll want to have a focus on restoring normal motion within the injured joint. Normal motion means obtaining what your body had prior to the injury, equal or comparable to the non-injured side, and most importantly the range required for specific activities such as BJJ.
BJJ requires a lot from our bodies. When you look at a kinesiology textbook or google “normal range of motion for the knee” you’re going to find targets of 135-145 degrees. That’s great, make sure that your knee hits this goal but being able to sit in someone’s guard with your heel to your butt requires more than this.
Keep in mind what we’re working towards, especially if you may be working with a rehab professional that doesn’t fully understand the demands of your sport.
This step is often looked over as we start to feel better and are working on higher level exercises. Later on if you’re forced into a position that the joint isn’t prepared for, then the risk of injury (or reinjury to the recently repaired area) goes up.
**Improving Tissue Tolerance**:
This is the key to what we’re working on throughout this phase and beyond
Force (or tension) and movement is the signal that guides the repair and remodeling phase of healing.
We want to target the affected area and gradually guide the healing process. As your body sends tissue to the area, it does so in a slightly haphazard way. Applying force in a gradual and progressive way will help align this new tissue in the direction that the tissue requires (i.e. more parallel or in line with the healthy tissue surrounding the area).
This is a long term goal and will not happen overnight. It will take weeks or months to truly rebuild this and there are a lot of factors again that may impact how this occurs. One important factor is the condition of your body prior to the injury. I talk a lot about physical preparation to help reduce the risk of injury, but it’s also extremely relevant to how your body will recover following an injury.
**There is a difference between having no pain and the structure having the strength or resilience to return to training.** This is another area where many people make mistakes and jump back into training too soon.
In summary here, our goal is to increase the stress tolerance of the tissue which was significantly reduced during and immediately following the injury. This process takes time and specific input for your body to efficiently complete.
Maintaining or Improving Cardiovascular Endurance:
There will be a variety of ways to do this, but be diligent about maintaining the cardiovascular conditioning that you already have.
The method will depend on the injury or what you can tolerate but getting some general exercise and systemic or whole body blood flow is fantastic to aid in the healing process and make sure you keep a good base of conditioning before getting back on the mats.
Restoring Movement Patterns and Positions:
While targeting the injured area with specific activities, there should be a focus on returning your ability to move through a variety of ways or planes of motion. We break motion down into three primary planes: Sagittal (forward/backward), Frontal (lateral or side to side), and transverse (rotational). True human movement then often comes from a combination of these planes.
A simple way to look at this in regards to your recovery is: can you perform movements or exercises effectively throughout a full range of motion with and without resistance. These may include (but are not limited to): forward/reverse lunges, lateral lunges, rotational lunges, squats, hip hinges, upper body pressing and pulling (horizontal and vertical) along with spinal motions including flexing/extending, side bending, rotating or a combination of the three.
There are other patterns you may look at but this is a great place to start and build from. Each pattern can and should be adjusted/tested with variables including: progressively building range of motion throughout the pattern, improving neuromuscular control and coordination, increasing weight or resistance at varying speeds, and/or eccentric/dynamic control into these movements
Progressing into BJJ Specific Movement Patterns and Positions:
As you build into some of the more standard movement patterns you’ll begin building your tolerance to BJJ specific positions as well. But we still need to make sure that your body can handle what you’re asking of it.
An easy example is at the knee again with sitting your butt to your heels, which is likely a position that you’ll experience when training. Another example for the knee is knee flexion (bending) when performing something specific like a knee cut which may also require tibial rotation (rotation of the lower leg) that can occur during this movement. Can your spine tolerate and effectively move into positions of full flexion or bending that may be required in a number of positions. Can your shoulders move overhead or rotate into positions that may be forced upon you during upper body submissions.
There are a variety of examples here but the most important thing is: even if you’re kicking butt with your rehab and performing a lot of exercises with progressive range of motion and intensity, it’s going to be important to slowly get into and test a lot more of the specific positions that BJJ includes.
This is where some controlled drilling and slow build up with specific, positional resistance can be a great tool to progress you from the clinic/gym back into more time on the mats
Slowly Transition Back Into Full Training:
At this point, you’ve accomplished a lot! This is the most exciting part but also one of the most anxiety inducing. The great thing is, as you’ve slowly progressed throughout your rehabilitation process you should have a much better understanding of how your body moves, feels and what it can handle.
Start with slow and progressive drilling with trusted partners making sure that you can do the “move of the day”. Then some situational sparring and eventually full rounds which will take time to get back to. Don’t rush the process, be comfortable with what you’re doing and trust the work that you’ve put in up to this point.
This is where a knowledgeable coach and rehab professional on your side can help. There’s no one size fits all approach so the more specific you can be with your body, the better your outcome will be.
Rehabilitation following an injury can be a long and difficult process. I hope this series of articles can help guide you along if you’ve recently experienced an injury. Just remember that working with a trained professional is the safest and most effective way to get you back to training BJJ and enjoying your life to the fullest. Take these as general ideas and guidelines, especially if you’re working with a rehab professional that doesn’t understand the sport. It can help provide some framework or a roadmap for you to follow. Also, remember not to rush, trust the process and understand that your body has an amazing ability to heal and get stronger as long as you give it the right signal!
Don’t guess when it comes time to take care of your own injuries. Reach out today to setup a short phone consultation to see how I can help you recover and get back to the training that you enjoy!
**Disclaimer: This article was written for informational purposes and is not to be taken as direct medical advice.
