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Understanding MMA and Back Pain

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Back injuries are incredibly common across a large number of sports. Mixed martial arts has its own specific rigours and with its increasing popularity we are seeing more and more cases of back pain from MMA in the clinic. This increase has lead some health practitioners to mistakenly believing that MMA is the problem and should be avoided. However, you would be hard-pressed to find any other athletes with the same level of flexibility, strength, core stability, and proper movement technique, when they are training properly.

Most martial arts styles promote a high level of joint and tissue flexibility. Some striking styles, such as Muay Thai, involve a great deal of rotational movements and proper movement patterning. Grappling styles, such as Brazilian Jiu Jitsu, build a great deal of spine stabilization and hip mobility. Martial arts is one of the best ways to stay healthy, especially if you were raised on the sport, but for those who start late and don't train properly, it can still be a quick road to injury.

Discussing individual injuries, such as disc bulges or muscle tears, would be too narrow a focus and it would rule out all the other common occurrences. Instead, we should first deepen our understanding of the biomechanical factors unique to MMA and how they benefit us. Then we need to uncover where the common training faults lie and discuss the solutions.

Part 1: Flexibility

It is common knowledge that flexibility can prevent many soft tissue injuries, but most people only discuss one mechanism of injury prevention when in fact there are many more.

The widely accepted positive effect of soft tissue (muscle, tendon, ligament, etc...) flexibility is that it helps to prevent injuries in the form of strains of tendon or muscle, or sprains of ligaments. Structures such as ligaments, joint capsules and fascia are vulnerable to injury when subjected to extreme stretch. Muscle and tendon can also be injured if they are too weak to resist against extreme stretch forces, as they are actually weakest at the end ranges.

Another protective effect of flexibility is that it allows forces to be exerted appropriately at each joint. Each body movement is made up of a chain of movements through various joints. Each joint in the body was built for a particular kind of movement. If there is adequate mobility in one joint, it will minimize the stress that goes through and is exerted on the next joint in the chain. Stiffness in one area can place additional strain on the neighbouring joints, which can result in an instability or injury. This is especially evident in the spine.

And finally, a third benefit of proper joint mobility is that healthy cartilage is better maintained when all the weight-bearing surfaces of a joint are loaded appropriately and regularly. It is well accepted that excessive and repetitive loading can wear cartilage down, but cartilage can also become weak and de-conditioned without enough loading. Some compression and distraction is helpful in nourishing the cartilage and keeping it healthy.

Common Faults:

Poor mobility affecting the low back.

Poor mobility can refer to low back stiffness directly, or indirectly from stiffness in the mid-back or hips. Spine and hip flexibility is very important in all styles of martial arts. If difficult techniques are attempted before the proper flexibility is achieved, injuries will occur. This is especially true for those who start martial arts late in life, or just have less natural mobility.

A direct example of poor back mobility is not having enough lumbar flexion, which can make it very easy to sprain a ligament, strain a muscle or even damage a disc. All three of these structures can be damaged in forward flexion or side flexion.

An indirect example is stiffness in the hips and mid-back (specifically the area of transition between the low back and ribcage). Both these areas are built very well for rotation, but if mobility is lacking, a lot of rotational strain will be placed on the lower back. Rotation stress is a major factor in both disc and facet joint (actual joints of the spine) injuries. The disc is built better for compression and distraction, and the facet joints of the lumbar spine only have a few degrees of rotation available per segment. In fact, limited hip internal rotation is very strongly correlated with low back pain.

Another indirect example demonstrates how the low back need not even be injured in the first place to suffer the ongoing effects of poor mobility. Kicking too high without sufficient flexibility can lead to a groin or hamstring injury. If this heals up with any restriction in movement, it can then directly upset the balance of forces at the pelvis and low back.

Decreased connective tissue elasticity.

As we get older our ligaments, tendons and joint capsules have less and less elastin in them, meaning they become slightly more stiff and less elastic. There is also a greater lag time in when our tissues return to their resting length after prolonged positioning or stretching. So with increased age, more attention needs to be paid to flexibility.

The Solution:

The first step to preventing injury is to find out identify your areas of concern. Each discipline will focus on different areas, but what you need to work on will never be exactly the same as anyone else. You should think about the purpose behind every stretch or exercise you do. A skilled physical therapist or other health care practitioner can assess you to determine your areas of concern.

Don't just focus on the flexibility of the low back. Maintain adequate hip and mid back mobility, as it's more important to MMA than to most other sports.

If you have an area of instability, make it stronger while getting adjacent areas more mobile to take stress off the unstable part. For example, if there is an area of your spine that moves excessively, try to change the focus of the stretch to a different part of your spine so the unstable part isn't continuously stressed.

There are many beneficial ways to stretch, but make sure you are doing at least a few good stretches in each position for 20 - 30 seconds. Studies show this length of time provides the best "value" in stretching to increase flexibility. These long stretches shouldn't be done right before training, but throughout the week. A more active warm-up going through the different ranges of motion is more beneficial.

Try to be in a restful position, and avoid bouncing. You will achieve your greatest results from stretching when the nerves entering the muscles and tendons are resting, i.e.: the muscle isn't working to hold you up or balance you, and the tendons aren't feeling any stretch from a bounce. This largely depends on the positions you choose for each stretch.

Part 2: Proper Movement Technique

This refers to both the sequence of movement as well as the fluidity.

The sequence of movement should be looked at more specifically as proximal-to-distal movement patterning. This simply means moving first from the center of the body to the end of the extremity (fist, foot, elbow, etc...) One of the earliest things students of most striking styles will learn is that the punch or kick is initiated from hip, and then to extremity. It has been taught this way for centuries, primarily because its the best way to generate power, but it also helps tremendously in preventing injuries. Without this pattern of movement, more joints will be at increased risk due to the unchecked forces travelling through them. This concept seems obvious in the world of martial arts, but it's often considered a novel approach when applied to other sports.

Fluidity of movement refers to controlled, steady movement (not necessarily slow). Regardless of the sport, we can always find those special athletes that make everything look easy and natural. In MMA, Anderson Silva's striking or Shinya Aoki's grappling are demonstrative of this. What's really happening is that the movement is being done in a very efficient manner. There are little or no wasted smaller movements making up the bigger body movement. True, some people are more naturally gifted in this department, but it can always be further developed by practicing proper technique. Again, when done well, it minimizes the excessive movement or strain placed on the various joints involved.

Common Faults:

Faulty movement patterning.

Coaches frequently witness faulty movement patterning when students try so hard to generate power but fail to move from the center of the body. The kick or punch will appear uncontrolled, and unchecked forces will then run through the other joints along the chain, including the core.

Moving outside the base of support.

The center of gravity should always end up within a solid base or stance; otherwise the body fights to stay upright. The immediate downfall of being off balance is that it makes you vulnerable to countering and delays your next movement. This fault also adds more shear and strain throughout the various joints, potentially increasing the risk of injury.

Engaing in unnatural exercises in the gym.

Some exercises might be good for building strength, but they don't translate into natural body movements that we do in our daily lives or physical activities. These potentially harmful because they stress the body in an unbalanced way, and they don't emphasize the proper movement patterning that comes from doing natural movements. All our exercises should consist of basic body movements, such as pushing, pulling, squatting, and twisting. It's helpful to use weight or resistance training to build strength, but if the exercise doesn't relate to our fundamental body movements, it will be of lesser benefit.

The Solution:

Take time to learn the proper proximal-to-distal movement patterning. Don't be the over zealous student who wants to throw all their power into the strike right away.

Always work at maintaining a solid base of support when you learn new skills and techniques. Don't develop the new movements while neglecting proper footwork.

When considering any cross-training or weight training to aid your performance, think of incorporating both basic movements (squat, lunge, push, pull, etc...) and movements that pertain to your sport. Kettlebell training for MMA is gaining popularity because it has good functional movements that can apply directly to the sport.

Part 3: Solid Core Strength

This refers to the ability of the body to hold its "core" stable, especially as forces are travelling up from the lower extremities through the pelvis and torso, or down from the upper extremities. Building core stability has nothing to do with developing a "6-pack". Core stability should be broken down into four parts. Two parts we have discussed already, relative mobility and movement patterning, as both will help keep the core stable by minimizing the shear forces through the low back and pelvis. The final aspects of core stability are the deep stabilizing muscles (transversus abdominus, pelvic floor, multifidus) and the large bracing muscles (erector spinae, latissmus dorsi, gluteus maximus). Focusing solely on either group of muscles will not be effective, as all must work together for optimal function.

Another more general principal to understand is that of eccentric strengthening. The eccentric part of an exercise is where the muscle being used is actually lengthening at the same time, for example your quads when dropping down into a squat. Eccentric loading creates more tension in the muscle/tendon than during concentric exercise (active muscle shortening), and is a great way to build strength if the resistance is gradually built up. Fighting off someone trying to flatten you out when they have your back places a large eccentric load on your abdominal muscles.

Common Faults:

Weak core.

This can refer to weakness in any of the four aspects discussed earlier. Core weakness can be seen in athletes of all levels. In fact, it is not uncommon to see in ex-athletes who are returning to their sport after a long time off. This population used to rely heavily on their core strength for stability, but let it waste away with inactivity.

Conventional abdominal exercises often focus on just the rectus abdominus (6-pack muscles), external obliques and hip flexors more than anything.

Muscle imbalances.

Often times, if someone is dominant with certain muscle groups, the weaker ones tend not to be used as well. For a lot of people, the weakness lies in their deeper core muscles, and they are already dominant with their hip flexors.

Inadequate strength built up for the activity or skill.

In the example above, fighting off being flattened out can build strength quickly, but it can also lead to abdominal strains and even hernias if a proper foundation of strength and stability was not been developed.

The Solution:

Remember that mobility and movement patterning, are often overlooked but vitally important aspects of core stabilization.

Just as with everything else, everyone comes to the table with their own unique strengths and weaknesses. Discover your weaknesses and build on them.

If core stability is seriously lacking, learn proper core muscle recruitment. This is probably the most difficult task when it comes to basic core stabilization training. It requires some time and patience in the beginning to gain control over some of the core muscles, like transversus or multifidus. Once this control is achieved, the exercises should progress to place more strain on the low back and pelvis while the focus is on maintaining stability. The little time taken in the early stages will pay off greatly in the future. This kind of specialized training may be best taught by an experienced physical therapist or other health care professional.

Working the larger muscle groups can be focused on once a base level of core stability is established.

And finally, don't just work on that 6-pack. If you are serious about training MMA, you should only be thinking of function.

Final Word

People who don't understand MMA often view it as too stressful or damaging for those with back injuries, while in fact there are few better ways to help build a stronger back. With correct training and knowledge of the underlying mechanics, you can actually fix MMA-induced back injuries far better than any massage or ice pack, and it will help you prevent any future setbacks as well.

Credits

Writer: Harry Toor, Sports Physical Therapist
Photos: Alex Law, www.alexlaw.dphoto.com
Location: Universal MMA, Vancouver