Knee issues in particular seem to be especially prominent lately, sidelining Georges St. Pierre, Dominick Cruz, Shane Carwin and many other fighters. During a recent episode of the Sherdog Radio Network’s “Rewind” show, FightMedicine.net’s Dr. Jonathan Gelber joined the program to discuss injuries, prevention and more.
On injuries in MMA: “One of the reasons I think we hear about so many injuries is because there are so many fights and so many cards. It used to be when Zuffa first was putting out the UFC in the earlier days you had maybe three or four cards a year. Now you have three or four cards a month. There’s that many more guys training. There’s that many more guys getting injured and there’s that much more news we’re hearing about it. And because the cards aren’t as stacked as they used to be, all you have to do is look at the [Dan] Henderson-Jon Jones debacle to see how one main event being cancelled can affect an entire card. I think there always were injuries. It’s just that there’s more people out there, more cards, and more injuries are a natural result of that.”
On knee injuries in particular: “With mixed martial arts, a lot of grappling, a lot of twisting of knees certainly can predispose you to ACL injuries. The addition, though, is, I think, shooting in. It’s very interesting to me. I’ve been looking at a lot of PCL injuries lately, and the PCL, which is behind the ACL, is not very commonly injured. You hardly ever see that in your clinic practice, but you have actually been seeing that a lot in mixed martial artists. Especially we just read about Shane Carwin having to have his PCL, his LCL and his popliteus, all ligaments in the back of the knee, needing to be reconstructed or repaired. I think that’s because of the shooting in.
“When you shoot in, your knee hits the ground and there’s a posterior, or a backwards-directed force, across the knee and that’s when the PCL gets injured. The other time it might happen is in a car accident. We call it a dashboard injury, where the dashboard pushes the knee backwards. You hardly see that in any other sport, but I think with mixed martial arts, you’re seeing that specific injury a lot from shooting in. I think another reason we’re seeing a lot of injuries in general is just the level of training these guys are having. There are so many cards the last two years that they’re training constantly, so they’re never giving their bodies a rest. You go in and train hard every single day because you don’t want to gas and you’re putting yourself at high risk every time you go 100 percent just in training.”
On ACL injuries and prevention: “A lot of ACL injury prevention is actually focused on women because women are predisposed to ACL injuries because of their biomechanics. For instance, volleyball players or basketball players, when they jump and they’re female, they tend to bring their knees in, sort of like a knock-knee position. We train them to land with their knees out in a sort of bowlegged position. It actually helps reduce ACL injuries because hitting the knee from the side, the knee turns inward, and that’s one of the mechanisms that affects the ACL and can cause it to rupture. Proper biomechanics is certainly good, doing things like box jumping or other plyometric exercises where you make sure you have strong legs and a good foundation, making your quadriceps stronger, your hamstrings stronger. These are also things that can help protect the knee because these are large muscle groups. If someone hits your knee or if you’re shooting in or you’re moving from side to side -- lateral movement is a big, big thing with the ACL -- these larger muscle groups tend to absorb the impact and thus spare the smaller ligaments within the knee.”
On the role of transitions in MMA injuries: “During that transition the fighter is not necessarily contracting his quad muscles or his hamstring muscles, so the knee is sort of at an area where it’s vulnerable because it’s not being focused on. Of course when you’re taking somebody down or they’re taking you down, you go down at awkward angles. … Your knee is being swept out from under you or you’re being lifted up and turned over. I certainly agree that these transitions are very vulnerable points for a fighter to get injured because it’s not something that you can train. You can’t be training to be swept down over and over again.”
On the effects of knee injuries: “If you look at these old-time football players, they’re hobbling around because their knees have seen four or five times the amount of injuries or force that the average person does. It’s actually a really good question: What are the long-term effects of these injuries on these fighters? I think given that they have knees just like the rest of us and the same anatomy, repeated injuries are going to take their toll. Whether they’re experiencing the same continual forces that an NFL lineman is, I can’t say, but I can certainly say that if they have a significant injury, it can lead to arthritis down the road.”
On Georges St. Pierre’s recovery: “I think Georges showed us what a great athlete he is, what great training he’s had. A lot of people, unfortunately, this year saw Adrian Peterson came back from his ACL reconstruction and only six or seven months and he’s kicking everybody’s butt on the turf, so a lot of people don’t really realize that the ACL is a huge injury. Adrian Peterson and now Georges St. Pierre being exceptions, the vast majority of guys do not get back to their level of play. … I think what Georges St. Pierre did is actually very impressive.”
Listen to the full interview (beginning at 1:25).