Nick PT discusses the current rash of injuries, causes and therapies

Image courtesy of Kevin Nicholson

Kevin Nicholson, superstar physical therapist and Bloody Elbow contributor, sits down with us in a great interview about the particulars of MMA injuries.

With the UFC once again experiencing an absolute shellacking from the dreaded injury bug, I decided it was time to speak to our resident physical therapist, Kevin Nicholson aka Nick PT here on Bloody Elbow. Iain Kidd and I spoke with Kevin for 30 minutes, and obtained a fair amount of solid information on the worst injuries, what could possibly causing the sudden influx of them and new advances in physiotherapy. I intend to do monthly segments with Kevin, so if our readers have questions, please hit me up and let me know what you'd like asked. For now, here's a brief transcript of yesterday's interview:

What is Causing the Current Spate of Injuries

It seems that most of the injuries, of course, occur during training camp, and that's what led me to write the piece 'how hard must a fighter train?'. I get the sense that these guys, and some of the comments by the fighters kind of acknowledge this to me, they're just training incessantly in some cases. There's a strength and conditioning component that is part of their routine, and then they're doing their skills, the BJJ, the striking, the wrestling, and if this is an intense thing they're doing day in and day out, with no breaks, injuries are going to happen.

One of the comments left on the article I wrote was very insightful; the fighters are going to be prone to injury just by the nature of their skills training, therefore the strength and conditioning portion needs to be very safe. I've seen video of guys jumping on two foot high boxes with a balance ball on top of it, jumping up and landing on it, and I'm thinking, what reasonable good does this do for someone in training? I mean, all you have to do is roll your ankle and you've snapped an ankle.

I think there is middle ground that could be approached, whereby the strength and conditioning component is changed up to be more basic, not a lot of the high-level, edgy activities that some of these guys are doing.

Again, I speak as someone who doesn't train professional athletes, so I'm sure that's open to some criticism, but when you put the two together, the intensity of the strengthening and conditioning, and the intensity of them working on striking and grappling day in and day out, sometimes I think that's over-training, and they get injured.

You're probably familiar with Junior Dos Santos, when he had that episode after his last fight with Cain Velasquez, where he basically started pissing brown urine from this problem he had, probably from over-training, called rhabdomyolisis. One of the things that can cause that is extreme muscular effort; over-training.

He was asked a question, if you knew this was going to change your life, and could harm you in the future, this exertion, would you quit or at least change the way you train? And he said, 'This is my life, it's everything I have, I want it so badly, I want to give everything I have to this.'

It's up to the point where he suffers a potentially very bad injury, that problem he had can cause kidney damage. That's not good. I think there are some episodes of over-training going on, which is leading to, and precipitating, some of these injuries.

Athletes vs Non-Athletes

Some of the more intense athletic types that I treat are actually veterans. I work with a large veteran population, and some of these younger guys are coming back from Iraq and Afghanistan with various injuries, up to even, you know, spinal cord injuries. It's not the same as it used to be. Many of them are very motivated, they still want to remain active, they still want to do these sometimes extreme activities. I find myself having to put the brakes on, to say, that's fine, but here are the things we need to think about on the back end. You're wanting to run a marathon in this racing wheelchair, going up and down hills and such. What's this going to do to your shoulders? You've got to think about this before you really start to commit to it. It's just a matter of making sure they're informed about the potential consequences of the path they're taking.

More than anything, I think people want information now. I'm talking about the average, everyday people that I treat. They want information about what's wrong with them, what's the process of this disease or injury, and what's the healing time. People want to know how long it's going to take them to recover, that's probably the biggest question I get, and that's just like the athletes.

I saw an interview recently with Dominick Cruz, who is still very non-committal about his return, because he can't be otherwise at this point. He said that his doctor is telling him there is no time line yet, and you can tell in the interview that's a very... he almost has to bite his lip whenever he says something like that, or so it seems to me. I'm sure he wants to know, when am I gonna be back? When can I get back into the Octagon and do what I love? Sometimes those answers just aren't there.

We give information, we make estimations of when people can come back from various injuries, but always with the caveat that things change sometimes, and rehab is not a perfect science.


Recurring Injuries and Chain Injuries

I know in my practice, whenever I treat patients after ACL surgery, for example, often times, for whatever reason, they maybe won't complete some component of their rehab that I want them to progress to. Sometimes the way the body reacts, the knee is a good example, whenever you don't get to a point where you are really rehabilitating the coordinated movement of the knee, what we call the proprioception of the knee, if that phase is left out then the way the body works, the way it walks, the way it runs, may change a little bit. All of a sudden you're injuring your hamstring when you try to jog. The knee feels pretty good, but your hamstring keeps getting injured, or you injure your quadriceps, for example. That is just because the knee wasn't rehabilitated like it should be.

Worst Injuries

Forrest Griffin had a really bad knee injury. I think he tore his anterior cruciate ligament, medial collateral ligament, meniscus and I think he had some injury to his kneecap as well. I think that was a training injury, though I might be wrong about that.

Maybe that had something to do with his decision to check his gear at the door and not fight any more, given how much mileage he had on his body. If you've ever seen pictures of that, his post-operative pictures, that knee looks horrible.

Frank Mir, when he destroyed Noguiera's arm with a kimura, he broke his humerus, I think he dislocated his shoulder, tore his labrum or maybe his rotator cuff ... That was a bad injury. He made a recovery from it, but the injuries with multiple components to them, rather than just a straight meniscus injury or something like that, those tend to be the worst.


Advances in Physiotherapy

I'm excited about rehab from achilles tendon tears. It wasn't that long ago, that if you tore your achilles, your foot was immobilized for a period of weeks with little or no weight bearing on your leg. Well, based on evidence and research, now we're seeing that it's good to start early weight bearing on the foot following achilles tendon tears. It helps to organise the healing scar tissue at the tendon, and helps to avoid adhesions between the tendon and the surrounding tissue. A lot of good things come from starting early weight bearing in a controlled setting.

Kobe Bryant has this dedicated rehab, and that's one of the differences; these elite athletes have dedicated rehab teams that they have access to, probably around the clock. The rehab after an achilles tendon injury is going to be advanced, and it's going to be happening quicker, and guys will be coming back successfully from it with a quicker rehab.

It's the same with the anterior cruciate ligament injuries. The biggest concern I have with ACL surgeries is the use of cadaver ligaments. I think there are some issues there, with the potential for re-injury of those ligaments when you use the cadaver ligaments, especially within an athletic population.

The main advances are all relevant to research and rehabilitative protocols, I think. Demetrious Johnson is another guy coming back. In march he had surgery, I think he had more than one labrum tear, had the surgery and here he is about to fight again. It used to be that it wasn't that quick. It's the new protocols for rehab from these injuries that's the big deal.

If you'd like to listen to the audio from the interview, you can do that here

You can follow Kevin via his Twitter account, @MMAInjury

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