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Shoulder Injury Prevention in MMA
- 1. Subacromial impingement in Mixed Martial Arts How to prevent it Vanderstukken Fran Vermeeren Laura Verhulst Julie
- 2. Content Introduction Prevention based upon… Patient, yes or no? Practical application Prevention poster Practical tips
- 3. Introduction Shoulder injuries are frequent in martial arts Subacromial impingement Aggravating injury Little sportspecific evidence literature review
- 4. Introduction Evidence impingement Sports analyses of MMA Experience with MMA Identification of general + sportspecific risk factors Sportspecific prevention plan
- 5. Introduction Objective Development realistic prevention plan Implementation in training attainability Illustration with an accessible prevention poster
- 6. Prevention based upon… What’s the fundament of the prevention plan?
- 7. Risk factors (RF) Predisposed athlete Susceptible athlete Inciting event(s) No Injury Intrinsic RF Extrinsic RF Intrinsic Shape acromion Posture Anat.abnormality Scapular dyskinesis (Hyper)laxity Muscle imbalance AC degeneration GH instability Previous impingement Sportspec. postur. Δ Sportspec. muscul. Δ Inciting event Training design Sportspec. postur. Δ Sportspec. muscul. Δ Trained muscle imbalance Fighting posture Repetitive movement High shoulder loads Punching technique Extrinsic Sleeping position Smoking status Profession Type of sport Repetitive movement Overhead movement High shoulder loads Fighting posture Punching technique
- 8. Sportspecific RF Punching technique Narrowing of the subacromial space Fighting posture Sportspecific muscular adaptations Emphasis during training Sportspecific muscular adaptations Extrinsic
- 9. Sportspecific RF Sportspecific muscular adaptations Muscle imbalance Typical muscle shortening Stiffness shoulder girdle Sportspecific postural adaptations Changed scapular position Intrinsic
- 10. Sportspecific RF, summary Posture •Thoracic kyphosis •Forward head posture •Protraction •Elevation Muscle weakness •Lower Trapezius •Middle Trapezius •Serratus anterior •Rhomboids Muscle shortening •Pectoralis minor •Shoulder girdle Scapular position •Anterior tilt •Elevation •Internal rotation
- 11. Emphasis prevention plan Sportspecific postural adaptations Typical fighting posture scapular position Sportspecific muscular adaptations Typical muscle imbalance Typical muscle shortening General stiffness shoulder region Punching technique (hook) Train weakened muscles Optimize motor control Stretch Mobilize shoulder region Stretch Pay extra attention to technique Avoid excessive internal rotation Keep posture functional
- 12. Patient, yes or no ? How to screen the athletes?
- 13. Who is at risk ? Basic thought: every MMA athlete is at risk Integrated prevention But: who will benefit from specific care? Screening + training observation General risk Specific risk
- 14. Who is at risk ? Specific screening Evaluation of How to evaluate Scapular dyskinesis Static and dynamic inspection Dynamic inspection, with SAT Possible clues: Medial rotation test Glenohumeral instability Apprehension-, Relocation-, Releasetest Shoulder laxity Sulcus sign Anterior drawer test General screening Evaluation of How to evaluate Pectoralis Minor length Determination Pectoralis Minor Index (PMI) Trained muscle imbalance Specific muscle testing with HHD
- 15. Pectoralis Minor Index (PMI) Athlete in supine position Distance coracoid – caudal edge 4th rib (cm) / height (cm) < 7.66 shortened
- 16. Hand Held Dynamometer (HHD) Middle Trapezius Prone position Horizontal abduction + external rotation Shoulder abducted to 90° Pressure applied at wrist, at lateral aspect radius Lower Trapezius Likewise, BUT shoulder abducted to 145° Serratus Anterior Supine position Arm in 90° forward flexion protraction Pressure at palm of the hand, towards table
- 17. Scapular Assistance Test (SAT) Active elevation of the arm Frontal plane - Lateral plane - Scapular plane Examiner manually follows scapular movement How does the scapula move? Any irregularities? Is there any discomfort? Relief when manually assisted?
- 18. Apprehension, relocation, release Supine position 3 phases of testing 1: external rotation (+ anterior translation) 2: posterior translation 3: release posterior translation Only proceed when preceding phase was positive Positive test Apprehension Pain
- 19. Medial Rotation Test (MRT) Supine position Arm 90° abducted, elbow 90° flexed Humerus in scapular plane Palpation coracoid & humerus 60° of active internal rotation Neutral position scapula & GH joint Positive test Forward tilt Elevation
- 20. Sulcus sign Seated Check for distance acromion-humeral head While pulling arm downward Positive test Abnormal laxity
- 21. Anterior drawer test Seated Fixation of the acromion Check for amount of movement While pushing humeral head forward Positive test Abnormal laxity
- 22. Practical application How to implement the plan?
- 23. Implementation Brief information session + conversation trainers Clarify problem Usefulness of prevention Implementation of prevention in training MMA training + individual powertraining Cooperation trainers Individual guidance, if needed Positive specific screening/history shoulder injury
- 24. Exercises Exercises for each specific problem area Closely associated Overlap During group training if possible Short session before or after training Individual treatment programma
- 25. Prevention poster Visual support of the prevention plan.
- 26. What is the SIP-chart? Prevention poster: Shoulder Impingement Prevention Complementary to prevention plan Selection of exercises Objective Support prevention plan Increase accessibility Increase compliance
- 27. Design poster •Brief and clear information about impingement Introduction Relevant anatomy and symptoms Sportspecific red flags
- 28. Design poster Section 1: Technique •Trapezius (middle & lower) •Serratus anterior •Rhomboids Section 2: Muscle function Section 3: Stretching Remark and credits
- 29. What does it look like?
- 30. Utilization Intention Support prevention plan integration Individual concept How to use the poster 2 exercises for each muscle 3 stretching exercises Variation! Guideline individual baseline + progression
- 31. Utilization Additional information Personal contact Website (not developed yet) Website www.sip-chart.com All necessary information Demonstration videos Request an introduction Order poster
- 32. Practical tips Some key points to remember.
- 33. Pay attention to… Correct punching technique Functional posture Balanced development chest/back Stretching as a habit Warning signals Disciplined prevention
- 34. Thank you for your time !