Subtle Risk to Future Athletic Performance

MMA is an up and coming sport on a meteoric rise. This success is bringing with it a larger pool of elite athletes. It will eventually vie for the top-tier of athletes, competing with professional football, baseball, and even basketball. There will be great opportunities with this growth as purses increase and sponsors come on board for longer periods of time. Longevity in this sport will yield a greater opportunity to achieve these levels.
Yet these athletes are under constant threats for insignificant aches and pains that come from the heavy workload of continual training, sparring and demanding combat sessions. A MMA athlete is vulnerable to many areas of injury, but the one we will focus on is the seemingly benign neck ache. The velocity of punches to the head can not only do damage to the brain in the form of a concussion, but there is also the likelihood of an acceleration/deceleration injury such as whiplash. Aside from the indirect threat of the impact of a punch or kick to the head, there is the more likely threat of submissions for the neck, such as the guillotine, neck crank, and triangle choke.
I enjoy training Brazilian Jiu Jitsu and Muy Thai. I am active with my unit in combatives in the United States Army Reserves so I understand the forces applied and the biomechanics behind them. As a physical therapist who specializes in orthopedics and sports medicine with over twenty years of experience in the field, I have primarily worked with wrestlers and football players with these types of injuries. However, over the last few years with the growing popularity of MMA, I have had the opportunity to work with some of these athletes. All of these athletes have something in common: the threat of injury not only to concussions but to neck injuries. I am not going to speak to the most obvious or serious type neck injuries. I want to discuss the subtle injuries that, if compounded, can put  all of these athletes at risk. The cervical sprain/strain is one injury that results in vulnerability it is a constant threat to future athletic performance. This could come in the form of slower reactions, a slight decline in balance, or decreased absorption of forces.
It’s important to consider the threat of these dysfunctions and have a plan for evaluation, diagnosis, and treatment. The emphasis here will be physical medicine. The alternative to active treatment is to ignore the problem and let overcompensation occur, followed by a decline of joint mobility, strength, neuromotor control and disuse atrophy (this is often undetectable because the deep muscles are most vulnerable to atrophy). Obviously, ignoring the issue is not the course of action being advocated here. X-rays are the first form of diagnosis, but by this time everyone is aware of the limitations they pose. Look up the missed dysfunctions on trauma in MVA and C-spine X-rays. That said, given this type of injury, X-rays can detect a decline in cervical lordosis (curvature). When injury occurs to the cervical muscles and especially the ligaments of the neck, the curve in the neck declines, indicating a sprain or a strain. More importantly, it identifies the very threat I am attempting to identify, a decrease in cervical curvature increases the vulnerability of future injury no matter what type of athlete. When the athlete with a neck injury presses on without treatment, studies demonstrate the risk of severe injury skyrockets. The damage to the ligaments which are responsible for the smooth movement of the joints by decreasing aberrant biomechanics is truly an under treated problem which can result in a more rigid spine less capable of absorbing forces. Said plainly today’s traumas are tomorrow accelerated arthritic joints if left untreated.
There are times where I have found a digital motion x-ray  is required if signs and symptoms persist longer than anticipated. Should other problems occur – which often happens with a quick return to full activity before properly healing – strength and motor control declines a CT scan and/or MRI maybe appropriate. To ensure a thorough evaluation, make sure the clinician is taking a thorough history, paying close attention to when pain occurs, what provokes it, and what decreases it. If headaches result from injury, how often they occur and their location must be examined. If medication is necessary, non-steroidal anti-inflammatory drugs (NSAID) and pain relievers are used occasionally. Muscle relaxers may be prescribed in some instances. However, I believe our athletes should start with the less aggressive course of NAIDs while receiving physical medicine. One demensiotional care of medication leaves athletes vulnerable. Just taking a medication to decrease inflammation doesn’t restore joint mobility, biomechanics, strength, position awareness or neuromotor control. In my practice, I am aggressive and comprehensive with my care. I am Manual Therapy Certified, so the cornerstone of care for me is a multimodal treatment approach, medical and physical medical care with an emphasis on a hands-on approach to improving biomechanics. Improving biomechanics is done by improving joint mobility, addressing muscle spasms, and examining myofascial involvement through a host of techniques. This is also done with supportive treatments, that said, the cornerstone should be the active therapy, therapeutic exercises that restore the range of motion, motor control and strength/stability of the neck.
The point is that I have additional certifications, competencies and specialties along with intimate experience with Orthopedics and Sports Medicine allowing a more discriminating approach to return athletes to play who are post injury with risk of recurrence or further damage. The primary concern is to decrease risk of recurrence by addressing all the subtle barriers to full recovery. Do your homework and ensure your MD to your DO to your PT that you are working with specialists in the field. Always take minor injuries seriously to decrease the risk of compounding an injury into something much more severe, and suffering from a subtle decline in performance and/or a carrier ending event. Remember it is important if you have sustained a concussion  to get registered and follow up with current testing.

Hopefully reading this also gives you insight, knowing that the forces that created a concussion could well have caused other collateral damage to you neck. That small changes from an injury could lead to future problems that could change performance or shorten a carrier.

Frank Layman PT, DPT, EdD, MTC
Orthopedic Physical Therapist, National Speaker Officer USAR and MMA practitioner,