Knee injuries are very common in Brazilian jiu-jitsu, especially since it seems like heel hooks, toeholds, and other leglocks are getting more popular. Is it the Toquinho effect? The rise of the 50-50 guard? Rubber guard disasters? Maybe leglock master “Judo” Gene LeBell is to blame. At any rate, the list of high-level BJJ (and MMA) fighters who have been slowed down by knee injuries goes on and on: Kron Gracie, Xande Ribeiro, David Avellan, Dustin Hazelett, Bas Rutten, Roger Gracie, Tito Ortiz, Romulo Barral, Marco Ruas, Georges Ste-Pierre, to name a few. How to these injuries happen? And how do you treat them?
Knee injuries are something I know a bit about, thanks to a combination of skateboarding, snowboarding, judo, and Brazilian jiu-jitsu that has resulted in torn ligaments, torn cartilage, surgery on both knees, and enough hours on a stationary bike to last a lifetime. I’ve touched on knee injuries in a few past articles like: “Leglocks in Brazilian Jiu-Jitsu“, “Leglocks for MMA and BJJ“, and my calf crush / calf slicer breakdown. I also published a knee injury series at Suite101 a few years ago and will be linking to those articles here.
Who designed these things? Human knee joints susceptible to injury
The problem is that knee structure is pretty poor for a joint that’s in charge of bearing all of your weight while simultaneously experiencing torsional forces. Evolution’s a bitch. What we have is the femur (the biggest bone in the body) resting on top of the tibia (shin bone) and the smaller fibula bone, the whole assembly being held together with what are essentially four pieces of tape (ligaments) and supported by the surrounding muscles: hamstrings, quadriceps, and groin.
Knee Joint Structure: Ligaments and cartilage
The ligaments stabilize the knee by keeping the bones of the joint from sliding out of place.
- Medial collateral ligament (MCL or TCL) runs femur to tibia, supporting the inner side of the knee.
- Lateral collateral ligament (LCL or FCL) connects femur to fibula and provides support on the knee’s outer side.
- Posterior cruciate ligament (PCL) runs through the centre of the joint from the front of the femur to the back of the tibia.
- Anterior cruciate ligament (ACL) goes through the centre of the knee from the back of the femur to the front of the tibia.
- Medial and lateral meniscus – shock-absorbing cartilage pads sitting between the femur and the tibia
Torn knee ligaments (aka sprains) come in three flavours:
- First-degree sprain: Ligament is torn longitudinally (ie. stretched).
- Second-degree sprain: More severe version of above.
- Third-degree sprain: Ligament is torn all the way through.
- The medial meniscus is attached to the MCL, so medial collateral ligament tears often tear the meniscus too, causing chips of cartilage to get stuck in the joint and impede motion.
Combat sports like wrestling, judo, grappling, Brazilian jiu-jitsu, and MMA offer a wealth of opportunities to injure your knees. A few examples:
A hit to the outside of your knee (ie. from a leg kick or sloppy footsweep) may result in a torn medial collateral ligament. These hurt and will take you out of action for a bit, but rarely require surgery unless there’s damage to the meniscus.
Defending the takedown often means turning and twisting while hopping on one leg. That’s the perfect way to tear up your knee.
Twisting leglocks like heel hooks and toeholds are especially deadly because there’s no pain until damage has been done. Tap too late and there’s a good chance that you’re looking at a torn ACL. If you’re really unlucky you’ll end up with the dreaded “terrible triad” – a torn ACL, MCL, and meniscus. A torn anterior cruciate ligament generally means surgery and somewhere around a year on the injured list. Tap early!
Using the rubber guard when you don’t have enough hip flexibility is knee injury city because it puts huge amounts of stress on your ligaments. A few years ago I saw (and heard) a rubber guard-induced total knee blowout from about six feet away. Not pretty. If you feel any stress on your knee during rubber guard, give it up until you’ve made your hips flexible enough to deal with the position.
So you’ve injured your knee. What do you do?
Initial damage control:
When you tear a ligament and your knee swells up, it’s because it’s bleeding inside. You want to get that under control. The old standby here is R.I.C.E.
Rest. Stop what you’re doing. Going back for “one more round” will probably cause further injury, more bleeding, and more swelling.
Ice. Cold helps get swelling under control by slowing down your circulation. This is good. But don’t give yourself frostbite – 15 minutes on, 15 minutes off is a good pattern.
Compression. Putting a tensor bandage on an injured area helps keep the swelling down. Don’t put it on too tight though – if your toes are getting cold or turning purple, loosen that thing up.
Elevation. Get gravity on your side – raise the injured area above the level of your heart.
DO NOT go home and try to soothe the injury in the Jacuzzi. Heat increases circulation and will make the swelling worse. However, a few days down the road when the internal bleeding has stopped, the circulation boost provided by heat will improve healing.
Get checked out. Find a good sports medicine doctor and get checked out. If you’re in Vancouver, I’ll recommend the people at the Allan McGavin Sports Medicine Clinic because they’ve helped me.
Natural remedies. Every time I get injured I take some arnica-based herbal stuff called Traumeel and I swear it helps. If it’s a placebo, it’s a damn good one.
Pharmaceuticals. Non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen can help a lot because they’re a pain killer and help reduce the swelling. Be careful though, ODing will make your liver look like Jason DeLucia’s after his encounter with Bas Rutten. (Note: I was once told told by a physiotherapist to avoid ibuprofen for the first couple of days after an injury because the initial inflammatory effect is actually beneficial.)
Rehabilitation and Physiotherapy
Take your recovery seriously. Strengthen the muscles surrounding the joint. Given the right rehabilitation program, it’s entirely possible to make a full recovery. On the other hand, taking your rehab lightly and returning to activity too soon will most likely result in further injury to the ligaments and cartilage in your knee, increasing your chances of arthritis as you get older.