Accelerating Recovery from a Sports Injury: Case Study – The Jiu-Jitsu Athlete

Caleb is a 20 year old man who has been training jiu-jitsu for the last two years. He was awarded with his blue belt—the next level up from the beginner white belt—three months ago. He since decided he should take his training more seriously to earn a spot on his gym’s competition team.

As part of training more seriously, he has been upping the intensity of his rolls—what sparring is called in the jiu-jitsu community—with larger and more skilled opponents. In one such roll, he got caught in an arm bar. He had recently been drilling escapes from this position. So, instead of tapping when caught he figured he might be able to fight his way out. This was an unfortunate miscalculation. His training partner had him firmly in the position, and without ill intention cranked on his arm until he heard a pop.

That pop, as he would learn later during his physical therapy evaluation, was a combination of his ulnar collateral ligament and common flexor tendon partially tearing. Given that it was not a full tear, there is a good chance he can eventually return to training without surgical intervention.

Managing the engine is the easy part. Caleb is enthusiastic about making the changes to his diet, sleep, alcohol, and tobacco consumption so that he can get back to jiu-jitsu faster.

The challenge in this case is with the steering wheel. Unlike running and lifting, combat and contact sports have wildly varying and unpredictable forces on the body. Further, Caleb’s injury is severe enough that he is having trouble lifting a gallon of milk. At the start, there is little on the mat that can help him, and a lot that can hurt him.

This all means that he will need to take time off from the mats. It does not mean he will need to take time off training.

The first week after the injury, his elbow is placed in a hinge brace that prevents excessive straightening and bending to protect it. Multiple times per day, he takes the brace off to perform gentle range of motion and isometric exercises. Because he can’t use his wrist and elbow for daily activities, he will not use his shoulder much either. This can lead to weakening and stiffening over time, so it’s important we keep the shoulder moving with exercises.

All of the other parts of the body can continue to be trained without limitations. The legs can be trained with hands-free equipment such as belt squats and sled drags. The unaffected arm can perform single arm pulling and pushing variations. Some might be concerned this would lead to an imbalance between the arms, but evidence is coming out that training the uninjured arm can improve healing and preserve motor skill patterns on the injured side.

The key idea with the Caleb’s rehab plan is to take advantage of the opportunities afforded. His injured arm prevents him from doing jiu-jitsu. It does not prevent him from doing many other forms of exercise. It’s unavoidable that he will come back from the injury having lost some sport-specific skill. But by redirecting the energy he would have used to train jiu-jitsu into an individually tailored strength and conditioning program, he can step back on the mats stronger and fitter than before the injury.

After the first week of rehab, he is able to practice bearing weight through the arm and working it through a full range of motion with very light resistance. Once he is confident moving the injured arm through a full range of motion and putting his weight through it, he can return to the mats to lightly drill technique. However, he is still far away from anything like rolling.

At around a month the arm is feeling much better with everyday activities, and Caleb has achieved a full return to the drilling component of his training. At this point he can incorporate light variations of grappling specific strength work such as sandbags and Zercher lifts. He can also return to low volumes of very low intensity rolling with lighter, well trusted training partners.

Over the following two months he gradually ramps up both sport-specific conditioning as well as rolling volume and intensity. By the time he is back to training with a similar structure he was before the injury, he has set personal records in all his lower body lifts, his core and unaffected arm are stronger than ever, and his injured arm is as strong—at least muscularly—as it has ever been.

Overall, while some valuable training time has been lost, much has also been gained. Caleb is stronger than ever. He now has a comprehensive strength and conditioning routine to supplement his sport training. This will help to prevent injury in the future and give him the tools to rehab himself from future injuries. And most importantly, he returns to training with a long term mindset; it’s not about how he can get the best of his opponent this roll, but how he can get the best training out of himself this week.