Injury prevention in athlete training is quite the hot topic in the sports medicine and science world, with lots of money for research being pumped into it in certain sports e.g. football, athletics, baseball etc. Sadly martial arts is quite far behind other sports both in research and in real world training, and unless the coach or athlete has one ear in the sports medicine world they’ll probably still think stretching after a session is enough to reduce their risk of injury.
Well this is not the case at all. Preventing the risk of injury in martial arts athletes involves exploring, monitoring and adjusting to a variety of factors. It’s not just a case of ensuring you have enough practice space, have a sensible partner to work with and keeping your joints supple. That might be ok for your average Joe who trains for a couple of hours a week to keep fit. But for a martial arts athlete who is training over ten hours a week and putting a greater demand through their body to get technically and physically better, much more is needed.
For the purpose of this post the type of injuries I am talking about are those affecting your musculoskeletal system e.g. muscle, tendon, bone, ligament or any other form of soft tissue. It may relate to other body systems as well, but they are beyond the scope of this post.
So how do these injuries happen?
Throughout our daily lives our soft tissue is able to absorb and tolerate a large amount of load (effort, energy etc) that is placed through it from a variety of activities. Injury occurs when a large amount of stress and energy is placed through the soft tissues, greater than it can tolerate. This can either occur in one instant (e.g. being hit by a bus) or over a period of time (e.g. weeks or months of increased intense training without sufficient rest). Although the instantaneous acute events resulting in severe breaks, dislocations or tears do happen from time to time, it is the overuse sprains and strains that the most common injury type in martial arts training (ref) . These are often the injuries that start small and build up gradually over time.
FIRST CONTROVERSIAL POINT!
Now obviously martial arts are contact sports where soft tissue trauma is inevitably going to happen, whether you are being punched, kicked, thrown, dropped, twisted etc. Over the years both coaches and athletes have blamed the majority of injuries on the contact ways of the sport with quotes like; “everyone is going to get an injury at some point”, “it was always going to happen”, or my personal favourite “well it’s just the way of the sport”.
HOWEVER. What we know from more recent research is that even if an athlete goes through a “traumatic” event it doesn’t always mean they are going to develop an injury, and actually there are certain positive and negative factors that can determine whether the athlete becomes injured from the event or not (ref) . If you think about it a martial arts athlete is repeatedly putting trauma through their body during training, and most of the time don’t develop any major injuries. In fact many of these “traumatic” injuries occur in ways where the athlete is doing something that 99.9% of the time wouldn’t result in any problems, yet it is that 0.1% time when additional factors are added on that can result in the injury occurring.
However I will concede that if enough force or energy is placed through a soft tissue then it will eventually break, though how often this actually occurs in these training “traumatic” injuries is probably a lot less than we think .
So what are these factors that can lead to an increased injury risk?
There a variety of internal (the athlete themselves) and external (things impacting on the athlete) factors that can increase or decrease an athletes risk of injury. On their own each factor has a fairly small risk of injury, but it is often when several are combined that we see injuries becoming more prevalent (ref) .
Internal factors include; age, gender, height, weight, strength, stability, flexibility, mood, individual thoughts & beliefs, etc. Now several of these things can be altered, but the more significant ones (e.g. age & gender) cannot currently which can make certain athletes more susceptible to injuries if the factor increases their injury risk.
External factors include; training environment, other athletes, coaches, family support, training equipment, training schedule, protective equipment, rules & regulations etc. All of these can be altered and adapted to have a positive or negative affect on an athletes injury risk.
So how can are these risk factors used in injury prevention?
The primary goal in injury prevention is for the athlete to be able to tolerate the load and demand they are putting through their body without it breaking down. To do this requires managing or adjusting the above factors to ensure they do not increase the athletes injury risk, it’s almost like a very long term game of plate spinning, whereby to be effective all plates (risk factors) need to spinning comfortably. However once one plate falls and breaks, then several could easily follow and potentially result in injury.
Now we cannot prevent all injuries but we can significantly reduce the risk them occurring if we manage the amount of load and stress going through a soft tissue and increase it’s ability to handle greater stress and load before breaking down.
Training & Injury Prevention
It is a well known fact that over time the greater the volume and intensity of training an athlete does, the greater their performance will be. However with this increase in volume and intensity comes an increased risk of injury.
SECOND (NOT SO) CONTROVERSIAL POINT!
It is often believed that those who train at a high intensity level for a long period of time develop more injures, but this is not actually true.
We know that actually those who train at a consistently high demanding level have reduced amount of injuries. As it can increase the physical and mental durability of the athlete, and allow them to tolerate greater amounts of stress before breaking down (ref) .
“Well lets just get everyone training at really high levels then” I can hear people saying. Hold on. It is that transition from average training levels to high demanding training levels which is where the injury risks lye.
Increasing the training demand
We live in a world where we want everything to be done quickly and rapidly, sadly our body’s tissue physiological adaptions take time (e.g. weeks to months) to be able to tolerate increased load demands before breaking down.
In sports medicine we have a term called the “acute:chronic ratio” (acute meaning short term, chronic meaning long term), but to keep it more simple I’ll use “short term” and “average”, short term being the amount of training you do over a few days/week, and average being, well the average level and amount of training you do over a longer term e.g. weeks/months. Now lets say our average Joe training guy decides he wants to become a UFC fighter (honestly who hasn’t heard this story before) and he knows that to become really good he’ll have to do much more training than his average two hours a week. So Joe has two options; he can decide to drop his job and jump straight into training 15+ hours a week, or he can take his time about increasing his training levels and improving his abilities.
If you decide to take the first option and rapidly increase your volume and intensity of training, then you will be at a much greater risk of injury. Why? Well your short term level of training is going to be much greater than your average, and hence you will be demanding a great more out of your body than it will be ready for. As a result your tissues are more likely to become overloaded and eventually breakdown resulting in injury as they cannot tolerate the load being put through them.
Alternatively gradually increasing training volume and intensity over time comes with a much lower injury risk as there is not a vast difference between the short term training demands and the gradually increasing average. Hence the tissue are able to adapt with time to the increasing demand, and are able to handle the gradually increasing amount of stress going through them without breaking down.
This does not just apply to those training up to that high level, it applies to athletes already there as well. Lets say a high level athlete develops an injury/illness and is unable to train for several weeks. They patiently wait to fully recover before being cleared to return to training. So should we allow them to jump straight back into their previous high intensity training levels? Of Course Not!
While the athlete has been resting their rolling average training level has rapidly reduced, and in that time their tissues will have weakened as a result. So if we throw them back into high intensity training immediately they are at a very high risk of re-injury, as their short term training intensity will be much higher than their average, hence their tissues will have a very high risk of overload and breakdown (ref).
THIRD CONTROVERSIAL POINT!
There are many martial arts athletes out there who suffer from a condition I like to call “Gymphobia”, where they, for whatever reason, decide not to go the gym and get stronger along with their technical training. Now there are several reasons why this could be, but what I repeatedly see or hear martial arts enthusiasts lambasting gym workouts claiming that they are a detriment to a training athlete and lead to more injuries.
HOWEVER. We know for a fact that doing strength workouts (e.g. weights) at the gym not only improves performance in athletes but leads to reduced injuries. In fact strength training has been found to be the number 1 thing you can do reduce the risk of developing most bodily illnesses, diseases and injuries (ref). The stronger and more powerful the athletes, the greater amount of load their bodies can tolerate before breaking down, which again could be the difference between winning or losing a fight.
On top of this, balance (or proprioceptive) exercises are also proven to be effective for reducing sports injuries as certain soft tissues such as ligaments respond a lot better to balance exercises, while muscles and tendons respond much better to strength exercises. So a combination of both strength and balance exercises can be very effective at reducing the risk of sports injuries, though what element is most effective is still unknown (ref).
But as for stretching…………
FOURTH VERY CONTROVERSIAL POINT!
Stretching is not as effective at reducing sports injuries as we all believe. Current research looking at the relationship between stretching and injury rates is of variable quality and results, some studies suggest it can reduce injury risk, while others firmly state stretching has no effect on injury rates (ref). The reason for this variety may be due to different sports being studied, as certain sports requiring explosive high effort movements (such as needed for striking & grappling) may benefit from more elastic muscles and tendons , while those requiring lower power repetitive movements don’t need as much flexibility (e.g. cycling/jogging), but time will tell (ref).
I will state that stretching and being flexible is essential for successful martial arts performance, whether it is for getting the maximum reach in striking or surviving submissions in rolling, you can see why it has so many advocates. But in relation to preventing injuries stretching is most effective when combined with strength and balance exercises, and is in a distant third for level of priority currently.
“But what about dynamic stretches?!” I can hear some people saying. In relation to injury prevention we simply don’t know, yes they have been found to improve a variety of performance factors, but there is no vast significant data yet in relation to injury prevention.
Rest & Fatigue
Sleep is the number 1 thing you can do for recovery. With the minimum recommended amount of sleep being 7-8 hours for a full recovery, and yet there are some athletes who will wake up at 3 a.m. to go for there morning run and go all the way through the day until they finish training at 11 p.m. Now if they are having naps during the day and regaining those additional hours lost they I can accept that, but having 1 long sleep so that you are awake in daylight hours and asleep at dark hours is generally the most accepted and effective way for your body to recover and replenish all your energy (plus who’s fighting at 3 a.m. anyway?) (ref).
The athlete also needs to give themselves time between specific sessions for the body to recover and adapt. To very simply explain how our tissues adapt to training: after our tissues are overloaded from a training session they will initially become weaker for a short period of time before then adapting (or “super-compensating”) so they can better meet the demands of the load that was applied, the physiological changes occurring will depend on the tissue involved. This adaption period occurs after roughly 24hrs from the previous training session, and then lasts for roughly an additional 24 hrs. So if you go and do the training session again roughly 24-48 hrs later, you would find it slightly easier than the previous time and be able to again push yourself slightly further, this is generally how developments in all of our body abilities occur. Of course if you don’t go train within that time period, then it will set back to it’s previous level (ref).
Now issues occur however when the athlete tries to repeat the intense training sessions within that initial 24 hour period. If you try to push the tissues within their initial weakened stage it will damage them further, actually making them weaker. As the tissues become weaker not only will you see a drop in performance, but these tissues will also be at a greater risk of overload and subsequent injury.
Now this doesn’t mean you just do 1 training session a day. Lets say an MMA fighter does a heavy legs workout in the morning, to avoid overloading their legs muscles for the 24 hr period they could go do jiu jitsu rolling in the afternoon and boxing in the evening without any overload risk as these aspects do not involve large amounts of leg strength or power. As long as the athletes, coaches and support staff can plan and think ahead with the athletes training sessions this issue can be avoided.
Stress & Psychology
It is now well known that athletes who take in high levels or frequent negative stress have higher injury rates (ref). This can can also have an effect once an athlete has suffered an injury, whereby negative mental states can delay healing, whilst positive mental states can encourage it, which is often the difference between whether the athlete feels pain or not, but I’ll save pain science for another time.
Negative psychological stressors can come from a variety of areas; family issues, coaches demands/expectations, outside work issues, finance problems, individual fears, I could easily go on. Now we can’t stop or prevent all of these stressors from happening, but by acknowledging when the athlete has got these additional negative stressors and reducing the training demand until the stressful period has resolved should help the injury risk increasing (ref).
Of course this involves having the athlete on board and willing to inform coaches and support staff when they are struggling with a stressful situation and I will come to compliance at the end. But ensuring that the athlete has some down time to do other things they enjoy doing can help maintain that more positive mind set and keep stress and fatigue to a minimum.
On a side note, greater levels of controlled stress, self coping and motivation has been associated with greater performance in elite kickboxers (ref).
There are a variety of different types of warm ups throughout martial arts, all with their individual positive or negative aspects on performance. From an injury prevention perspective there is no “ideal” warm up that we have found that significantly reduces injury risks over others, but generally a good warm up should contain a mix of; aerobic, agility, strength, stability and flexibility drills to cover most bases. So far research has found that warming up “can” reduce lower body injury risk, though the quality of evidence and interventions used is very variable (ref), and so far there has been one study into the relationship between warming up and reducing upper body injury risk which covered handball athletes (ref).
The more important factor is here is that the athlete actually does some form of warm up for a good 10-15 mins before an intense session, not just wiggling their arms around for 30 seconds before jumping in. Covering most of the bases listed will cause an increased blood flow, heart rate and lung expansion along with a psychological state of readiness meaning the tissues are primed and ready to take on the session and the load demand being put through them (it takes minutes not seconds for them to be ready). Not doing this could again mean they are not ready to take on the high load demand, increasing the risk of breaking down.
It should come as a surprise to no one that many martial arts athletes do not inform anyone that they have picked up an injury and continue to train and compete through it. There are many reasons why they choose to do this; fear of looking weak or vulnerable to others, fear of upsetting other coaches or athletes, not knowing what is classed as an “injury”, necessity to gain financial or other benefits from training etc. Regardless of the reason, training through injury or returning to training before an injury has sufficiently recovered increases the risk of re-injury or further deterioration of the issue, as the weakened tissue is not it in a state to handle the potential high load demands of training and so is at a greater risk of breaking down if it is applied.
This however does not mean the athlete should not train at all. Lets use an example of a male orthodox boxer who has sprained his right wrist, now obviously to allow the tissue rest and time to heal he should avoid heavy load activities such as punching and heavy weights training using his right wrist, but he can still do training for all other areas where that is not required e.g. cardio, legs strengthening, footwork, left hand punching etc. So that all his other tissue properties (strength, stability etc) are maintained and can still tolerate a high load demand, whilst his right wrist is able to recover within days/weeks, and once successfully recovered can gradually return to sport without any major issues.
Of course returning to high intensity before an injury has fully recovered brings us nicely onto…………….
Previous injury is the biggest risk factor for an injury occurring, hence why it is so essential to ensure that the tissue has fully recovered before returning to intense training and more importantly ensure that it is further strengthened in the long term so that it can better tolerate the initial load that caused it to break down. If this is not achieved then not only does it increase the risk of injury re-occurring to the injured site, but also increases the risk of injuries occurring to other body areas which have to pick up the slack and take on more load than previous (ref).
Which can all result in Unexplained Underperformance Syndrome (Previously Overtraining Syndrome)
Rapid increase in training intensity, lack of rest, increased negative psychological state combined along with other factors can all lead to a global fatigue encompassing the athlete leading to a variety of symptoms (physiological and/or psychological) across different athletes, as well as a steady drop in performance. The evidence is still unknown as to exactly what factors lead to unexplained underperformance syndrome (UUPS), and why some athletes deteriorate at certain stages while others don’t (ref).
The only way to recover from this is with rest and reduced training demand. There is no magic pill, drink, food, ointment, massage etc that you can take to help recover faster, the athlete simply has to rest or reduce the amount of intense training for a minimum of weeks until the symptoms have resolved and then they can gradually return back to training if able, with necessary changes made to stop it happening again. All of the suggestions already listed could help prevent UUPS, though much more evidence and time is needed (ref).
Hence why prevention is so important not just for injuries but for performance as well!
Alright, so how do we get athletes to follow this?
Even if you tell an athlete that doing something is going to be of benefit to them, it does not mean that they are going to follow it (ref). Education is likely the simplest and most effective means of building engagement into injury prevention measures. I’m not just talking about educating the individual athlete or their coaches and support staff. Martial arts organisations, leadership and culture as a whole need to be educated as well so they can encourage athletes and coaches about injury prevention, otherwise they will risk losing the time and money they have invested into the athletes.
If you are an athlete/coach then spread this around so that there can be a greater amount of injury free competition and training partners to make a better athlete, if you are an organisation or leader then send this out to your roster so that you have as many injury free fighters as possible which will hence bring in greater audiences and investment.
Of course athletes who have had previous injuries are generally more willing to engage in injury prevention measures to reduce the risk of re-occurence. For those who have not had any serious injuries an appropriate role model to encourage injury prevention measures could increase the likelihood of compliance as well (ref) (I wonder what would happen if Connor McGregor or Floyd Mayweather started promoting injury prevention measures?)
And that’s about it.
Any questions or feedback feel free to let me know.
Have a nice day,