What are common shoulder injuries in MMA?
Shoulder injuries present one of the most common and debilitating orthopedic conditions facing an MMA fighter. If left untreated, a mild problem can quickly become chronic, leading to lost training time and potentially missed fight opportunities.The purpose of this article is to describe the most common shoulder injuries and to provide a treatment algorithm in the event an injury occurs.
The shoulder is the most mobile joint in the human body involving:
- Three bones – clavicle, scapula and humerus
- Three joints – Gleno-humeral (GHJ), scapular thoracic (ST) and acromio-clavicular (ACJ)
- Well over 20 muscular attachments.
Stability in the shoulder is provided by capsule, ligament and muscular attachments.These structures are placed under tremendous stress by the extreme ranges of motion and high compressive forces encountered by MMA fighters.
Three most common shoulder injuries/treatment:
- Gleno-humeral dislocation: The shoulder joint is a ball and socket joint and can become injured when overpressure is applied to the arm when it is place in the “throwing motion” or “goal post” position.
Treatment: GHJ dislocations require medical attention. Occasionally the shoulder self reduces but often needs a trained medical professional to put the joint back in place. X-rays are required to evaluate injury to the bony structures for possible fracture and an MRI may be ordered to look at the joint capsule and labrum (cushion that supports the joint). A sling will be used for comfort and a course of physical therapy consisting of progressive range of motion and gradual strengthening will begin. The sling is usually discontinued within a week and return to normal daily activities is allowed as comfort dictates.
During this time the fighter can continue with core and lower extremity strengthening along with cardiovascular work as tolerated to maintain fitness levels.Return to light bag work will begin around 4-6 weeks and full striking, likely after the 6 week mark. Wrestling/ground work needs to be light until the 6-8 week mark with protection from the “throwing motion” or “goal post” position. The likelihood of re-dislocation is fairly high (>80%) so progression back to full activity needs to be controlled and monitored. If repeated dislocation occurs, then surgical stabilization may be the only alternative to get the fighter back to prior level of competition.A fighter can expect a 4-6 month time frame back to full activity after surgical reconstruction.
- AC separation: This occurs when a fighter lands directly on the point of the shoulder without and outstretched arm. Typically the fighter’s body weight plus the weight of his opponent drives the shoulder into the mat causing injury to the joint that connects the clavicle (collar bone) and the scapula (shoulder blade). AC separations are classified as grade I, II and III. Grades I and II are mild to moderate sprains, they are painful but do not require surgery. Grade III injuries are complete dislocations that may require surgery if pain, function and cosmetic appearance continue to adversely affect the athlete.
Treatment: X-rays are commonly taken to rule out a clavicle fracture and to evaluate the elevation of a clavicle with grade III injuries. In all three classifications a sling is recommended for comfort only. Range of motion exercise and progressive rotator cuff and scapular strengthening begin immediately. Training will need to be reduced significantly for 2-4 weeks with a gradual return to unrestricted activity. These injuries can linger; it’s not uncommon to have pain 6-8 weeks after an injury. If pain persists, an injection of cortisone can help reduce inflammation and assist in returning back to full training quicker.
- Rotator Cuff Impingement: Repetitive striking combine compressive and distraction forces on the ground can cause inflammation of the rotator cuff tendons and the bursa (cushion) that underlie the bony shelf of the scapula called the acromion. Ordinarily there is about 1cm of space for the tendons to move; the chronically forward head and rounded shoulder position fighters maintain can reduce this space and cause or aggravate an already inflamed shoulder.
Treatment: Initially ice and anti-inflammatory medication in combination with a slight adjustment in training intensity may be enough to get fighter on track.Typically a comprehensive course of soft tissue work, rotator cuff/scapular strengthening, postural training and selective stretching is needed to completely heal the shoulder and prevent recurrence. The degree of inflammation is easily rated on the following scale:
Stage I: Pain at the beginning of practice that resolves after warm-up
Stage II: Pain at the beginning of practice that increases during practice
Stage III: Pain during practice that last after practice and affects daily function
Early intervention is key and may prevent a minor condition from becoming significantly worse. Once an athlete begins to have increased pain during practice that affects daily function it is time to have a medical professional evaluate.
Is there something I can do to Prevent injury?
Absolutely! Increasing postural awareness by avoiding the forward head and rounded shoulder position outside of the gym will immediately take pressure off your neck and shoulders reducing the chances of getting rotator cuff impingement. With respect to traumatic injuries, the stronger, more stable and flexible the shoulder joint; the less likely it will become injured even in extreme loading patterns.
Encouraging “Passive” end range in the joint will also help to teach control in a range we do not usually expose the shoulder to.This in turn should help when exposed to extreme positions such as “armbars”
If you have a shoulder problem or would like more information call Sports Therapy Scotland on 07966570733 or email David Jenkins
Treatment room in Glasgow and Stirling