Today’s topic isn’t sexy. There aren’t any clever armbars, killer chokes, or brand new strategies that’ll give you an edge on the mat.
But it might just save you years of suffering and stalled progress.
Today I want to talk about three big lessons I learned dealing with various types of martial arts injuries…
Injuries are the bane of progress, but unfortunately, they’re almost inevitable when you’re doing a contact sport like BJJ.
There are, of course, the little tweaks and strains. Stuff like that is just part of the game, and most of the time dealing with them is fairly straightforward. If you bruise your elbow then the normal R.I.C.E formula (Rest, Ice, Compression, Elevation) will probably be all you need.
That’s not what I want to talk about today.
Instead I want to address long term and more complicated conditions. Like chronic injuries that just won’t go away… Conditions involving multiple body parts… Back injuries that never heal… Fatigue that never seems to lessen…
This is where things really get frustrating, in part because everyone you go to for help is going to give you a different answer.
To illustrate this let me briefly talk about the years when my lower back was constantly in pain.
At its worst my lower back spasmed so badly once that I collapsed onto the floor of my study, and then spent almost 24 hours lying right there, unable to get up, unable to crawl, and unable even to get into bed.
On that floor even basic bodily functions turned into insane ordeals. It took 20 minutes of pure agony to roll from my back onto my side in order to pee into a jar, and then another 20 minutes of teeth-clenching, millimetre-by-millimeter adjustments to get flat onto my back again.
To fix my back I tried at least 18 different treatment modalities, ranging from traction, to drugs, to massage, to chiropractic, to acupuncture, to physiotherapy and more… I tried some of those modalities more than once: in all it must have been at least 100 different sessions with at least 30 different practitioners.
Getting a good diagnosis is critical to fixing a problem. So of course each of those health practitioners was eager to give a diagnosis of what was wrong with me.
But the actual diagnoses were all over the map.
The various experts pointed the finger at everything from torn ligaments, to muscular imbalances, to spinal misalignment, to bad movement patterns, to bulging discs, and to nutritional deficiencies.
The funny thing was that almost practitioners gave a diagnosis for a condition that they specialised in treating.
It was the physiotherapists who diagnosed muscular imbalances. And, surprise, surprise, physiotherapists are good at correcting muscular imbalances.
The chiropractors diagnosed the source of the pain as ‘facet syndrome’. Which can be treated by chiropractic adjustments of course.
Doctors who specialised in fusing vertebra thought the pain came from bulging discs that had to be removed.
I forget what the acupuncturists said, but probably it had something to do with a qi deficiency of the spleen meridian which can be fixed by – wait for it – acupuncture.
How very convenient!
In the end I received a diagnosis of pelvic malalignment from a medical doctor, as well as some corrective exercises. Finally I had something that actually worked! Today my back is 99% as strong as it ever was, and I can’t remember the last time it was in pain (*knocks on wood immediately*).
So if you’re suffering from back pain there is hope – don’t give up! If you keep looking then you’ll probably find a solution eventually. And it will likely be something different than from what fixed my back.
But that’s not really the main point here…
The first take-home message is that you should expect conflicting diagnoses. Everybody looks at the situation through their own lenses, using their own tools, and speaking their own language. And you can’t overlook the vested financial interests that the experts have in treating you with their own special brand of treatment.
In the end it really doesn’t matter what the ‘truth’ is so long as the diagnosis leads to treatments that are helpful.
The next injury story relates to a chronic condition I dealt with for about a year called Thoracic Outlet Syndrome.
This is a condition where the nerves and blood vessels going to the shoulder get pinched. This meant that my arm would go numb from time to time.
It wasn’t life threatening or particularly painful, but it was annoying and worrying so I started looking around for solutions.
My doctor recommended a specialist who recommended a surgeon. I met with the surgeon, and within a few minutes he was talking about removing my first rib and permanently severing some of my smaller neck muscles.
This seemed a bit extreme to me, and no grappler ever wants to hear about weakening his neck muscles!
So I put that option onto the back burner and continued looking for other solutions.
Fortunately in the case of Thoracic Outlet Syndrome there’s a fairly easy test that you can do yourself to see how severe your condition is, which made it really easy to test the effects of the different treatments I tried.
Eventually I asked a massage therapist to attack the scalene muscles in my neck with some deep tissue massage. It was painful, but a few minutes later I tested my shoulder and found that the symptoms were almost entirely gone.
The choice between having a surgeon sever neck muscles and having a massage therapist occasionally working on your neck should be a no-brainer.
The lesson of this second injury is that unless there’s a huge time pressure and your life is on the line then start with the less invasive, less dangerous and less expensive treatments first.
The final lesson comes from a foot injury I sustained in Judo class.
A visiting competition team from Japan had come to train at the UBC dojo, and I was paired up with this big, heavy Japanese kid who had excellent gripfighting.
This was back in the day when double leg takedowns were still legal in Judo, so I decided to bypass the whole gripfighting stage by shooting in for a low takedown. Unfortunately he sprawled at just the right moment and my foot got stuck on the mat. I heard a loud cracking noise from my right mid foot, and that was followed by severe pain and waves of nausea.
Not only was this foot injury painful, it was also potentially very serious… The injury I had sustained is called a ‘Lisfranc fracture dislocation’ because 200 years ago a French surgeon in the Napoleonic era named Lisfranc had amputated a whole lot of feet of cavalry officers who had been thrown from their horses and dragged by their stirrups.
It’s a debilitating injury that starts out painful, then gets better, and then gets worse – much worse (which is why they used to use amputation).
But the medical system almost missed it…
You see, after the injury I hobbled into the Emergency Room and had my foot X rayed. The ER doc took a look at the pictures, pronounced them normal, and sent me on my way with an admonition to come back in a couple of weeks if it was still hurting.
That night I started googling and researching foot injuries, and became increasingly freaked out. I learned that for some types of foot injuries there was actually a rather small time window in which to initiate treatment if you want a full recovery.
So the next day I cajoled my way into the office of my sports medicine doc, who sent me for a different type of X ray – the results of which were suspicious – and then referred me to a specialist. The specialist sent me for an MRI – the gold standard diagnosis tool for soft tissue injuries – which showed nothing.
(In case you’re keeping track, that’s now two out of three imaging techniques showing that there wasn’t a problem. False negatives, in other words.)
Finally the specialist recommended exploratory surgery, and since I had done my research, my foot wasn’t getting any better, and I knew that there was a short timeline, I agreed to going under the knife.
I woke up with two new scars and a rebuilt foot.
It turns out that when they actually opened up the foot there was a mess of torn ligaments and little pieces of broken bone.
So much for X rays and MRIs being foolproof!
In this case they were batting 33%: I had had three imaging tests and only one of them was correct. The other two gave false negatives (i.e. saying that there wasn’t a problem when in fact there actually was a problem).
And that’s the lesson of the third injury. That doctors can be wrong, and that diagnostic tests can fail.
How many times have you heard someone say that an MRI showed that their aching back was caused by bulging or herniated discs?
MRI’s often give false positives (diagnosing a condition where it truly doesn’t exist) and false negatives (missing a condition where it really is present). For example, an MRI completely missed the shredded ligaments in my foot was a false negative.
People love certainty, and there’s a certain relief that comes from thinking that you know why you’re in pain all the time. Hence people abrogating responsibility and taking the easy route: “It’s my bulging discs – there’s nothing that I can do about that except surgery.”
Or course that’s sometimes true – bulging discs can definitely cause back pain – but an MRI is NOT a magic bullet.
A doctor once explained to me that there are lots of people with bulging discs diagnosed by MRI’s that are completely pain and symptom free. And lots of people who have all the painful symptoms of bulging discs who would have completely normal looking discs if you dissected them post mortem.
My point is that all diagnostic tools are potentially faulty.
False negative test results may prevent you from getting treatment that you actually need – in the case of my Lisfranc foot injury two out of three imaging techniques gave the (incorrect) all clear message.
False positive test results may encourage you to undergo treatments that may not actually help, as well as being potentially very expensive and dangerous.
Injuries suck, and your best protection is prevention. A single injury can cost you months, even years, of training.
And if you do get injured then don’t leave it in the hands of whichever ‘experts’ you encounter. Keep in mind that everyone has ulterior motives and an agenda, usually involving their own financial well-being.
As always: Caveat emptor, buyer beware!
Just like in all other aspect of training, ultimately the responsibility is yours. Educate yourself, evaluate the treatments, monitor any progress, and take control of your own health!