Category Archives: Health

Ankle Injuries

 

© Sinew Therapeutics

Ankle injuries are common and generally will heal in time with very simple measures. Most injuries are inversion injuries where you roll your ankle towards the outside of your foot. These are common in BJJ and can and do happen commonly. Usually, if you can walk it’s a good sign (even if it’s a brave hobble out the door!!) but is not perfect at picking out those ankles that are fractured. An ankle that’s feels really unstable is a bad sign, as is one with severe pain that is not settling. Swelling, bruising and moderate pain are sadly normal.

The most commonly injured ligaments are the posterior and anterior talo-fibular and calcaneo-fibular ligaments. These ligaments are the tough fibrous tissues that hold bones in the correct anatomical position.

© eOrthopod.com

 

Sprains are graded and either a grade 1,2 or 3.

  • Grade 1: Slight stretching and microscopic tearing of the ligament, some tenderness and swelling
  • Grade 2: Partial ligament tear, moderate tenderness, swelling and looseness
  • Grade 3: Complete tear, severe swelling, pain and looseness
    Treatment

Grade 1 and 2, especially for athletes, should be seen by a physio or a good GP or sports doctor. Although this does not change how long it will take to heal, it’s important to rule out further injury and make sure the treatment plan is sports specific. In the immediate time frame, motion, ice, compression and elevate are important. Gentle motion is just initially flexing and extending the foot. How ice and cold on injuries is poorly understood and the evidence suggests it likely make little difference, but is better than heat. It is suggested that compression for athletes should be lace up ankle brace supports but there is no hard evidence on, what to use, how long to use it or how tight to make it.
Regardless, early return to functional activity is the goal. Early motion and accelerated rehabilitation is the goal to a more rapid return to sport. It is really important to strengthen the lateral ligaments to avoid further injury. I have done this over the years by using a mini-tramp or normal trampoline. I started just rolling from my toes to my heels supporting myself with my good foot. Eventually, I increased my strength to bouncing on my injured ankle. It took a few months but I have rarely had an ankle injury since.

© iHealthSpot, Inc.

Grade 3
This is a complex treatment plan and is well organised in the following PDF:
https://www.rcmclinic.com/pdfs/foot-ankle/lateral_ankle_grade_III.pdf
Usually, surgery can be avoided but care should be taken to be followed up by a skilled physio or doctor.

Different functional treatment strategies for acute lateral ankle ligament injuries in adults.
Kerkhoffs GM, Struijs PA, Marti RK, Assendelft WJ, Blankevoort L, van Dijk CN Cochrane Database Syst Rev. 2002; (3):CD002938.

Orthopaedic ankle information https://orthoinfo.aaos.org/topic.cfm?topic=a00150

Accelerated Rehabilitation https://www.ncbi.nlm.nih.gov/pubmed/20457737/

Shoulder injury

Shoulder injury is one of those real bug bears of any athlete, and especially in BJJ. An injured shoulder, even minor really can put you out for some time. Many of us even stop training on minor injuries as we know that they can be the first warning sign of badness to come. Anyway, today we will cover assessing injury, train and treat, medication and when to see the doctor.

Sometimes shoulder injuries are really obvious with immediate pain after an event like an over extended shoulder lock ect. This type of injury we wont really cover as they are a no brainer and should be seen asap by your doc. The injuries Im talking about are those ones that sneak up on you the next morning after a session, or that become progressively worse over time.

A good way to work out where this injury is originating from is by extending your arms all the way backwards, forwards and over your head. You can also hold your arms out to the side and roll your palms up and down. There are occasions rarely, that you cant pinpoint the pain, or feel it in the actual shoulder. This can occasionaly be known as ‘referred pain’ and usually comes from your neck and into your brachial plexus http://geekymedics.com/brachial-plexus/

Once you happy the pain is likely not too serious, its time for physiotherapy and medication. Two of my favorite first up treatments are ball throwing and open handed swimming. Usually with a cricket ball I will play catch with a willing assisatant. Kids are great as they never get bored!! throw from as many angles as you can, underhand, overhand, sideways, soft and medium. Try not to overhand throw hard. Try this for 30 – 45 mins a day. Add to this swimming with fins on and open handed swimming. You can still maintain fitness and add to shoulder strength at extension with minimal loading. Do short sessions with all strokes except butterfly.

Add to this some simple analgesia such as non steroidal anti-inflammatorys such as diclofenac or ibuprofen. Check of course these are medictions your not allergic too, or cant take for other reasons.

http://www.nps.org.au/conditions/nervous-system-problems/pain/for-individuals/medicines-treatments-for-pain/nsaids_pain_relievers

We use these not just so your not in pain, but to improve range of movement, increase training volume and reduce inflammation. You can use these with panadol as directed on the packets.

Try doing this and still rolling, but of course you must inform your partner that you have an injury. And of course, tap or call stop if in pain!! If it remains sore, have a week off the mats. If you return and the pain is not improving pop into your doctor and discuss with them what you have done already. Physios are also a great port of call.

Macronutrient Evolution

Fuel. What do you need to power you to your best performance, particularly for competition?

I started off thinking the carb loading of endurance events had something to recommend it. After all, if you can run a marathon, why shouldn’t that be good fuels for a few rounds of fighting? After seeing Tim Ferriss post on the Slow Carb Diet, and subsequently publish The Four Hour Body, I started to see that a diet high in carbs probably wasn’t going to be the best thing to make weight.

So then I was more focused on protein and low carb vegetables, like cruciferous vegetables (broccoli, cauliflower etc) and lefty greens, salads and such.

From there I started to hear about gluconeogenesis, from Ben Greenfield’s podcast, and also from the book Keto Clarity by Jimmy Moore. Basically if you eat too much protein, it gets turned into carbohydrate. Back to the same problem.

Now I’m working on a ketogenic diet. Eating about as much fat as possible, and minimising carbohydrate. A smoothie I make involves a can of coconut cream and an avocado. I have a blood glucose monitor, to regularly check the impact of the meals I eat. I’m also looking to get a device to measure breath ketones. A ketogenic diet also helps with intermittent fasting, sometimes inadvertently, because I’m not overly hungry.

For further reading check out Ketogenic Diets and Physical Performance by Stephen D Phinney.

On the Topic of Fingers

As we are on the topic of fingers, an Avulsion Fracture occurs when the ligament tears out the fragment of bone that it attaches to. The little grey lump near the second knuckle is the fragment of bone that the tendon has torn out.

Avulsion Fracture

 

Caused by an over under pass from half guard, and the opponent turned to their knees. Splinting and therapy for about eight weeks to recovery. Still a couple of degrees range of movement missing, but it works well otherwise.

 

Finger injury-Dislocated and Mallet finger

Well, lets start off simple but with something really common. Fingers are injured so often in BJJ and many times if we think they are dislocated we just pull on them till they ‘clunk’ into place. Hey, that’s not a bad option.

To do this you have the person sit in front of you  on the ground, and you gently grasp the end of the finger. Now just tell the person to take the weight slowly on their finger and you slowly match the resistance. Its really quite deceiving, but you usually need quite some pressure even to put back the very small end (distal phalanx) of the finger. There really should be no pain, and actually relief when the joint pops in. They should then be able to move it with some ease and it should look and feel normal. From there its the usual sporting injury care.

But, one thing though to watch out for is mallet finger. This is where the tendon tha make the finger extend is torn either partially or fully. Left untreated this can cause lifelong trouble, especially if its your dominant hand (bye bye ezekiels!!) Its usally easily fixed with a Mallet finger splint . For more info check out Mallet finger treatment. Happy choking!!

Red wine ramblings…

So, as I sit here sipping on a glass of red, nursing my sore, arthritic knuckles from a hard day’s training, I have to wonder, what makes any Barossa Shiraz so awesome?….. The producer, the geography, the climate, the soil… ahhh, that’s right, the Terroir!!!!

And how does this relate to Jiu Jitsu? Well, I’m not sure…. but then when it comes to BJJ, there is a lot I’m not sure about… for instance, what would make sane, intelligent people step onto a mat and choke each other for fun.  What possesses us, day after day, to commit to the acid test that is an open mat, where everyday your ego is checked, when, in every session you can and will be tested. Why, when off injured, you compromise your recovery to just ‘play’. The enjoyment as 2 grown men stand, drenched in sweat, bruised and sometimes bloodied, after sparring for 10 minutes, face each other and smile a genuine smile and then… hug! What about the frustration that comes with trying to explain this martial art, sport, hobby, past time, religion, obsession, life style, family, to someone who doesn’t train. It truly is a conundrum.

People talk about it being an emotional roller coaster, the highs, the lows and everything in between. But in the 15 or so years that I have been training in BJJ, it has never got any easier. In so many ways it gets harder, especially once you get that coveted black belt strapped around your waist… Thanks for that Mr. Robert Drysdale!

Harder in what way? Well, dealing with the responsibility that comes with the rank is a huge one for me. As a person of integrity, I truly want to represent the honour that has been bestowed upon me and on a daily basis I strive to live up to my belt, even having had it for about 4 years…

Another is continuing to try and improve my game, an area I have struggled with for the last year or so, but that will come again… For me, as cliched as it sounds, this is a lifelong pursuit, so a year of marking time is a drop in the bucket. So I won’t let myself get too frustrated, I will deal with my injuries, regain my focus and continue forward…

Then there is the responsibility for students, furthering their education, assessing methods and techniques, adjusting what you do and teach, motivating, leading, inspiring, consoling, learning, listening, reflecting… trying not to let the bad days show, maintaining the daily running of the school… etc, etc…

Anyway, I digress, this blog is about the journey. I am blessed with the people I have around me, the friends that teach, test and mould me, the gym that is my church, and BJJ that is my religion.

As we progress with it, I am going to try and relate what I have learnt, mistakes I have made as well as progression, positives and negatives, ups and downs. In this I hope to impart some knowledge, stimulate some thought and modify some concepts…

So lets try and figure out the essence of why we do this, lets talk about what works and what doesn’t and why, let us observe and report on training methodology (both conventional and un-orthodox), lets throw in health, fitness, performance, nutrition and technique, lets try and work out the terroir that makes Jiu-jits so special to us all….

 

 

 

 

 

 

Injury and training

Great to see a post about weight and training. I guess for us three the main goal now is to keep on the mat. Quite funny how priorities change, but thats the journey eh! We will really get into this more with specific plans for injury as time goes on. However, this is really the guiding philosophy. So often fighters will end up with an injury (insert anything really), but will will keep it simple and say left knee. Ok, so when you see these fighters at the gym/shops/bar they are really likely to tell you how bad their injury is and that’s why there has been no training. Well, the news is that there is plenty of body and one highly organised brain strapped around that knee. There is always so much more you can do and the combinations are endless. One I like is come down to the rolling/training sessions and do push-ups and chin-ups while your teammates rest, and then watch the roll. Your now training a body part you may not usually train, your inspiring your mates and every roll you actively watch you learn something!!! Any how, think up your own deadly combo and trial it. Doesn’t need to be crazy, even the above with 6 chins and 10 push-ups adds up over a session. Injuries are an advantage. They allow us refocus if we choose to, and just get stronger.

Quantify Me

If you want to track your overall health and performance, and in particular avoid over-training, what should you measure? What device should you buy to give you insight into when you should push harder, and when you should really just rest up.

Over the years I have tried tracking a number of metrics. Heart Rate Variability (HRV) is a popular metric, that is supposed to give you a good overall picture of your readiness to train. I have also tracked CNS score, reaction times, resting heart rate, weight, sleep quantity and quality.

After tracking HRV with a dedicated OmegaWave device, and other heart rate monitors such as the Polar H7 in conjunction with various apps, I am yet to be convinced the results are consistent with my ability to perform.

I think one of the  worst metrics is weight. If you are competing in a sport that you must fit into a weigh category, then it is obviously important, but as to your general health lighter is not always better.  It is easily affected by hydration levels and glycogen depletion.

I have been between 73 and 90 odd kilograms. When I was at 73 kilograms, I was thrashing my body with long arduous training sessions in excess of two hours, and restricting my calorie intake significantly. This lead to an extended period of 12 to 18 months to recovery from the over-trained state I had put myself in. This morning I’m 77.3 kilograms after six weeks of high fat, low carb diet with no calorie restriction and trying to keep additional training outside of Jiu-jitsu to high intensity, low duration to minimise the amount of recovery needed.

The two metrics that I see reflect the progress of my training are reaction times, and resting heart rate. As my Jiu-jitsu volume and intensity increases in preparation for competition, I see my reaction times generally trend downward. When you feel faster, it’s because you are faster.

For me, resting heart rate is the key metric that shows me the state of my recovery. When it starts going up, I start backing off. When it stays low, I know I’m good to keep pushing. I try to maintain the integrity of the measurement, by using an accurate measurement device, and having a consistent environment to take the measurement.