by Don Heatrick and Lev Borukhov
This is a joint article with Lev Borukhov, a physical therapist from the U.S. with a Doctorate of Physical Therapy from New York Institute of Technology who specialises in working with fighters. He’s passionate about Muay Thai and has an informative blog at www.fightpt.com. We’ll be acting as a tag team — Lev handling the physical therapy and I’ll handle the strength and conditioning, and both of us contributing to the Muay Thai training recommendations.
Physical Therapy — Lev Borukhov:
In this post we are going to walk you through the process of correctly fully rehabilitating and training a fighter for an upcoming fight after a medial collateral knee ligament sprain (grade 1-2). This is not a step-by-step guide because every person is different. This is a general case with small sport specific additions that I like to include for fighters.
Grade 1 Sprain — Pain and tenderness, no laxity
Grade 2 Sprain — Pain and tenderness, some laxity but there is an endpoint (knee cannot be bent sideways all the way)
Proprioception — The ability to sense the orientation of ones extremities in space (ex- knowing where you place your foot when your eyes are closed)
IASTM — Instrument Assisted Soft Tissue Mobilization also known as Gua Sha in Traditional Chinese Medicine uses metal/wooden/stone tools with a blunt edge to decrease fascial adhesions under the skin.
MCL — The medial collateral ligament is on the inside of your knee joint. It plays a big role in keeping the knee stable by resisting a valgus force (knock knee). The MCL is also connected to the medial meniscus, and some fibers of the semimenbranosis (inner hamstring) muscle. The MCL has a good blood supply and will usually heal on its own with grade 1 and 2 sprains.
A grade 1 or 2 MCL sprain occurs when a force or twisting motion is applied to the outside of the knee forcing the knee inward, especially when the foot is in contact with the ground its very common in Muay Thai. For example; if you receive a low roundhouse to the outside of your planted leg. So be sure to check those kicks :)
Lets say that you were sparring and someone landed a low kick on the outside of your lead leg that was planted on the floor, you didn’t check it and felt your knee turn to the inside (a valgus force). You kept going until the end of the session. As you’re walking back to the locker room you notice some pain in your inner knee, you shrug it off, and go on with the rest of your day.
The next day, you wake up with some knee pain; sit up from your bed and your knee buckles. You feel some pain and it looks swollen, every step creates more pain. Then you get to some stairs and its more difficult than usual to ascend or descend them.
You walk into your physical therapists/ medial professional office and they confirm it with some diagnostic tests. It’s a Grade 1 MCL sprain. The first thing that needs to be done is to get rid of inflammation. Inflammation decreases muscle mass and it also decreases proprioception, something fighters can’t afford to lose. This is usually done with soft tissue work and then applying some Kinesio-Tape (Rock Tape). Rock tape is great because it stays on for 3-5 days 24 hours a day. It’s not restrictive and decreases inflammation exceptionally well. Exercises like quad sets, heel slides are also initially done to make sure there is no limit in knee range of motion (ROM).
Before the patient leaves I make them get a knee brace, nothing fancy, just a neoprene sleeve the will help stabilize the knee, and not stress the MCL when walking and going up and down stairs.
Too often, when an athlete walks into a health professional’s office with an injury from an activity or sport, they are simply told to stop doing the sport. It’s very important that the athlete/fighter see someone who understands/ specializes in the activities or sports that they participate in. So they are not told to stop, just modify their activity levels correctly to prevent further injury.
Strength & Conditioning — Don Heatrick:
In this example, the medial knee ligament damage was the result of a traumatic blow to the joint, so we aren’t looking to correct any movement dysfunction. It wasn’t an internal self-destruction caused by overusing poor movement mechanics, but rather an external factor – a hefty low kick.
The rehab work will have strengthened the supporting muscles surrounding the knee joint to regain stability and recovered mobility. Once given the all clear by the physical therapist (usually after a week or two), now we’re ready to employ functional and dynamic exercises to regain athletic qualities.
When injured, it’s especially important to thoroughly warm up and activate the stabilising muscle groups at the beginning of every resistance training session, to give your knee the best chance of keeping up. A sequence I’d recommend would be 8-14 reps of the following:
Start with 8 reps of each and add a further 2 reps each successive week until you reach 14 reps after 4-weeks back to resistance training.
Load & Volume
Remember that you will have lost strength as a result of the injury, you must progressively build the resistance back up. The load, the number of sets and reps that you use can be tailored by how the session feels, but as a guideline I’d start with 3 sets of 10-12 reps for all lower body lifts, with a load that you feel you could lift perfectly at least 14-16 times.
In the following table, I’ve broken down how I’d reintroduce exercises week by week. Each successive week details what could be added to the exercise selection already permitted.
Your training sessions shouldn’t hurt your knee. If they do, regress to the previous weeks exercises and continue with those for a further week or more before considering stepping up and including the next set of exercises. Monitor how you feel during and after each session and gauge whether to increment your current training intensity/volume (load/set & reps) up or down.
Curb your extremist tendencies as a fighter to push on regardless; this attitude doesn’t help you recover quickly from injury. Remember the long-term goal is for progression of athletic ability not a temporary buzz – keep that ego in check.
Here’s a rough timeline of a fighter’s progress: