Training & Rehab

Dr Smith answers some common questions

We were lucky enough to speak with Dr Catherine Spencer Smith, asking some specific questions about common combat sports injuries. Dr Catherine Spencer Smith is a Sports Physician who has extensive experience treating athletes for their injuries. For more information please see her website here . 
By Women Who Fight
November 2018

1. Do you have any suggestions about when shoulder pops in and out? Any dos and don’ts for prevention and recovery. Also why do our joints do this?


“Generally speaking our shoulders shouldn’t pop in and out. You can experience a true dislocation in the shoulder, which is agonising and is the sort of thing that takes you to casualty, and then sometimes we stretch out the shoulder joint with a movement in the shoulder that is called subluxation. This means that it’s not fully out, but it’s on the edge of being out of place. If this is something that is happening regularly then it needs to be addressed. Any healthy joint can be pushed to the extreme with somebody manhandling you, but generally speaking in normal movements under our own control it shouldn’t be happening. It’s very important to get a proper assessment with a physio or osteo or sports doctor etc and if you are wanting to prevent episodes like this happening again, you need some good specific rehab advice to strengthen the serratus rotator cuff in particular.”


2. When there is a rib cage misalignment, ribs can be pushed in during training. Is there any advice on how to recover and avoid ribs ‘sinking in’.

“In the ribcage area there are the intercostal joints which are the gristle joints that interconnect tissue parts of the rib cage to the bony parts of the rib cage and the breast bone. If these joints get disrupted then they will have more movement than normal. It’s not something that should spontaneously happen in sport.

If you injure your ribs in this way, you have to go through a process of healing. You can’t speed that up, it will take 6-8 weeks to feel much more comfortable. And if you’ve got poppy intercostal joints that can mean you are stiff in your thoracic spine as well. This means you don’t move well at the other end of your ribs, so getting good physio and osteo help is really important.”


3. How can we stay fit when we have to protect our ribs as they heal?

“You can’t hurry this process of healing, you have to be patient.”


4. When elbows pop out – like golfers elbow – what can we do to help it heal?

“If you have an elbow that physically, that mechanically pops out, then the lateral restraints around the elbow, one of the ligaments, is damaged. This is very different from golfers elbow, which simply means an overloaded muscle attachment in the same area. If you’ve got fundamental instability you need proper diagnosis and treatment, and in some extreme cases, surgery.”


5. How can we get back from LCL and ACL damage?

“As in all things, it depends on how extreme the damage is. If you’ve had an ACL rupture but you are not going through surgery, or you are, then rehab is hugely important and in fact most people don’t take their rehab far enough. They start off with a physio, they get some sessions to improve strength, and they do lots of hamstring work to protect the acl in particular, but they don’t take it through enough loading, so they don’t get the symmetry back in terms of strength volumes in both legs. They don’t do enough climature conditioning, and neuromotor functioning has to be corrected as well. So if you are doing quick twists and turns those neural pathways have to be relearned. So its about really good strength training and conditioning with a physio with that high end rehab stuff. There’s loads of data about that especially in the footballing world that shows most of the time that not enough of that happens.”


6. With a torn meniscus and recent operation (within 3 months), how long is it before one can go back into grappling/training?

“If you’ve had a bit of a trim to your meniscus and you’ve not had something very fancy like a meniscal transplant, then most of us can aim to get back into doing something pretty physical in 12-16 weeks. It’s not just time though, you have to have regained strength, good coordination and muscle firing patterns, and you can’t have any swelling. So providing you can carry out some sports specific drills with your rehab physio or osteo, then you are ok to go back.”


7. Hurt knee during sparring, and still want to keep training. Are there any exercises that will help recovery?

“We don’t know what’s happening in your knee, get a proper diagnosis, stop trying to self treat.”


8. What do we do with badly bruised ribs, that take us out of training for a few weeks? How can we avoid being re-injured when we start training again?

“It comes with the territory, there is nothing you can do when getting bruised and re injured, it’s down to your fitness and your training partner.”


9.  If you feel pain in the shoulder during a bench press and it persists every time, is it something to worry about, and what can one do about it?

“Yes it is something to worry about if you want to continue bench pressing. Typically people tend to overload supraspinatus tendon in their shoulder, and also they can overload the long headed bicep tendon, and occasionally an area in the shoulder called the labrum. If you keep doing this, you can degenerate the soft tissue structures, so don’t ignore it, get it sorted.”

10. If your knee feels weird doing certain movements but when it’s warmed up its fine, is there anything to worry about, is there anything you can do?

“Generally speaking if your knee feels weird it means you’ve got a bit of instability. You might have a bit of a stretch in your ACL, maybe a little bit of overload in your meniscus. When we’ve warmed up, generally our muscles are fine and they keep up in alignment. It comes back to getting a proper assessment, and with a proper diagnosis you’ve not then neglected an ACL stretch that’s not being properly treated.

11. With a Medial Collateral Ligament injury, how long do you need to stay off of training? What do you need to avoid, and would a knee brace be useful?

“It depends on how damaged the medial collateral ligament is. Most people who have a grade 3 tear, which means it’s completely disrupted, find it hard to get back to sport without having it surgically repaired. If you’ve got a nasty grade 2, that can take a several months to get back into sports, but a grade 1 stretch or tear, providing information settling around that, I would expect most people would be able to get back into a good level of training between 2-3 months. This is very much based on whether there are any other injuries occurring around it, for example ACL injuries are more likely to occur if you’ve got a meniscus problem as well, so you need a proper diagnosis.”

12. What is better for your muscles, to do weights before training martial arts or after?

“There are a couple of issues regarding this. When we are lifting weights, and its first thing in the morning, our lumbar spine discs are at their most turgid, and interestingly if you are going to hurt your back by lifting weights, it’s more likely to happen in the morning. On the other end of the spectrum if we are really tired and lifting we can get injured as well. Lifting tired can mean you are lifting with poor form, and it is my general feeling that if you train later in the day, I would always suggest doing a bit of cardio first, then doing your weights, then doing you martial arts training. That way you know you’ve had good form and you’ve set yourself up well for a proper session.”


13. How important is Strength and Conditioning for your health and safety as an athlete? Why?

“Hugely important, and it always gets neglected. A lot of the time we love our sport and we just want to spend our time doing the sport. There is overwhelming evidence that strength and muscle control is vital for the protection of joints. If you are somebody who is getting a little bit older, it’s very important to have a good muscle mass, and increasingly we know now that weight training is vital for extended bone health. Plus you perform better when you are stronger!”