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  • Jade Elkind

Lateral Collateral Ligament Injuries In Brazilian Jiu Jitsu


Some of us know it all too well…


You’re in the middle of a good sparring round with one of your favorite training partners. Warm up rounds are done, so the both of you are really getting after it. You’ve already had a few good scrambles and you’re only 60 sec into a 5 minute round. During one of your scrambles you see an opportunity to wrap your right leg around the back of his head and arm. It’s your opportunity to lock him into a triangle choke! You’re close, but you still need to “cut your angle” and keep his posture, down. You don’t want your opponent to posture up, so you grab you right ankle with your left hand. At this point, he can’t posture his head up because you have it pinned down underneath your right knee, with your left hand keeping it bent.


“I got this," you think.


He really tries to extend his back in an attempt to break your lock. It’s making you use your leg with more force and you also need to grip your ankle much harder. You’re still hanging in there, and then it happens…


POP.


The POP in your right knee.


The dreaded POP that can leave a grappler off the mats for weeks, months, or over a year.


“I felt fine and then all of sudden it just popped,” is something I hear over and over again when working with grapplers.


Being a former amateur mixed martial artist and one who enjoys wrestling and Brazilian Jiu Jitsu (BJJ) myself, I understand. Sometimes things happen, but why did this happen?


Personally, I think that it is because we are taking something and turning it into what it is NOT.


According to Hinz et al, the knee is one of the most common of injuries with BJJ.


As far as the knee goes, it is basically a hinge joint (think of a door) with some mild rotation. Therefore, it does not have the vast range of motion that the shoulder is built with.


But when we lock in a submission such as a heel hook, we make the ankle immobile, and then proceed to put a lot of torque and twisting through the knee joint, which is not normal.


We can even take the triangle submission, for example. If you have someone’s head and arm underneath your leg, and they are trying like mad to get out of there as you are trying to keep a strong grip on your ankle as a way to keep your triangle from breaking, it can put a lot of stress on the outside of your right knee which is where your lateral collateral ligament (LCL) resides.


Imagine sitting with your feet over the edge of a bench and your knees bent at 90 degrees Your thigh is completely held down so that it can’t move or rotate and someone is trying to push your right foot past your left foot. That will result in a tone of pressure on the outside of your right knee.


The knee joint wasn’t made to bend that way, but when you are tying to finish a triangle submission, you may be trying to make it do so.


Also according to Hinz et al, older age and higher belt rank were correlated with increased injury risk.


I believe this is an issue because of the cumulative damage that occurs from the years spent on the mat.


And let’s face it, most BJJ practitioners just want to train. They don’t want to spend more time doing the necessary mobility, conditioning, and strength work that may prevent these POPs from happening in the first place.


Now don’t get done reading this article thinking that triangle chokes or any leg locks are off limits because you’re going to pop your (or your partner’s) LCL.


There are some things you can do to prevent this from happening.


One that I’m big on, is HIP MOBILITY.


Why? Because if you can rotate through your hips, less rotation is going to be forced through the knee. If there is one thing the knee does NOT like, it’s forced rotation, especially when your foot is planted or rendered immobile (think heel hooks). Forcing a rotational stress through a joint that is made to bend and straighten in one plane of motion is how you get popped ligaments.


Go back to the triangle: If you can open your hip more due to improved hip flexibility, then you will not have to pull on your ankle as hard as you try to fit a human being underneath your bent knee. As a result, less strain will go through your LCL.


Here is one exercise I like to improve hip range of motion (ROM):

Banded fig 4 stretch:



The band helps to target the joint capsule, and therefore get a deeper stretch.


According to Moustafa et al. the optimal time to hold a stretch is 30 sec, as demonstrated by an improvement in hamstring ROM in older adults. Give yourself 30 seconds and over time, your hip ROM should improve.


Now the good news is that Temponi et al. reported that partial LCL injuries had the potential to heal with nonoperative means (this was confirmed via MRI) but I think that the best solution is prevention. It can also take upwards around 180 days for a ligament to heal!


If there is one thing I’ve learned over the years as a doctor of physical therapy working in the Reno and Sparks area, it’s if something doesn’t move the way it should, something else is going to give.


Any mobility deficit we have will eventually lead to compensations somewhere else.


If you’re serious about improving your mobility for your rolling time, reach out to me and let’s get it taken care of!



These videos are not intended as medical or professional advice. Our YouTube exercise videos are provided for educational purposes only and are not intended to serve as medical or physical therapy advice to any individual. Any exercise has potential to cause injury or pain if it is incorrectly done or is not the right exercise for an individual’s medical or physical problems. You should consult with a physical therapist or medical provider for individualized advice.


References:


Hinz M, Kleim BD, Berthold DP, Geyer S, Lambert C, Imhoff AB, Mehl J. Injury Patterns, Risk Factors, and Return to Sport in Brazilian Jiu Jitsu: A Cross-sectional Survey of 1140 Athletes. Orthop J Sports Med. 2021 Dec 20;9(12):23259671211062568. doi: 10.1177/23259671211062568. PMID: 34988235; PMCID: PMC8721390.


Moustafa IM, Ahbouch A, Palakkottuparambil F, Walton LM. Optimal duration of stretching of the hamstring muscle group in older adults: a randomized controlled trial. Eur J Phys Rehabil Med 2021;57:931-9. DOI: 10.23736/S1973-9087.21.06731-9.


Temponi EF, Saithna A, de Carvalho LH, Teixeira BP, Sonnery-Cottet B. Nonoperative Treatment for Partial Ruptures of the Lateral Collateral Ligament Occurring in Combination With Complete Ruptures of the Anterolateral Ligament: A Common Injury Pattern in Brazilian Jiu-Jitsu Athletes With Acute Knee Injury. Orthop J Sports Med. 2019 Jan 24;7(1):2325967118822450. doi: 10.1177/2325967118822450. PMID: 30719481; PMCID: PMC6348520.

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