Martial Arts Athlete Shoulder Injury Prevention 2016

A little while ago I produced a piece on Shoulder Injury Prevention for Judo & BJJ which you can read here:

Judo & BJJ Shoulder Injury Prevention 2016

Since then I have become a bit more…….well, busy. I have since started working for Tsunami Gym MMA with their amateur and professional fighters, with the same plan of dealing with traumatic injuries as well as setting up injury prevention programs to try and reduce the amount of non-contact injuries.

As I already had a decent amount of evidence and support for the shoulder I decided why not expand that first of all to cover all of the other disciplines that come under the MMA banner (Boxing, Muay Thai, Wrestling, Kickboxing, Karate, Sambo, Taekwondo etc). So after spending some time collecting extra evidence I have produced the martial arts athlete shoulder injury prevention program for 2016.

On a side note I have also been asked how the exercises in the no equipment program could be progressed to involve equipment in a gym environment, therefore I have produced an updated video showing some progressions involving gym equipment (See far below).

Shoulder Injuries in MMA

Although the shoulder is not as frequently injured in MMA compared to the head, face or hands, when injuries do occur they can be quite significant. Again they come in one of two ways; as a traumatic injury or an atraumatic injury.

Traumatic shoulder injuries in MMA can happen in standing when a fighter has been taken down and they land directly on their shoulder or outstretched arm, very rarely does happen from a direct blow to the shoulder. Alternatively they can occur on the ground when a fighter is caught in a submission and they are unable to submit in time, resulting in excessive force going through the shoulder and damage occurring.

Aside from teaching people how to land correctly and to submit at the right time these injuries are generally unpreventable, and at the end of the day these are contact sports where direct trauma will inevitably happen, though the extent of the damage can vary from bruises and contusions (most likely) to fractures and dislocations.

Atraumatic shoulder injuries are those where there has not been any direct trauma or specific incident from which the pain has started, these are generally the pains that start small and get steadily worse over time. These injuries will typically affect the soft tissue due to the causes which I will describe below, though there is always the small risk of a stress fracture.

Atruamatic injuries typically occur as the soft tissues (e.g. Muscles, tendons, ligaments etc) around the shoulder are unable to tolerate the effort that the brain and the body are asking them to achieve. Many factors can overload the soft tissues such as; rapid increases in training rate/intensity, under-training before intense competitive activity, repeated intense activity without sufficient rest. The list goes on and there is much more detail to this, but I’ll save general training injury prevention for another time.

The good news though is that a lot of atraumatic shoulder injuries in MMA and martial arts as a whole are preventable with the big two adjustable contributing factors being the rotator cuff and shoulder blade control.

The rotator cuff is a set of four small muscles that sit around the ball and socket joint of the shoulder, where their main job is to help control and stabilise the shoulder joint during arm movement. On top of this they also help out with rotation movements of the shoulder ( because they are the “rotator” cuff, get it?).

Now in rotator cuff problems what can happen is that the part of the rotator cuff that does inward rotation becomes a lot stronger than the part does outward rotation, which has been found to occur in marital arts athletes. Especially in striking martial arts where repeated punching or forward arm movement has been suggested to lead to similar shoulder problems as seen in baseball pitchers and tennis players.  As a result this can lead to reduced ability for the muscles to control and stabilise the shoulder joint which could in turn lead to problems developing.

In grip fighting especially this group of muscles are required to work especially hard, and if they are not trained properly then they will fatigue quickly which may be the difference between winning and losing the fight. So how do we prevent this problem? By getting the rotator cuff strong and able to endure long stints of activity.

MMA Grip fighting

Shoulder blade control is a bit of a contentious issue in the physio and sports science world, especially in relation to shoulder pain, and I’m not going to start a debate now. But what we do know from anatomy is that as you raise your arm upwards your shoulder blade basically has to lean back so that you can bring your arm up to your head. Problems occur however when the ability of the shoulder blade to do this is reduced.

There are a few things that could potentially cause his to happen but the most likely and adjustable one is that the muscles in your lower shoulder blade (the ones that assist in the leaning back job) are too weak or become overpowered by the muscles at the top of the shoulder blade, which pull your shoulder blade forward and down instead, which has been found in athletes with atraumatic shoulder problems.

Also if there are problems with the rotator cuff as described above then the muscles of the shoulder blade have to work overtime to help control and stabilise the shoulder. If they are too weak then they could fatigue and again lead to some problems occurring.

Back

Aim of the programme
The overall aim of this shoulder injury prevention programme is to increase the strength and endurance of the external rotator cuff muscles and lower scapular muscles.

This should help to maintain or improve the control and stability of the shoulder and as a result, hopefully reduce the amount of atraumatic shoulder injuries occurring in martial arts athletes.

Basic shoulder principals
Before we get into the nitty gritty of the programme I’ll just run though a few principles in relation to maintaining general shoulder health for athletes.

• Avoid sitting in a static position with your shoulders rounded forwards for more than 1-2 hours. Fairly simple advice, although can be quite hard to achieve if you work in an office all day. By getting up and moving around every half hour or so it should prevent the tissue around your shoulder getting tight.

• Do an even amount of chest to back strengthening. Although a big chest may look good for the beach, you need to have strong back muscles to work against them. If your chest is too strong compared to your back then shoulder problems could develop.

• Vary the way you strengthen your arms, chest and back. Whether it be mixing between dumbbells, barbell or a smith machine, or just changing body position, variability in strengthening has been shown to reduce the monotony of a workout and injury risk.

• Don’t do any exercises that cause you pain or that you physically cannot achieve. Fairly common sense (hopefully).

• Don’t do any prolonged static stretches prior to your strength workout or training session. Over stretching a muscle reduces the amount of power it can produce, which is especially important in martial arts, and can increase injury risk in certain types of soft tissue. Static stretching after a workout or training session is ok.

• Ensure you give yourself adequate rest time between heavy strength or training sessions (roughly 24 hours). Not resting enough between hard sessions can actually increase the stress on the body, potentially resulting in loss of performance and ability rather than gains.

• If you are going to increase the amount or intensity of training then do it gradually over time. Rapid increases in training amount or intensity can put excessive demand on the body which it cannot handle, resulting in potential injuries occurring.

I will also say that although this programme focuses on the control and stability muscles of the shoulder, it does not replace the general arms, chest, back and general lower body strengthening you would expect a martial arts athlete to be doing as well.

Squat

The programme
This programme should ideally be done as a warm up prior to any shoulder workout or training session, and should take roughly 10-15 minutes. The weight you should use should only be about 1-2 kgs, a full water bottle is sufficient. The exercises can be done in any order, and only do the maximum repetitions you can achieve comfortably.

All of the exercises below produce large amount of external rotator cuff and lower shoulder blade muscle activity, without much activation of the upper shoulder blade and other arm muscles.

Please see the videos below:

New Equipment Version

No Equipment Version

The Push Up Plus
• Get into a press up position and straighten your arms so that your elbows cannot bend, turn your hands slightly out to the side and have them shoulder width apart, make sure they are close to your chest.
• Then let your body drop down slightly so that your shoulder blades come together, then push your body up as far as possible taking your shoulder blades apart and hold for roughly 5 secs, all the while ensuring that your arms remain straight.
• Once you have done one rep crawl slightly forwards, backwards or sideways and repeat moving position each time, to progress perform the push up plus on an unstable surface e.g. wobble board to get more muscle activation.Repeat for 1-2 minutes.

Twist & Raise
• In a press up position have the arm to be exercised across the chest, it can be holding a light weight or theraband if necessary.
• Then slowly over at least 5 seconds take it out to the side straightening the arm with your thumb pointing upwards, as you do so turn your trunk so that you facing the side of the moving arm.
• Hold for up to 5 seconds before slowly relaxing down over 5 seconds. Repeat 10-15 times each arm. To progress again perform it on an unstable surface.

Scaption with Serratus Punch
• Start by standing with your arms straight by your side holding onto light weights or a theraband with your palms facing forwards and your thumbs pointing out to side.
• Slowly raise your straight arms upwards pointing away from your body over 5 seconds, and hold them at roughly chest height before pushing them directly forwards without bending your elbows for 5 seconds, then slowly lower back down to your side over 5 seconds.
• Repeat 15-20 times.

Side Lying External/Internal Rotation
• In a side lying position resting on your lower arm and with your upper leg bent with the foot flat on the floor.
• Rest your upper arm elbow on the bent knee, with the elbow bent at roughly 90 degrees.
• Slowly rotate your arm upwards as far as possible, hold for 4-5seconds then slowly lower and rotate your arm down, go as far as possible and hold for 4-5 seconds, then repeat.
• It should take a minimum of 5 seconds when rotating the arm up or down.
• You are looking to do 10-15 repetitions on each arm.

Superman
• Get into an all 4’s position and ensure that your back is straight.
• Slowly raise one arm straight out in front of you while at the same time straightening and raising the opposite side leg until they are both parallel with your body.
• Hold for up 10 seconds then slowly relax down in unison. Repeat 15-20 times. To progress again you can place your hand on an unstable surface.

And that’s about it feel free use it as much as you it like, if you think it’s good, bad or otherwise feel free to let me know.

Have a nice day.

Ben.