#82 - Common Conditions for Mixed Martial Artists, Part 2

Hi guys, welcome to another episode of The Factor Podcast. I'm your host, Jessica Riddle. Welcome and thanks for listening. In our last episode, we discussed common submission and takedown techniques in the world of mixed martial arts. And our guest instructor, Dr. Nate Stegwis, gave an in-depth overview of the injuries that can occur in these scenarios. We also discussed fighter evaluation and rehab strategies, ways to manage pain and inflammation, and strategies for restoring range of motion post-injury. In today's episode, Dr. Nate will talk more about ways to manage pain and inflammation, strategies for cross-training, and the importance of incorporating strength and conditioning programs for these unique athletes. We will also discuss the best methods for optimizing recovery and talk through ways to track progress and athletic development. Let's cue the intro music and dive in.

Then we'll go to the lower half, straight ankle, goes into plantar flexion and inversion.

It's going to stress the ATFL and retinaculum and other structures around here a lot.

Could fracture an ankle, sprain, strain the surrounding structures, dislocate if you pull hard enough, if you rotate it enough. You can do some ligament instability, tarsal tunnel. I'm experiencing a little bit of that right now. It's not great. But it's—

when you see what it is, I kind of treat it kind of like an ankle sprain, like just a typical ankle sprain, like if someone was Coming in after just playing basketball, it's similar mechanism, and then you can take that protocol and that experience that you have with those type of injuries and apply it to this. We use the compression, the Voodoo Floss, Factor Floss, whatever you have for this to restore the range of motion. It responds really well to that.

And then to add resistance to ankle can be a little challenging at times.

If you have like a rocker wobble board, that's, that's pretty good.

Kettlebells with shifting weight with a knee over toe, that works pretty well. We have the monkey feet here. If anybody's tried the monkey feet, it's amazing. It's really, really simple to incorporate the weight through the range of motion.

And then I have them do— this is called shots. Basically, you want to have them try to lean their knee all the way over the toe and then Explode off of it. There you go.

This is also one of the more important aspects of Brazilian jiu-jitsu. Just got to be able to take them down. Kneebar, similar to armbar but for the knee. Maximum is about— maximum knee extension is 0 to about 15 degrees. So when you— after you lock it out and hip up, that's usually the end of that. Think of knee hyperextension injuries like in football and stuff, you're going to think of the ACL. Other collateral cruciate ligaments can be involved ligaments. And I check out the hamstrings as well just because it's in the lengthened position. So a lot of times if ACL, MCL, like all the ligaments are fine and stuff, but they feel some pain around the knee and stuff, maybe it could be like a hamstring tear or some kind of like nerve entrapment around that area you can do. So chronic, you get knee barred a bunch and stuff, you can get some instability over time. Hamstring mobility, just— In general, it's just something to look out for. Let's use the Venom around the knee. Helps out greatly with a lot of things, especially involving the knee.

Just helps get it warmed up, get it ready for motion.

TRX is really good in the early stages that we like to do because it helps take the body weight or take any extra weight and strain off of it.

It'll get the range of motion back to where it needs to be, and then after that you add your resistance. Bodyweight squats, good place to start.

Monkey feet, monkey feet are great for nearly any lower body one.

I can add in the hamstring curls and quad extensions, anything else that you could find with that. Bulgarian splits, and then Nordics. With Nordics, I would recommend starting at the most regressed. So start off at about maybe like 15, eventually building up the tolerance to get it full if that's one that's bothering them. And then for the grappling and striking drills and stuff, if they utilize a lot of kicks, I have them just start kicking, kicking the heavy bag just lightly and stuff, building up, building that tolerance back up, getting used to takedowns again, seeing if they can roll around and fight off submissions, and then positioning and doing technical get-up as Luke is demonstrating right there.

And then you return them.

Heel hook. I'm going to spend about a few minutes on this one just because it is very prevalent and it's probably one of the more devastating injuries. It's pretty controversial with a lot of people, and what happens is you're going to isolate the lower leg. You're going to clamp onto the upper part of the femur so you can extremely rotate the lower part of the leg. around either an internal or external rotation. And what it does is it simultaneously attacks both the ankle and the knee joint.

So you can look up on YouTube heel hook injury. It's not for the squeamish because it can be particularly devastating.

In a lot of places it's been outlawed and a lot of schools won't teach it to their lower level.

You got to be at least probably like a purple belt or above, just depends on where you go. Just because of the potential for serious damage.

There's other organizations and other competition boards that outlaw it, so if you try it, you're immediately disqualified.

So, but it is good to know about it because the ones that do allow it, typically a no-gi one, people go for it because it's one of the quickest ways to win. Because as you'll see, One of the first things to go is the cruciate and collateral ligaments of the knee, because once you isolate the knee joint, there's no real defense for it. And what they say is you're good until you're not. So you're not going to feel anything.

It's going to feel fine, like, okay, I can fight this off, fight this off, fight this off, and then boom, there's— there goes a ligament, or boom, there goes a meniscus tear, or whatever happens. And a lot of the times If they're fighting it off, the tibia can create a spiral fracture as well. It's just, it's nasty little submission and can be very devastating. Take people out for a very long time. Rehab considerations, if they do have pretty extensive injury, you might want to opt for an ortho consult before you get started. But if you can, similar concepts: compression, heat, elevate, control pain, inflammation. Restore the range of motion slowly. It's going to be typically a long, very long recovery with that. Add your resistance, build back up with balance issues, your strength issues, whatever else that comes from it. Incorporate the grappling and striking, and then return to practice.

Typically, anybody that gets caught in a really bad heel hook, it's going to be at least almost a year, just because I've seen how devastating that is. I always get a little nervous whenever I see People do that in competition and I'm doing coverage here.

So then we'll go into the blood and airway chokes.

These are some of them.

Obviously these aren't all the ones that we can do.

I would be here for 4 or 5 hours with you, but a lot of them will have similar presentations. So we'll just kind of motor through the mechanisms and then we'll go to how to recover from them afterwards. First one I'll talk about is guillotine choke.

It involves compression of the carotid arteries. Bilaterally, and you can see with a little bit of cervical flexion to the affected side, it is not pleasant to be in from personal experience.

It can be performed standing or in guard. Either way, does not feel good.

The potential injuries— loss of consciousness is the first thing. Typically they say it takes about 10 seconds of compression to cause the loss of consciousness, and then anything from 30 seconds to 4 minutes can induce some brain damage. So if you're training with someone and you don't pay close attention, you have them holding on to a choke for too long, don't realize that they're out and stuff, you can cause some damage.

So I would have the athletes be sure that they pay attention to what they're doing out there.

Cervical sprain strain.

This is typically from trying to pull your head out of the attack.

If you're holding on for—

trying to get out for dear life and a guy's holding on for you, you can definitely—

I see a lot of cervical and upper back Strain that goes along with that.

Tracheal damage, basically bruising, just feeling like you've been compressed because a lot of the force goes through from the forearm when you're locking your hands on the opposite side like that. TMJ damage, I've experienced.

I had a black belt and I attempted to get out of a guillotine. He proceeded to squeeze down on my jaw and I felt it detach for a second.

So that was fun. I had a nice little headache for A few days after that. So that's also a possibility if they come in with that. Nerve irritation, just check your nerve roots and see if there's anything referring down into the arms.

Rear naked choke, this is one of the most popular ones. It's compression of the carotid arteries and trachea. People that go for the back typically want to go for this one. MMA, this is one of the most effective ways to end a fight because once you slap on one of these and it's tight, it's almost impossible to get out of. So Loss of consciousness, tracheal sprain strain, cervical strain, TMJ. The initial way to block the rear naked is to duck your chin like such, so if someone comes along with their arm, covers that, and puts enough pressure on it, you can aggravate the TMJ joint pretty easily as well. D'Arce choke, compression carotid arteries, assistance from the opponent's arm. Kind of similar in setup to the rear naked, but this is going to be from side control.

You get an arm trapped, compress it down through there.

Similar potential injuries: neck, shoulder, TMJ. Triangle choke, you can do head and arm or from guard with the legs. Similar mechanism, similar injury.

And then the rehab is going to be similar. You're going to control the pain and inflammation, restore the range of motion, Traction can help if it's more of a chronic issue than an acute issue. We use the Iron Neck a lot here, especially with all our grapplers, just because it's great for injury prevention.

Having a strong neck in general never hurt anybody.

We put the Iron Neck into doing drills such as sprawls, any type of shoots and stuff. Just adds a nice little layer to rehab, and we see a lot of good results with that.

Carpal tunnel grappling and striking drills.

Shadowboxing, just something to get the head off midline, make sure that they can defend themselves, light submission defense. Maybe just hold them, don't like crank down on them if you want. Positioning and transitions, and then let them loose after that. Striking injuries real quick.

Pretty self-explanatory.

I mean, if you've ever stubbed your shin on like a bedpost or anything like that, imagine that coming at you about 50 miles per hour.

Gonna have the potential to fracture some bones.

Concussion's a big one. You get knocked out and stuff, back of your head hits the mat. Fractured ribs. People that throw kicks and stuff, they'll be targeting the liver and spleen, so you can get some internal organ damage.

Hematomas, especially on the face and stuff.

You can see people with huge knots after, especially if it's a long fight.

Bone bruises.

Fractured teeth.

People that especially like if someone's fighting, say like a Muay Thai heavy person holding on to the head, getting a knee right underneath, the mouthguard can only handle so much. You can fracture a jaw, have some teeth knocked out.

It's pretty nasty when that happens. Fractured tib fib.

If someone is checking a kick, I've seen an uptick of it over the last couple of years.

I think last part like Conor McGregor was one of them. He Tried to kick and then tib fib fracture.

Anderson Silva, one of the best fighters of all time, he's had it. Chris Weidman's had it.

So it's just that too much force and the bone does not adapt to it, so it breaks and it's pretty nasty. Lacerations to the face, that's pretty easy over time. So if you take enough punches, your TMJ, you'll have chronic pain in that.

Post-concussive symptoms. Make sure they, they're still experiencing it. Hold them out of practice and have them see a neuro and get the all clear from that because you don't want to have the double impact, any potential of that. Hand injuries is a big one. Punching someone in the face, you'll have a chance of getting a boxer's fracture, any of the metacarpals really, but typically it's going to be the 5th metacarpal. The DIP, so your distal and your proximal interphalangeal joints. That's why people will— the old school jiu-jitsu people will tape up their fingers beforehand just to add a little bit extra, because when you're gripping, especially on gis and stuff, it's really high intensity, a lot of speed, velocity, and strength that goes behind it.

Really easy to hurt your fingers that way.

You can do some grip strengthening. There's— they've got equipment out there for grip strengthens.

You can have them grip rice.

Just get back to Normal activities. Grip strength is really kind of an underrated but a very important part of martial arts too.

So if they're experiencing that, that's another bit of advice you can give to them. And then certain techniques can just be more devastating than others.

There's an oblique kick which basically causes extreme hyperextension of the leg, valgus stress, hits to the back of the head. They're A lot of these are largely illegal for that, but they do happen sometimes. So just allow sufficient time for it to heal and refer out as needed.

So this is a question I'll let everyone answer that if they feel like answering.

And it's going to be, what is the most commonly diagnosed ailment of MMA athletes?

This is what people actually go to see their primary care or see a doctor for.

Okay. Someone said headaches. I'd imagine head and neck is probably going to be Gonna be up there at the top. Lacerations.

Okay, all right, so yeah, headaches and lacerations, that's—

those are pretty good.

But next brain. Okay, thanks.

I was gonna wait for one more, so glad we got one more here.

All right, skin infections.

So staph, MRSA, ringworm—

this is rampant. It can be very rampant once someone gets it in the gym. Maybe they don't realize that they have it.

But just the nature of the beast here and the environment— MMA gyms are hot, sweaty, not a lot of ventilation, and you're grappling and you're in close contact for a long period of time.

So it's pretty nasty. It can get pretty bad. It can be— yeah, those, those gis don't wash themselves. That's right. Yeah, absolutely.

Yeah, approximately 17% of all collegiate wrestling Injuries involve skin infections. So that's all injuries. It's pretty bad. And it can be spread through cuts, blisters, or exposed skin.

So that's why if someone has a cut, if someone has an open wound and stuff, we largely tell them to wait till it heals before you get back because you naturally have staph, MRSA, all that stuff on your skin. If you have like an increase of it, you have that open, It's just an easy portal in and the stuff can, can spread even with antibiotics and aggressive treatment.

It could still cause some devastating injuries and could potentially be fatal if not treated appropriately. So if you see that on someone, someone has this big boil, it's hot and just looks off, just send them to the primary care, have them make sure you wash down everything that was in contact with it. And tell them to stay off practice till they get that taken care of.

All right, case study.

This is the one that, with permission from the athlete, this is the one that I've been training her for years now.

In March of 2022, she had a particularly devastating injury.

This was just at practice. This wasn't even during, during a competition, but she called me up late at night.

She said that she hurt her knee and she can barely walk now.

I was like, okay, well, I'll come into the gym tomorrow and We'll see what's going on. And when I got there, she was on crutches. So I knew it was bad because she's really, really tough. 2-weight-class champion, amateur champion.

So this has to be pretty devastating if it's causing her to do this. Moderate decrease in flexion and extension with pain.

Positive McMurray's with noticeable click and bogginess along the lateral aspect. All her collateral and cruciate ligaments were intact. So I didn't really think I didn't think it was ACL or anything that we'd have to go immediately into like a surgical consult or anything like that. But she had some strength deficits, no numbness, tingling distal to the site of the injury.

But I was figuring she probably tore her meniscus pretty good.

Got the MRI several weeks later, bucket handle tear, left lateral. You can see right here, this little, this little break. So I told her that, let's just, let's rehab you.

And if you want to get surgery later, you can always opt for that. But let's get you upright so you don't get deconditioned too much and see if you can stay at least semi—

stay practicing for at least a little bit while we get everything else figured out. So weeks 1 and 2 focused a lot on pain mitigation and light resistance, just getting her able to try to get to as much full extension and get it as strong as we could.

I had her on the exercise bike.

Just adding up little by little over the first couple of weeks. By week 3, she was a pretty quick healer. So she was able to do a little bit more. We started light jogging for just a couple of minutes at a time, just to test the tolerance, some agility drills, BJJ ground mobility, such as like shrimping, doing her get-ups and stuff. And by week 4, she was able to Stay up and support her weight and do a little bit more as the days went on.

Obviously, we did some light judo drills, had her do some takedowns, very light, probably about 40-50% of competition speed, and she was able to do it.

And we had her doing drilling up to hers. When it came to this, we were able to give her a protocol and give her her standard that she could exercise and train.

To her tolerance and really helped after week 7 and stuff. I saw her semi-regular basis going forward just to keep track and make sure there's no regressions.

She went to the arthroscopic several months later and she continues today.

And she actually has her first fight over about 14 months this Saturday.

So I'll be excited to see her go after that. So it's really good. It's really enriching, especially when you see if you can be like a small part of these people's journeys and stuff. It's really enriching and it's a very Very fun way to use your license.

All right, last little bit. For a little bit of advice, if fighters come up to you and they just want to ask stuff, I always tell them, tap early, tap often.

It's not worth—

it's not worth taking off a year of your life just to try and fight out of something in practice.

Make at least one day a week for recovery. A lot of people, a lot of fighters want to go every single day and stuff, and eventually, eventually something's going to break down. So Try to make time to recover, hydrate, eat clean, wash your gis, wash your equipment, wash yourself, especially after being in contact with people.

Outsleep the competition. Sleep is highly underrated, and when it comes to recovery, if you don't sleep good, everything else kind of just falls apart. Minimize the outside distractions.

There's a lot of information out there. Not all of it's great. So if they'll come up to you and ask you about certain stuff that might seem a little silly, but Just kind of put them in the right direction and then be safe and be good to your partners.

It's not—

nobody wants to go out and hurt anyone. So just be safe with it and have fun.

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And always remember to provide thorough examination, your movement screenings, and correlate the findings with the fighter style and treat accordingly. That's the SETT principle. And then provide support and reassurance.

That's it.

So yeah, it was hopefully not too information-laden. Hopefully everyone got a little, little bit about that. Now we'll open it up to questions.

Awesome. Thank you so much, Dr. Nate. You talked a minute ago about kind of how you encourage rest and recovery. Could you expand a little bit on how you help your athletes come up with a system or a schedule for rest and recovery in between their practices and then any matches they have?

There's, there's not really like a specific one.

Everyone's going to have different needs depending a lot on their like personal schedule. Like some people, like I said, some people have jobs, some people have more time to, you Give to recovery.

But I know people that are fighters and then they work, they're the bouncer at a nightclub at night, so they could sleep like 4 or 5 hours.

So like if they can only sleep a little bit during the night, not maybe like up to about like maybe a 7 or 8 hours, that would be ideal. I tell them to try to get a nap in after practice to try to like get these little bits and pieces of recovery as they can, as opposed to just one large one. But it'll come down to, it'll come down to the specific athlete and kind of like what they, what else they have, the outside factors that they have going on in their lives.

Absolutely. And I think that's, that's definitely key there is kind of individualizing that to each patient and their needs. Another question that came in, someone was asking about if you have any standard recommendations for an amateur fighter that's training several days a week, how do you kind of balance their soft tissue therapy, their injury prevention weekly or biweekly? They come in. They have a really rigorous training schedule. How are you balancing in their sessions with you and their rehab amongst all of that?

Yeah.

So this will come down to basically if they're in fight camp or if they're not. If they're in fight camp, I like to see them at least once a week just to kind of make sure that they're on schedule. No, nothing new pops up that we can kind of get a jump on. If they're outside of fight week and just want to like recover and stuff, use like cold plunge or Sauna or you get adjusted, soft tissue therapy, whatever like that, typically like every other week if they can swing it. If not, once a month is fine too. But for fight camp, yeah, we try to see them at least weekly, keep them on track, make sure there's no— there's nothing that wouldn't keep them from performing their best during the fights. That's a really big—

that's a big opportunity for you and the fighter to like kind of bridge That relationship, if you go out and they're feeling 100% and they go as far as they want with their career, that's one of the more enriching parts of the job. It's less frequency when they're not in a fight, I would say.

But again, it'll come down to if they have like a chronic issue, like if they have chronic deficits.

I see a lot of boxers with like rotator cuff syndrome because if they're volume punchers, meaning like they're not knocking people out in one fight, they're not doing doing Mike Tyson type work and stuff, they're going to absorb all that force throughout the matches and practices into their rotator cuff. So they might need one a little bit more frequently than someone that's just doing jiu-jitsu or someone that is not as reliant on their striking. So it helps to be familiar with your fighter's type of style as well.

Absolutely. Are there any things that have been surprising to you that you've seen in terms of interventions and things that you might work on rehabbing that make a big difference? So for example, a lot of sports docs will talk about how looking at things like breathing dynamics can make a huge difference for their powerlifters, which isn't something that you would necessarily think intuitively, like, hey, I need to look at their breathing first.

Yeah.

Is there something like that that you've seen across the board with your fighters that you're like, Every single time when I have a new patient come in that I know is involved in MMA, this is something I look to every single time. And if we can make this change and fix this, it makes a huge difference.

Yeah, there's a couple.

One of the more interesting ones that I found was what's called your frames. Basically, I have them put their hands up and then I'll test to see if they can hold it.

And a lot of times they'll have one arm or even both arms sometimes that just, you can Slap them down right away and they just can't hold that position. So we can work on some upper core strength and stability. If they have inability, like doing the neck flexion tests and stuff, we can go for cervical stability with that. Like the iron neck is great for that. Planks, overhead dead bugs with the ball.

You can get creative with it.

But yeah, I've seen—

Especially with it, because like being able to hold your opponent off is such like a vital part of your offense and defense. And some of the times some of these guys just can't do it.

Like maybe they weren't even, they didn't even notice that they weren't able to or something.

But once we shore that up and stuff, they say that they typically feel a big difference, not only in pain and function-wise, but definitely in performance as well. So if people have a movement screen that they do and stuff, and then they could find that and correlate that to the fighter's preference and stuff, that's great. I like to do Something really specific to them, like when it comes to like holding their frames or seeing if they can hold their punches, like seeing how much force that they can generate behind it, and then just kind of reverse engineering from that, attacking that tissue, restoring that mobility, strengthening up that area, whatever. So that typically yields pretty good results.

Absolutely.

The next question that came in is specifically regarding Brazilian jiu-jitsu athlete.

Okay.

With experienced fighters increasing their volume and experience that are experiencing hand soreness, would you suggest more grip strength training or is there a more worthwhile intervention for that?

I think that would depend.

If they're having difficulty, like the—

was it the Fromans?

Yeah, if they're having like difficulty like holding that, you can look up the chain, see if there's a nerve entrapment somewhere, release that, and then doing some grip strength training.

I don't think it ever hurts someone to get strong in a certain area, especially with, with grip strength because it's used so often. But I would definitely test the muscles and see if there's any nerve kind of dysfunction going on there, and then apply that and then see if that helps with improving the grip.

And if you wanna go for strength, I like to have people do more endurance-based, so lower weight, just higher reps. Maybe that would help more than just trying to holding up as much weight as possible when it comes to the grips.

Absolutely. The next question here is regarding hypermobility. The first part of the question is, do you always test your fighters to see first if they are hypermobile so that you know if that's a consideration to look at? The second piece of that question is, if you encounter an athlete that is hypermobile, are there specific taping jobs that you're doing for that when you know they're preparing for a fight? Are there specific ways that you kind of cater your rehab to help strengthen those areas where they may be experiencing a lot of that hypermobility, especially your grappling athletes?

With that and stuff, taping might not be allowed in some of the competitions and stuff, so I try not to have them reliant upon that. If they're gonna stay in here for like a long rehab session, then I might utilize that.

It depends on the athletic commission and if they allow for people to be taped because I don't want them to be like Reliance on it, then not use it, and then feel off and stuff when it comes to that. Hypermobile people and stuff, like, I will do my passive-active stuff if they're off the charts with that. Obviously, I know I'm not gonna waste too much time on trying to restore the motion.

I'm just gonna go down the chain and start to find the weaknesses.

Typically, if they're hypermobile, like, say for instance, I had a fighter the other day and her hip Internal rotation was like off the charts. I'd never seen as much internal rotation as that. But when I tried to have her resist me and stuff, she couldn't hold it. So all that mobility is great and all if you're like throwing kicks, but eventually it's gonna—

it can eventually cause some issues.

So I was more focused on strengthening up that range than trying to get as much mobility as I can out of it.

It actually works.

It works pretty well in jiu-jitsu, but if you can't hold the position Especially with like hip mobility, hip strength and stuff, they can't hold that, then how are they going to hold someone in guard for a while? So it's something that you can relay to them to kind of let the light bulb turn on, like, okay, we can set you up with a program, strength and conditioning program. I hand them out to Luke out there. He's an MMA fighter as well, so he knows the program, and we just kind of Rinse and repeat until we get the desired result. And typically they respond really quickly because a lot of, a lot of these athletes have never heard, don't really know of this concept.

They think they didn't really realize that they were weak in a certain area and that has something to do with jiu-jitsu.

So it can definitely help out a lot.

Wonderful. Another question here. Someone was saying that a lot of professional teams and collegiate teams have training rooms and open access to care that amateur fighters don't. How do you create the relationships with athletes that benefit them? Do you do memberships, standing treatment times, direct care, or fight camp offerings?

We do fight camp offerings and memberships here. We do like monthly, like month to month, because we understand like fighters will have certain financial restrictions as well as timing restrictions and stuff. They can't always make it in, but ones that are like really dedicated and are able to and stuff, they'll come in and we'll have Yeah. Programs for them. They can come in and use the recovery stuff, the cold plunge, the compression sleeves, red light, sauna, weightlifting, whatever they want. If they need soft tissue, then we go from there too.

A big way to open that realm to the access of care too is just to go to the gym and start practicing.

Because like I've made so many connections and stuff with athletes and stuff just by going there and practicing with them.

It's a great time for both physical and mental health, jiu-jitsu and mixed martial arts has been one of the best things for many, many people that I've talked.

But it's, it's good to overall health and to get a better understanding of what they're going through.

And that'll help to gain rapport with them and help give them better treatment.

Do you have specific guidelines that you give your athletes when it comes to frequency of practice during rehab? Let's say someone comes in to you with a rather acute injury, obviously you have your rehab schedule that you're putting them on for when they come see you. How do you have that conversation with them about type of practice, type of workout? Like, what do they need to do while they're still in that acute phase? How do you get them to tap the brakes a little bit on their typical training schedule?

That's easier said than done because a lot of them, a lot of them like to go 100 miles per hour at all times. So it's just really good to Kind of reiterate the importance of your recommendations.

And it helps to know the head coach. The head coach is typically the owner of the gym. If you can get in good with them and the athlete doesn't mind you discussing like the case with them, you can also correlate with that, like coordinate, see how it is. Typically, if there's an injury during fight camp, like a specific one, they'll probably just pull them out. So you don't have to worry too much about altering That, but if it's just like an everyday one and someone, if you don't think they're good to go grapple like 5 rounds intensely and stuff, you can just be like, hey, just go half speed for like 1 or 2 and stuff, see how it is and stuff, build back up your tolerance. And then over time you can release them to full activity. But open communication is just, and just stressing the importance of it is highly important.

And one last question here. Someone was asking for your top 5 recovery tools that you use in practice.

We use a lot of the Venom, I would say.

Oh boy, what else do we use? Iron Neck.

Yeah, Iron Neck, the Venom, the Monkey Feet. Those are really specific tools, which I like. I use the decompression table a lot. That helps for me. It helps for a lot of like the more chronic people as well. And when we get the cold plunge in, that'll be probably the one that a lot of people like to use the most. But like sauna and cold Cold plunge, definitely, especially because now it's, it's a craze everywhere in the recovery world.

So that helps out. People get some good benefit out of that.

Wonderful. Well, thanks again, everyone.

Okay.

One final question here from someone here in the chat. Do you have any specific baseline testing that you do for concussions? How often are you doing concussion screening with these athletes? Is that something you encounter a lot?

So The new one, I think they came out with the SCAT-6 not too long ago. You can reference that for concussions. The SCAT-5, SCAT-6, I think the SCAT-6 came out pretty—

but if you're at a competition, if you're the only one, typically if they, you feel like they have a concussion, like I'm just going to stop the fight or like keep them from competing anyway.

I would, if there's a neuro in the, what do you call it, in the ringside, because a lot of the MMA ones, they'll require you to be an MD or they'll require you to be Uh, neurologists, they'll have that. So, so that's typically— I try to stay in my lane when it comes to that. If they have like recurrent concussive symptoms, like they're experiencing like brain fog, they have headaches constantly, they can't sleep, they have nausea and stuff, keep going, then I'll just refer them out. You can pretty much know if someone's acting different and they just took a major blow to the head, like they take a head kick, got knocked out and stuff, and then they're just feeling funky for about a week and stuff.

You can just send them up the—

send them up the chain, practice within your scope. And hope for the best.

Wonderful. Thank you so much. And obviously concussion is such an important thing to look at with these athletes. As you mentioned, pull them out, like stop the fight, pull them if you have that suspicion for sure. And obviously you have to work within the constraints of your scope of practice and then what you're allowed to do ringside. I know that's very important across the board with different sports and different organizations in that regard.

That's it for today's episode. Be sure to tune in for episode 83, where we feature a fascinating new training with Dr. Nawaz Habib on vagus nerve stimulation. In this 2-part series, we will explore how the vagus nerve's regulatory pathway impacts inflammation, the role of acetylcholine in modulating immune responses, and we'll learn how these mechanisms can be leveraged to improve conditions such as autoimmune disorders, neurological diseases, and more. You don't want to miss it. Episode 83 drops in 2 weeks. If you enjoy our content, please be sure to like, download, and subscribe to the show and share a link with a friend. Every share helps us fulfill our mission to provide world-class free education to health providers around the globe. If you're interested in listening to past episodes and viewing all of our recorded webinar replays, be sure to visit our website at factorpodcast.com. We have a few exciting interview-style Q&A episodes planned for the future, so be sure to send us any questions that you may have for today's instructor, Dr. Nate Stegwis, when you visit the episode page on our website. You can even click a button and submit your questions through voice message. Which I think is pretty cool. We'll 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 check out our show notes for any special offers, discounts, or links from our sponsors. We'll see you next time.

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