Neck Bridges for MMA


Your spine if very precious and important! Don’t risk injuring it with neck bridges.

Bridges are traditionally used by wrestlers and boxers to develop strength in their neck. A strong neck can help to reduce the risk of concussion and also reduce the risk of an injury to the neck during competition.

Neck bridges certainly work for developing huge neck muscles, but they also compress the discs in the cervical spine. This can lead to acute, and/or chronic injuries to the neck including prolapsed (or herniated) discs – which can literally lead to constant pain for the rest of your life. No joke, if you ‘pop’ one of the discs in your neck, it can cause all type of nerve problems, often meaning that you lose strength in one of your arms.

Bas Rutten & Kurt angle had neck problems, that caused one of their arms to pretty much waste away due to nerve issues.

Bas Rutten's Tiny Arm
Bus Rutten’s Tiny Arm (relatively tiny!)
Herniated disc on the right of above image – Image Source

Using bands or even manual resistance (i.e. your own hand) can be a great alternative to neck bridges.

For example, you can simply place both hands on your forehead, and push back and forth (slowly) as you nod your head backwards and forwards against the resistance of your own hands. This can also work well with a band.

You can then repeat this exercise but with a lateral-flexion – i.e. moving your right ear towards your right shoulder and then your left ear towards your left shoulder.

Isometrics are also safer than neck bridges. Push against your hands or even a wall with your forehead for 20 seconds. Start with your head already against the wall, you shouldn’t move at all, just push against it without actually moving!

If you still really want to bridge, there are a few modifications which make it a bit safer. For example you could use a bench, or even a stability ball (this is still not ideal and still risky):

The other weird thing people do is bite on a towel and hang weights on it, and then flex and extend the neck. If you can afford the dentist and a gym, it might have some merit. Anthony Joshua is doing this below – it should be more slow and controlled, the weight is too heavy and he is risking an unneccessary injury:

The Iron Neck is probably the safest way to strengthen the neck:


Click here to see our blog post about the Iron Neck machine

Click here to read our complete guide to neck & spinal injuries

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Bompa Periodisation for MMA Strength & Conditioning


Always consult a doctor before undertaking a new exercise routine. If perform incorrectly these exercises could result in injury or death. 

Bompa periodisation

MMA has developed into one of the most technically and physically demanding sports on the planet. One of the greatest challenges that MMA places on its combatants; is the huge range and diversity of skills and fitness requirements that have to be studied and mastered in order to compete at the top level. Muay Thai, Freestyle Wrestling and Brazilian Ju Jitsu are just some of the disciplines that need to be addressed and practised, whilst speed, power, stamina, flexibility and strength are necessary physical proficiencies that form the foundation of every successful fighter. 

In order to accommodate and succeed in all aspects of MMA, a fighter should break down his training into a number of separate goals. A general base of fitness needs to be established, and then specific goals are set to reach peak performance at a set time.

It was outstanding athletics coach Arthur Lydiard that noted ‘Athletes tend to repeat basic training patterns over and over again, yet with each repetition of the basic plan they expect different (i.e. better) results’. Without a periodised training programme, fighters will reach a plateau relatively quickly. In addition, many sport scientist theorise that peak performance cannot be maintained and therefore should be in order to coincide with key competitions. 

long jump world record

The body does not adapt well to numerous overloads at once, and therefore the different aspects of physical fitness, such as strength, muscular endurance and V02Max training should have separate periods where they are emphasised. Motor learning is similar, in that the phases of learning are progressed through more quickly if the brain can focus on one or two things at a time.

Therefore, especially when an individual first enters the sport, it is best to separate technical training into stand up, wrestling, and ground fighting, and have periods of time when each is emphasised while the others are maintained. This is the foundation of periodised training. 

The organisation of training can be dated back to the ancient Olympics. However it was not until the early 1900s that specialists such as Murphy and Kotov suggested preparatory exercises and distinct phases. Research and further development into periodisation, took its next significant steps in the 1960s when Russian physiologist Leo Metveyev and Czechoslovakian sport scientist Tudor Bompa expanded and organized the periodization model. Since the 1960s, Bompa’s model has been tweaked and expanded upon by many sport scientists, but the basic fundamentals remain the same. 

In a non periodised training programme; all physical parameters contributing to sporting performance receive equal attention throughout the year. This approach is less efficient than a sensible periodised programme due to a number of factors: 

– lack of time in a single week to fully attend to all the parameters that influence performance 

– The development of some physiological parameters are interfered with by the concurrent development of others 

– Some components of performance can not be adequately developed before certain prerequisites are met. 

The complete periodisation of an MMA fighter’s routine would take at least a few days to put together. When you consider that every thing from striking power, core stability, nutrition and strength has to be periodised in relation to everything else. It gives me a headache just thinking about it! I’ll do my best to touch on strength training. 

The importance of strength training for MMA is not to build big muscles, since they are rarely equated with improvements in power. In fact strength should be built along side other important abilities such as reactive power and power endurance. Strength training must be structured into training phases leading into a competitive phase. If during fights, strength gains are not effectively utilised to produce peak performance, then the whole training has been useless regardless of muscle size. 

Gains in strength must lead to fight specific adaptations. A fighter requires the development of three main abilities: 

  • Power – refers to the state of applying force. When speed is integrated with maximum strength, power is the outcome. 
  • Reactive power – being able to repeat powerful movements in quick succession. For example, immediately throwing a jumping knee after falling to execute a double leg. 
  • Power endurance – the ability to throw hard strikes, and remain explosive throughout a fight. 

According to Tudor Bompa, strength training is time phased into five distinct sections. A typical periodised strength training plan would incorporate the following: 

Phase 1: Anatomical Adaptation 

Phase 2: Hypertrophy 

Phase 3: Maximal Strength 

Phase 4: Conversion Phase 

Phase 5: Transition 

Phase 1: Anatomical Adaptation 

The first phase is known as anatomical adaptation.

This phase forms the base of your strength. It is an important, but often neglected part of training. It is required after a medium to long term rest from training, or when beginning a strength based programme. Ligaments, tendons need to be overloaded extremely gradually, and the central nervous system needs to adapt to new weight lifting techniques before the muscle will become a limiting factor (rather than technique or ligament strength). The exercises in the phase will be general in nature, focusing on the often neglected qualities such as joint stability, strengthening connective tissues, correcting structural imbalances, and preparing for the more intense and specific training to follow. 

The length of time spent in this phase will depend on how long a fighter has rested from training and/or their training history. The novice fighter may spend 8 weeks in this phase, whilst others may spend as little as 2 to 3 weeks. When training for strength, intensity is fairly low, lifting weights of around 60% of 1 rep max, with high repetitions (between 8-15). 

The exercises incorporated in this phase will again depend on the fighter’s experience. Exercises such as deadlifts which put great stress on the core and require a fairly high level of technique, would not be recommended for those who have not trained with weight before. Similarly for those who have not weight trained before, it is recommended that repetitions are kept high, until correct technique and posture for each exercise is learnt accurately.

The length of the routine, including the number of sets will also depend upon the intensity and duration of other training undertaken (thai boxing, wrestling etc). Within the last 2 years, their has actually been an increasing body of evidence suggesting that training one set of an exercise to failure is just as effective in building strength as training with multiple sets. Although more research is required with elite athletes, this would suggest that a workout lasting as little as 30 minutes could be highly effective. 

The below programme is recommended for an individual with no experience of weight training. It consists mainly of compound and core exercises that will form a base of strength, core stability and technique for the rest of the programme. I have seen exercises such as deadlifts, squats and even variations of Olympic Lifts added into this phase. From my own personal experience I have found that due to a lack of core strength, and due to massive muscular imbalances in beginners, such exercises are rarely effective. Instead I have included exercises such as front squat and overhead squat which will predominantly stress and develop the core, and will prepare the body for the exercises to come. 

Remember to do ten minutes of cardio and mobility exercises before doing any weight training. As with every phase leave at least 1 day in between routines. 

Day 1 

Dumbell Bench Press 3 sets x 15 reps 

One arm Row 3 sets x 15 reps 

Single leg calf raise 2 x 20 

Leg Press 3 x 12 

Lunges 2 x 12 

Swiss ball crunches 2 x 15 

Plank 2 x Hold for 45 secs 

Side plank 2 x Hold for 45 secs 

Superman 4 x Hold for 20 secs 

Stretch 

Day 2 

Lat pull Down 2 x 15 

Swiss Ball Shoulder Press 2 x 12 

Dips 2 x 12 

Upright Row 2 x 12 

Back extensions 2 x 15 

Overhead squat 2 x 12 

Front squat 2 x 12 

Russian twists 2 x 20 

Cable wood chops 2 each side x 12 

Gluteal bridge 2 x Hold for 30 seconds 

Cuban Press 1 on each arm x 15 

stretch 


Phase 2: Hypertrophy 

This phase may not be applicable to those fighting in specific weight categories, as the individual is likely to gain weight. This phase provides a solid foundation for building maximal strength, and provides greater muscle fibre mass, to increase the potential strength and power that can be attained. This phase is usually about 5 weeks long. Compound exercises should be emphasised in the weights room, with repetitions of 6 – 12. rest intervals should be varied; between 30 seconds and 3 minutes. In the following routine I have added squats, but with high repetitions. Before attempting heavy squats or deadlifts a fighter should first ensure that their posture is correct, that their core is strong and their flexibility is adequate. Common mistake include bowing of the knees and raising of the heels off the floor. Each exercise performed in this phase should be preceded with a warm up set of the same exercise; using a light weight for 15 + repetitions. 

Day 1 

Weighted Chin ups 3 x 10 

Barbell bench press 2 x 8 

Squats 3 x 12 

Barbell Row 2 x 10 

Multi directional lunges 2 x 12 

Leg extension 1 x 8 

Leg curls 1 x 10 

Hanging leg raises 2 x 12 

Swiss ball plank 2 x Hold for 30 secs 

Weighted crunches 2 x 12 

Day 2 

Dumbell Shoulder Press 3 x 10 

Weighted dips 3 x 10 

Upright row 2 x 8 

Seated bicep curls 2 x 12 

Front squat 3 x 10 

Dumbbell step ups 2 x 12 

Lateral raises 1 x 12 

Cuban Press 1 on each arm x 20 

Back extensions 2 x 15 

Cable wood chop 2 on each side x 10 

Swiss ball side crunch 1 on each side x 10 


Phase 3: Maximal Strength 

Maximal strength is often a limiting factor in power, and therefore is very important for an MMA fighter. Power = force x velocity, and training strength will increase the force that a fighter can potentially produce. Moreover, maximal strength and power is most often used during a fight and is therefore more specific to MMA than higher repetition training programmes. Each time a fighter shoots in for a double leg, and throws a flying knee, they are exerting their maximal force, rather than around 75% of maximum as with many bodybuilding protocols. 

Generally speaking, in this phase, the weights lifted should be 85% – 100% of 1 rep max, with repetitions from 1 to 6, and rest intervals 2 to 6 minutes long. However, I would not recommend doing 1 rep max exercises too often, and would never do them with isolation or core exercises. 

Remember to warm up and perform a warm up set before each exercise. Perform a number of warm up sets before completing a working set of deadlifts. I have separated the routine into 3 shorter workouts, to reduce the effect of fatigue on strength training. I would even be tempted to remove some of the isolation exercises such as calf raises, shrugs and French press is recovery effects other aspects of training. 

Day 1 

Weighted chin ups
1 set of 6 reps
1 set of 4 reps 

Deadlifts
4 sets of:
6, 5, 4, 2, reps

One arm Row
2 sets on each arm of 6 reps

Weighted dips
2 sets of 8, 6 reps

French press 
2 sets of 8 reps 

Weighted crunches 2 sets of 8 reps

Hanging leg raises 2 sets of 10 reps

Swiss ball plank

2 sets
Hold for 1 minute 

Day 2 

Barbell Shoulder press
3 sets of:
6, 6, 4 reps

Full Squats
4 sets of 8, 8, 4, 2 reps

Partial Deadlifts
3 sets of 8, 6, 4 reps

Lateral raise 2 sets of 12 reps

High Pulls
3 sets of
6, 4, 2 reps 

Day 3 

Barbell Bench Press
3 sets of
8, 4, 2 reps

Incline close grip Bench Press 2 sets of
6, 4 reps

Barbell rear lunges
3 sets of 8, 6, 6 reps

Shrugs
3 sets of 8, 6, 4 reps

Standing calf raise
2 sets of 12, 8, 6 reps

Good mornings
2 sets
12, 8 reps

Cable wood chops
2 sets of 10 reps each side 


Phase 4: Conversion 

This phase is incorporated in order to convert all gains in strength, into more functional, sport specific abilities. Strength in the weights room forms a good base of strength and power, but in order for this to transfer directly to the cage, more specific exercises must be performed. In order to convert strength into more sport specific power, exercises such as Olympic lifts and plyometrics should be performed. Before undertaking these exercises, it is important that the fighter has a strong core, a high level of proprioception and flexibility. All of which should have been built in the previous three phases. 

Maximal strength training has taught the body to exert maximal effort against a maximal load. Power training will teach the body to exert maximal force against less resistance, and with greater speed. In addition, functional exercises will develop the specific coordination and neuromuscular pathways needed in order to perform take downs, strikes and other techniques with maximal speed and power. 

This is the phase of training where injury is most likely to occur. The fighter should warm up with at least 10 minutes of cardio, of an intensity of around 75% max heart rate. This will not only reduce the risk of injuries, but muscles have been shown to be more explosive and powerful when warm. Complete at least 2 warm up sets before each exercise. 

Day 1 

Power Clean

4 sets of
6, 4, 2, 2 reps

Push Press
3 sets of
6, 6, 4 reps

Squat – done at speed
3 sets of 8, 6, 6 reps

Plyometric press ups

2 sets of 8 reps 

Reverse lunges
2 sets of 10 reps

Hurdle Jumps
2 sets of 10 reps

Lateral Barrier Jumps

2 sets of 20 reps 

Weighted Swiss ball crunches

2 sets of 12 reps

Russian twists
2 sets of 20 reps

Day 2 

Weighted Towel Chin ups 3 sets of 6 reps 

Weighted jumps
3 sets of 6 reps 

Front squat
3 sets of 8 reps

Depth jumps
2 sets of 8 reps

Medicine ball chest pass 
3 sets of 10 reps

Push up depth jump

2 sets of 12 reps

High pulls
3 sets of 8, 6, 4 reps

Medicine Ball oblique Side throws
2 sets of 6 reps each side 

Good mornings
2 sets of 12 reps


Phase 5: Transition 

This phase is simply to recover from the previous training; to give muscles, joints and connective tissue a good rest. Light cardio, preferably none-impact such as cycling, and stretching is the only exercise that I would recommend here. This phase should last for 2 – 6 weeks depending on if any injuries have been incurred. 

Well; there you have it. This is a very general and basic example of a periodised programme. I fighter should work backwards from the date of his/her fight, and look to peak on that day. Training should be tapered so that the fighter is fully recovered and rested on the day of the fight. Training in the weights room should be adapted to fit your personal training programme.

Remember that even short training programmes with 1 set of each exercise can be very effective and is well worth doing.

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High Altitude Training – The Research


Live High, Train Low – MMA, Boxing & the Research of High Altitude Training

High Altitude Gives Power Athletes an Advantage- Beamon?s Long Jump at altitude, set a record that has stood for 23 years.

For information purposes only. Exercise at your own risk. 

After Tito Ortiz was “out-cardio’d” by Frank Shamrock, the story goes that Tito began to focus on his endurance and began training at high altitude in Big Bear, California.

But why? What is the advantage of training at high altitude?





When the Olympic Games were held in Mexico City in 1968, the results for the long and middle distance events were not particularly impressive.

The 1500m was won by Kino, in an Olympic record time, but Biwott won the 300m in a time 4% greater than the world record, Temu won the 10,000m in a time 7% greater than the world record, and Wolde’s winning time for the marathon was 8.5% longer than the world record.

From this athletes and sport scientists began to investigate in more depth, the effect of altitude upon performance, and also the physiological adaptations that take place during altitude training. 


Daniels and Oldbridge in 1970 studied the effect of intermittent altitude training on 3 and 1 mile running events. In accordance with other studies such as those carried out by Balke (1965) and Dill & Adams (1971), it was concluded that altitude training had a beneficial effect upon endurance performance.

In contrast however, studies conducted by Buskrik et al (1967) and Faulkner et al (1968) showed no effect of altitude training.

These studies were criticised for having low training intensities, and the short duration spent training at altitude. One of the best controlled of the earlier studies, was conducted by Adams et al (1975). A cross over , randomised design was adopted, within which 12 subjects completed 3 weeks training at sea level and 3 weeks at altitude. The study concluded that there was no effect on aerobic capacity after the altitude training. 


Davies & Sargeant (1974) adopted a less conventional protocol. They studied the effect of training for cycling, with one leg in normoxic (normal) conditions and the other under hypoxic (les oxygen) conditions. Both legs demonstrated an increased aerobic capacity, but, although the hypoxic leg had increased to a greater extent than the normoxic leg, the difference was insignificant.

In addition, in 1991 Klausen et al’s study upon cross country skiers showed no significant benefit of altitude training. This led to a statement in 1996 by Wolski et al that ‘at the present time, there is no evidence in the scientific literature to suggest that altitude training could benefit any type of athlete who is interested in improving sea level performance’. 


In 1997, Levine et al stepped into the frame with a more highly controlled and thorough experiment than those that had gone before. This study addressed many of the limitations of the previous studies including: control of the training, adequate number of subjects, balanced, randomised design and the subjects were given iron supplementation in an attempt to catalyse the theoretical increase in haemoglobin. 


The study had 3 groups. A ‘low-low’ group, within which subjects lived at a low altitude and trained at a low altitude; a high-low group, whereby subjects lived at high altitude and trained at low altitude; and a high-high group, with subjects both living and training at high altitude.

The subjects in the H-H and H-L groups showed increased levels of haemoglobin, increased aerobic capacity. The H-L maximal steady state group also demonstrated an increased value of maximal steady state v02, increased velocity at V02 max, and showed the greatest improvement in a 5km time trial. The only limitation of this study, is that non-elite athletes were used. 

Living High, Training Low (High-Low) Produced the greatest benefits in terms of fitness as measured by Vo2Max




The advantages of High altitude training include, increased haemoglobin, increased red blood cell mass, increased ventilatory capacity, and increased capillary density. 


Disadvantages include a risk of acute mountain sickness, decreased vo2max (when at altitude), decreased training intensity and decreased plasma volume. It would appear that the most effective way to train, is to do so at 1250 to 2500m above sea level, and live high and train low!

Since the Wim Hof method has been backed by science and proven to prevent mountain sickness, it would be interesting to see if the method could help altitude training create greater fitness benefits.

Click here to learn more about the Wim Hof method

altitude mask
£14.99 on Amazon.co.uk – worth the investment?

Altitude masks don’t reproduce the same effects or environment as altitude. They work by resisting and building respiratory muscles. Calling them “Altitude Masks” is a marketing technique.

do altitude masks work

Click here to see our Altitude mask blog post

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Exercise & Type I Diabetes – A Scientific Overview


For information purposes only. Exercise at your own risk

Please note that (A surname in brackets) relates to the person who conducted a study and that “et al” just means ‘and colleagues’ i.e. that he/she had help from others to do the study.

‘To know Diabetes is to know medicine and healthcare’

(Haire-Joshu) 

Professional MMA fighter Jordan Williams has Type 1 diabetes. You can read more about him here.

Exercising with a medical condition generally requires additional supervision & precautions, but many sufferers still make it to the elite level.



The condition Diabetes Mellitus is no longer considered to be one disease, but is believed to be a group of diseases differing in etiology, biochemical features, and natural history.

Diabetes is generally characterised by a relative lack of insulin, but the acute insulin deprivation often occurring in the insulin dependent diabetes sufferers emphasises the crucial role of insulin in the regulation of metabolism (Groff, et al 1995).

Insulin has a variety of actions on metabolism, its importance being highlighted by its primary role in major functions including the controlling of glucose, decreasing hepatic glucose output, increasing glucose oxidation, glycogen deposition, lipogenesis, protein synthesis, and cell replication (Evans 2004).

The importance of insulin in the body is well documented, and Groff et al (1995) highlighted this by stating that ‘an absence of insulin not only inhibits the use of glucose by muscle and adipose tissue, but also sets into motion a sequence of events that, without effective intervention, will result in coma of the affected animal or human’. This paper will identify the metabolic and physiological effects of diabetes mellitus on the human body and the problems experienced by those affected by diabetes mellitus through participation in exercise. 

Exercise and Diabetes: An Overview

There are two types of Diabetes Mellitus, insulin-dependent (IDDM or type 1) and non-insulin dependent (NIDDM or type 2). This paper will concentrate on the difficulties associated with control of glucose levels during exercise in individuals affected with IDDM. IDDM is a less common form of the condition, which is not generally attributed to poor lifestyle.

This condition is generally caused by ‘an autoimmune process that destroys the beta cells of the pancreas causing an inability to produce insulin’ Colberg (2001) and is thought to have multi-factorial genetic influences (Onengut-Gumuscu and Concannon, 2005). One of the fundamental principles involved in controlling both conditions is the accurate regulation and maintenance of blood glucose levels. The participation in exercise then poses a problem as one of the fundamental metabolic facts involved in the exercise process is the use, and subsequent replenishment, of muscle glucose levels.

On this issue, Haire-Joshu (1992) stated that :

‘adding exercise to this issue often increases the difficulty in maintaining metabolic control since exercise, especially acute exercise bouts, can drastically alter the delicate balance of glucose’.

This was echoed by Komatsu et al (2005), who stated that ‘a persons exercise capacity is dependant on various physical factors such as neuromuscular activity, hemodynamics, respiratory mechanics, energy metabolism, and hormonal response. A decreased physiological performance of each of these can reflect in the limitation of exercise capacity’.
source/study

This highlights the sensitive process of glucose management, and the various problems arising from exercise. However, this does not mean that exercise should be avoided if you suffer from diabetes. In contrast, White (1994) found that ‘persons with NIDDM exercise has been shown to be a useful adjunct to diet for improved metabolic and weight control’. 

The role that exercise should play in the lives of diabetes sufferers may not be as clear as first thought. Exercise is of benefit in preventing, treating, and halting decline in a number of different illnesses, but its association with diabetes is less clear. It seems that diabetes is a condition suffered by people from all race, genders, and socio-economic backgrounds, with increased prevalence in certain races and society’s. 

Diabetes: Epidemiology and Demographics

Diabetes is widespread. It is ranked as one of the most common chronic diseases. In 1993, there were 11 million people who were living with the condition in the United States of America alone (Groff, et al 1995). With the levels of obesity reaching almost epidemic proportion, levels of non-insulin dependant (NIDDM or type 2) diabetes are also increasing. This was highlighted by Colberg (2001) who stated that ‘increasing incidence of type 2 diabetes is associated with a decreasing level of physical activity and an increasing prevalence in obesity’. 

According to Haire-Joshu (1992) ‘diabetes is a clinical syndrome characterised by inappropriate hyperglycaemia caused by a relative or absolute deficiency of insulin or by a resistance to the action of insulin’.
source

In 1992, it was thought that up to 200 million people suffered from a form of the condition, with 90% of the 12 million sufferers diagnosed in the USA living with NIDDM, and 18% of their 65 to 74 year old population diagnosed with NIDDM. As an example, direct medical costs in USA in 1992 accounted for 43% of total costs for diabetes as compared with only 22% for cancer, 27% for circulatory disease, and 11% for musculoskeletal diseases ( White, 1994). 

There is also high prevalence of the condition in minority groups, with NIDDM being twice as common in blacks, and five times as common in Hispanics. ‘This cannot be attributed solely to the high obesity rates in Hispanics, as NIDDM levels are high even when adiposity and socio-economic status are controlled’ White (1994). 

Clinical research in the west has focused exclusively on diabetes as a physical disorder, and hence the treatments that have been researched have involved stimulating the pancreas through drugs, or by controlling the glucose levels by dietary restrictions, artificial insulin, and more recently, by physical exercise. Clinical research in India, by contrast, has recognized that diabetes is a ‘psychosomatic disorder, in which the causative factors are sedentary habits, physical, emotional and mental stress and strain’ Franz (1996). To an IDDM sufferer, the process of glucose control during exercise is one of the most important aspects of managing their condition.

Glucose Levels during Exercise During exercise, it is imperative that a working muscle is supplied with adequate amounts of oxygen, as is the ability to process and maintain muscle glucose at an acceptable level.

On this issue, Franz (1996) stated that

‘blood glucose during long-duration exercise in non-diabetic persons is maintained at a fairly stable level despite what can be a twenty fold increase in whole body oxygen, five to six fold increase in cardiac output, and an even greater increase in blood flow and oxygen consumption in the working muscles’. 

During intense exercise, the production of adenosine triphosphate (ATP) is determined by the availability of blood glucose and muscle glycogen. Though it is possible to perform light exercise with low levels of these fuels, depletion results in an inability for the muscles to sustain the contractile tension needed. If carbohydrate levels are low, utilisation of fat and protein can occur in order to generate the required energy, but this is still inadequate when compared to the energy derived from carbohydrates. In general, carbohydrate is recommended during exercise due to its rapid metabolism and absorption compared to fat and protein. 

The type of carbohydrate that is ingested can affect the potential rate of glycogen repletion. To identify this, Colberg ( 2001) measured blood sugar levels in individuals affected with IDDM post exercise. Individuals had fasted for 24 hours before being fed either glucose, white bread, or nothing and completing a period of exercise. The exercise consisted of 45 minutes of riding a cycle ergometer at 60% of maximal aerobic capacity (VO2 max, )in the morning before an injection of insulin. Without any glucose, blood sugar levels fell slightly despite having the lowest levels of circulating insulin in the morning. However, intake of 30g of glucose resulted in an excessive rise in blood sugar levels. Glucose ingestion resulted in twice the increase in blood sugars as the ingestion of white bread due to the differing glycemic indexes (GI). 

This study indicates effective management of factors affecting the rate at which glycogen stores are replenished is paramount as different carbohydrates will have differing rates of absorption according to their glycemic indexes. Alterations in Fuel Metabolism Pre and During Exercise in Persons with IDDM A major determinant of the body’s response to exercise is related to insulin availability pre-exercise. The fuel reserves of the body are affected due to often fluctuating insulin levels pre-event. Due to this fluctuation, important stores such as muscle and blood glucose are affected. 

In persons with IDDM, metabolic control is best achieved by a regular or consistent life-style that includes regular meals and snacks covered by a controlled amount of insulin. A homeostatic balance gained through frequent snacks and adequate insulin intake will inhibit the acceleration into hypoglycaemia or hyperglycaemia that would occur if the condition was poorly managed.

As an IDDM sufferer is unable to produce sufficient amount of insulin to help control the rate of glycolosis, without the introduction of insulin, exercise often resulted in a more pronounced hyperglycaemia. When treated with insulin, blood glucose levels have been shown to fall. This metabolic response varies depending on the availability of insulin at the start of exercise. Too little circulating insulin during exercise can lead to an excessive hormonal response that may elevate blood glucose levels and ketone body production.

An example of the differing effects of circulating insulin has been highlighted by Haire-Joshu (1992) who found that

‘in nonketotic persons with diabetes with mild to moderate hyperglycaemia, moderately heavy exercise 24 hours after insulin withdrawal causes blood glucose to fall. In contrast, in persons with more severe hyperglycaemia and mild ketonemia, exercise causes a significant rise in blood glucose concentration’.

This could be attributed to an overproduction of glucose from the liver or under use by the working muscles. 

Another affecting factor could be the enhancement of lipolysis during insulin deficiency which would increase the ketone and free fatty acid (FFA) levels in the blood, resulting in an inhibition of glucose uptake by the muscles.

This affecting factor was highlighted by Gordon (1993), who stated that

‘concentrations of free fatty acids increase at low insulin levels, such as what occurs during exercise or with uncontrolled diabetes, and the use of FFA in muscle increases’.

In general, the importance of FFA as a fuel, relative to carbohydrate, increases with the duration, and decreases as the exercise intensity increases. The increase in FFA lipolysis can be attributed to an increase in ketone plasma levels, and an increase in exercise.

On the relationship between increased ketone levels and increased FFA lipolysis, White (1994) stated that recent studies have suggested that ‘a defect in peripheral clearance of ketones is a major affecting factor resulting in an increase of FFA lipolysis’. An increase in exercise levels has also been attributed to this increase in FFA lipolysis.

This is due to increased ketone levels, as in severely insulin deficient persons with diabetes and hyperketonemia, strenuous exercise causes a further rise in blood ketone body levels’ White (1994). An increase in lipolysis from increased ketone levels during hypoglycaemia increases the importance of fats as a fuel, and emphasises the usability of ketones in effective metabolism. Plasma Ketone Levels During Exercise The plasma ketone levels are normally held at a low level, but may increase in situations of accelerated FFA oxidation and low carbohydrate intake or impaired use. Also, the inadequate supply of blood glucose reduces the oxaloacetate levels which inhibits the rate of oxidation through the Krebs cycle. As glucose levels diminish, the body will cease to catabolise glucose, and catabolise FFA in its place. The rate of FFA oxidation will then accelerate in order to replace the lack of energy being made available. This shift to fat catabolism, and a decrease in oxaloacetate levels, would result in an increase in ketone levels.

Even though ketone bodies make no effective contribution to the fuel supply of muscles (Evans 2004), the livers ability to distribute the ketone bodies to peripheral areas of the body results in ketone bodies providing benefit. On this issue, Groff et al (1995) stated ‘the livers ability to deliver ketone bodies to peripheral tissues such as the brain is an important mechanism for providing fuel in periods of starvation‘. 

In mild-kenotic persons with IDDM, the ability to use ketone bodies effectively during exercise is found.

According to Evans (2004)

‘recent studies suggest that a defect in peripheral clearance of ketone rather than a marked increase in ketogenesis during exercise in insulin-deprived individuals is the major factor’.

As the metabolising of muscle and blood glucose stores is an issue for sufferers of IDDM and NIDDM, the process of FFA oxidation through an increase in ketone levels will benefit the person. Even though high levels of ketone in circulating blood can disturb the body’s acid base balance (Groff et al 1995), it becomes a necessary process to provide the body with an energy source in the form of FFA.

This also highlights the responsibility of the liver during possible hypoglycaemia. Plasma Free Fatty Acid (FFA) Concentrations As stated, the levels of FFA increase when insulin levels are low. In IDDM persons, metabolising their plasma FFA levels efficiently increases in importance as the intensity of the activity increases. On a study identifying FFA levels during exercise in an IDDM sufferer, Evans (2004) identified that ‘during prolonged exercise at a low intensity (40% of VO2 max ), FFA oxidation accounts for approximately 60% of muscle oxygen consumption’. The rate of FFA uptake is not dependent of insulin as such, but there are high levels of plasma FFA in hypoglycaemic IDDM sufferers.

The relationship between FFA levels, whether basal levels of a ketotic diabetic sufferer or of one poorly managing their condition, and its utilisation by working muscles has produced a plethora of research documenting their relationship. In non-diabetic suffers, an initial decline in FFA levels during exercise is expected to be followed by a gradual rise as plasma FFA as lipolysis occurs. 

In contrast to this, Evans (2004) stated that ‘persons with diabetes with marked hyperglycaemia and ketosis already show an elevated FFA level at rest, and the rise during exercise is more marked’. As a result of this greater availability of FFA, uptake of FFA by working muscles is increased. On this issue, Haire-Joshu (1992) stated that ‘in mildly ketonic persons with diabetes, a sevenfold increase in FFA uptake by muscles was shown, as compared with a three to four fold increment in non-diabetics’. 

Hormone Regulation During Exercise Although one of the fundamental principles of the IDDM form of diabetes mellitus is often the regulation of glucose due to the lack of insulin present to regulate glucose production, persons with IDDM diabetes may have a higher level of plasma insulin present. This in turn leads to a decrease in plasma glucose which also leads to an inhibition of both gluconeogenesis and glycogenesis due to the high insulin levels present.

The counterregulatory hormones, along with insulin, monitor glucose production, but even if the counterregulatory response is high ‘the hepatic glucose production cannot match the rate of peripheral glucose use, and blood glucose falls’ Haire-Joshu (1992). The counterregulatory hormones involved, mainly glucagon, play a large part in keeping a homeostatic glucose balance during exercise. Adrenaline, which reflects the ‘fight or flight’ sympathetic system activation, has been shown to be ‘of major importance in stimulating glycogenolysis in both liver and muscle and in stimulating lipolysis in adipose tissue.

An increase in response to high intensity exercise or declining blood glucose also stimulates hepatic glycogenolysis and lipolysis’. The use of other hormones, such as growth hormone, are less important to glucose control as they are less vital during short term exercise, but they become effective as the duration of the exercise increases. On this, Haire-Joshu (1992) stated that ‘growth hormone is less important in response to short-term exercise, but they increase lipolysis, decrease insulin-stimulated glucose uptake in peripheral tissues, and increase hepatic gluconeogenesis over longer periods of exercise’.

As shown, poor working of counterregulatory hormones, along with insulin production, are major effecting factors. The impact that poor counterregulatory hormone control can have has been highlighted by White (1994) who explored persons who exercise when in moderately poor control of their diabetes. After the resulting increase in glucoregulatory hormone secretion, he stated that ‘ insulin deficiency plus a high concentration of counterregulatory hormones enhances gluconeogenesis at levels 2 to 3 times those seen in nondiabetic persons, resulting in an exaggerated increase in hepatic glucose production and circulating plasma glucose concentrations’. 

Post-Exercise Glucose Levels

After exercise, at most intensity’s, muscle glycogen stores are mostly depleted. Replenishment of these stores can often take several hours, and begins with an increased insulin sensitivity of the exercised muscles. According to Rasta’s et al (2004), ‘whole body insulin sensitivity has been found to be increased for at least 48 hours following 1 hour of bicycling at a moderate intensity’. This resulting increase in insulin sensitivity will probably result in hypoglycaemia in athletes with IDDM.

The 48 hour duration post-exercise where a diabetic athlete is at risk of becoming hypoglycaemic without adequate intervention is one that was the basis of a study carried out by Evans (2004). He investigated the effects of different insulin adjustments in nine persons with IDDM. When hypoglycaemia occurred, it was noted 5 hours after exercise 5 out of 8 times. A similar study carried out by McDonald (1987) selected 300 young people with IDDM. Post-exercise hypoglycaemia occurred in 48 of the subjects during the two year study period. The incidence of hypoglycaemia varied from 3 to 31 hours after exercise, but was most common 6 to 15 hours after exercise. Hypoglycaemia 1 or 2 hours after exercise was relatively uncommon. He concluded by stating that ‘the incidence of hypoglycaemia varied from 3 to 31 hours after exercise, but was most common between 6 and 15 hours after exercise’ (McDonald 1987). The above study highlights the importance of taking on carbohydrates straight after exercise to replenish the spent stores. If none are ingested, they may become hypoglycaemic within 6, or even 31 hours of exercise. 

Conclusion

With one of the fundamental factors of diabetes being the management of glucose levels, diabetic athletes have to have a good knowledge of contributing factors in order to effectively control the condition. It has been shown that exercise is not to be avoided if you are a diabetes sufferer. In fact in NIDDM, it is of paramount importance in controlling the condition and the general poor lifestyle which may have contributed to its onset. The issue of exercise to an IDDM sufferer is less clear. It is the less common form of the condition and seems to be linked to ones genetics.

The condition is controlled by regular injections of insulin and adequate carbohydrate consumption. To a person exercising with the IDDM condition, the type of carbohydrate consumed is important as the GI of the food needs to be taken into consideration.

The time of ingestion of the carbohydrate is also a factor as research has been cited showing that the onset of hypoglycaemia can occur after 6 hours and up to 31 hours later. In IDDM, the inhibition of replenishing glucose stores leads to possible hypoglycaemia, or ketosis due to increased ketone levels in the blood, and this in turn leads to increased fat metabolism by the working muscles.

These adverse factors only occur from poor management of the condition, and exercise is not directly attributed to hypoglycaemia or hyperglycaemia. In summary, the body deals with the loss of insulin by placing a number of systematic processes in place in order to provide the muscles with the necessary fuel. These processes are all related to the metabolism of FFA to counter the lack of glucose present. Careful dietary control both in terms of what is consumed and when, is particularly important for diabetics when engaging in exercise.

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Exercise & Heart Disease Guidelines & Recommendations


For information purposes only. Exercise at your own risk

Overview – Exercise & Heart Disease

If you already have heart disease and/or issues with your heart, then it is crucial that you speak to your doctor before changing your physical acitvity levels. A doctor can review your ‘clinical status’ before giving you the all-clear. More information in this pdf here.


Physical inactivity is a major risk factor for developing coronary artery disease.

This disease occurs when deposits of cholesterol, calcium and other substances cause a narrowing of the arteries supplying blood to the heart.

Physical inactivity is associated with high triglyceride levels, low levels of HDL (good) cholesterol, high levels of LDL (Bad) cholesterol, high blood pressure and type 2 diabetes.

All of these factors increase an individuals risk of a heart attack and stroke. For example the high blood sugar levels associated with type 2 diabetes can cause damage to artery walls which in turn provide the foundations for cholesterol to deposit upon the wall.

As these deposits build up they can block blood vessels. People who are physically inactive are over twice as likely to develop coronary heart disease than their active peers. It is estimated that 20 million adults in the UK are ‘physically inactive’ (See the 2017 BHF report here)

walking for heart health
Walking is a great way to begin exercising

Recommendations / Guidance For Keeping Your Heart Healthy

(AT YOUR OWN RISK, always consult your GP first)

Even moderately intense physical activity such as brisk walking is beneficial when done regularly for a total of 30 minutes or longer on most or all days. Remember that exercise can be accumulated throughout the day. Gardening, cleaning etc all count as physical activity or exercise, as well as more formal classes etc. Remember that exercise has many benefits beyond simply enhancing CV health.

Bones and muscles become stronger, core stability is enhanced, it can help to maintain weight and also improve sleeping patterns. It improves both physical and mental health. Adults should aim to complete 30 mins of exercise on at least 5 days of each week. The intensity should be high enough so that you feel slightly warmer and so that you breath more heavily.

To start off with it should not be so hard that you can not talk. If 30 minutes is too hard, start off with 5 minutes and look to build up to 30 mins on most days within a month or two. Some activities may include brisk walking, swimming, cycling and/or gardening. Some safety points include: If you feel pain or a high level of discomfort then you should stop 

Increase the duration and intensity of activity gradually begin very gradually for the first two or three mintues of an activity 

Do not exercise if you are unwell 

Wear a helmet if cycling and walk in well lit areas at night 

Talk to your GP first, especially if you are taking any prescription medication. 

Designing yourself an Exercise Programme


If you’re planning on getting fit, then why not design yourself a programme. This often helps organise your exercise and helps to prompt and motivate you to begin your regime.

Programmes generally include the Frequency, Intensity and Duration of each activity session. However, for most simply writing in your diary to walk 30 minutes on Wednesday morning is a good start. 

Frequency (how often) and Duration (time of each session) are pretty self explanatory. However calculating intensity is a bit more tricky. Intensity can be calculated using Rate of Perceived Exertion – usually from 1 to 10: 

Please be aware that another version of the Borg scale rates exertion from 1 to 20 and not 1 to 10 as shown above!



Percentage of VO2Max or percentage of maximum Heart rate. 


Percentage of Max HR is probably the most commonly utilised amongst recreational exercises, however, the calculation of maximum heart rate is not particularly accurate, unless you have a proper test done in a sport science lab. The easiest and most well known way of calculating your Max HR is to minus your age from 220. there are a number of other ways:
http://www.brianmac.co.uk/maxhr.htm

For most people it would be a good idea to start of with an exercise intensity of around 6 on the Borg Scale (although you should discuss this with your doctor). Many forms of exercise, including weight training have been shown to decrease the risk of heart disease. 
http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid;=12387651&cmd;=showdetailview&indexed;=google 

whilst low intensity exercise is perhaps safer in the short term for a previously sedentary individual, there is some evidence that higher intensity exercise can have greater benefits to cardiovascular health 
http://www.ajcn.org/cgi/content/abstract/75/5/818 

Exercise for Cardiovascular Disease – Conclusion

·Benefits of Exercise High blood pressure — Regular aerobic activities can lower blood pressure.

·Cigarette smoking — Smokers who become physically active are more likely to cut down or stop smoking. 

·Diabetes — People at their ideal weight are less likely to develop diabetes. 

Physical activity may also decrease insulin requirements for people with diabetes.

·Obesity and overweight — Regular physical activity can help people lose excess fat or stay at a reasonable weight. 

·High levels of triglycerides — Physical activity helps reduce triglyceride levels. High triglycerides are linked to developing coronary artery disease in some people. 

·Low levels of HDL — Low levels of HDL (“good”) cholesterol (less than 40 mg/dL for men/less than 50 mg/dL for women) have been linked to a higher risk of coronary artery disease. Recent studies show that regular physical activity can significantly increase HDL cholesterol levels and thus reduce your risk. other benefits of physical activity 

·Physical activity builds healthy bones, muscles and joints, and reduces the risk of colon cancer. Millions of Americans suffer from illnesses that can be prevented or improved through regular physical activity. 

·Physical activity also helps psychologically. It reduces feelings of depression and anxiety, improves mood and promotes a sense of well-being. 

·The 1996 Surgeon General’s Report on Physical Activity also suggests that active people have a lower risk for stroke.

“Specifically, a direct connection has been found between exercise and lower death rates from heart attacks, stroke, high blood pressure, non–insulin-dependent diabetes, brittle bones, some cancers, anxiety, and depression”

https://www.ahajournals.org/doi/10.1161/01.CIR.94.9.2045

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Exercise & Type II Diabetes


For information purposes only. Exercise at your own risk

Due to the increasing prevalence of sedentary lifestyles and diets high in sugar, type II Diabetes is rising among the UK population at an alarming rate. Whilst many people rely on drugs for many years, diet and exercise have been proven to be a much more effect intervention than drug therapy.

The main signs of type II Diabetes are fatigue, weight loss, nausea, the frequent need to urinate, constant thirst, blurred vision, frequent infections and wounds that are slow to heal. It’s vital that you consult your doctor immediately if you experience any of these symptoms, as left untreated, diabetes can cause kidney damage and heart disease.

If your body continual receives/consumes high levels of refined carbohydrate, the body’s hormone insulin, becomes more and more insensitive to a rise in blood sugar.

This means that carbohydrate, and other macronutrients, are less readily converted into fuel stored within the body.

With type II diabetes, too much insulin is produced and the body does not make effective use of it. This is known as insulin resistance and prohibits glucose from entering the muscle cells. In turn, glucose rises to abnormal levels in the blood. Thus, type II diabetics are non-insulin dependent.

Type II diabetes, unlike type I, which is genetic, is a degenerative illness that invades unhealthy bodies, usually those overweight. Because most people with type II diabetes don’t begin to think about their health until the disease is diagnosed, the same techniques used for prevention – a healthy diet and regular exercise – are used to control its advance. 



Prevalence of Type 2 Diabetes

Approximately nine out of ten cases of diabetes in the United States are type II and most commonly affect people over the age of 40.Goals of therapy for type II diabetes Type II diabetics must regulate their glucose levels to help reduce the onset of complications from this disease.

If unchecked for extended periods, elevated glucose levels lead to heart disease, kidney failure, blindness and nerve dysfunction.

Therefore, type II diabetics must modify their nutritional habits, as well as physical activity levels.How does exercise help? For type II diabetics, diet and exercise can normalize glucose levels.

It is important for type II diabetics to lose weight to improve glucose control and insulin effectiveness. Also, many health-related outcomes of physical activity (e.g., lowering blood pressure, favorable lipid and lipoprotein changes, body weight maintenance) are part of the exercise therapy.



What exercise is recommended?

Type II diabetics should exercise a minimum of five to six times per week. Exercise should be performed at a low intensity for about 40 to 60 minutes. Walking is highly recommended for type II diabetics. Other non-weight-bearing activities should also be encouraged (e.g., water aerobics and cycling).

In addition to aerobic exercise, type II diabetics should engage in strength training and flexibility exercises as well.

Exercise & Diabetes – What are the precautions?

There are lots, because there are lost of complications with diabetes. But remember, these will only get worse if you do not exercise or diet.

Persons with neuropathy should avoid activities that cause systolic blood pressure to rise to 180-200 mm hg (systolic is the first reading on a monitor). Those with later stages of renal disease should participate in lower intensity exercise with physician approval.

Those with retinopathy should limit systolic blood pressure to 20-30 mmHg above baseline during each training session. Autonomic neuropathy interferes with the heart rate regulation by depressing maximal heart rate and blood pressure, and increasing heart rate. Phsical activity for these persons should focus upon low level daily activities, where mild changes in heart rate and blood pressure can be accommodated. 

Peripheral neuropathy affects the lower legs and feet, and results in loss of sensation. Non weight bearing activities should be performed. Proper foot wear should be worn for daily activities and feet should be examined daily.

Nephropathy. It remains unproven whether exercise induced blood pressure changes exacerbate the progression of nephropathy. If you suffer from this it Is best to consult your GP. (as you should anyway).Type II diabetics should monitor their glucose before and after exercise to understand how they respond to certain types of activities. Also, exercising with a partner and wearing an ID bracelet that indicates one’s diabetic condition are important. type II diabetics should see their physician prior to beginning a physical activity program and should return regularly to assess the status of diabetic complications. If complications of the eye, kidney or heart are present, it is important that a physician give clear boundaries regarding the intensity of any physical activity.

A lovely picture of a neuron

Some Suggestions: If you’re not too keen on going blind or getting a premature heart attack then you need to be exercising. It is recommended that resistance training be performed at least twice a week as part of a well rounded programme.

A minimum of 8 exercises involving major muscle groups should be performed with 12 – 15 repetitions near to fatigue. Caution needs to be adhered to especially with resistance exercise due to the short term increases in blood pressure that can occur. Limiting the amount of isometric exercises and sustained gripping, overhead lifting and using a sensible intensity will help avoid problems.

Risks and complications of Exercise

Moderate intensity exercise increases glucose uptake by 2-3 mg/kg/min above usual requirements. Six to 8% carbohydrate solutions are absorbed better and cause less stomach distress than regular soft drinks and fruit juices, which are 13-14% carbohydrate. Hypoglycaemic reactions in connection with exercise in persons with type 2 diabetes are rare, occurring mainly in persons being treated with sulfonlurea oral medicationsInitially those with type 2 diabetes should engage in physical activity for 10-15 minutes each session. 

Ideally it is recommended that this be increased over a couple of weeks to 30 minutes. Alternatively 30 minutes could be accumulated by undertaking 3 x 10 min bouts of exercise during the day.

When weight loss is the desired goal, individuals should build up to an hour of low to moderate intensity exercise, in order to achieve a significant amount of energy expenditure.Walking is often undertaken as the mode of exercise, as it is low intensity, and safe for most populations.

However those with peripheral neuropathy or arthritis should look to do non weight bearing exercise like cycling, swimming or aquatic activities.At least 3 or optimally 5 days a week should contain physical activity sessions.

The acute effect of exercise on blood glucose lasts 72 hours post session; therefore to maintain these acute benefits, diabetics should exercise on a regular basis. Intensity may be difficult to gage with diabetic individuals, due to autonomic neuropathy.

Therefore it may be beneficial to start to exercise under supervision, until a comfortable but beneficial exercise intensity can be established.Physical activity programmes for diabetics should include appropriate endurance and resistance exercise, this will help ensure calorie expenditure, an increased insulin sensitivity, cardiorespiratorty fitness and muscular function and strength. Light stretching should also be included post exercise 

See our article regarding Exercise & High Blood Pressure

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How Do MMA Fighters Make Weight – Legal & Illegal Ways


Making Weight is Dangerous – Hire a professional. Article for information purposes only

To become a great fighter in the ever-evolving world of MMA, an individual requires a very specific blend of psychological and physiological abilities and skills. All modern day martial artists are superb athletes and physical proficiency structures the foundation of every distinguished champion. A fighter will only have potential if he possesses the base attributes of speed, strength, stamina, power, agility and the neuromuscular coordination and ability to acquire new skills and techniques that are required to stay at the top of the game. In addition, a fighter must posses the desire and dedication to train relentlessly everyday, and the focus and intelligence to maximise his performance within the unforgiving walls of the MMA cage. 

Without a doubt, the likes of Randy Couture (back in the day), Yoel Romero and GSP possess all of the qualities listed above; they are superb athletes who display awesome technical skills as well as drive, determination and focus. These characteristics form the basis of their success, but this alone is not enough to make it to the top of the sport, and there are a number of other important factors which must be accounted for. Top MMA fighters have sport scientists, physiotherapists and nutritionists to advise them on such peripheral, yet crucial factors; one of which is ‘making weight’. Fighters not only have to be in great condition, they have to make a chosen weight class whilst retaining the capacity to fight to the best of their ability. Being able to drop 10-15lbs over a 48-hour period is perhaps one of the most dangerous aspects of the sport, whilst becoming completely hydrated and glycogen loaded in time for the fight is extremely difficult and equally as perilous. A well-planned and researched weight loss strategy can make the difference between winning and losing, even life and death. 

In boxing, when Arturo Gatti signed to fight Joey Gamache at welterweight in 1999, HBO announced that Gatti had put on a staggering 19lbs since the official weigh-in. The Canadian boasted a frightening 16lbs advantage over Gamache. For a welterweight this represents an extra 10% of body mass – an enormous amount. Gatti was teeing off at will, and a series of frightening knockdowns later, Gamache was left KO-ed on the canvas. He later announced he would never fight again, in a similar fashion to Gattis’s previous under-weight victim Reyes Munoz. Gatti’s ability to lose weight rapidly had obviously given him, quite literally a massive advantage over his opponents. However his victory over Gamache sparked a huge amount of discussion and investigation into the possible merits of weighing in the day of the fight rather than 24+ hours before. Although the potential dangers of severe dehydration were acknowledged, nothing was done to prevent the trend of boxers who employed dangerous rapid weight loss techniques to gain a size advantage. This may have had fatal repercussions. 

It has been suggested by many that the untimely and mysterious death of Panamanian boxer Pedro Alcazar may have been due to his rapid weight loss and ensuing weight re-gain. Alcazar death was caused by swelling of the brain, which could well have been related to an extreme amount of dehydration to make weight and subsequent rehydration for the fight. Alcazar, like many other fighters, may have been tempted to fight in a lower weight category by the prospect of having a size advantage over his opponent. His example, serves as a warning as to how dangerous this temptation can be. Attempting to loose weight rapidly is even more dangerous if a fighter does not have the knowledge or support staff to guide him/her. Weight loss is a science in its self, which should be well researched, planned and constructed to the specificities of an individual. 

Early Weight Cutting in the UFC

In 2003, when Randy Couture first entered the octagon as a light heavyweight contender, he had reduced his fighting weight from 227lbs to 205lbs over a 3-month period. Manipulating his weight to the precise pound would have required a strategy for long-term and short-term weight loss.

For long term weight loss, a nutritionist or dietician can offer a plan for modifying the diet after an athlete has undergone body composition analysis and evaluation of his/her current diet. The only legitimate way to reduce body weight in the long term is to reduce caloric intake and/or increase caloric expenditure through physical activity (or to some extent supplementation).

The degree of energy restriction required to induce weight loss, will depend on body size, typical energy intake and expenditure, and the period allotted for weight loss. In general, reducing energy intake by 10-15% may be all that is necessary if an athlete is exercising daily. Tapering the caloric deficit and/or manipulating the time period during which the athlete is in negative energy balance can control the amount of weight loss induced. Creating a negative energy balance – consuming fewer calories than is expended through basal metabolic rate + physical activity – is the only way to induce a weight loss which will remain over a period of weeks, rather than hours. 

A Little Help With Weight Loss (illegally)

There are a number of ways to catalyse long term weight loss and help to prevent associated muscle atrophy. Unfortunately many of the most effective methods involve the consumption/injection of banned substances, including anabolic steroids. One of the most commonly used illegal drugs is ephedrine. Ephedrine is a central nervous system stimulant and increases an individual’s metabolism by about 3%. It is often stacked with caffeine and aspirin to form a compound often referred to as ‘ECA’.

The theoretical ratio is E:C:A=1:10:4. The E and C work together to promote weight-loss, boost energy and enhance athletic performance. Aspirin is there just to prolong the effects created by the other two ingredients. ECA also has some anti-catabolic properties, which means that an athlete can retain a lot more muscle even while ‘cutting’. Side effects of ephedrine include anxiety, shaking, increased sweating, light-headedness, dizziness, light headache, gastrointestinal distress, insomnia, irregular heartbeat, increased heart rate, heart palpitations, stroke, seizures and psychosis. 

ECA works best when cycled with another drug called clenbuterol. Clenbuterol is a Beta 2 Sympathomitetic and CNS stimulant. It is used in certain countries in a medical sense as a bronchodilator for the treatment of asthma. Athletes utilise the drug due to its thermogenic and anti-catabolic (muscle sparing) effects. This is down to its ability to slightly increase the body’s core temperature, thereby raising calorific expenditure. It is thought that a 1°F increase yields around a 5% increase in maintenance calories burned. It is either used on a 2 day on, 2 day off protocol or 2 weeks on 2 weeks off protocol. It should NOT be taken in conjunction with ephedrine, it should be cycled i.e. taken during the 2 weeks off. Side effects are similar to those experienced with ephedrine and is therefore potentially fatal. 

In recent years athletes have also begun to use thyroid drugs such as Cytomel in their quest to loose body fat. Obviously these drugs influence the thyroid gland to promote fat loss. Thyroid hormones are often referred to as the metabolic regulators of the body.

High levels of Cytomel speed up the metabolism of an individual, allowing him to burn more calories and use calories more sufficiently. Both hyper-and hypothyroidism can have severe consequences on an individual, such as goiters (enlargement of thyroid gland) and other nasty stuff. In addition, misuse of this compound can leave you dependent on exogenous thyroid hormones for the rest of your life. So some caution and research is required before putting Cytomel in your body. Generally cycles should be limited to 4-6 weeks tops, many bodybuilders recommend 3 weeks of use at a time and alternating cycles with 3-week cycles of clenbuterol.

It is also important to taper doses up and down during a cycle to avoid a massive ‘crash’ when you come off. Other illegal drugs such as DNP (2,4-Dinitrophenol) exist but are extremely, extremely dangerous and have mad side effects. DNP causes the body to uncouple oxidative phosphorlylation from ATP production. In essence, normally, people metabolize food to produce energy (ATP). DNP causes the body to metabolise food but instead of producing energy (ATP), heat is generated; so much heat that the organs can actually cook in the body! So, if you don’t mind liquefied organs, DNP will help melt away body fat, literally. Quality! Oh, and your body can’t tolerate many carbs which is not ideal when you are training hard. So I definitely would not recommend this one, although I am sure many bodybuilders would! 

There are also a number of legal supplements that are generally less effective but a lot safer. These include Conjugated Linoleic Acid (CLA), Yohimbine, Octopamine, Tyramine, Green Tea, Synephrine, chromium and Caffeine. Few nutritional supplements advertised to “burn fat” have ever been proven effective. Only two nutritional supplements, chromium and pyruvate, have undergone scientific scrutiny as weight loss agents – but in obese subjects, not athletes. Creating a negative energy balance remains the most effective strategy for weight loss, and supplementation of any sort should not be necessary. So if you want to stay nice and healthy, you need to scrutinise and manipulate your diet so that you are consuming less calories than you expend. 

Weight Loss with Dehydration

Whereas long-term weight loss can be a relatively safe and healthy procedure, rapid weight loss can never be. Rapid weight loss can have many effects upon a person, all of which influence athletic performance. Increased levels of food restriction during the two weeks preceding the contest can accelerate weight loss. Reducing carbohydrate intake can cause a significant drop in bodyweight because it is stored with water.

However food restriction can’t cause a 5 or 6 pound drop in several hours like is often seen in the wrestlers, boxers and MMA fighters who rely on dehydration to make weight. A number of publications have addressed this issue, including the Position Stands of American College of Sports Medicine (ACSM) on Weight Loss in Wrestlers, and Exercise and Fluid Replacement. In severe dehydration, i.e. >5% weight loss, physiological systems are progressively compromised and the risk for cardiovascular or renal problems is increased. Athletes and individuals who are heat adapted may tolerate dehydration better, but the effect if any, is small. 

Severely dehydrated athletes will experience reduced blood and plasma volumes, cardiac function during submaximal work (e.g., higher heart rate, smaller stroke volume, and reduced cardiac output), thermoregulary capability, and renal blood flow and renal filtration. Without sufficient fluid in the body, the ability to cool the body by sweating is compromised, thereby increasing the risk of heatstroke. These factors can lead to poor performance, but more importantly can endanger the athlete’s life. Combined with restriction of energy (caloric) intake rapid weight loss can also lead to cardiac problems, reduced immune function, pancreatitis, and kidney impairment and damage. 

Sodium loading and depletion is a technique for dehydrating the body that originated from bodybuilding. The explanation of this technique is a bit hard going, but please try and bear with it. Sodium causes the body to retain water. In the body sodium is present in large quantities compared to potassium and other ions. As a result the body’s cells are always trying to pump sodium out and take potassium in. To do this, there are what is called sodium potassium pumps. So sodium is constantly pumped out and potassium is constantly pumped in. For every 3 molecules of potassium that come in 2 sodium molecules are pumped out. When an individual loads sodium, the sodium pumps have to work harder to pump out all the sodium that comes into the cell. Then when the sodium intake is reduced, the body will continue to pump out sodium at that fast rate. Less sodium inside the cells, means less water retention and thus a lower body weight. Hope you followed! Unfortunately sodium is vital for muscular contraction, and therefore any sodium restriction must be embarked upon with caution. 

Dehydration & Illegal Drugs for Weight Cutting

With large fluid losses during the dehydration process, there will also be electrolyte losses, which could further affect muscle function and plasma volume and result in muscle cramping. Despite this athletes often resort to the use of diuretics to further increase weight loss. Diuretics such as Lasix are often used. Lasix is prescribed to reduce swelling in the body caused by congestive heart failure, liver disease, or kidney disease.

Chemically, it is 4-chloro-N-furfuryl-5-sulfamoylanthranilic acid. The active ingredient is Furosemide and it is available as white tablets for oral administration in dosage strengths of 20, 40 and 80 mg. Taking just one or two 40mg tablets can result in fluid loss of between 5 and 8lbs. It goes without saying that this is extremely dangerous. A legal diuretic is dandelion root, although legal does not mean safe! Dandelion is sometimes used for treating high blood pressure or poor digestion by stimulating the circulation of blood to the body. Dandelion also has some anti-inflammatory properties which may help alleviate inflammation and muscle spasms, plus it acts as a mild laxative relieving constipation. Dandelion, contains a high concentration of potassium, therefore it will not deplete the body of potassium as much as some other diuretics when used for weight loss. A typical dosage of dandelion root is 2 to 8 g 3 times daily of dried root; 250 mg 3 to 4 times daily of a 5:1 extract; or 5 to 10 ml 3 times daily of a 1:5 tincture in 45% alcohol. The leaves may be eaten in salad or cooked. 

For some athletes, diuretics alone are not enough, and other, even more extreme methods may be employed. Glycerine suppositories are allegedly used in some sports to loose an extra 2 or 3lbs of bodyweight. Glycerine suppositories pull water from the intestines, into the stool, and stimulate the intestines to expel the faeces. Yes, you shove them up your ass then wait to do a monster turd! Not for me thanks.

Moving on…Preparation H. This is used by many body builders to remove water from specific areas. Allegedly the yeast cell extract it contains draws water out from under the skin. However, this is impossible to verify, there is no research to support this theory, and I wasn’t up for testing it on myself (sorry). Something to consider is colonic irrigation (seriously!). It is said to remove pounds instantly by clearing years of built up undigested waste from the intestines. But this would not be something to try the day before a fight! Ideally all weight loss strategies will have been pilot tested months before the fight.

A fighter needs to establish a long-term weight management plan months before a fight. It is also important that the effects of weight loss are monitored. This includes effects on cognitive (e.g. concentration) and emotional (e.g. moods) functioning, stress on relationships, and physiological effects should as resting heart rate and blood pressure. Obviously weight itself should be monitored frequently so that it is either decreasing at a steady rate, or not increasing at all. As for rapid weight loss, several studies have shown that after severe dehydration even using the most optimal replacement fluids, rehydration takes 24 hours or more. Likewise, after fasting, restoration of energy stores can’t be accomplished in a day. The athlete and his support team should consider this carefully. 

Well, there we have it. I hope that this article has been both informative and enjoyable to read. Weight loss is a serious business that should not be overlooked or dismissed as simply skipping for a few hours in 10 layers of waterproofs. Have a long term plan, stick to it, and don’t do anything stupid! 

Disclaimer – I wrote this article for a MMA Magazine in 2004. I don’t recommended anything mentioned above!

A specific weight loss (legally) manipulating water consumption:

MMA Fighter’s Weight Loss Diet


To lose around 15lbs in a week (depending on current weight -remember this should be done with medical & professional supervision)

6 Days out from the weight in:

Day 1:
Increased water consumption

This effects the regulation of aldosterone. The hormone which influences water retention and sodium:

Drink 9 litres of water (some people recommend distilled water)

Eat around 50-60g of carbs

Eat plenty of protein and fats, within 3 or 4 meals, no snacks

Plenty of organic veg, omega 3 etc.  You’ll need nutrient dense food to stop you feeling too run down.

No Salt

Day 2:
Drink 4 litres of water

Eat around 50g of carbs

Plenty of protein and fats, within 3 or 4 meals, no snacks

No Salt

Day 3:

Drink 4 litres of water

Eat around 50g of carbs but no starches or refined sugar

Plenty of protein and fats, within 3 or 4 meals, no snacks

No Salt

Day 4:

Drink 2.5 litres of water

Eat around 50g of carbs but no starches or sugar

Plenty of protein and fats, within 3 or 4 meals, no snacks

No Salt

Day 5:

Drink 2.5 litres of water

Eat around 20-40g of carbs but no starches or sugar

Plenty of protein and fats, within 3 or 4 meals, no snacks
last meal by 6pm

No Salt

It is generally agreed that you should be about 3-6lbs over your weigh-in weight, the time you go to bed before the night before the weigh-in.

Weigh in Day:

2 very small meals

less than 10g of carbs

No water or salt until weigh in

Weight Loss through Sweating – VERY dangerous and potentially damaging to performance

Be aware of physical effort and energy expenditure if making weight for a fight.

You can do low intensity cardio wearing heavy or waterproof clothing the day of your weigh in.

Weigh yourself at 5 minute intervals.

You can soak in a hot bath the night before the weigh in.  Weigh yourself at 10 minute intervals.
Put everything in the water, except for your mouth and nose.  Towel off after each interval and weigh yourself, do not shower, as this can make you gain more weight.
Take 5-10 minute intervals between 10 minute bouts in the bath.

MAKE SURE YOU HAVE PROFESSIONAL SUPERVISION

This weight loss is short-term only

See our article on Boxing Nutrition & Boxing Diet Plans By Clicking Here

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Spinal Injuries in MMA & Other Contact Sports


Spinal Injuries: Part 1

For information purposes only. Exercise at your own risk. Always consult a doctor if you sustain an injury

Neck (Cervical Spine) Injuries 

In this 3 part blog post, we will be taking a look at the most common spinal injuries that can arise from both MMA training and competition. Due to the structure of the spine and the nature of spinal injuries we shall divide the spine into its three natural anatomical areas; the neck (cervical spine), the mid back (thoracic spine) and the lower back (lumbar spine). 

mma injury



The Neck 

Function The function of the neck or cervical spine is to support the head, house and protect the spinal cord and allow a wide range of head movement (e.g., forward and backward movement bending side to side and rotation.) 

Anatomy 
Vertebrae and Discs 

The cervical spine is made up of seven individual vertebrae stacked on top of each other to form the top section of the vertebral column. In between each one of the vertebrae is a gel-like disc (intervertebral disc) which allows movement, helps to absorb shock, distributes stress, and keeps the spine in correct alignment. As you age your discs slowly degenerate and cause the vertebrae to get closer together. The spine, like any other articulations in the body (elbow, knee, shoulder etc) also has joints and these are known as zygoapophyseal joints (or facet joints for short!). Each vertebra has two pairs of facet joints that link the vertebrae together with the one above and below. The facet joints are located at the rear (posterior) of the spinal column. It is the facet joints that help to make the spine flexible. Muscles, Tendons and Ligaments 


Surrounding the bones and discs are a complex system of ligaments, tendons, and muscles which help to support and stabilize the cervical spine. Ligaments are inelastic bands of fibres that prevent excessive spinal movement that could result in serious injury. Tendons attach the muscles to the bones and the muscles control movement as well as providing stability and balance. 

Central and peripheral nervous system

The movement of the muscles is controlled by nerve impulses that originate in the brain and are sent via the spinal cord to the nerves of the body. The nervous system itself is split into two major regions: the central nervous system (CNS) and the peripheral nervous system (PNS).

The CNS consists of the brain and spinal cord whilst the PNS consists of the nerve roots and all nerves beyond the central spinal cord. The CNS and PNS are responsible for all movement in the body. As the spinal cord is a major part of the CNS and the vertebral column houses and protects the spinal cord the spine is an area you want to avoid injuring at all costs! 


Neck Injuries 


There are a number of ways to develop neck pain (or cervicalgia) but in the case of most MMA practitioners we can rule out degeneration with age as by the time this occurs your training should not be in the combative arena! If you are a more senior practitioner however and you have been suffering with long standing neck pain, degeneration of the neck joints (or spondylosis) may be the culprit and advice from your GP or Chartered Physiotherapist is essential if you wish to continue to train. 
Cervicalgia as with all areas of the spine may be Acute (recent) or Chronic (longstanding). Acute injuries of the neck will tend to be soft tissue injuries (STI) which covers basically everything that isn’t bone. Fractures of the cervical spine do occur but thankfully are rarer than most people would think in MMA

Acute Injuries 
The most common ways to incur acute neck injuries in MMA will be from head strikes, landing during throws and takedowns, neck “cranks” and of course chokes. Strikes to the head are also responsible for a large number other problems such as facial fractures, lacerations, abrasions, haematomas and loss of consciousness (LOC). These other injuries are beyond the scope of this article however and will be covered at a later date when we examine head injuries in MMA. The same is true for chokes as only the effect on the neck will be discussed and the effect of LOC will be left for another time. 

The most common type of acute injury occurring in the neck in the general population tends to be whiplash. In whiplash the head is literally whipped in one direction and then another, rapidly overstretching and compressing the opposing soft tissues of the neck. This traumatises the neck causing pain, swelling, stiffness and spasm in the neck muscles and possibly headaches and nausea (if you’ve ever been in a car crash you’ll know what I mean!).

Similar injuries can occur with strikes to the head (especially a high Thai round kick to the side of the neck or head) or from throws (suplex onto the back of the neck). Trauma from striking can damage muscles, tendons and ligaments. Trauma to ligaments tends to cause persistent problems and will nearly always require physiotherapy intervention to recover full pain free range of movement.

Trauma may also occur with a choke but this is usually from compression of one of the bones of the forearm (Radius) against the soft tissues of the neck. This not only reduces the flow of blood to the brain by compressing the Carotid artery but may also cause bruising (haematoma) of the surrounding soft tissues by rupturing smaller blood vessels. The bruising from a choke (which is technically a “strangle”, as a “choke” limits the intake of air whilst strangulation limits flow of blood) is short lived and fairly harmless but just looks bad! The major damage caused by a choke is actually internal to the brain and can neither be seen nor treated once the choke has occurred! So tapping out before unconsciousness arrives is usually a good idea! 

neck massage


If in the days following a neck injury you have weakness, pins and needles, numbness or burning in one or both arms you need to seek advice and assessment from a Chartered Physiotherapist ASAP. If any limb becomes paralysed or you suffer any of the above symptoms immediately following a neck injury during training or competition then get yourself to A&E; ASAP and get checked out for disc or nerve damage. Any alteration in sensation or function following a neck injury suggests nerve involvement and although the spine is very strong, its internal structures are very delicate and extremely important for normal function.

There’s a very good reason why a number of neck cranks and elbow strikes to the spine are outlawed in a lot of MMA promotions! Don’t be alarmed at A&E; if they’re not concerned about X-raying your neck following an injury, as true dislocations or fractures of the vertebrae are very rare and usually occur in sports like motocross or show jumping (remember Christopher Reeves?). More likely to occur however is the chipping of bone or compression (or wedge) fractures of the cervical spine and possible disc protrusion but these usually take some force, like being dropped on your head from a great height….more WWE than UFC! 

Bob Sapp
Bob Sapp Slamming Big Nog



With the exception of bruising all neck injuries that persist beyond 24 hours should be checked out by a Chartered Physiotherapist to evaluate the injury and advise on subsequent treatment, rehabilitation and strengthening. 

Chronic 
Neck pain that has been around for more than a few weeks or has occurred without any injury (insidious onset) will often be biomechanical in origin. This means postural i.e. the way you sit, stand and move about. It has been estimated that 85% of neck and back pain is from postural dysfunction and only 15% of neck and back pain is from traumatic injuries. This figure may be slightly different in MMA but as most practitioners of MMA are amateur and not pros then they have to work for a living at something else during the day. 40 hours at a desk, sitting in a van or working over a bench will give you a neck problem in no time at all. An underlying neck problem like this will soon start to impact on your training if not remedied. Again any neck pain that persists, whatever the cause should be assessed and treated. You’ll pick enough injuries up training MMA without getting anymore from work! 

Assessment 
If you have suffered a neck injury or have neck pain or stiffness then see a Chartered Physiotherapist and get the problem assessed. When dealing with neck injuries avoid the advice of mates down the pub or even in the dojo (even if they do mean well!). The neck is as about as important as it gets when we are looking at the musculoskeletal system so get it treated properly 1st time around. Assessing the problem correctly is paramount to successful treatment. Remember that neck pain is a symptom and not actually a diagnosis! 

Treatment 
As with all uncomplicated STIs, PRICE(MM) is the favoured approach. The Protection, Rest, Ice are fine but Compression may not be the best idea around the neck for obvious reasons! The Elevation occurs naturally because of the location of the neck anyway. Medications and Modalities (physical treatments) should be sought from your GP or Chartered Physiotherapist if the pain persists more than a few days. 


If pain from the injury persists beyond 24 hours it’s a good idea to start to increase the movement in that area gently. In a national study of people suffering from whiplash injuries, those who began gentle range of movement exercises a few days after injury made a better recovery than those that didn’t. 

Most treatment plans for the neck will include manual therapy (manipulation and mobilisation), exercises (gentle bending and rotation of the neck) and modalities such as electrotherapy (ultrasound) or acupuncture (for pain and inflammation). All these treatments however are injury specific, so again assessment is very important. 



Rehabilitation of Neck Injuries

 
As always one of the major goals of rehabilitation is to maintain your cadiovascular fitness levels, so for instance when you suffer a neck injury try avoiding the continued impact of roadwork, try aqua jogging with a flotation belt (running upright in a swimming pool without your feet touching the bottom of the pool). As a word or warning avoid swimming though, as the extended position of the cervical spine tends to aggravate neck problems.

You, your coach/trainer and your physio should work together at devising alternative training programmes as soon as possible particularly if you are a competitive fighter. In addition to cardiovascular fitness, you may use the injury period as an opportunity to strengthen weaker areas whether they be physical, mental, technical or tactical.

Your physical rehab plan should include exercises to restore normal strength using progressive resistance exercises and then continue to further develop strength in that area to protect it from possible future injury. In addition in the later stages rehab you should include some combat-specific drills (with an emphasis on proper technique). Both boxers and wrestlers usually have tremendous neck development. It enables boxers to take a punch and wrestlers to bridge their bodyweight without additional support from the arms to avoid being pinned.

Performing a wrestler’s bridge can be a great exercise for developing strength in the neck but it can also be a great way to injure the neck! This is a technically and physically demanding exercise and should only be attempted under close professional supervision.

neck injury mma

Some training facilities will use a head harness with an attachment for free weights to work the neck. The main problem with this is it relies on moving the weight against gravity so the resistance is variable through the exercise depending on your position (you usually have to lie down or bend over to exercise). This also means that if you injure your neck whilst training you still have a weight hanging off your head whilst in an awkward position!

Strength however can be built up in the neck using isometric exercises for resistance. It’s usually easier to use either your hand against your head as resistance or a towel held in both hands, or even a soft ball against a wall. As an example; 1) place your palm of your right hand against your forehead, 2) without allowing your hand to move push your forehead against your hand, 3) continue for 10 seconds remembering to breath throughout, 3) repeat for a few sets and you’ll soon feel the difference in your neck muscles. If at anytime you feel any discomfort just stop pushing so there is no risk of additional injury during your rehabilitation.

This exercise can be repeated in different directions and angles around the head with either one hand as resistance or a towel held between both hands either side of the head with the head pushing into the middle of the towel. As also mentioned that instead of using your hand a ball (a cheap kid’s football is ideal) can be placed against a wall and the forehead pushes into the ball creating resistance with some give in it for comfort and safety. 

It must also be appreciated that the power, speed and angles which occur during competition may far exceed the criteria for successful completion of rehabilitation exercise. To be ready for competition you must perform over and above what you are required to do in competition. 

Return to Training/Competition 
Depending on the severity of the injury, it may take several months of physical therapy for you return to full training or competition. The differing types of neck injury makes for a wide range of recovery and rehab times. Muscular injuries may be days to weeks whilst ligament injuries often take months to rehabilitate and a fracture or disc injury may prevent a return to full MMA competition permanently even after many months of rehabilitation.

As always two key factors exists for return to full training/competition; firstly the risk of re-injury and secondly the ability to fight/perform at a satisfactory level. These factors are often intertwined. When there is a risk of re-injury, the potential for further or permanent damage must also be considered and in the neck permanent damage can have a huge impact on the rest of your life. The criteria for return to competition after a neck injury include restoration of normal strength, flexibility and stability. With biomechanical problems it is important to identify the specific activity that caused the initial injury so that activity can be avoided or training or postures modified. Avoidance steps may include changing technique, training habits, and equipment, and modifying posture and ergonomic practices at home and at work as well as during training. 

This is just a brief outline of the neck injuries you may incur during MMA training and competition and a rough guide to treatment and rehabilitation principles. If you have any specific neck or spinal problems you will need to seek first hand advice, assessment and treatment from an experienced sports injuries Chartered Physiotherapist. 

Check out parts 2 & 3 in this series: Mid Back (Thoracic Spine) and Rib Injuries & Lower Back (Lumbar Spine) Injuries 

This article is for the purpose of information only and it is not intended to diagnose or treat medical conditions and is not considered to be a substitute for individual medical assessment and advice.

iron neck

Click here to read about the Iron Neck Machine





Spinal Injuries: Part 2

For information purposes only. Exercise at your own risk. Always consult a doctor if you sustain an injury



In this series of 3 articles we will be taking a look at the most common spinal injuries that can arise from both MMA training and competition. Due to the structure of the spine and the nature of spinal injuries we shall divide the spine into its three natural anatomical areas; the neck (cervical spine), the mid back (thoracic spine) and the lower back (lumbar spine). 

The Mid Back & Injuries



Function 
The function of the mid back or thoracic spine is to support the trunk, form the rear of the rib cage, create attachments for the trunk muscles for movement and respiration (breathing) and protect the spinal cord. Due to the fact that the ribs attach to the thoracic spine movement in this region is limited to some degree. 

neck



Anatomy 
Vertebrae, Ribcage and Discs 
The thoracic spine is made up of twelve mid-sized vertebrae stacked on top of each other to form the midsection of the vertebral column (between the cervical and lumbar spines). Attached to each of the twelve thoracic vertebrae on each side is a rib making twelve matching pairs (Contrary to popular belief you don’t have a spare one!). The ribs curve from the spine towards the front of the body and join at the breast bone (sternum) at the front of the rib cage.

The ribs form a joint with the thoracic vertebrae and have cartilage at the sternal end to allow movement during breathing. The purpose of the ribs is to form a protective framework for the lungs, heart and other vital organs. Attaching to the top of the sternum on the left and right and running to each shoulder are the collar bones (clavicles). The clavicles form a joint with the shoulder blades (scapulae) on each side forming the only bony connection between the trunk and the upper limbs (arms). In between each one of the vertebra is a wedge shaped gel-like disc (intervertebral disc) which allow movement, help to absorb shock, distribute stress, and help keep the thoracic spine in correct alignment.

The discs have a gel like interior with a fibrous outer coating which allows them to deform under stress and absorb huge amounts of force through daily life. The thoracic spine, like the cervical spine also has facet joints that link the vertebrae together with the one above and below. In the thoracic spine the facet joints are more suited to rotation than bending forward or backwards. Muscles, Tendons and Ligaments 


Surrounding the bones and discs are a complex system of ligaments, tendons, and muscles which help to support and stabilize the thoracic spine. Ligaments are inelastic bands of fibres that prevent excessive spinal movement that could result in serious injury. Tendons attach the muscles to the bones and the muscles control movement as well as providing stability and balance. Central and peripheral nervous system

The movement of the muscles is controlled by nerve impulses that originate in the brain and are sent via the spinal cord to the nerves of the body. The spinal cord is situated in the centre of the spine or spinal column is a vertical channel called the spinal canal. The bones that create the spinal canal serve as protection to prevent injury to the cord itself.

Through spaces between each vertebra small nerve roots branch off from the spinal cord and extend out into the entire body. The nervous system itself is split into two major regions: the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS consists of the brain and spinal cord whilst the PNS consists of the nerve roots and all nerves beyond the central spinal cord. The CNS and PNS are responsible for all movement in the body. As the spinal cord is a major part of the CNS and the vertebral column houses and protects the spinal cord the spine is an area you want to avoid injuring at all costs! 


Injuries The majority of problems occurring in the thoracic region in MMA practitioners will be from impact. There are a number of congenital (born with) disorders of this area that can show up later in life but they are beyond the scope of this article. Thoracic spine pain as with all areas of the spine may be Acute (recent) or Chronic (longstanding). Acute injuries of the mid back will tend to be soft tissue injuries (STI) which covers basically everything that isn’t bone. Due to the size and density of vertebrae fractures of the Thoracic spine are usually wedge or compression fractures that occur with falls from a great height. 

Acute Injuries 
The most common ways to incur an acute STI of the thoracic region in MMA will be from excessive rotation under stress or from direct impact. Direct impact to the thorax usually occurs in MMA whilst on the ground though it can occur also in the clinch in standing or from stand up strike range and also as a result of a throw. Generally the further away (kicking range) you are when you strike your opponent in the ribs the greater the potential force you can generate is but the closer in you are (guard position) the less force you can generate but the frequency with which you can land a clean strike is much higher. Injuring the ribs or intercostals muscles (“between ribs” muscles) will affect your opponent’s ability to breathe deeply by causing pain on movement of the rib cage.

The harder you breathe the greater the movement of the rib cage, the more trauma of the ribs and intercostals there is the less your opponent will want to deep breath. Without sufficient air going into the lungs he (or she) will fatigue….and as you know “Fatigue makes a coward out of anyone!” If you yourself receive an injury in this area don’t hold your side whilst fighting as your opponent will be relentless in their pursuit of your pain! As the old boxing adage goes ”Kill the body and the head will die!” If an injury occurs in training, stop immediately and get it checked out by your GP and/or Chartered Physiotherapist.

If it occurs in competition and you’re struggling it’s better to throw in the towel and return to competition within a month or so than have your ribs broken even further and risk puncturing a lung and ending your fight career altogether. On impact, ribs will give and spring back but a direct blow with enough force or repeated blows to that area may break (fracture) a rib but it will usually remain intact. Repeated blows to a fractured rib however may cause a flail segment (loose piece of broken rib) to occur and puncture a lung causing a pneumothorax collapsing that lung. Damage to the ribs may also occur when landing badly from a throw. 

mma



STIs to this area will usually occur whilst rotating during a throw or in the clinch and is usually uncomplicated and limited to one specific area. With the adrenalin of competition or intense training these injuries may not be felt until later on or even the next day. As with the Lumbar spine this sort of injury is more likely to occur as you fatigue as a fight progresses or at the end of a grueling training session. That’s why when performing any strenuous movements that rely on the back, technique is always of paramount importance. 

Another common area for STIs in the thoracic region is the mid back between the spine and inner side of the shoulder blades (medial border of the scapula). Here the deep stabilising muscles of the scapula are often injured or become over stressed as a result of poor biomechanics of the shoulder or poor neck postures. As a huge majority of neck pain is posture related problems in this area are extremely common.

As always any back pain is not there to be trained through, pain is your body trying to tell you something and it’s usually something you should listen to! If in the days following a mid or upper back injury you have referred pain, pins and needles, numbness or burning to another site on your body then you need to seek advice and assessment from a Chartered Physiotherapist ASAP. If you suffer any of the above symptoms immediately following a mid or upper back injury during training or competition you need to stop and seek appropriate advice. Due of the location these problems they are very rarely serious but are very often persistent and usually require some encouragement (physiotherapy) to get rid of. 

Chronic 
As with the neck and low back any mid or upper back pain that has been around for more than a few weeks or has occurred without any injury (insidious onset) will often be biomechanical in origin.

This means postural i.e. the way you sit, stand and move about. As stated previously, in MMA most practitioners are amateur and not pros so they have to work for a living at something else during the day. I’ve said this before but I’ll say it again because it’s that important, 40 hours at a desk, sitting in a van or working over a bench will give you a back problem in no time at all. Underlying mid or upper back pain like this may soon start to impact on your training if not remedied, although some may actually go away when training only to return again at rest. If that is the case then the problem will most usually be postural. Again, any mid or upper back pain that persists, whatever the cause should be assessed and treated. 


Treatment of Mid Back Injuries



Assessment

Daniel Cormier Slamon Josh Barnett

 
If you have suffered a mid or upper back pain then see a Chartered Physiotherapist and get the problem assessed. I’ve said this before as well but I’ll keep on repeating it until everyone is clear on the matter, when dealing with any back pain avoid the advice of mates down the pub or even in the dojo (even if they do mean well!). It’s important you look after it correctly and get it treated properly 1st time around. Assessing the problem correctly is paramount to successful treatment. Remember that the same as elsewhere in the body pain is a symptom and not actually a diagnosis! 

Treatment 
As with all uncomplicated STIs, PRICE(MM) is the favoured approach. The Protection, Rest, Ice, Compression are fine although Elevation is not really practical. Medications and Modalities (physical treatments) should be sought from your GP or Chartered Physiotherapist if the pain persists more than a few days. 

If pain from the injury persists beyond 24 hours it’s a good idea to start to increase the movement in that area gently. This can be done with a few, gentle range of movement exercises. 

1) Lie on your back with your knees bent and your feet flat on the floor. Gently rock your knees from side to side. Increase your range of movement until the side of your right leg reaches the floor. Repeat this movement to the left. Continue to repeat this movement for ten repetitions each side. Try to keep your head and shoulders flat on the floor and remember to breathe gently throughout the exercise. 

2) Lie on your back with your knees bent and your feet flat on the floor. Take hold of your knees in your hands and slowly pull them up towards your chest. Hold them to your chest for a count of five seconds then slowly return them to their starting position. Continue to repeat this movement for ten repetitions. Try to keep your head and shoulders flat on the floor and remember to breathe gently throughout the exercise. 

3) Lie flat on your front with your hands palm down on the floor underneath your shoulders. Slowly straighten your arms so your head and shoulders rise up from the floor. Keep your low back relaxed so it begins to arch backwards as you straighten your arms and rise up. Keep the back relaxed (it’s not a press up) and remember to breathe gently throughout the exercise. Slowly lower yourself down and return to lying face down on the floor. Continue to repeat this movement for ten repetitions. 

For fractured ribs take the immediate advice of your GP or Chartered Physiotherapist regarding returning to training but other than rest and strapping there is very little that can actually be done. 

Most treatment plans for the back will include manual therapy (manipulation and mobilisation), exercises (gentle bending and rotation of the neck and back) and modalities such as electrotherapy (ultrasound) or acupuncture (for pain and inflammation). All these treatments however are injury specific, so again assessment is very important. 


Rehabilitation 
With the exception of rib or intercostal injuries the injuries in the thoracic region don’t tend to impact too much on training. The problem is though they do impact on deep breathing and so they can limit cardiovascular (CV) training. As a result your level of CV training may need to be reduced as will your level of physical contact although some light training may be beneficial. As always each case is individual so take the advice of your GP and Chartered Physiotherapist. With any injury, you, your coach/trainer and your physio should work together at devising alternative training programmes as soon as possible particularly if you are a competitive fighter. If your CV training is effected you may use the injury period as an opportunity to strengthen weaker areas whether they be physical, mental, technical or tactical. Your physical rehab plan should include exercises to restore normal strength and full range of movement using progressive resistance exercises and stretching then continue to further develop strength in that area to protect it from possible future injury. In addition in the later stages rehab you should include some combat-specific drills (with an emphasis on proper technique). It must also be appreciated that the power, speed and angles which occur during competition may far exceed the criteria for successful completion of rehabilitation exercise. To be ready for competition you must perform over and above what you are required to do in competition. 

Return to Training/Competition 
If you have incurred a rib fracture or injury, it may take several months of physical therapy for you return to full training or competition. Muscular injuries may be days to weeks whilst rib or joint injuries often take months to rehabilitate before you make a return to full MMA training/competition. As always two key factors exists for return to full training/competition; firstly the risk of re-injury and secondly the ability to fight/perform at a satisfactory level.

These factors are often intertwined. When there is a risk of re-injury, the potential for further or permanent damage must also be considered. The criteria for return to competition after a thoracic or rib injury include restoration of normal strength, flexibility and mobility of the ribs when deep breathing. With postural or biomechanical problems it is important to identify the specific activity or posture that caused the initial injury so that activity or posture can be avoided or modified. Avoidance steps may include changing technique, training habits, and equipment, and modifying posture and ergonomic practices at home and at work as well as during training. 

This is just a brief outline of the mid, upper back and rib injuries you may incur during MMA training and competition and a rough guide to treatment and rehabilitation principles. If you have any specific problems in this area you will need to seek first hand advice, assessment and treatment from an experienced sports injuries Chartered Physiotherapist. 

Check out parts 1 & 3 in this series: Neck (Cervical Spine) Injuries & Lower Back (Lumbar Spine) Injuries 

This article is for the purpose of information only and it is not intended to diagnose or treat medical conditions and is not considered to be a substitute for individual medical assessment and advice. 




Part 3- Lower Back (Lumbar Spine) Injuries 




In this series of 3 articles we will be taking a look at the most common spinal injuries that can arise from both MMA training and competition. Due to the structure of the spine and the nature of spinal injuries we shall divide the spine into its three natural anatomical areas; the neck (cervical spine), the mid back (thoracic spine) and the lower back (lumbar spine). 


The Lower Back 

Function 
The function of the lower back or lumbar spine is to stabilise and support the trunk and spine, house and protect the spinal cord and allow a wide range of trunk movement (e.g., forward and backward movement and bending side to side with some rotation.) 

Anatomy 
Vertebrae and Discs 

The lumbar spine is made up of five large individual vertebrae stacked on top of each other to form the base of the mobile vertebral column (the Sacrum is below the Lumbar spine but is fused so relatively immobile). In between each one of the vertebra is a large gel-like disc (intervertebral disc) which allow movement, help to absorb shock, distribute stress, and keep the lumbar spine in correct alignment. The discs have a gel like interior with a fibrous outer coating which allows them to deform under stress and absorb huge amounts of force through daily life. As you age the discs slowly degenerate and cause the vertebrae to get closer together causing “wear and tear” in the low back.

The Lumbar spine, like the rest of the spine has two pairs of facet joints that link the vertebrae together with the one above and below. The facet joints are located at the rear (posterior) of the spinal column. It is the facet joints that help to make the spine flexible. Muscles, Tendons and Ligaments Surrounding the bones and discs are a complex system of ligaments, tendons, and muscles which help to support and stabilize the lumbar spine. Ligaments are inelastic bands of fibres that prevent excessive spinal movement that could result in serious injury. Tendons attach the muscles to the bones and the muscles control movement as well as providing stability and balance.

Central and peripheral nervous system The movement of the muscles is controlled by nerve impulses that originate in the brain and are sent via the spinal cord to the nerves of the body. The spinal cord is situated in the centre of the spine or spinal column is a vertical channel called the spinal canal. The bones that create the spinal canal serve as protection to prevent injury to the cord itself. Through spaces between each vertebra small nerve roots branch off from the spinal cord and extend out into the entire body. The nervous system itself is split into two major regions: the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS consists of the brain and spinal cord whilst the PNS consists of the nerve roots and all nerves beyond the central spinal cord. The CNS and PNS are responsible for all movement in the body. As the spinal cord is a major part of the CNS and the vertebral column houses and protects the spinal cord the spine is an area you want to avoid injuring at all costs! 


Injuries 
There are a number of ways to develop low back pain (LBP) but in the case of most MMA practitioners we can rule out degeneration with age as by the time this occurs your training should not be in the combative arena! If you are a more senior practitioner however and you have been suffering with long standing LBP, degeneration of the lumbar spine joints may be the culprit and advice from your GP or Chartered Physiotherapist is essential if you wish to continue to train. 
LBP as with all areas of the spine may be Acute (recent) or Chronic (longstanding). Acute injuries of the lower back will tend to be soft tissue injuries (STI) which covers basically everything that isn’t bone.

Due to the size and density of Lumbar vertebrae fractures of the Lumbar spine are usually reserved only for falls from a great height and car crashes. Although Lumbar fractures have been reported in pro wrestling this may be theorised as being a side effect of long term steroid usage, which is know to cause osteoporosis (thinning of the bones) rather than purely a result of over zealous grappling! 


Acute Injuries 
The most common ways to incur acute LBP in MMA will be from spinal flexion (bending forward), lateral flexion (side bending) and/or rotation. The main cause of these movements will be grappling in standing, throws and takedowns. In the case of the Lumbar spine it may even be more likely the person executing the throw or takedown is the one more likely to become injured! Other than the impact and possible superficial bruising from being thrown the likelihood of receiving a serious low back injury from being thrown is fairly low. This all comes about because of the biomechanics of a throw.

Essentially when taking an opponent down to the mat you have to control his mass (weight) and move his centre of gravity outside his base of support. If this happens he will fall down…simple.

However if he decides he is going to do this back to you, then you have a problem on your hands. One of the key ways to control someone’s bodyweight is via rotation as in a hip throw or “whizzer”. If however your opponent can resist your force then the physiological stress you place on the structures of your lower back may exceed their natural strength and injury will occur. This sort of injury is more likely to occur as you fatigue as a fight progresses or at the end of a gruelling training session. That’s why when performing any strenuous movements that rely on rotation of the back, technique is of paramount importance. 

The most common form of acute LBP injury occurring in the general population tends to be actually from poor posture and not trauma. It has been estimated that 85% of LBP is from postural dysfunction and only 15% of LBP is from actual trauma. Of the 15% suffering acute LBP from trauma most of those will have occurred from the physiological stress of excessive force on the soft tissues during flexion, lateral flexion and/or rotation. 

As with all injuries LBP is not there to be trained through, pain is your body trying to tell you something and it’s usually something you should listen to! LBP usually takes one of two general forms; the uncomplicated type with pain localised to one area and LBP that also has a component of referred symptoms into the buttocks or down into one or both of the legs. These referred symptoms may take the form of pain, pins and needles, numbness, weakness or altered sensations in various distributions in the legs. 

If in the days following a back injury you have weakness, pins and needles, numbness or burning in one or both arms you need to seek advice and assessment from a Chartered Physiotherapist ASAP. If you suffer any of the above symptoms immediately following a lower back injury during training or competition or your leg(s) becomes paralysed, or there is an alteration in your bowel or bladder function, or if there is any pins and needles on your upper inner thighs then get yourself to A&E; ASAP and get checked out for disc or nerve damage.

Any alteration in sensation or function following a lower back injury suggests nerve involvement and although the Lumbar spine is very strong, its internal structures are very delicate and extremely important for normal function. Don’t be alarmed at A&E; if they’re not concerned about X-raying your back following an injury as true disc protrusions (slipped discs) are actually much rarer than people believe. The Drs in A&E; will be more concerned with what is termed your “clinical presentation” (signs and symptoms) than giving you an X-ray or MRI (Magnetic Resonance Imaging) scan. If they are concerned about your clinical presentation then they will scan you just to confirm the severity of the problem. 

LBP with referred or radiating pain is known clinically as Lumbar Radiculopathy and is commonly known as “Sciatica” as it is often the Sciatic nerve that is involved. Radiculopathy occurs in specific patterns or distributions known as dermatomes. Each dermatome covers a specific area of the lower limbs (legs) and is innervated by a specific lumbar nerve and the leg pain is caused by compression of that nerve root. The diagnosis of leg and back pain starts with a detailed history of the injury and clinical examination. This compression on the nerve will usually be from a protrusion of an intervertabral disc.

It is a popular misconception that you can have a “slipped disc” and that it can “pop” in and out! Due to the structure of the disc itself it can become damage by force and may bulge causing a protrusion of the disc or even extrusion of disc material into the spinal canal or press onto the nerve roots. This will usually be termed a herniated disc, ruptured disc or prolapsed disc. This protrusion may be reduced and the pressure relieved from the surrounding nerves with physiotherapy but it is not “popped” back into place. In most cases Lumbar Radiculopathy will respond to physiotherapy but in some extreme cases surgical intervention may be the only option. Remember however that due to the delicate structures of the spine and the severity of possible side effects, spinal surgery should only ever be an option when all other treatment avenues have been exhausted! 

In general, with the exception of bruising all low back injuries that persist beyond 24 hours should be checked out by a Chartered Physiotherapist to evaluate the severity of the injury and advise on subsequent treatment, rehabilitation and strengthening. 

Chronic 
As with the neck any LBP that has been around for more than a few weeks or has occurred without any injury (insidious onset) will often be biomechanical in origin. This means postural i.e. the way you sit, stand and move about. As stated previously, in MMA most practitioners are amateur and not pros so they have to work for a living at something else during the day. 40 hours at a desk, sitting in a van or working over a bench will give you a back problem in no time at all. Underlying LBP like this may soon start to impact on your training if not remedied, although some may actually go away when training only to return again at rest. If that is the case then the problem will most usually be postural. Again any LBP that persists, whatever the cause should be assessed and treated. 



Treatment of Lower Back Injuries



Assessment 
If you have suffered a low back injury or have LBP or stiffness then see a Chartered Physiotherapist and get the problem assessed. As always when dealing with LBP avoid the advice of mates down the pub or even in the dojo (even if they do mean well!). They can replace hips and knees but they won’t be replacing your back so it’s important you look after it correctly and get it treated properly 1st time around. Assessing the problem correctly is paramount to successful treatment. Remember that the same as elsewhere in the body pain is a symptom and not actually a diagnosis! 

Treatment 
As with all uncomplicated STIs, PRICE(MM) is the favoured approach. The Protection, Rest, Ice, Compression are fine although Elevation is not really practical. Medications and Modalities (physical treatments) should be sought from your GP or Chartered Physiotherapist if the pain persists more than a few days. 

If pain from the injury persists beyond 24 hours it’s a good idea to start to increase the movement in that area gently. This can be done with a few, gentle range of movement exercises. 

1) Lie on your back with your knees bent and your feet flat on the floor. Gently rock your knees from side to side. 
Increase your range of movement until the side of your right leg reaches the floor. Repeat this movement to the left. Continue to repeat this movement for ten repetitions each side. Try to keep your head and shoulders flat on the floor and remember to breathe gently throughout the exercise. 

2) Lie on your back with your knees bent and your feet flat on the floor. Take hold of your knees in your hands and slowly pull them up towards your chest. Hold them to your chest for a count of five seconds then slowly return them to their starting position. Continue to repeat this movement for ten repetitions. Try to keep your head and shoulders flat on the floor and remember to breathe gently throughout the exercise. 

3) Lie flat on your front with your hands palm down on the floor underneath your shoulders. Slowly straighten your arms so your head and shoulders rise up from the floor. Keep your low back relaxed so it begins to arch backwards as you straighten your arms and rise up. Keep the back relaxed (it’s not a press up) and remember to breathe gently throughout the exercise. Slowly lower yourself down and return to lying face down on the floor. Continue to repeat this movement for ten repetitions. 

Most treatment plans for the back will include manual therapy (manipulation and mobilisation), exercises (gentle bending and rotation of the neck) and modalities such as electrotherapy (ultrasound) or acupuncture (for pain and inflammation). All these treatments however are injury specific, so again assessment is very important. 

Rehabilitation 
As always one of the major goals of rehabilitation is to maintain your cadiovascular fitness levels, so for instance when you suffer a lower back injury try avoiding the continued impact of roadwork, initially try swimming instead and then progress onto aqua jogging with a flotation belt (running upright in a swimming pool without your feet touching the bottom of the pool). You, your coach/trainer and your physio should work together at devising alternative training programmes as soon as possible particularly if you are a competitive fighter. In addition to cardiovascular fitness, you may use the injury period as an opportunity to strengthen weaker areas whether they be physical, mental, technical or tactical. Your physical rehab plan should include exercises to restore normal strength using progressive resistance exercises and then continue to further develop strength in that area to protect it from possible future injury. In addition in the later stages rehab you should include some combat-specific drills(with an emphasis on proper technique).

There are plenty of rehab exercises and drills that can be worked with Swiss (Physio) balls and Therabands (variable resistance elastic bands) to aid strength in both flexion and rotation without overstressing the spine. However, as with any strengthening exercise in this area professional supervision is required to ensure the correct areas are being developed in a safe and progressive way. 
It must also be appreciated that the power, speed and angles which occur during competition may far exceed the criteria for successful completion of rehabilitation exercise. To be ready for competition you must perform over and above what you are required to do in competition. 

Return to Training/Competition 
Depending on the severity of the injury, it may take several months of physical therapy for you return to full training or competition. The differing types of lower back injury makes for a wide range of recovery and rehab times. Muscular injuries may be days to weeks whilst ligament injuries often take months to rehabilitate and a disc or nerve injury may prevent a return to full MMA competition permanently even after many months of rehabilitation. As always two key factors exists for return to full training/competition; firstly the risk of re-injury and secondly the ability to fight/perform at a satisfactory level.

These factors are often intertwined. When there is a risk of re-injury, the potential for further or permanent damage must also be considered and in the lumbar spine permanent damage can have a huge impact on the rest of your life. The criteria for return to competition after a lower back injury include restoration of normal strength, flexibility and stability. With biomechanical problems it is important to identify the specific activity that caused the initial injury so that activity can be avoided or training or postures modified. Avoidance steps may include changing technique, training habits, and equipment, and modifying posture and ergonomic practices at home and at work as well as during training. 

This is just a brief outline of the lumbar spine injuries you may incur during MMA training and competition and a rough guide to treatment and rehabilitation principles. If you have any specific low back or spinal problems you will need to seek first hand advice, assessment and treatment from an experienced sports injuries Chartered Physiotherapist. 


This article is for the purpose of information only and it is not intended to diagnose or treat medical conditions and is not considered to be a substitute for individual medical assessment and advice.

Read our Article on Neck Bridges for Neck Strength here





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Elbow Injuries in MMA


Elbow Injuries

For information purposes only. Exercise at your own risk. Always consult a doctor if you sustain an injury


Anatomy 

The elbow is a hinge joint that is formed by 3 bones – the humerus (upper arm), the radius (thumb side) and ulna (little finger side) of the forearm. The elbow joint flexes (bends) and extends (straightens) the arm. Elbow Injuries 

Due to its structure and the number of muscles that are attached near the elbow, it is a common site for injury in MMA during both training and competition.

Elbow injuries may be divided into 3 categories: 


1. Single-event (acute) trauma 

The most common cause of this type of injury is when adverse force is applied to the elbow joint. This can happen in MMA if, for example, an armbar is applied and you do not tap-out soon enough. An acute injury may only be soft tissue damage (muscle, tendon or ligament) or more seriously fracture or dislocation. 

elbow vs bricks



Dislocations occur when the arm is fully extended at the elbow and excessive force is applied to the joint forcing the bones out of position, as in an armbar. 

Dislocation of the elbow may be accompanied by a fracture but always involves major damage of the elbow ligaments. With these injuries, damage to nerves and blood vessels is always a possibility so medical attention is considered urgent and essential following a dislocation. Dislocation may also be accompanied by a sharp pain and the sensation of muscle tearing at the front of the arm followed by a sudden contraction of the biceps muscle. This suggests a biceps tendon rupture and will probably require surgical reattachment of the tendon before you can return to training. So how do you know if you’ve dislocated your elbow?…well believe me you’ll know when it happens! You’ll experience immediate intense pain and swelling and your elbow won’t bend anymore! 

Table source




2. Acute-on-chronic injury 

Single-event trauma is the most obvious cause of injury in MMA. However, what appears to be a single-event injury to the elbow may actually be an acute-on-chronic injury, or a single-event trauma to tissue which has been made vulnerable by overuse. For example, rupture of the elbow ligaments that occurs with punching or an armbar may commonly involve ligaments that have been weakened by overuse or excessive stress during training or previous competition. 




3. Multiple-repetition Injuries 


Multiple repetition, overuse or chronic injuries usually occur as a result of constant overuse and typically stem from biomechanical stress (biomechanics is the science behind movement of living creatures).

These injuries may occur as a result of over-training in a particular technique or an incorrect training pattern which works against the biomechanics of an individual. Locking out during punching, weight training and armbars, excessive strain during gripping and repetitive strain at work may also lead to these sorts of problems. These problems often develop without any specific trauma. Symptoms may start slowly with burning pain on the outside or inside part of the elbow that gradually worsens over weeks or months and is worsened by gripping or lifting objects such as in Tennis and Golfer’s Elbow. It is important that you consider the cumulative impact of all stressful activity on the elbow including work, not just training. Over time, if not treated, chronic injuries can lead to permanent restrictions t
o training and competition. 


Elbow Injuries – Principles of Treatment and Rehabilitation

 

Acute Injuries 
For simple soft tissue injuries of the elbow, PRICE(MM) is the favoured approach. Protection, Rest, Ice, Compression and Elevation should be applied by the individual, then Medications and Modalities (physical treatments) should be sought from your GP or Chartered Physiotherapist. If you think your elbow is dislocated, fractured or if your bicep’s tendon has been ruptured, you need to immobilize it and go to your nearest Accident and Emergency department.

A dislocated elbow requires reducing (putting back in place) right away but do not attempt it yourself or allow anyone else who is not suitably qualified reduce it for you. An incorrectly reduced dislocation may produce additional damage to nerves and blood vessels that may affect the future use of the arm. Once it has been reduced and other injuries have been checked for, you should seek advice regarding your future rehabilitation from a Chartered Physiotherapist. 

Acute on Chronic Injuries 
To ensure effective treatment and rehabilitation, these injuries require aspects of both acute and chronic management approaches to be taken into account to ensure effective treatment and rehabilitation. 

Chronic Injuries 
As the injury may have occurred due to a biomechanical stress and dysfunction a detailed physical examination from a Chartered Physiotherapist is essential to ensure a correct diagnosis and evaluation of the nature of the problem. Treatment will usually be conservative, with emphasis on strength-building rehabilitation, addressing the biomechanical dysfunction and return to full fighting fitness.

Many chronic injuries may be prevented with good training and work habits and paying attention to your body. Never train through elbow pain, instead visit a Chartered Physiotherapist who will treat the affected arm whilst advising you on how to avoid further injuries. 

With chronic injuries it is sometimes possible to find some alleviation of symptoms with changes in diet & other lifestyle changes that reduce inflammation. For example, exogenous ketones, fasting and curcumin supplementation may help for some tendinitis-related injuries. Another great tip, that many people ignore – is not avoid exercises that aggravate the injury. Barbell bicep curls for example, may make golfer’s elbow more painful. Don’t do this exercise, or switch to using resistance bands.



Rehabilitation 
The principles of rehabilitation of the elbow include maintenance of general fitness, targeted rehabilitation exercises for return to combat and control of overuse. You should seek the advice of a Chartered Physiotherapist to ensure that you have a plan for your rehabilitation to work your elbow back to full function.

To maintain general fitness you should start a fitness program for all uninjured areas ASAP, with a focus on the maintenance of cardiovascular fitness for competitive athletes. Your rehab plan should include exercises to restore normal strength using progressive resistance and postural exercises that should involve the biceps and triceps as well as the entire shoulder girdle, upper back, and neck. In addition in the later stages rehab should include eccentric as well as concentric exercise and plyometric training followed by combat-specific drills (with an emphasis on proper technique), agility training and bracing as appropriate.

It’s worth pointing out however that if you are bracing or strapping (with the exception of hand wraps) a joint you should not be full contact training or considering stepping into the competitive arena.

It must also be appreciated that the power, speed and angles which occur during competition may far exceed the criteria for successful completion of rehabilitation exercise. To be ready for competition you must perform over and above what you are required to do in competition. 


Return to Training/Competition 
Depending on the severity of the injury, it may take many months of physical therapy for you return to full training or competition. The diversity of elbow injuries makes for a wide range of recovery and rehab times with tendon and ligament injuries often taking months to rehabilitate and a complete fracture dislocation preventing return to full MMA competition even after six to nine months of rehabilitation.

armbar injury
He’s defo thinking of switching to an armbar

For return to full training /competition two principal factors must be considered, firstly the risk of re-injury and secondly the ability to fight/perform at a satisfactory level. These factors are often intertwined. When there is a risk of re-injury, the potential for further or permanent damage must also be considered. The criteria for return to competition after an elbow injury include restoration of normal strength, endurance, and flexibility. With repetitive injuries it is important to identify the specific activity that caused the initial injury so that activity can be avoided or training modified. Avoidance steps may include changing technique, training habits, and equipment, and the use of an elbow counterforce brace in the early stages of rehab. 


This is just a brief outline of the elbow injuries you may incur during MMA training and competition and a rough guide to treatment and rehabilitation principles. If you have any specific elbow problems you will need to seek first hand advice and treatment from an experienced sports injuries Chartered Physiotherapist. 



Disclaimer 
This article is for the purpose of information only and it is not intended to diagnose or treat medical conditions and is not considered to be a substitute for individual medical assessment and advice.

See our post about treating Golfer’s Elbow

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Can You Exercise with High Blood Pressure?


You certainly can exercise if you have high blood pressure and in doing so, you can actually lower your blood pressure significantly. Especially when combined with a suitable diet full of whole foods and low in sugar.

Consult your doctor before increasing physical activity levels



Exercise & Blood Pressure

High blood pressure or hypertension means high pressure (tension) in the arteries. The arteries are the vessels that carry blood from the pumping heart to all of the tissues and organs of the body. High blood pressure does not mean excessive emotional tension, although emotional tension and stress can temporarily increase the blood pressure.

Normal blood pressure is below 120/80; blood pressure between 120/80 and 139/89 is called “pre-hypertension”, and a blood pressure of 140/90 or above is considered high blood pressure. The systolic blood pressure, which is the top number, represents the pressure in the arteries as the heart contracts and pumps blood into the arteries. The diastolic pressure, which is the bottom number, represents the pressure in the arteries as the heart relaxes after the contraction. The diastolic pressure, therefore, reflects the minimum pressure to which the arteries are exposed. 


How is high blood pressure defined? 



Since blood pressure can be affected by several factors, it is important to standardize the environment with this in mind when blood pressure is determined. For at least one hour before measuring the BP one should avoid eating, strenuous exercise (which can lower blood pressure), smoking, and caffeine intake. Other stresses may alter the blood pressure and need to be considered when blood pressure is measured. 



Even though most insurance companies, quite reasonably, consider high blood pressure to be 140/90 and higher for the general population, these levels may not be appropriate cut-offs for all individuals.

As a matter of fact, many experts in the field of hypertension view blood pressure levels as a continuum, or range, from lower levels to higher levels. Such a continuum implies that there are no clear or precise cut-off values to separate normal blood pressure from high blood pressure. Individuals with so-called pre-hypertension (defined as a blood pressure between 120/80 and 139/89) may benefit from lowering of blood pressure by life style modification and possibly medication especially if there are other risk factors for end-organ damage such as diabetes or kidney disease (appropriate life style changes are discussed below). 



For some people, blood pressure readings that are lower than 140/90 may be a more appropriate normal cut-off level. For example, in certain situations, such as in patients with long duration (chronic) kidney diseases that spill (lose) protein into the urine (proteinuria), the blood pressure is ideally kept at 130/80, or even lower. The purpose of reducing the blood pressure to this level in these patients is to slow the progression of kidney damage. Patients with diabetes (diabetes mellitus) may likewise benefit from blood pressure that is maintained at a level lower than 130/80. In addition, African Americans, who have an increased risk for developing the complications of hypertension, may decrease this risk by reducing their systolic blood pressure to less than 135 and the diastolic blood pressure to 80 mm Hg or less. 

In line with the thinking that the risk of end-organ damage from high blood pressure represents a continuum, statistical analysis reveals that beginning at a blood pressure of 115/75 the risk of cardiovascular disease doubles with each increase in blood pressure of 20/10. This type of analysis has led to an ongoing “rethinking” in regard to who should be treated for hypertension, and what the goals of treatment should be. 

Lowering your blood pressure – whether you have high blood pressure or not. Regular physical activity may help you to prevent heart disease and stroke by preventing or lowering high blood pressure. 


Improve your blood cholesterol levels(?)

A controversial one – many health practioners now state that high cholesterol isn’t necessarily a risk factor in terms of health. The ketogenic diet for example, is based on high fat foods and has an increasing amount of scientific literature to support it.

A study carried out in 2006 for example, concluded that:

This study shows the beneficial effects of ketogenic diet following its long term administration in obese subjects with a high level of total cholesterol. Moreover, this study demonstrates that low carbohydrate diet is safe to use for a longer period of time in obese subjects with a high total cholesterol level and those with normocholesterolemia.

Click here to see study

It was previously thought that – Saturated fat (animal fat) increases cholesterol and in turn, this causes narrowing or furring of the arteries and increases the risk of a heart attack or stroke. There are two types of cholesterol – LDL (Low density lipoprotein) which settles in your arteries, narrows them and can block them and HDL (High density lipoprotein) which removes LDL cholesterol from arteries. Regular physical activity increases the amount of HDL (good) cholesterol in your body. 

The type of diet that will lower your blood pressure, may actually depend on your genetics. Speak to your doctor or dietitian and consider getting a genetic test from the likes of 23 and me.

Read more about high fat diets in our blog post – are low carb diets healthy?

Losing Weight Can Help to Lower Blood Pressure


Exercise is important for health, in that it can help you to lose weight or help to maintain a healthy weight – being overweight is another cause of high blood pressure. By becoming more active and reducing the amount of energy (calories) that you eat you can lose weight. 

Exercise can also help to control and prevent diabetes – if you have diabetes (type 1 or type 2) then being active can help you to reduce the number of tablets or the amount of insulin that you need to take. It can also reduce your risk of developing non-insulin dependent (Type 2) diabetes. 



Most importantly, being active will help you to feel much better. It is those people who have been inactive, who then start to take regular, moderate, activity that benefit the most. You do not have to reach a certain level of activity before your body starts to benefit; even a little activity is better than none at all. 







What does physical activity do to my blood pressure? 



If you are regularly active and you maintain that activity in the long-term it can help you to lower your blood pressure. Most people will notice a reduction in their blood pressure within the first ten weeks after increasing the amount of activity they do. As long as you keep active your blood pressure should stay at this lower level. 

Physical activity can lower systolic blood pressure by an average of 4 – 9mmHg. 





Is it safe to be more active if I already have high blood pressure? 



Almost everyone will be able to become more active. However, make sure you check the following before you start: 

Have your blood pressure measured and check with your doctor or nurse that it is safe for you to start becoming more active. If your blood pressure is consistently above 180 systolic and/or 110 diastolic (180/110 mmHg), you should not be doing intensive activity until your blood pressure has been treated and lowered If you also have other medical conditions like diabetes, heart disease (such as a previous heart attack) or breathing problems you may need different advice. Check with your doctor. 

You will generally be recommended to start low-intensity cardiovascular exercise such as walking. Avoiding resistance training is generally also a good idea, as in the short term, this can increase blood pressure greatly.





How much physical activity do I need to do to Lower Blood Pressure? 



You are aiming to do at least 30 minutes of moderate physical activity at least five days a week. You should be a little out of breath but still able to talk, warm and slightly sweaty. This much activity will burn off 150 -180 calories a day, which could add up to a weight loss of 6-12kgs (13- 26lbs) every year. A little bit of activity regularly can make a real difference. 

If you have not been active for a while then gradually build up the amount of time spent on activity, adding a few minutes each week. You can get as much benefit if you decide to do smaller amounts during the day to make up 30 minutes. For example, you could start with three ten-minute walks each day, increase to two fifteen-minute walks and then finally achieve a full 30 minutes in one go. Set yourself a series of goals to help you towards your final target. 

If you are trying to lose weight, or have lost weight and are trying to maintain that weight loss, you may need to do 45-60 minutes of activity every day. 





What kind of physical activity should I be doing to Lower Blood Pressure? 



Brisk walking, swimming, cycling, jogging, playing a team sport such as football or hockey, dancing and tennis are all activities that will help you to strengthen you heart and lungs (cardiovascular system). It is this kind of actively that can help you to lower your blood pressure. 

As well as these kinds of activities you should also include activity that strengthens your muscles and helps you to stay supple and flexible. These kinds of activities might include climbing stairs, walking uphill, yoga, pilates, and gardening. Doing a range of activities will stop you from getting bored and help to keep you motivated. 

Some people use a pedometer, or step counter, and aim to do 10,000 steps every day. This can be a good way to set yourself goals and targets and helps you to become aware of how much (or how little) you are doing every day. 







Is there any activity I should not do if I have high blood pressure? 



Avoid lifting weights and very vigorous sports such as squash if you have high blood pressure. If you are very overweight, have a heart or breathing condition or have not been active for a long time, check with your doctor before starting a new exercise routine.




What if my Client or Gym Member has Blood Pressure?

Information for Personal Trainers & Fitness Instructors:

Everyone seems to have it, but what exactly is high blood pressure?

Blood pressure is the force in the arteries when the heart beats (systolic pressure) and when the heart is at rest (diastolic pressure). It’s measured in millimeters of mercury (mm Hg). High blood pressure (or hypertension) is defined in an adult as a blood pressure greater than or equal to 140 mm Hg systolic pressure or greater than or equal to 90 mm Hg diastolic pressure. High blood pressure directly increases the risk of coronary heart disease (which leads to heart attack) and stroke, especially when it’s present with other risk factors. 

Classifying Blood Pressure 

  • Less than 130 (systolic) and Less than 85 (diastolic) Normal blood pressure 
  • 130-139 or 85-89 High-normal blood pressure 
  • 140-159 or 90-99 Stage 1 (mild) hypertension 
  • 160-179 or 100-109 Stage 2 (moderate) hypertension 
  • 180-209 or 110-119 Stage 3 (severe) hypertension 
  • 210 or higher or 120 or higher Stage 4 (very severe) hypertension 

——————————————————————————– 

One of the central and most specialized roles of a fitness instructor, is that of exercise prescription. Individual clients will have specific goals and needs that must be catered for in order to design the optimal programme of exercise. In spite of this specificity, most individuals can be categorized into one of a number of general populations. A number of medical considerations will have to be taken into account or even be central to programme design; one of the most common will no doubt be hypertension.

Hypertension is present in epidemic proportions within industrialized societies and is linked to many cardiovascular pathologies. There remains much debate over the merits of aggressive pharmological therapy in the treatment of individuals with mild to moderate elevations in blood pressure. There is however, no such debate over the efficacy of aerobic exercise as a treatment. 

Research suggests that aerobic/endurance exercise is most beneficial for hypertensive populations. Endurance exercise training will elicit an average reduction of 10mmhg for both systolic and diastolic blood pressures in individuals with mild hypertension (ACSM, 2000). As a fitness instructor the mode, frequency, duration and intensity of exercise need to be evaluated.

It is recommended by the ACSM that endurance training at 50-85% of maximum oxygen uptake is undertaken for 20-60 minutes 3-5 days per week. It should also be emphasised to the client that physically active and aerobically fit hypertensive individuals have markedly reduced mortality rates in comparison to there sedentary hypertensive peers. This is due to the fact that endurance exercise has a beneficial effect upon the cardiovascular system that interacts with other CVD risk factors. 

The danger that is associated with the adoption of an exercise programme, is the higher blood pressure induced by exercise. It is thought that hypertensive individuals are at greater risk of sudden cardiac death. Although there is limited evidence to support this notion, it remains prudent to recommend lower intensity exercise (<85% max oxygen uptake). Resistance training can still be prescribed, but high repetitions should be prescribed and perhaps a circuit of exercises should be encouraged rather than a standard sets and repetitions protocol.

Another consideration is the interaction between exercise and medication. Although most anti hypertensive drugs will generally reduce the absolute level of blood pressure that is experienced during exercise and also the heart rate response. This is a crucial consideration when setting the intensity of exercise on different exercise equipment. Beta blockers are thought to reduce absolute exercise tolerance and the exercise induced rise in HDL cholesterol. It is therefore suggested that angiotensin-converting enzyme inhibitors. Calcium channel blockers, and alpha-blockers are especially well suited for persons with uncomplicated essential hypertension and physically active lifestyles. 

The adoption of a physically active lifestyle is itself something that must be emphasised and promoted. Research that have investigated the effect of exercise on blood pressure and stop training, indicate that their blood pressure returns to initial pre-exercise values following a sustained period of detraining. The blood pressure lowering effect of exercise training is evident only as long as a regular training programme is maintained. This should be outlined to clients, once a regular pattern of physical activity had been adopted.

Other important considerations for hypertensive individuals, as mentioned earlier, is the possibility that endurance exercise training may elicit other health benefits in addition to lowering of blood pressure. The incidence of other modifiable CAD risk factors, including obesity, abnormal lipid profiles, insulin resistance, and glucose intolerance, is also more prevalent in hypertensive individuals. 

Endurance exercise training, in addition to reducing blood pressure in hypertensive individuals, also improves glucose intolerance and insulin resistance, obesity and caloric balance and lipid profiles in relatively healthy individuals.

Hopefully the previous information has given a brief overview of exercise and hypertension and in addition to a knowledge of exercise types and programme design, should provide enough information to construct exercise programmes that provide major physical and mental health benefits to your clients. The following is a brief summary of the special considerations that you may wish to take into consideration during the construction of a programme of exercise for an individual with hypertension:
· The type, frequency and duration of activity are important. People with hypertension should exercise daily for 30 minutes or more at a moderate level to gain health benefits.
· People using medications, such as beta-blockers, should be cautious of developing heat illness when exercising. These medications and diuretics impair the ability to regulate body temperature.
· Adults with hypertension should extend the cool-down period of the workout. Antihypertensives, such as alpha blockers, calcium channel blockers, and vasodilators may cause BP to lower too much after abruptly ending exercise.
· Overweight and obese adults with hypertension should combine regular exercise and weight loss to effectively lower resting BP. 

· Promoting the BP-lowering effects of single exercise sessions may best motivate people to exercise. Physicians are encouraged to promote the role of exercise in controlling BP to their patients. 
· A physician evaluation and clearance is necessary for those with severe or uncontrolled BP prior to beginning an exercise program. Higher risk patients (such as those with coronary artery disease or chronic heart failure) should lessen the intensity of their training program. 

In addition to exercise prescription however, it would be thoughtful to provide a client with additional lifestyle guidelines.

Perhaps an information sheet containing the following points would be prudent:

  • Maintain a healthy weight. 
  • Exercise on a regular basis. 
  • Reduce sodium to 2.3 grams or less each day. 
  • Avoid appetite suppressants, decongestants, and nonsteroidal anti-inflammatory medications. 
  • Reduce stress by learning relaxation techniques. 
  • Reduce dietary fat and cholesterol. 
  • Limit alcohol consumption to less than one ounce daily. 
  • Stop smoking. 

Motivation is key in the fitness industry, and information such as that contained within this article is essential for reinforcing any desire a client or potential client has to adopt an exercise programme.

In addition, if staff appear knowledgeable and caring it will further reinforce the incentive to exercise.

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