Preventing common shoulder injuries in combat sports training

The rise in mainstream popularity of combat sports in recent years has seen more people taking up the sport as a way to keep fit. Be it boxing, muay thai, jiu-jitsu, or mixed martial arts (MMA), combat sports are great for stress-relieving, as well as offer a cardio-intensive full-body workout.

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While this development is exciting and highly promising, there is a growing concern over the increase in numbers of combat sport-related injuries we see in the clinic, particularly in the shoulders. This can greatly impact on your training and performance in the sport, and if not treated in time, develop into a more serious chronic condition.

Here are the top 3 most commonly seen combat sport-related shoulder injuries:
 

1. SHOULDER INSTABILITY

The gleno-humeral joint of the shoulder is a ball-and-socket joint, in which the spherical humeral head (ball) is ideally centered in the glenoid cavity of the scapula (socket).

Symptoms:
Feeling “loose” in your shoulder, as though the shoulder is going to pop out of place with certain movements.

 

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Causes:
Shoulder instability may be due to one or more of the following contributing factors:

  • Structurally shallow glenoid cavity
  • Looseness of the ligaments from previous dislocations or misalignments
  • Generalized joint hypermobility
  • Decreased activity of surrounding stabilizing muscles

Prognosis:
We’ve seen our fair share of shoulder dislocations while fighters are trading punches, or getting caught in a clinch. A dislocated shoulder can put you out of training and fighting for months. Left untreated, shoulder instability may result in recurrent misalignments and dislocations, causing fighters to lose precious training time and confidence in their punching, clinching, or grappling abilities.

 

2. ROTATOR CUFF DYSFUNCTION

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The rotator cuff is a group of muscles in the shoulder that primarily moves the shoulder into internal and external rotation, and also functions to improve the stability of the shoulder joint.

Symptoms:
Rotator cuff dysfunction may present as:

  • Rotator cuff weakness
  • Rotator cuff tendon inflammation
  • Rotator cuff tear

Causes:
In the absence of acute trauma, rotator cuff dysfunction in combat sport athletes often begin as relative weakness of the external rotators in comparison to the internal rotators, which are often in a shortened resting position as a result of a typically-hunched fight stance. Over time, the external rotators become strained in an elongated position, as they counter the force of the internal rotators.

Prognosis:
With repetitive straining over time, the tendons of the rotator cuff undergo degeneration with wear and overuse. Overtime, rotator cuff weakness and inflammation may eventually lead to a tear. Rotator cuff tears are often painful and debilitating, leaving fighters unable to train and compete for several months.
Rotator cuff tears have been known to heal poorly. The majority of rotator cuff tears often go on to become larger tears or full-thickness tears if untreated over time. Hence, it is important to seek treatment early to maximize healing and minimize further injury.

 

3. ABNORMAL MOVEMENT OF THE SHOULDER BLADE (SCAPULA)

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The scapula is an important consideration in the shoulder joint. Since the glenoid cavity (as mentioned above, it’s where the ball-shaped end of the humerus) is part of the scapula, its position in motion is crucial in housing the humeral head to maintain smooth and efficient movement of the shoulder.

Symptoms:
Scapular dyskinesia is a collective term referring to dysfunctional motions of the scapula during shoulder movement. It often presents with increased bony prominence of the scapula.

Causes:
This often occurs due to a lack of control and variations in interaction between some of these muscles:

  • Trapezius – a major muscle covering most of the upper back and the posterior of the neck
  • Levator scapulae – at the back and side of the neck
  • Serratus anterior – fan-shaped muscle along the ribs underneath the armpit

Prognosis:
While scapular dyskinesia itself is rarely the source of pain, it may be present in shoulder injuries or any muscular imbalance in the shoulders, making it worth an assessment for any contributions to structural and functional errors in the shoulder.

 

PHYSIO-RECOMMENDED WARM UP/”PRE-HAB” EXERCISES

To minimize the risk of shoulder injuries during training, here are some simple “pre-hab” exercises to warm-up and prepare our shoulders for a training session:

Foam rolling of the shoulders, concentrating the following muscles:

  • Subscapularis
  • Latissimus dorsi
  • Posterior capsule
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Shoulder internal and external rotation

 1. Holding a dumbbell in one hand, rest you elbow on your knee, with your arm pointed downwards.

1. Holding a dumbbell in one hand, rest you elbow on your knee, with your arm pointed downwards.

 2. Lift the dumbbell by turning your arm upwards.

2. Lift the dumbbell by turning your arm upwards.


Shoulder forward flexion with isometric external rotation

 1. Hold a resistance band around your hands.

1. Hold a resistance band around your hands.

 2. Stretch the resistance band by bringing your hands in-line with your shoulders.

2. Stretch the resistance band by bringing your hands in-line with your shoulders.

 3. Raise both arms in front of you while keeping the the resistance band stretched.

3. Raise both arms in front of you while keeping the the resistance band stretched.


Scapular stability + rotator cuff activation

 1. Pull a resistance band towards your chest with your elbows bent at the side.

1. Pull a resistance band towards your chest with your elbows bent at the side.

 2. Turn your forearms upward.

2. Turn your forearms upward.

 

PHYSIOTHERAPY CAN IMPROVE YOUR SHOULDER FUNCTION IN COMBAT SPORTS

The above exercises serve as a general guideline to athletes looking for warm-up ideas for a healthy shoulder. Should you experience shoulder instability or pain during your martial arts training, or have been diagnosed with a rotator cuff injury, you might want to consider visiting a Physiotherapist.

During your physiotherapy session, your Physiotherapist can:

  • Assess for shoulder instability, possible rotator cuff injury, or any other shoulder injuries
  • Assess biomechanics, including the movement of your scapula, and identify biomechanical errors in your movement
  • Treat soft tissue limitations
  • Prescribe a rehabilitation program to improve shoulder stability, scapular motion, rotator cuff strength, and overall shoulder function

Your rehabilitation plan may often consist of a program that progressively loads the shoulder, with an emphasis on motor control and dynamic stability through movement. The aim is to get you back to training with greater confidence and reduced injury risk.
 

Do you participant in combat sports training regularly? We can help you in your training performance and recovery!


ABOUT THE AUTHORS

Daniel Arthur and Nada Khalid are Physiotherapists at the UFIT Clinic. Between them, they share a great passion and plenty of experience in combat sports training, which provide them with the understanding of prevention and treatment methods for combat sport-related injuries.

 Daniel holds black belts in Taekwondo and American freestyle kickboxing. He is a Bronze medalist at the ICO World Championships in Italy, where he represented England. He is also an experienced kickboxing trainer, having taught the sport since he was 16.

Daniel holds black belts in Taekwondo and American freestyle kickboxing. He is a Bronze medalist at the ICO World Championships in Italy, where he represented England. He is also an experienced kickboxing trainer, having taught the sport since he was 16.

 As an active muay thai fighter, Nada trains up to 6 days a week. She has won multiple national-level Muay Thai fights, and most recently fought and won her professional debut in Thailand by a technical knockout.

As an active muay thai fighter, Nada trains up to 6 days a week. She has won multiple national-level Muay Thai fights, and most recently fought and won her professional debut in Thailand by a technical knockout.