#81 - Common Conditions for Mixed Martial Artists, Part 1

Hi guys. Welcome to another episode of The Factor Podcast. I'm your host, Jessica Riddle. Welcome and thank you for listening. Today we kick off a new 2-part training on the common conditions and rehab techniques for the Mixed Martial Artist with Dr. Nate Stegwith. Mixed martial arts has experienced a huge popularity spike over the past decade, and with that comes more opportunities for rehab-based professionals to enhance and prolong the careers of these special athletes. And in the world of mixed martial arts, or MMA as it's commonly referred to, injuries are as inevitable as they are complex. Understanding the various forces and mechanisms involved with combat sport And knowing the proper methods for evaluation and screening will help ensure that your patient is well-equipped to perform at their best on and off the mat. And who better to tackle this topic, no pun intended, than Dr. Nate Stegwis? Dr. Stegwis's passion for MMA was ignited prior to completing his chiropractic degree during his military service, where he trained in the Modern Army Combatives Program. After enduring a severe lower back injury, Dr. Stegwas found that conservative care and grappling were pivotal in stabilizing his condition and improving the quality of his everyday life. Today, Dr. Nate actively practices Brazilian jiu-jitsu, striking, and judo 3 to 4 days a week. This hands-on involvement in MMA allows him to deeply understand the unique needs of his patients and effectively translate those needs into his treatment. In part 1 of this 2-episode series, Dr. Nate will provide us with an overview of common submission and takedown techniques in the world of MMA. He also discusses the injuries that can occur in these scenarios. We'll talk more about fighter evaluation and rehab strategies, ways to manage pain and inflammation, as well as some strategies for restoring range of motion post-injury, and how to develop a training and recovery plan that is both sport-specific And tailored to the individual athlete. It is a jam-packed episode today, so be sure to take notes. Let's get started.

All right. Thank you, Jess, for having me. I'm Dr. Nate. I practice here at Apex Performance down in Orlando. And since I have started my career down here about 4 years ago, one of the biggest group of patients that I've seen is with mixed martial artists. And we'll go through it and see how I can use the FACTS protocols and everything else with chiro, whether you're a chiropractor, physical therapist, or just want to learn a little bit more. Hopefully you'll get some good information out of this one. So we'll start off. Disclaimer, everything is for educational purposes. Only practice within your state's scope and research, and when in doubt, refer out as needed. We'll start. Here's my bio. CCSP, PES, mixed martial arts conditioning specialist, and Factor Protocols. I like to blend a little bit of everything into what I see and the people that come in, and we've noticed some pretty good results. with everything alongside that is in addition to practicing myself. And I've also had been given the experience to be ringside medical provider for several Brazilian jiu-jitsu tournaments, MMA, taekwondo. Seen a lot of injuries, some interesting ones, some pretty intense stuff. And the more I'm around it, the better I understand it. And I feel like the better care I can provide to my patients and everybody else that comes in. And I made this presentation— basically, I want to just introduce some of the different disciplines that people may not be totally aware of, maybe just want like a little bit more clarity how different attacks that people utilize can result in some of these injuries that might come through your door. And how we introduce the fracture rehabilitation protocols. and everything else to provide the best care possible. Here's some vocabulary that we'll kind of go through if anybody is not familiar with it. I'll give you a chance to write all this down. Start off with the basic ones. The fighter is the athlete or combatant that we'll be talking about. Mixed martial artist, it boils down to having both a stand-up and a ground game. The stand-up provides multiple disciplines such as boxing, kickboxing, Muay Thai kickboxing, which involves a lot of Elbows and knees as well as kicks, punches. Taekwondo, if people have that background, they can use that too. I've seen people use that in MMA to pretty good effect. Boxing, stand-up, basically mostly with the hands, and kickboxing utilizing kicks as well. Ground game is— or grappling if you want to refer to it— basically revolves trying to get people on the ground and then utilizing your attacks that way. Wrestling, Brazilian jiu-jitsu is really good, sambo, judo, all involves kind of similar approaches and stuff but with different nuances to it and involves trying to get the victory by holding people down, submitting, utilizing your offense that way. The submissions that we'll talk about later will include the blood or airway chokes and joint locks. They'll have different injuries, different potential dysfunctions and stuff that come after submitting. An opponent. Take a look at that. A tap, which is the signal of submission, which is what people do if they don't go unconscious or they don't— something doesn't break. Typically this is just submitting or showing that they would like to quit because they fear of grave injury. Anyway, KO, TKO, knockout or technical knockout. So if an opponent gets punched and gets knocked out of the ground, that's a way to win. If they're getting punched, not necessarily getting knocked out, But, or can't defend themselves, the referee will typically step in, call the fight. Or if they get hit and something breaks, that also can be considered a technical knockout, and that's another way to stop the fight. And then we'll talk about with Brazilian jiu-jitsu, gi and no-gi, which the gi is the traditional uniform worn with a belt. We'll go over the belt system and all that. This is to utilize the clothing grips that go along with the offense. No-gi is Similar, like without the use of the uniform. So grips are involved but in a different way, and we'll kind of go over that as we go along too. All right, so my story. I first got introduced to martial arts when I went through basic training, Fort Benning, Georgia, 2008. It was probably like the second or third day. I had seen a little bit of MMA in the past, but I haven't ever had an opportunity to try it out. So the first couple of days we went up against each other and went up against the drill sergeants and got thrown around and got punched. And a lot of injuries happened to, especially to the people that were new to it. And it's, that's kind of like when the whole becoming enamored with that sport kind of came up because it was a lot of fun. And even though starting off, you have your growing pains at first, it gets better the more you practice it, and you'll notice a lot of benefits as long as you keep up with it. Towards the end of my enlistment, I suffered a very serious back injury after a tour overseas and a bunch of other injuries that I sustained throughout the years. It caused me to develop stenosis within my L4-L5. Still deal with that to this day. Just injured my back the other day again, so I'm going through that right now. And what I've found is like by using some of these FACTOR protocols, been on the decompression, doing soft tissue therapy, doing weightlifting to kind of help further the process along and doing jiu-jitsu, doing martial arts and stuff helps kind of stabilize my back. So I feel like if I could stay in the game by doing this, I can help other people and see that these protocols really do work and give everybody the best chance of care possible. Some background information before we pop in. These are some popular MMA promotions. UFC, everyone knows UFC is everywhere now. That was the most popular one, especially during the pandemic when all the sports shut down. UFC was on every weekend. We got a big, really big boost in revenue. They had over like $360 million in profit this past year just because of how popular it's getting. It's everywhere now. You can't avoid it. Bellator, PFL, those are Other ones that are popular getting promotion, you'll have your local state promotions as well depending where you're at. It's really popular down in Orlando. There's amateur fights all the time, pretty much year-round, and a lot of people, more and more athletes are getting into it every day. So you'll figure that out as we go. Some other things to consider: all matches start on the feet, so everyone that does want to get into mixed martial arts should have an understanding of a good ground and starting on the— sorry, stand-up game. Thank you. Competitors come in all shapes and sizes. They have unique skill sets. As you look on the left, this is Yoel Romero. This was probably taken 10 years ago, but he looks pretty much similar today. He's defying the— defying age right now. And then on the guy on the right is Daniel Cormier, 2-weight division champion. One of the— obviously like one of the greatest of all time when you look at all his accolades. I know from experience like wrestling, some people that are more lean versus the more rotund people that can go, it's a lot more difficult to submit someone like that. So it's the interesting part of all the sports is all these people have different strengths and weaknesses and stuff that come onto it. So the training camps that they do go through are Extremely rigorous and do not, often do not have an adequate recovery routine. It's because these guys are going 2, 3 times a day to practice.

Yeah.

Weightlifting, other stuff, and they might not have the resources available or the know-how to do an adequate recovery routine. It just depends on where they're at and they have available to them and the familiarity with it. So that goes into the barriers here. Familiarity with the treatments and stuff, they might not know About Factor, they might not know about chiropractic, they might not know about PT and what it can do. So it's good to get out in front of them, strike up conversations, do some training yourself, get like in that realm and let them know what you can do to help them. Financial aspects, a lot of fighters are broke. You'll run into that a lot, especially the amateur ones, people coming up that want to make it pro level. It's just, it's hard if you put in all your time and effort into it, but there's no money to start off with. They That can be a big, big barrier to wanting to come and get the necessary treatment. A lot of them just choose to power through. And then time, if they don't have a lot of money, but they need to feed themselves or pay rent or anything like that, they'll have a job in addition to training all the time. So they might not be able to make it in. And then different competitions have different rule sets that goes by the state commission, local, and about the promotion because different ones have In different rule sets. So you can get familiarized with that. Here's state level. Here's some concepts to recall that we'll kind of touch on as we go along through everything. Wolff's and Davis Law. This will be with the kind of like the repetitive trauma and stuff that fighters take, whether it be through competition or just training. Very rigorous. And I've noticed a lot— one of the Recent ones that was more stunning to me that I saw and kind of made sense, there was a Brazilian jiu-jitsu black belt came in. He's been training for 20 years, had some elbow discomfort, so I asked him to show me his range of motion and stuff. And extension, it was probably stuck with about a 30-degree deficit, and that was as much as he could get. So I'm like, this guy's been fighting off arm bars for 20 years. Obviously you're going to get those tight tendons, tight ligaments. Probably some bursitis going on in there and just, that's how it is. So you gotta, you gotta figure out how to work around that and see what the limitations of the treatment is and set realistic expectations. And then specific adaptation to imposed demands. So if someone's more of a striker, I'm gonna formulate their treatment and recovery along someone of a striker versus grappler and Go into more of that here in a little bit as well.

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Fighter weight classes are just a couple examples. As you can see. It varies greatly. Everyone on here jumps up 10 pounds up until you get from lightweight to welterweight. The maximum weight for championship is on the right-hand side if they're fighting. If it's not a championship, they can go 1 pound over. But as you can see, some people might walk around at a heavier weight, say like 185, but they want to fight at like 170 or 155. So that'll go into a lot of the recovery aspect that we talk about later when it comes to hydration and just overall health here. Belt categories. I'm sure everyone's heard of black belts, brown belts, all that stuff. There's 5 basic ones, or 5 major ones in Brazilian jiu-jitsu for the adult categories. Everyone starts out as a white belt, then you move on to blue, purple, brown, and then eventually you get your black belt after Everyone's course is different. Some people might get there faster than others. Typically takes at least a few years to get your blue belt, and then however consistent people are, that's when they can move up to purple, brown, and black. All right, that's a photo of me over at the Brazilian jiu-jitsu submission-only competition. I got to do medical at, and that was, that was pretty fun. I got to do that a couple times, and recently I did the The Taekwondo event. It's pretty intense, so you gotta keep you on your toes, and it's a lot of fun. If you ever get a chance to do it, if it's within your scope, definitely try and get in there. So overall, let's start just from the beginning and what actually is mixed martial arts. So it went up a little bit taller, but I'll just read off of it. I'll let everybody live this here for a minute if you want to write it down. This is just original quote from myself. Combatants utilize multiple disciplines of martial arts such as but not limited to Boxing, wrestling, Brazilian jiu-jitsu, and judo, amongst others. Competition lasts until an opponent is incapacitated or time has elapsed in all rounds. Basically hand-to-hand combat in a legal, organized manner. So, all right, fighter styles. So the ones that come in, once you talk to them and stuff, they'll kind of give you a rundown and like what their sport is, what their background is. And for the most part, it comes on like a spectrum. You have a person that's really grapple heavy on one side, you'll have a striker on another side, so someone that utilizes more stand-up than grappling in their game, and then in the middle you have the people that utilize a little bit of both. Just depends on their skill level, depends on their preference and their backgrounds. One on the left here is one of the famous— more famous grapplers of all time, Ronda Rousey. Everyone should know who this one is. She's a former Olympian in judo. She took the world by storm. She was 12-0 before her first loss with all finishes. 9 of those finishes were submissions, 6 of them by arm bars— all of them by arm bars rather— and 6 of them came in under a minute. So everyone knew, everyone knew what she was doing, and she just put it on them anyway and got people out there until she ran into a fighter that could stuff her takedowns and she couldn't utilize her offense, and eventually she lost her belt in that one. And then on the opposite end of the spectrum, one of the best strikers of all time, Conor McGregor. Everyone should know him too. Left hand was knocking people out left and right for many, many years. He was the first 2-weight class champion in the UFC, one of the most famous, richest athletes in modern history here. And then he ran into Khabib Nurmagomedov, which is probably one of the best grapplers of all time. Couldn't get the strike, ended up losing his career. He's still fighting now, but it hasn't been to that level since. And then we go around to the all-rounder, George St-Pierre, on the shortlist of greatest mixed martial artists of all time. 26-2. He's won multiple weight class Championships. He utilizes his black belt in both karate and Brazilian jiu-jitsu, as well as wrestling and other disciplines of martial arts that he's really, really— he was really, really good at. And so he went up against someone that was really grapple heavy, he would stand to strike with him, put on a clinic there. If someone was really strike heavy, he would go back to his wrestling and Brazilian jiu-jitsu. And this is one of the guys that I grew up watching, and it was always a treat to watch him put on a clinic. And so you'll see a little bit of one or the other. Typically, the fighters on the come-up have one way that they sway, and then eventually the more experience they get, they come out and to be well-rounded. Go right this— some personal protective equipment that we utilize here in our gym. We have boxing gloves down here, the shin guards for practice, and even amateur fights they have shin guards because Bone contusions and injuries to the lower leg can be very, very devastating, as we'll see. Mouthpieces guard up the jaw and teeth. Headgear is optional. A lot of people should be wearing it, especially if they're sparring a lot, just to keep that repetitive trauma from getting to the head— concussions, all that. Protect the ears from getting cauliflower ear. There's pretty much the basis right there and the wrestling mats that we have back here as well. So injury prevalence, there's different studies out there that'll have different ones for different values for different, different types of different venues basically. But what it boils down to is roughly about 78 to 80% of everyone that practices or competes in mixed martial arts is going to sustain an injury at some time. And I think that number is low because I think Pretty much everybody's going to sustain at least some form of injury at some point because of just the demand and the nature of the sport. You got punches, submissions, overusage, like a whole bunch. There's just so many ways to get injured, and it's good to be able to recognize that and get the appropriate treatment. These are injuries that we're going to discuss. I'm going to touch over. We're going Acute versus chronic when it comes to the submissions and striking, and then simple versus complex. Brazilian jiu-jitsu is one of the ones that I'm most familiar with. We're going to just start with some of the basics and then we're going to go from there. So basic positioning that you start off with is guard. Man on the bottom is trying to control man on top. You can set up some, some of your submissions from there. This is basically just kind of like a safe haven if you are just holding them there, or if you want to start an offense. This is one of the most basic positions that you could start off with. Side control. There's 5 different positions that all control or all fall under side control, but basically you're just holding someone down, putting the top pressure on with the chest, as you can see up there. Hold in. This is almost getting like a crossface going right there. Just another way of controlling them. You're going to move around this, and a lot of the times it just segues into other positions such as the mount. The mount is the most advantageous, the most dominant position in grappling. As you'll see, you can set up chokes from here. In mixed martial arts, if you get the mount, you're going to be raining down shots, punches, elbows. Whatever. It's typically when you get down here, it's the other guy's in some pretty big trouble. But if they can get out of mount, typically they roll over and then they give you your back. This is another very dominant position for the attacker. You see right here, you can do a lot here. You can attack the neck, attack the arm, hold them down. It's a very tough day for the guy being attacked. So now we're going to get into the, the meat of the presentation here. We're going to look at some of the attacks, submissions that can go on, visually the blood choke and the joint lock, how we discussed earlier. First one is the Americana, and how it's kind of the format of this is we're going to have like the name of the submission. We're going to show like how it's executed, basically like the mechanism of injury that can go on, and then we'll go into the potential Injuries to the soft tissue and that can occur to that, and then how to go about treating them with the F.I.T.T.O. protocols. So the Americana is you're going to hold down, isolate one of the arms. As such, you're going to put a— your grip on there, and then you're going to externally rotate the shoulder joint until you feel the break. Typically about after 90 degrees and stuff, you'll start to feel the joint capsule tighten up. And by then the guy should be tapping. If not, then he's probably gonna get hurt pretty bad, but 9 times out of 10, they're gonna tap a lot sooner than that. Some of the potential injuries in the acute is rotator cuff sprain strain. You're putting so much tension to all the muscles and ligaments of the rotator cuff when you do that. Same with the capsular damage. Capsules get irritated, get inflamed, cause some decreased range of motion. Labral tear, you put enough Put enough rotation and put enough force into that, you definitely can tear up some labrums. And then fractured humerus, if you are seeing someone that's fighting out of it a lot, enough counter-pressure— you'll see this in a lot of other submissions as well. Sometimes some of the injuries don't come just from the person, it's from the guy trying to escape out of it, and maybe they put a little bit too much counter-pressure into it and spiral fracture. Long bone pretty easily. Chronic injuries. So if they fought out of it, felt hurt, but didn't go and get it treated, or wasn't noticing a whole lot of deficit, but it came back later, frozen shoulder can occur. Some bursitis and instability, basically just inflammation over time and repetitive trauma, decrease the range of motion, and then you just keep going on it for a while. And typically people will show up. Say it's been bothering you for months or even years and stuff, and then it's like, well, you got a lot of work to do after that. So just some of the things to look out for. Rehabilitation protocols. So basically from the factor Dr. Riddle, which presentation that he shared with us, we go from static to dynamic with controlling the inflammation and pain. You can use whatever methods that you like to do with that. We really like to do— start off with Venom, a little bit of dry needle, maybe taping, myofascial release, restore the range of motion. We do— I like to incorporate a lot of PVC pipe when it comes to shoulder. It's nice, simple, easily accessible for a lot of people. If they don't have PVC pipe at home, you can have them use a towel, you can use a broomstick, whatever. else can kind of mimic that. Wall walks, wall angels, passive external rotation. Can use bands, whatever they have available to them. Adding resistance to the range of motion with the shoulder, you can do medicine balls, rotations, your standard bands, internal, external rotation. We have sledgehammers, you can use maces, anything. Just go simple to compound when it comes to and the resistance in that range. And then incorporate some grappling striking drills. If they injured it with— they're more of a boxing type and stuff, you want to have them do like some jabs. You can have them punch. They have a bag at home, or if you have a bag in your gym. We have several bags and striking dummies here. We have the bob here. So we'll just have them do the regular ones. Build up that tolerance in there and eventually ramp it up and then return to practice once you feel like it's necessary. Typically just depends on the athlete and how quick they recover. So this would be like kind of a recurring pattern that we'll see in all these other ones, but we've noticed some pretty good results utilizing this protocol. Next one, we'll go Kimura, similar to the Americana, but instead of the external rotation, we're internally rotating. glenohumeral joint. After about 70 to 90 degrees, you'll start to notice it, it adds a little bit of extra torque towards the back. When it gets into internal rotation, tap pretty quickly. You can do this from several spots. One of the main ones is from guard. People typically fight out of that pretty good. You can also do it from side control. Injuries include the rotator cuff sprain strain, shoulder dislocation, humeral fracture. Again, someone's trying to fight out of it. You'll have that counter shear. I've seen it happen in, in the UFC several times. Several fighters have been trying to fight out of Kimuras. Everything seems good until it doesn't, and then all of a sudden you have a broken arm on your hand. AC joint sprain. This is lower on the spectrum, things that— but it's not out of the realm of possibility of things that could happen. And then we go back to your frozen shoulder, your bursitis.

Nerve dysfunction.

You have the axillary nerve, it's running through there, so you get some irritation in the surrounding tissues and stuff. They could feel pain, discomfort in the rotator cuff, so just make sure you address that. Protocol, rehab considerations, similar. We're gonna control pain and inflammation, gonna restore the range of motion, added resistance. I use a lot of sledgehammer, as you can see right here. What we'll do is have them hold it, Up towards the top near the weight. We have them in 8, 10, 15-pound increments and stuff. Start at the lowest, you build up the tolerance. Start closest to the weight, have them externally rotate, bring it up and over to internal rotation and hold it out. And after about 3 or 4, people usually are sweating pretty hard. Once that gets easy and stuff, you just move it down till about halfway to Halfway down the handle. That'll add a little bit more resistance, and then once that gets too easy for them, then you go up in weight. Then after all that, there's no more pain, you have full function of it, then you can go back and incorporate your grappling and striking as needed, and then return them to practice and comp. Arm bars. Arm bars are one of the first ones that I was taught. I'm sure it's one of the first ones most people were taught. It is an attack that you can do from pretty much anywhere. There's multiple positions that you can do, and if you're caught in an armbar, it's not pleasant. It hyperextends your elbow, and yeah, you'll definitely feel it for a little while after, especially the ones that don't tap. You try to push through it, it can go south pretty quickly, but you only have so much play in it. Once it locks out and they add the hyperextension in, it's, it's over pretty quickly for them. All right, in the acute, it can definitely tear a ligament or a tendon, definitely fracture an arm. I've seen that happen a time or two. Pec tear, if you're trying to rotate away from it to try to create space, a lot of pulling, a lot of tension, especially goes up into the anterior portion of the shoulder. Can get a SLAP tear too. A lot of things could go wrong. Chronic tendinosis, tendinitis, and bursitis. Nerve entrapments. Maybe you'll get some pronator teres syndrome, even a little bit distal to the elbow. And like I've said, like the people that have been doing this for a long time, they're typically going to have some elbow dysfunction, some loss of range of motion and some discomfort just because they've been fighting these off for forever. Rehab considerations, same thing. You're going to control pain and inflammation. You're going to do whatever soft tissue whatever restorative range of motion that you like to do. We like to add a little compression flossing as well and then add some eccentric loading as Luke is showing here with one of the resistance bands. We try to get as much extension as we can. You might not get it back to normal, but if you can return it back to pain-free and functional, that's typically what you look for. And then you go back into your grappling and striking drills. I like to utilize technical get-ups with this because it involves extending of the elbow. That's one of the most important, more important aspects of jiu-jitsu is being able to, if you're on the ground, or mixed martial arts, to get down and get back up. So think of like a Turkish get-up, but similar, similar mechanics, but this is more specific to mixed martial arts and Brazilian jiu-jitsu.

That's it for today's episode. Be sure to tune in for episode 82, where Dr. Nate dives deeper into strategies for cross-training, the importance of incorporating warmups, cooldowns, and strength and conditioning programs to prevent injury, as well as methods for optimizing recovery and ways that you can track progress and athletic development. You won't wanna miss it. Episode 82 drops in 2 weeks. If you enjoy this content, please be sure to like, download, and subscribe to the show and share the link with a friend. Every share helps us fulfill our mission to provide world-class free education to healthcare providers around the globe. And if you're interested in listening to past episodes and viewing all of our recorded webinar replays, be sure to check out our website at faktorpodcast.com. That's F-A-K-T-R podcast.com. We are working on some exciting interview-style Q&A episodes for the future, so be sure to send us any questions you have for Dr. Nate when you visit the episode page on our site. You can even click a button and submit your questions through voice message, which I think is pretty cool. We will be sure to cover all of your Q&A submissions in a future episode or on our YouTube channel. And finally, don't forget to visit the show notes for links to the webinar replay from today's episode. Along with any special offers from our sponsors. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.