Interviewed by Women Who Fight
Joana graduated as a Physiotherapist in Portugal in 2011 and since then she has been working within the Musculoskeletal field having specialised in sports injuries/rehab. She gained experience in well respected private clinics where she treated many post-surgery patients and professional and amateur athletes. She also had the chance of collaborating with the Portuguese Gymnastics team for a while which certainly made her grow as a professional.
Currently, Joana is employed in a private practice in London called Marcophysio which has expanded to several locations and she is based in three of them: Westferry, Victoria and Triyoga Shoreditch. She mainly sees clients with Musculoskeletal disorders, from sports injuries to work based problems. She is also a BJJ purple belt athlete proudly under Marco Canha (Checkmat) at Fightzone London. She started Brazilian Jiu-jitsu in Portugal with a Portuguese female black belt – Monica Silva who was and still is a massive inspiration to her.
How did you become a physiotherapist?
I chose to study physiotherapy as I’ve always taken part in sports since a young age and because of that I had contact with several physios and rehab professionals. I always admired their job and their ability to help, which inspired me to study towards the degree. It was a good way to combine health with sports which are two areas I enjoy. I don’t regret it!
Tell us what is it that you do exactly (for those that have never had physiotherapy before).
As a Musculoskeletal Physiotherapist, my primary goal is to assist on the recovery of an injury (reduce symptoms as pain, inflammation, stiffness etc) helping people to return to their normal activity without limitations and ideally maximising their performance. It is also the goal of a physiotherapist to provide self-management strategies for possible future symptoms as well as help to prevent further injuries.
You are also a BJJ practitioner, how does your knowledge and experience of this come into your practice as a physio?
Being a BJJ practitioner and a physio means that I understand the biomechanics of the sport and which type of areas of the body can be mostly affected, having experienced some injuries myself!
By practicing sport, I am more aware of the psychological effects behind the injury, athlete and competition and this helps me understand and advise people both in rehab and prevention which is super important. It helps when you have a good understanding of one particular sport as a physio, as you can really help with tailoring the rehab program to that specific activity. I guess the two areas end up influencing each other in my case.
How do we know when it is crucial to see a physio? Are there any signs? We are often unsure if a pain is muscular or if it is something more serious that needs to be checked.
When you suffered an injury during training or at a competition, it is sometimes hard to decide if it’s serious or not. It is important to consider several aspects such as: How did you suffer the injury? Was it a fall? A sudden movement? A big impact?
Generally speaking if you suffered a big trauma, you feel sudden sharp symptoms, however quite often with adrenaline and other factors, you may not feel intense symptoms straight away. If you hear a loud clicking sound; check if there is a swelling or bleeding; deformities on the affected area; check if you cannot weight bear on your leg or cannot move at all the area that you hurt. Pay real attention to other red flags such as sickness, blurred vision, loss of sensation in one or both limbs, changed on bowel and bladder, unexpected bleeding, shaking, night sweats/ pain (the list isn’t exhaustive.).
I would say that if we are dealing with the conditions that were just mentioned, it is very important to be seen by emergency services at the hospital as soon as possible. They will be able to perform further investigations and deal with any possible serious condition that may be happening.
However, if the type of injury appeared in a different way as in: you only felt symptoms hours after training or the day after or your symptoms started a few months ago and now are getting worse and you don’t suffer from red flags; you may be possibly dealing with another type of injury that may or may not require to be assessed by a professional.
Usually the first 3 or 4 days after an injury, there is an inflammatory process that also causes effects (swelling, pain) so unless any serious symptoms are happening to the point where you need to visit the hospital, then I would suggest to wait before you see a physio; unless you have the opportunity to see one right away (then perfect!).
The first thing you need to do as soon as you injure yourself are the PRICE principles;
P-Protection: Immobilise the area affected to avoid further injury (ie. A splint on the shoulder or a knee brace)
R – Rest: It is important to rest and take of the load (stop training) so that the injury has time to heal.
I – Ice: Apply ice for 12 minutes several times during the day.
C – Compression: Apply a compression bandage if possible but do not use it at night while sleeping.
E – Elevation: Elevate the affected area in order to reduce the swelling (ie. Place your leg above pillows if you have a knee or foot injury).
If after 3/ 4 days your symptoms still persist then a Physiotherapist would be able to help you. If you have an injury or pain for too long then the body will start creating even more dysfunction and compensations that can then lead to further complications.
Physiotherapists are great professionals at physical examination; they would be able to tell you if the injury you are suffering is serious enough to the point where you need to be referred for further investigation such as an MRI, or X-ray or to be seen by a specialist consultant; they would be able to advise you on what to do next and help you with the rehabilitation process as soon as possible to get you back on the mats.
What are the most common problems you have seen with women engaged in contact sports?
With contact sports any injury can happen, however the ones I tend to notice the most is on the extremities: fingers and wrist, toes and ankles due to grips and falls; knees due to sudden twists or submissions; elbows are usually very vulnerable and shoulders as well.
What are the main differences between men and women’s bodies? Where do women most commonly injure & hold strength? What are common areas we should strengthen?
There are definitely differences between men and women’s bodies that influence the type of injuries that we (women) are more vulnerable to. More research is needed in this field to understand this gender gap, but some of the differences that have been stated are: higher estrogen levels (which contributes for less muscle mass and higher body fat); more flexibility and therefore looser ligaments and less power in the muscles; a wider pelvis that influence alignment of knees and ankle.
There are some common areas of injuries for women in contact sports which are statistically higher than in men such as: ankle sprain, shoulder and knee injuries and tendon injuries.
Why do some women always get hurt and others never seem to?
There are several factors that make some individuals (in particular women) more vulnerable to injuries than others. These factors can be within the athlete herself (like psychological and personal factors, weight, strength, conditioning, nutrition) or can be external factors to do with the training environment, training partners, coaches, and schedules. It is most likely when several of these are combined that the risk of injury increases. Prevention of injury plays a big role on how often you get injured.
Is there anything general we can do to prevent injury?
Martial arts is obviously a contact sport where our body is vulnerable to consecutive traumas (punching, take downs, sudden twisting movements, submissions… but this doesn’t mean that every time you get punched or submitted you are going to develop an injury.
Injuries occur when the soft tissue is put into a situation where load and forces are superior to what it can actually handle. This load can be intense to the point where it causes a significant and serious injury (ie, if you break a bone or tear a ligament) or can have a gradual effect over time – overuse or overload of the structures. These are actually the most common injuries in martial arts and what we can prevent the most.
So the starting point is that the athlete gains more tolerance and ability to tolerate consecutive traumas or overload of structures.
There are several points to have in consideration:
Strength and conditioning training: By increasing your strength and stability, as well as conditioning you will be able to prevent a lot of issues. This training though should be appropriate to what you are practicing (ie; drills and relevant weight exercises for the areas that are strained the most during your training).
Gradual progress: the longer you have been training the more you will be able to tolerate. However, if you have a rapid increase of training you are not actually giving time for the structure to suffer a proper adaptation. So this intensity needs to be gradual and side to side with the other factors.
Nutrition and hydration plays a massive role on injury prevention. When you eat the right meals you are providing your body the right ‘fuel’ and nutrients in order to prevent it ‘breaking down’. Hydration also replaces the nutrients that we lose when we sweat.
Warming up before training with light aerobic exercises and gentle stretches will help increase the blood flow to the area as well as increase flexibility of the structure preventing injury or the reoccurrence of another one.
The balance between rest and training is also important. If you are too tired the chances of injury will increase and your performance will drop.
There are other points to consider such as stress and psychological effects but as I mentioned, prevention is a very big factor to consider. My advice for those who train at a high intensity and competitive level and and want their training to be sustainable in a long term, is to seek recommendation from personal trainers and nutritionist that have experience in contact sports for an accurate guidance.
What is your advice to women who continue to injure themselves?
They should reassess all of their training methods and personal and external factors I mentioned above in order to understand what can be contributing to the recurrence of injury. Ultimately I would recommend seeking professional advice to help create an adequate training plan even if it includes stepping back from intense training.
What are your experiences of injury? How did you recover physically and mentally? What is your advice to others in this situation?
Whilst training BJJ I have experienced a few injuries, some less serious that go away after a week or two and others which were more serious and stopped me from training for a few months. When you train with high intensity, it is natural that you go through this and/or have had contact with someone who went through it as well.
There are physical and psychological consequences with injury and the more serious the injury is, the longer you need to be off training to recover which can be very stressful and cause a loss of self confidence.
I definitely experienced this myself but we need to have in mind that the physical recovery and mental recovery are both important on the path of rehabilitation. The better our attitude is towards the rehabilitation, the smoother it will be. There are studies and authors who are specialists in the area, (Sheinbein 2016) who explains that Athletes’ willingness to commit to rehabilitation, as well as the value they give to the rehabilitation process, influences their cognitive, emotional, and behavioral reactions to injury rehabilitation’ .
There needs to be an acceptance that the injury exists so you can then commit to the treatments and adjust one’s goals towards the rehabilitation, seeing each step as a success and being closer to full recovery.
The Physiotherapists goal is to guide you along this psychological process as well but in some cases athletes may need specialists opinion and guidance to have further strategies to deal with the problem.
Do you see attitudes changing for women in regards to training in athletics/combat sports? Both from society as well as men and women themselves?
It is definitely visible that women are having more attention in sports in general. However and unfortunately there is still a stigma that sports are separated between feminine and masculine sports. Fighting is seen as a men’s sports but how many great women fighters have we seen out there? Women are as interesting to watch fighting than men and often even more as women tend to be more technical.
Women still have to go through limitations and barriers when performing sports due to some cultural environments, body image concerns, social aspects, family… But as professor David Rowe from the Institute of Culture and Society from Sydney said: ‘Enhancing girls’ and women’s participation in sport, which is below that of boys and men, is an important area of social and cultural policy. This is not only a matter of promoting good health, but also of ‘cultural citizenship’ and the right to take part fully in social life’.