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David: Hey, Lachlan, how are you?

Lachlan: Good. How are you?

David: Yeah, good. Thanks. Thanks for coming on the podcast.

Lachlan: Thank you. When I was practicing more physiotherapy, I was a long time listener of this podcast. yeah, it's cool to be on.

David: Yeah, it's great to have you on. I've been looking forward to diving into BJJ injuries. You've got lots of experience with these. You've also competed at the highest levels of Brazilian jiu-jitsu. You have coached top level competitors, and you've seen and experienced that as well as studying knee injuries in your PhD. Lots to explore in the podcast and really look forward to diving in into all that, into your experience, into the research and giving people that are listening, lots of strategies and tactics that they can use to successfully treat their BJJ athletes.

Excited to have you on and have a chat about all that.

Lachlan: Sounds great. Looking forward to it. Just in case, because I might get a few quite a few jiu-jitsu people that listen in as well. And I'm just going to say, please don't message me with all your injuries and asking me how to, what you should do about your sore knee or shoulder or anything like that.

Yeah, that's, I'll just start with that because already get some of those questions and I usually just say it's hard to say online. You need to see a professional. That's where I got to start with. I'm not really practicing anymore. Just full time jiu-jitsu now, but hopefully I can provide some insight into injuries in jiu-jitsu and some other things. Yeah.

Lachlan's PhD

David: Let's go back a little bit. It's 2015, 2016. You were competing at the highest levels of BJJ. You were coaching. You were also working as a physio, and you were completing your PhD, you had a lot on your plate. Talk to us a little bit about how you actually fitted all that into your life at that time.

Lachlan: I don't even know how I finished it all, let's say 2015, 2016, I got into my third year of my PhD and I was competing jiu-jitsu at the time, I'd be studying and doing that, and then I'd be working as a clinician as well.

Then probably able to train really usually once a day in jiu-jitsu. And then whenever I could, I'd try to fly nationally or internationally to competitions to compete. I completed it in four years. In my third year, I took a six month break to go to Brazil and train, it happened to allow me some time to write some papers and, it wasn't fully off, the good thing about, when you're trying to, train a sport at a high level and you're doing something like a research is you can do that lying down well, you can be resting and recovering while you're doing some of your research, let me get some papers published and on and then I came back and completed the last the final study of my PHD.

David: So you were pretty busy at that time. Talk to us a little bit about the background. What did you do your PhD on?

Lachlan: You've had Jill Cook on. Jill Cook was one of my supervisors and Kate Webster and Jodie McClelland. When I was talking with Jill Cook, we were, we thought it was a bit silly, all the people trying to isolate particular VMO and versus just general quadriceps and on.

So we thought we'd do, the idea was to do a study to compare whether there's any differences in quadriceps atrophy in particular VMO more atrophied than Vastus Lateralis or the other quadriceps muscles. That was the kind of subject we wanted to look at first, and a good way to start was with a systematic review on just whether there's quadriceps atrophy in patellofemoral pain, which I guess that's something that we all knew, going into it, we knew there was quadriceps atrophy, but it's nice to actually put it all together in a systematic review and as just learning to do research and learning to do a systematic review.

It was a nice long process of finding an answer for something you already knew. After that, I then did a validity study using ultrasound to measure the size of the individual quadriceps muscles. I did a study comparing ultrasound measurements to MRI measurements to see if it was a valid method, and then, once we found there was some validity in using that method, then we got a whole bunch of people with patellofemoral pain and compared them to people without patellofemoral pain, measured the quadriceps and found that the atrophy was throughout all the quadriceps muscles and it wasn't isolated to vastus medialis.

I guess suggesting that, there's a global quadriceps inhibition and atrophy versus isolated VMO issues. And then the last part of the PhD was, I had to work out, what do we do to follow up from that? I don't know where, I've been reading somewhere about blood flow restriction training.

It's reasonably well known now. Back when I looking at it, it wasn't well known. I read something about it being good at strengthening. Like it can create hypertrophy and strength gains at lower loads than traditional strength training. And I thought, I just somehow matched the two and I said, Oh, that could be an interesting one to do for patellofemoral pain because obviously like we want to strengthen the quadriceps.

We know, we already know that quadriceps strengthening is actually a, an effective treatment, but it's one of those things you read the papers and you know that quadriceps strengthening works, but then when you have a patient in front of you, you recommend strengthening and then they'll get flared up because it's hard to manage how much load to actually give them.

And I thought, Oh, maybe in this case we can go a lower load, put the blood flow restriction in, they get their strength gains without overloading the actual joint, which had a slight treatment effect overall.

My takeaway from the actual study was that, I would just do normal quadriceps strengthening. I think if you had someone who was flaring up, you could then possibly try blood flow restriction.

If like they are someone who, does flare up, then blood flow restriction.. They actually did do well in getting stronger even using lower loads on that end it was good, it was just like, the actual outcome of pain and improvement was not necessary, I don't think it was not significantly better than just doing quadriceps strengthening, that's what we ultimately usually want, is a reduction in pain, or like an improved function, but we didn't find that much, but we did find it was good at strengthening the quadriceps. You can use that as an adjunct to your treatment.

David: And what was your control group? You had your blood flow restriction training, and then your control group. Was that another group doing the same exercises without blood flow restriction or a control group doing no exercises or what did you have to compare it to?

Lachlan: We compared it to just a traditional strength training program. We took their one RM and then we tried to go 70 percent of that and then we would reassess that and increase it as need be as the, I think it was over eight weeks.

But if they had pain. Then we'd had to drop it to the whatever their maximum amount they could do with that pain. If it ended up being 30 percent of 1RM, then that's what it would be, I guess we're pretty careful. I think that's what we do clinically anyway. If someone's got pain, we often don't just push through, although there may be some cases where you do, but often you try to find a level below that and then build up.

As you should with research, really, I think, you want to compare to what people are actually doing clinically to see if your intervention is actually better than what the current, best practice is.

Lachlan: Blood flow restriction at around 20 or 30 percent of 1RM versus no blood flow restriction at up to 70, depending what pain would allow.

Can VMO be targeted with rehab?

David: We looked at VMO and at that time there was a lot of people targeting VMO with biofeedback EMG really trying to get VMO firing or working.

That was one of the key areas that a lot of people were focusing on with knee pain. what did you discover about VMO when you did your studies?

Lachlan: I think the literature on like the muscle timing whether it was delayed, some studies said, yes, some said no. Maybe there is some slight delay in the actual activation of it, but I guess that, first of all, is that true? Maybe. Then , if it is true, what do we actually do about it clinically? Can we actually isolate this one muscle and make the VMO work more than the other quadriceps? My thoughts were that's, that seems ridiculously challenging to do. Like I, I would generally consider myself very body aware and Most of our patients are not going to be to the same level as a physiotherapist in terms of aware like even what the muscles are when they're activating when they're not and I don't think I can make my VMO activate without my rest of my quadriceps. It's just a question of can we do it, first of all, is it actually an issue?

Maybe. The quadriceps atrophy suggests that it wasn't that much of an issue. If it is, can we actually change that? Or does just doing quadriceps strengthening work? And we already know that doing quadriceps strengthening works. My advice would be to just do quadriceps strengthening. I'm sure there'd be some people who might argue that, and that's fine. But that's my suggestion. Yeah.

David: Brilliant. Why don't we have a bit of a chat about BJJ now, and maybe if we give some of the listeners a bit of background on what BJJ is and some of the injuries that BJJ athletes actually experience that sort of thing.

Lachlan: It's basically submission grappling, like the goal is to try and get your opponent in a submission. Foot lock or a arm lock or a leg lock or a choke or strangle as some people like to be pedantic about calling it. And basically, the aim is to make your opponent give up basically. You're putting them in a position where they're like, if I don't give up now, I'm going to get injured or choked.

In a competition, that's basically the goal, right? Like you're getting to a position where you make them go my arm's extended. I need to tap out. Otherwise my arm will break or I need to tap out cause I'm getting choked and otherwise I'll pass out.

It sounds probably if you have never done it before and you just listen to that, it sounds horrendous, but it's actually, if you're practicing it properly and different to a lot of other sports, I think where you can, especially at I'm an experienced black belt, but I can probably move at like 50 percent speed and effort and still be very effective and handle, most people.

You can be very relaxed and flowy and not necessarily be putting a high stress on any of your body. Obviously you are trying to get your opponent in a submission, but even then when you're just training, ultimately you shouldn't be trying to actually break your opponent's leg or arm or cause any serious damage with your training partners.

You're trying to just get them in a position where they recognise, okay you got me, I'll tap and then we start again. The closer you get to the higher level competitors, the the more they're willing to risk, that's how you know. If you're wanting to compete at a world championship level, you need to know under a bit more stress, can I get out of this arm lock or leg lock like when someone's really trying to put it on? Obviously the closer you get to a high level competitor the more risk they're probably taking in their training.

I think that's a really nice introduction to BJJ and sums up what's happening in the sport, basically your goals, are to try and submit or get the person to tap out using different locks or chokes, but normally in training or even in a competition, you're not looking to injure them. You're just looking to try and get them to tap.

The biggest injury risk is probably very early on, just from you don't know what you're doing. You tense up way more. If you go very frantic, often it makes your opponent go frantic as well. And then there's much more likely that injuries are going to occur. Usually between two experienced people, injuries are quite rare. Unless you start getting in that highly competitive environment, where, as I said, people are going to take higher risks.

What challenges do Physios face when treating BJJ athletes?

Lachlan: When physios out there are treating BJJ athletes, what are some of their issues or challenges that they're going to face when they're trying to get their patients back to being able to train, being able to roll or spar or back to competition?

I'm no longer working clinically pretty much, just full time  jiu-jitsu now, I've got a Instructional website. I teach jiu-jitsu a lot. I still see a lot of injuries and I usually handball onto someone else as quick as I can.

Lachlan: But, the challenge for a physiotherapist is unless you've done jiu-jitsu, there's a lot of terminology and positions and if you haven't done it before, it's very hard to understand the mechanisms of injury and what your patient can actually go back and do.

I've got an LCL tear right now and I tore it like three weeks ago. I was pretty much back training a few days later and I've just totally modified what I'm doing.

Lachlan: So I'm playing half guard, on bottom and on top I know which way I can't turn my knee. I'm obviously very aware of what directions my knee can and can't move at the moment. But you can get back to training and there's lots of, there's lots of ways people can work around an injury, stay in the sport.

And that's often what they want to do. But that also does require experience because I've got a lot of experience. I can go, most people I go against, I can control what's happening, I can, and I'll often, I'll tell them before just be careful of this knee and I can get back to.. That's not necessarily what I recommend you tell your patients though, because what I'm doing here is, it's like having a deep knowledge of my injury and what I can do in jiu-jitsu, but the hardest thing for a clinician is just, all those different positions and where things can be twisted and turned and then knowing what they can get back to.

So probably the easiest thing is a blanket, don't get back until it's near a hundred, 80, 90 percent when you're back to the return to sport phase, like you'd normally do. If you've got a physiotherapist who does jiu-jitsu, they can possibly give some suggestions that is going to allow someone to get back even earlier, cause they'll know what positions are going to put strain on the injury you've got, have you got a lower back injury you're probably going to have someone avoid getting stacked. There's some moves where essentially you get your legs stacked right over your head, which tends to put a lot more stress on the back than again, someone like playing half guard or playing on top, like you can just on top where you basically don't have to have much stress at all on your lower back.

That side of it's probably the hardest for a physiotherapist. In terms of the injuries, I'd say you get everything. Knees are probably the most common. It's a bit different to most sports in the amount of deep flexion that we in jiu-jitsu.

There's a lot of time spent essentially in a near full squat or kneeling on your knees, under load and rotating and twisting around your knees in that sort of position where obviously most sports you're standing up running around and the most you'll bend your knees is, I suppose if you jump, you might bend a bit more, most of the time you're not bending much more than a hundred degrees of flexion I'd say. Here we're in like full end range of the flexion a lot in your knees.

When to allow patients to continue training

Lachlan: First off, you got back into training pretty quickly after your LCL injury. Besides the fact that BJJ athletes and most sports people want to get back to training as quickly as possible, or keep training, why wouldn't you give your LCL injury a good solid five to six weeks recovery to make sure it's fully healed before getting back into training? Is there a reason that you might want to keep someone training in BJJ as opposed to giving them that recovery period where they're not training?

Two reasons. One, they're going to want to. You'll if you can, you'll have a happy patient. But obviously you have to be very wary that you're not putting you in a position where they're going to re-injure. But certainly something I've observed, and I was always a big fan of the theories around loading.

Lachlan: I feel like you decondition a lot from the sport by, if you took six weeks off , all parts of your body are deconditioned and they're all now primed to potential overload when you come back. Whereas I feel like if you can keep training and just in a position that works around your injury, then you keep the rest of your body fit and healthy. When that injury does recover, you don't have something else that's waiting to be injured. I'd see these people that they get injured, you don't see them for a while, they come back, something else gets injured.

You don't see them for a while, they come back. And in my experience, keeping, trying to keep a steady training volume regardless of the occasional injury is is better. If you can.

David: Yeah, definitely.

It's one of those sports where you can hit the gym, you can be doing all the conditioning, but still very different to rolling on the mats. It's lots of different stress on your body and different to lifting weights or any of the other sorts of conditioning that you can do.

Lachlan: I think I could probably run for 3 minutes, but do jiu-jitsu for an hour straight, but you got me to jog. Yeah. I'd be gone after three minutes I reckon. yeah.

David: Yeah, I had elbow surgery and I had six weeks off training and rolling, and I was still hitting the gym, but I felt like at the end of that, it took me three months really to feel okay and to get my conditioning back and feel okay after training. it's definitely one of those things that it's very specific, the stresses that it puts on your body.

Lachlan: Do you try to approach it the same way now, like keep trying to train around things as, as much as you can, obviously knowing there some injuries you can't, LCL, technically you shouldn't..

David: Yeah, definitely. when I've had injuries and my patients have had injuries, generally looking for positions that they can actually work in or maybe it's drilling and finding those, positions or attacks or defenses that don't stress that area.

If it's an ankle ligament injury, maybe they're avoiding foot locks or they're avoiding stuff where they're hopping around on it, like wrestling, but then finding the stuff that they can actually do that doesn't stress that area and, finding the level of training that they're able to do without, injuring it further.

Different types of training

Lachlan: Yeah actually that something I did want to discuss. There's three modes of training if we can generalise it there's drilling which is just essentially just working a technique your partner's not really trying to fight you, give you much of any resistance at all.

They should give you like feedback and proper postures and on. You have to like practice dealing with grips that you're likely to encounter, but that's just getting repetition or even just troubleshooting problems. There's a lot of strategy and techniques.

There's a lot to learn in jiu-jitsu. You can get a lot out of, even if you can't actually train hard, you can come in and troubleshoot and there's much you can get, even if you're not able to actually train live hard. That's Drilling.

Most gyms these days, I think, will usually do some drilling and then they'll do situational sparring, which is essentially, there's different positions in jiu-jitsu.

It's not just, we're not always in the one spot, like squaring off against someone. You might be on top, you might be on bottom, you might both be standing. You might have taken someone's back. There's various positions. And even within that, there's sub positions, different types of guards and on.

Different ways your legs can be configured. And specific trainers usually like, isolating one of those positions. Could be broad or it could be very specific. And saying let's just go from here. And when we extract ourself from this position, we'll stop, we'll go back and we'll train that position again.

That's probably where I would generally, if I'm getting, trying to get someone back to training earlier than they're not fully ready yet. But I might be like, Oh, in this position. Your knee will be fine. Okay. It's just when we can't do full live training. The last one is rolling called free rolling or free sparring.

That's where anything can happen. Obviously that's the last thing you're going to take someone back to after an injury, but the specific trainings often allows them to actually still get a bit more of a workout. They're trying things live. That's, let's them have fun at training because drilling can be a bit boring. The quicker we can get to some specific training that's not going to stir their injury up is is usually a good thing.

Lachlan's training with an LCL injury

David: And that's what we'll probably dive into. There's different guards, different positions, and they all place different stresses on different parts of your body. But you've got an LCL injury at the moment. Do you mind sharing how that happened and how you've adjusted your training and that sort of thing?

Lachlan: One of the injuries that you will very rarely see. In other sports is an LCL, for example, I remember back when I was working with Tanya Pisari, she took my MRIs cause I had a bad, I'll talk about that in a moment, a bad LCL injury, but she used to bring it to her clinical professional development talks and show the MRI, it was almost like thought that LCLs don't happen.

That's rare to tear an LCL, but in jiu-jitsu. It's quite common for someone to be gripping your leg and externally, they might grab your ankle and they're externally rotating your knee. This is a good way to take someone down for example. I actually have fully ruptured my left and right LCL when I was much younger, I had surgery on both of my LCLs when I was 19, I did my left one, and then I tore my right one when I was 21. These were actually both from wrestling training takedown, which is part of jiu-jitsu, but it was a specific wrestling class. Since then I pretty much haven't had any major injuries, I've had that recent minor LCL, I've done another minor LCL before. There, it's an interesting one, the LCL. Like when, both of my full ruptures, I had zero pain, did not feel any pain at all. The first time it happened, obviously I was, I think I was in first year physio. I heard a loud pop as my knee turned.

I said, Oh, that's funny. I kept training for another 45 minutes or so. I did feel my knee wobble a bit during that and then the next day it was a bit swollen. I went and saw my physio at the time and he thought the LCL was fully torn and sent me to a sports doc. I ended up getting surgery within a week.

And then the second one was similar, no pain at all. It was on the other knee and I knew I was upset cause I knew what coming. It was basically a year of rehab. I'm not painting the sport in a very good light. Am I?

David: Yeah, but that's the reality.

Lachlan: This recent one I must have some weakness in my LCLs to some degree.

It was a pretty innocuous event. It was just someone holding my ankle. I went to just lift my hips up. I was on the ground actually, they were lifting my foot up. I went to lift my hips and I knew it was LCL. I wasn't sure how bad, but it seems like it's a grade one or two. I didn't get it scanned, but it's got a decent amount of stability there. Again, not much pain, I guess that's something to be considerate of I've seen quite a lot of LCLs throughout my jiu-jitsu coaching and being a physio. And often, there's very minimal pain. It can put you off because it'll be like, oh, it didn't hurt. Obviously that's sometimes a sign of a Grade 3. But even a Grade 1 can sometimes have no pain. For some reason, it's not a very highly innervated ligament, or must be some reason why it's not causing pain. But for the LCL for those who are watching, like there's a lot of jiu-jitsu movements where like your foot comes towards your head, right?

Imagine you're basically trying to touch your foot to your head. This is useful for, if you're on the bottom and someone's trying to squash you, you usually want to try and get your legs in front of them to push them away. if you can fold your foot to your head, pretty much, that's going to allow you to get your foot in and then you can push them away and make some space.

That's one way some people get injured by trying to fold their leg in front like that. But also, obviously when you've got an injury, like right now, I'm not doing any of that motion. When I'm on the bottom position, I'm just trying to keep my legs low down and latch onto my opponent's leg and use a position called half guard to try to sweep.

You do have to be a little careful with the LCL, if you can imagine if you had a weak, an injured LCL, even just, if you want to go to stand up and you fold your leg and you try to come up over the top of that leg, there's a certain point where your LCL actually takes a bit of strain.

Some people injure that under tension. I've seen some people injure that. But when it's an injured ligament, you've got to be careful even just getting up like that. Usually there's bottom position, top position. When I'm on top I'm just wary not to allow my knee to go outside my ankle.

As long as I keep my knee inside my ankle, I can basically, I can run left and right, I can pivot, I can do all that and I don't feel any LCL stress. I'm just very acutely aware not to let anyone push my knee outwards. I can almost do everything from top position unless someone starts, if someone starts to grab a hold of my leg and try to do anything, I'm just, I'll basically just stop there and say, okay let's stop and I'll start again. I'm trying to just actively avoid them grabbing my leg. I think If you're very experienced and you're rolling, you're training with partners that you trust This is something you can work around like that. But generally I would, for the most part, I'd just tell people to take the amount of time until it's pretty much back to a return to sport sort of thing you'd that you would normally do and then give them the all clear Probably with some, advising them that you can go in and drill beforehand.

Just be wary with most jiu-jitsu people. If you tell them you can go back to training and drill, they're probably going to train. They're going to, will, at least from my experience, people will push it a lot further than what you tell them as a physio. I think if you tell them something conservative, they're always going to do little bit more.

David: Yeah. There's always that temptation. You can say, oh, you can do a bit of drilling, and next thing you know they're rolling and going a bit bananas.

Lachlan: Look, most of the people I've seen that do that, they actually end up, most of the time it's fine. Like they, most of the time it is okay to push yourself a little bit, but obviously that's within reason.

Common injuries in BJJ

David: Alright, let's talk a little bit about the sort of common injuries that you see in jiu-jitsu. What are the most frequent ones do you think?

Lachlan: So with the knee, basically all ligaments. PCL is pretty rare but ACL, particularly when you see people, doing takedowns, so when you're both standing, trying to put someone down, obviously, it's pretty easy to have someone collapse across your knee. ACL is pretty common. MCL as well. Same mechanism pretty much. Meniscus , because of the deep flexion that we're working in, I think meniscus is more common. One that actually very common in jiu-jitsu.

You'll come across these people, they. They'll be like, oh, my knee pops out then I straighten it and it clicks back in again, and then I'm okay. And then they often will say oh, it's like happening more frequently but I had a few people like this and they would often go and get an MRI and it would come back with showing nothing, they'd be like I got an MRI and nothing came up. So it's not meniscus and then I had one guy who managed to get an MRI when it felt like it popped out and he managed to go and get an MRI when it was popped out. And this is something I'd already uh, spoken to a sports doc who thought it was this, but the lateral meniscus had shifted forward and it was actually the whole meniscus was sitting in the anterior part of the joint.

And then for whatever reason, like these people often can like straighten it around.. I don't know if I saw much of this outside of jiu-jitsu. I'm sure it happens in the general population as well. But that's something to be aware of because they're often pretty frustrated actually because they're like, I went and got an MRI. They told me there was nothing wrong. Because when it's back in position, it often looks good. I did have one sports doctor I was talking to who was able to like he said when you look really closely on the MRI like the attachment for the meniscus looks like there's a bit of there was some issue with the, I'm not amazing at reading MRIs, but there was some issue with like he could see it once he knew like what he was looking for from the clinical presentation, he was able to find it.

But most MRI technicians who are just looking MRI this knee and me what's wrong would not be finding that. if you're finding someone with like recurrent they at least this sports doc referred to it as like a subluxing lateral meniscus. Yeah, that was an interesting one to me. I wasn't sure if I believed it until I saw the MRI of it actually sitting out. I don't know if you've come across some people who've had that.

David: No, but I've read some case studies that have been written up about patients, gymnasts and other people that have had dislocating lateral meniscus. But I haven't seen any, myself, seen plenty of meniscal tears, bucket handles, that sort of thing. But none of these.

Other areas injured in BJJ, and why low back pain occurs

Lachlan: Obviously this is just one of the types of meniscal tears. Any meniscus tear can present quite similar with the locking, but I guess it's just the key difference here would be the returning of a normal MRI result.

It doesn't necessarily mean that the meniscus is actually normal. This is quite common. That's That's in the knee, pretty much everything. What are we, ankle, yeah ankle, as you said your son had an ankle injury, there's ATFLs very common, medial ligament. Those would be treated, very similar to how you would treat, I think if you treat those ones just like you would for any sport, I think you're fine. Hip, not too much. I haven't seen too many hip issues. Lower back's pretty common. Like your normal lower back things. In jiu-jitsu there's probably two things that tend to put a bit more stress on the back.

There's, one is, on the style, some people do a lot of inverting, which is included, like you roll legs over your head almost. You can spin under your opponent and get some good angles to attack from, but often people who do this a lot will complain of back pain.

And then there's obviously just, there's lifting involved as well, right? Especially with takedowns, but there's a lot of times when someone's trying to pull, break your posture down, they're trying to pull you down and you're trying to, posture up and stand up against that. There's some, back strain there. Those are some things that you can certainly work around to some degree while you're training, depending how how severe the injury is. Necks are pretty common. Two reasons for the neck. Probably the easy one is there's a lot of chokes and on, but sometimes you're getting choked and your neck's getting twisted.

It's not uncommon to see cervical radiculopathy radiculopathy and on for, which is obviously something you need to manage. Those are the sort of ones I'd probably want to make sure that probably fully recovered before training. It's hard to fully hide your neck and go to jiu-jitsu training.

The other way people get injured is often like with some of the takedowns, you're bumping into your opponent with your head. It's very common for wrestlers to have neck issues. Shoulders, yeah, all your standard shoulder injuries. I don't think there's anything too unique.

I've seen quite a bit of osteolysis of the AC joint. You can sometimes land on your AC joint. Because jiu-jitsu guys get back to training, there's a lot of kind of movement under stress with the arms.

Osteolysis seems pretty common.

Elbow, very common. I'd say just about everyone who's been doing jiu-jitsu for over 10, 15 years, will have elbow issues. It seems to be, I'd say that's like extremely common. I know a lot of people who have had bony ossicles taken out of their elbow.

Probably from like arm bars where your arm gets straightened. I'll say it's probably because of that. I'm not a hundred percent sure, but by having your arm straightened, and of course we try to tap at the right time, but I think it only takes a couple that you're a bit late to and you get these little bits of essentially floating bone in your elbow that occasionally, like you get people who, as they try and straighten their elbow, they get locked at about 10 degrees off full extension. If not more or less and sometimes it gets caught, like they go to straighten and they feel like they have to click it and then straighten. I definitely have that myself. I haven't had surgery on it. Still got full range, but I sometimes feel a little, like something gets caught in it and it clicks and that's something I've certainly noticed. I think that's tends to be something that develops in people that have training a long time.

Fingers and hands specifically people who.. There's two kind of main training. There's the Gi, which is like a karate uniform that you might have seen. And then there's no Gi, which is basically you're wearing a rash guard and shorts. In the Gi where you've got the kimono the Gi. There's a lot of gripping, you get a lot of finger and hand issues. Someone tries to break your grip, you can get the fingers and hands caught in that and if you look up jiu-jitsu fingers or something on Google, you'll probably see some ugly looking hands. This is from people onto sleeves in a fully closed fist, and they often get these like bony growths around the joint of each finger. It's yeah, it's not the most attractive thing, but

David: Yeah. jiu-jitsu hands there great, aren't they?

Lachlan: Yeah. Despite all that, you can train it in a very safe way, that's actually very low risk of injury. It's very much up to you, like, if you're losing, how much do you want to fight to come back and get out of a bad position and a lot of the risk is on yourself.

You can do this in a way that's, I think, very healthy. You get fit, you can keep your flexibility, your strength. Heaps of fun. There's there's definitely a way to train well. And there's a way that you can train that you won't last in the sport that long.

How BJJ athletes can train to stay healthy and avoid injury

David: What are some of the common ways that people shortcut their careers or their ability to train or, injure themselves?

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Lachlan: The most obvious one is not tapping. You can look up a picture of Paulo Miyao getting knee barred. Basically like some people just don't tap. It's less common right now, I think, but at one stage people would just would not tap to leg locks like at the high level, like the world championship level. Yeah, these people are just like, I don't care. You can be breaking my ankle, breaking my knee. I'm just not going to tap. And you, if you look at this picture with Paolo Miao, he was one of those, he never tapped to a leg lock or a heel hook or anything.

Probably, he's being knee barred, which is like a move that hyperextends your knee. And his knee's probably in a good 20 degrees are all gone and he didn't tap. He eventually got out. I think he even won that match.

David: Yeah.

Lachlan: It's actually amazing to see like, not only can people withstand some of these things, but they'll often be able to keep competing and a lot of the time things you're like, I don't know how you're like ,what are you doing? That's terrible.

And then you see them compete two or three months later. It's amazing how well people can recover from some of these injuries, but then you're not going to like in there five years down the track That's a different matter. Eventually they just get like a joint that's swollen all the time and it really impacts their ability to train and then if you can't train properly, you can no longer compete how you once were, and then it stops.

Look, some people justify that there's a classic match, Ronaldo Jacaré and Roger Gracie and Jacare. Roger Gracie is considered like the greatest of all time and he, in the world championship final, he had an arm bar on Jacaré and Jacare basically had his, let his arm break, shrugged it off basically ran away for the last minute and he won the match.

Maybe, if that's your life's work, like you've done all this training, like some people might justify for themselves, like having an injury like that to win it, to be a world champion. But I guess I see an issue with it as well, just like then you see people in a local tournament trying to emulate their heroes and they sometimes will yeah, try to repeat that mentality. But I think it's gotten better. The real mentality I think you should have is, for me to get better, I've got to get better at not getting caught in this position. There's a lot of mistakes I've made to allow you to have a hold of my leg or my arm like this.

And if I just tap now. I go back to the gym and I work on fixing those mistakes. I won't be here now And then that's the pathway to improve. I think that's the healthy mindset.

So we're talking about not tapping is one way to get injured and have a pretty short career.

I think just the speed and pace of your training. It's probably not a politically correct term, but people use the term spaz, like people just like moving around very fast with minimal goals about their movement. Everything you do should be really deliberate, like I'm gripping this leg because I know when I grab that leg, he can't put the foot on me and then I can start to advance my grips.

So everything should be deliberate, which allows you to play this slow style, and I think that's the key to a longer career. Slow is fine. When you're moving very fast, that's when things unexpected can cause injury. Slow, even, I think you can put a lot of strength behind something as long as it's applied slowly.

I don't think it's too likely to cause injury if you're actually like, if you are using high effort, but in a slow controlled manner that's fine. When you start adding a lot of speed, it starts causing issues.

Getting back to training and rolling

David: Yeah, rolling in particular, like most people tend to match the effort of their partner. if you're going in hard, then their partner's going to go in hard. How do you find you can tend to adjust things besides positions or other ways you can get people safely back into training.

Lachlan: Yeah, that's a good point. Once you've been training at your gym for a little while, you know who's a dangerous person to, to train with and who's calm and methodical, despite all your efforts, like I try to encourage that sort of calm methodical style, but you're going to get people who do all sorts of things, like one, one way to just avoid getting injured, just don't train with, you don't have to train with people that you don't want to. If someone's a lot bigger than you. If you're small, if you're 55 kilos, I think it's good to learn how to beat a big person. Like it's a very useful skillset to learn how to, if you're 55 kilos, it's a good feeling to know that you can go against 120 kilo. roided up person and you can take care of them. That's like a nice feeling, but if you're doing that all the time, that's high stress on you. Like all your movements require near maximum effort just to create some sort of effect. And that's obviously much more likely to injure you than training people with people your size, where you can use 70 percent of, or 60 percent effort which is much more tolerable.

So that's a, that's an important thing. Yeah, I definitely think in returning to sport picking the right training partners. And you got to look at yourself as well, reflect on yourself. Are you the training partner you think you are? Because I think most of the people who run around very fast and who I'd say are like high risk of injury.

If you ask them they think they know, they're on the slow methodical side. People don't always have a great perception of what they're actually like. Something that's often worth recording yourself training and just have a look and go, what do I actually look like?

Am I moving in the way that I want to move? But a lot of that's, you can set the pace a little bit yourself. if you're against someone who's moves around like that, often if you come in much slower and with some sort of soft grips, it'll often tend to bring them down at least. If you can take them down 10 percent from their speed, that can be much better for injury prevention.

So I think often how you initiate the role will dictate what it's going to be like from then on.

David: Let's have a bit of a chat about inverting, where people are up on their upper back, they've got their legs up over their head on the floor or up in the air, and you mentioned you do a fair bit of it, and it was a big part of your game. do you think that, overall, is it a safe position for people to train in or what are some of the prerequisites that make it safe, and when do you tend to avoid it for your athletes?

Lachlan: Yeah, good question. I think, first off, I think there are some flexibility prerequisites before even considering doing inverting. If you're not flexible and your feet are being pushed above your head, your neck's probably going to be the one that takes most of the strain. Imagine you've got like a, not a very flexible lower back, not very flexible hamstrings.

feet are being pushed back here. You're going to get rolled back and your neck's going to get jammed up. I've seen quite a lot of very stiff people just from their feet being pushed above their head, basically having their neck jammed up they get an injured neck. Then if you do have the flexibility requirements where you can put your feet above your head and you can still lift your head up and down off, off the mat, I'd say that means you've at least got some slack left that you can, you're not fully jammed up.

If it's done well, there's very minimal stress on your body. If it's done offensively, I've set up some good grips, and I'm now inverting to improve my positioning. I'd say that's safe. You can also sometimes be forced to invert. As a way of preventing a worsening position, like someone's about to pass you, they're about to I'm trying to say this in a way that someone doesn't understand jiu-jitsu.

They're about to squash you very bad and you see an opportunity to put your leg in front of them, but now you'll be squashed, but your legs in front of them, basically. That's like the inverted position. And it is usually a better outcome, like from a tactical perspective, maybe not from an injury perspective, but from a tactical perspective to have your legs in front because they're the strongest weapon you've got to push them off you.

So if you can, you would want to get your legs back in front of them, but you're now going to be jammed up in this sort of very contorted position. And you're also going to have to use a bit of energy to try to push them off. you're in a bad position and also , because of that bad positioning, you have to use quite a high amount of force to get rid of them.

Overall, you'd be, you'd probably be less likely to get injured if you just let them pass the guard and try to recover a different way. But that depends on your goals. If you're a competitor, you, you've got to have a mindset of, I'm willing to risk some chance of, like in any single incident, your chance of, is quite low.

It's just if you're doing this every day over and over again, like at some point you probably will run into some issues. If your aim is longevity, I'd probably try to avoid, minimise the amount of time you spend in that. And also just make sure you're stretching to have the flexibility that if you do have to happen to get in those positions that you can relax in the position.

And there's not that much stress. It's only trying to fight out and push them out. But I feel like you actually to feel a lot of stress through your body. at least if you're flexible enough, you can relax into the position and yeah, hopefully eventually find your way

Tests before patients "invert" with their legs over their head

David: If BJJ athletes are thinking about inverting or getting back to inversion or taking it up, are there any sort of baselines, anything you're looking for when it comes to flexibility, strength, control, that sort of thing to identify whether that's likely to be a safe or a comfortable position for them to train in?

Lachlan: A functional test for inverting would be, lie on your back, swing your legs above your head and to the point where you touch your feet on the ground.

So obviously few things are going to be stressed here. It's going to be your lower back, and your hamstrings for the most part. sciatic nerve a bit as well because you're going to be dorsiflexed. You're going to try and touch your toes. First, can you touch your toes on the mat behind your head while you're lying down and rolling back? Then, can you lift your head up off the ground? That's the assessment I would use and probably the main thing I would recommend people stretching if they can't do that is the hamstrings.

In particular, it's very minimal added strain and it's going to help with your range of motion in that. And then save your neck and your back. If your hamstrings are flexible, you're flexible enough through your hamstrings, you could almost touch your feet behind you with very minimal bending of your back or your neck. That would be ideal.

David: When you're working with your BJJ athletes and they're wanting to invert or they're a bit stiff, is there any particular hammy stretches or anything that you find can actually help them to get into these positions?

Lachlan: For that one in particular, I think probably your standard touching your toes style stretching is probably okay. But when I stretch my hamstrings, I usually basically do like the front splits. I mostly stretch more for performance than injury prevention.

But there's a few things like in terms of recovering your leg, sometimes your free leg has been pushed back. It's very extended, like in a front splits, and you still need your other leg to come up and try to get in front. having that splits type action I think is pretty good at reproducing that same action.

Hip external rotation, I can't do that right now with my LCL, but that hip external rotation is very beneficial for getting your leg back in front of your opponent that sort of pigeon type stretch I think is quite good. Most of the stretches I usually recommend are like around the legs.

I think if you've got flexible legs in terms of performance is quite beneficial for when you're playing on bottom. Yeah. I think overall having a level of flexibility is good for injury prevention, but then I think a lot of people who are flexible then rely on it and they spend a whole lot of their training getting squashed while they're inverted. Because they're flexible, they're like, Oh, I'm comfortable going to this position. And then much time there that I think that is probably a problem too. Yeah.

What sort of problems does that cause?

Most people who do that a lot, I think, have a sore lower back. Mostly lower back, I think. Again, if you're not flexible, I think the neck then starts taking the stress, but usually it's the lower back.

Lachlan: To be honest, most of the people I've seen that have a sore lower back, it's usually just stiffness I've seen a few more severe radiculupathies and on but, I would actually overall say that hasn't been as frequent as I would have thought, given the amount of time some people spend there.

David: Sounds like Flexibility's a pretty important part of it. You've gotta get your legs into different positions, to retain your guard or get back to better positions, or even just achieve the positions that you want to. But what about strength and conditioning? How does that fit in and what sort of requirements do you think you need from a strength and conditioning perspective?

Or is it as important as flexibility or more important? Where do you think that sits?

Lachlan: That's the one thing that in the literature has been pretty consistently shown to reduce injury risk. I would say for most people. I'm, saying people should do, I actually don't do any strength and conditioning , but that's do as I say, not as I do.

Right. It's a good idea. It's having strength just means, if you do happen to find, you are getting about to get twisted in a funny position, and you've got the ability to some strength to redirect whatever the limb or your neck or whatever it is that's about to get put in a bad position.

I do think that's helpful.

Something that almost no one ever does is neck strengthening. I do think probably worth a little bit of that without going too hard. I think with a lot of these things you can, people go, Oh, I'm going to strengthen my neck.

And they do it like they're about to do a one RM of some, wrestling bridge and they end up making it worse. And the other time is people, when they get injured, they're like, Oh, I'm injured now. I'm going to strengthen my neck. And then obviously there's a lot more risk with managing the load that you put through.

I think because people are going to be pulling and twisting your neck. It is worth doing some level of strengthening for the neck as well, for injury prevention. But most of the strength, again, most people in jiu-jitsu are probably one, interested in it for the injury prevention point of view, but also for performance, I think is important.

In jiu-jitsu, a lot of people say strength doesn't matter. which is obviously, false. Because, obviously technique is supposed to be the ultimate thing. Which, if your technique is good enough, you'll beat anyone.

But I think you want a level of strength. Where you can move, you might not be able to move your opponent, if they're much stronger than you, you can't move them. But you need to be strong enough that you can move yourself around them. you need to be strong enough, if you need to, if you get a grip on their arm and you want to pull, if you can't pull them to you, then you gotta be able to pull yourself around them.

There's a certain baseline level of strength that I think is massively important for performance, and anything beyond that is a bonus.

David: You're not a fan of doing it yourself?

Lachlan: I just, I don't enjoy it.

In the past, I've done small amount, but yeah. I don't think I ever lost a match where I was like, oh, if I was stronger, I would have won that. I usually when I lose, I'm like, oh, they did, they put their leg here and I just need to fix this or that. And, that problem won't exist anymore. There's always a technical solution to a problem even if, if your opponent is much stronger than you. Of course, strength helps. It probably increases the probability that anything you're doing might work. If you're trying to do a move and you're 10 percent stronger, then it's much more likely to work than if you were 10 percent weaker.

Leg entanglement, 50/50 and leg locks

David: All right, so We've talked about inversion. Let's have a chat about leg entanglement where you are using leg attacks or positions that where you're trying to get locks on the person's knee or twist them with heel hooks. Is there anything particular around leg entanglement that you think it's good for physios to know that can contribute to injury or that would be good for people to know?

Lachlan: Probably like for the LCL just knowing like how you're going to injure an LCL. One position, it's called 50-50 a reasonably common way to injure your LCL is in this position called 50-50, where you're basically standing up but your legs trapped and someone's trying to put you there on the ground and you're on top of them, but your legs caught and they're trying to twist your knee outwards to tilt you over and get on top. If they're doing that to your knee and you're trying to stay up, then it's your whole legs being externally rotated and that can cause an LCL strain.

Just simple awareness if my knees being turned out I need to accept it actually. Just go with it. It's worth keeping your knee intact and giving up position. It means the other person does get on top but then next time you got to find a way to keep your knee pointed more inwards they can't twist it out.

LCL is reasonably common. Otherwise most of the injuries from entanglements are actually usually, then just come from not tapping. You need to be aware of heel hooks. A heel hook is a move that sort of attacks the knee and the ankle a lot of the time. And it's a rotation of the foot or of the foot, which then rotates the tibia that is combined with a bridge into the knee, which puts some, usually some medial or lateral pressure on the knee, depending which side of the heel hook you're doing. The issue there is often, like if someone hasn't trained with them before, like a heel hook, often, there's no pain. I think people, a lot of the time when they want to tap to a submission, they're waiting for it to hurt, Oh, my arm's straight.

When it hurts, I'm going to tap out. The person's holding my leg when they're twisting my knee. And then when I feel pain, I'll tap and then I'll be okay. But the problem with some of these submissions is it often doesn't hurt. It just pops, you need to develop a sensitivity that you need to sit down with someone, get them to do it to you. Be paying attention to is their tension building up in my knee. And as soon as you feel that, you're tapping to the tension. And then also just even before that, you've got to recognise the grips, your opponent, like when I see that they've got good grips to finish a heel hook, I've already got to be thinking, is this time for me to tap or not?

Because if it was a competition. They're not going to be nice and put it on slowly. They're going to put it on very quickly. I need to be good at recognising early, like when they have the grips and ability to apply pressure. But a lot of it, that, that is very situational knowledge of what to do.

David: Anything else you think it'd be good for people to know about before we dive into some other injuries that occur in BJJ?

Lachlan: I think wrestling, the standup side of it is probably the most, the highest injury risk. That's certainly what I've seen. That's.. Takedowns. When you're both standing and you're both trying to put each other down, that's where I've seen by far the most injuries. I've stopped, I've basically retired from that aspect of jiu-jitsu now. I've retired from competition, I don't need to do it anymore. I just stopped wrestling. In six months of wrestling, I'd get more injuries than in a few years of jiu-jitsu.

You're now having to put a lot more energy. You grab someone's leg, you gotta run them down. It's quicker. You're falling now. In jiu-jitsu, usually, most of the time, you're on the ground, there's less worry about someone's falling and twisting something, because you're close to the ground already.

But when you're both standing, you can get a foot caught as someone comes across your knee, or even just your shoulders and neck from going for takedowns. It's very high injury risk. You want to do it for a long time, minimise that. If you look at the sport of wrestling, there's not many hobbyists that are doing the sport of wrestling.

In America and Russia and all these countries that are, that is popular, it's like, if you're talented, then you continue doing it in your early twenties to mid twenties. If you're really good, keep going until, thirties or whatever you can retire, but otherwise people just stop. I think there's a reason for that. .

Positions to use when coming back from an injury

David: Yeah, anything else?

Lachlan: There's a position called Half Guard where if you're on bottom, you trap one of your opponent's legs with your legs. , Lots of variant there's. Probably about seven or eight different types of half guard that you can play. But, as a general rule, you're just trapping their leg, and by trapping their leg, they can no longer run around you, and again, create these sort of frantic movements.

This is probably one of the slowest positions and one that requires the least flexibility to play and it's because it's slow, you can see a lot of the things happening and you can protect yourself quite well. It's often for a lot of injuries, if someone's coming back and I'd recommend like sometimes first starting just play half guard for a while. They can't run around and you don't have to swing your legs in front of their head or have all these sort of frantic movements.

It's very slow. There's a lot of like good techniques you can work in there. I think just often that's a good place to start if someone's coming back from an injury.

Rib and costochondral injuries

David: Yeah, that's a nice practical tip. We've chatted about common injuries that occur in BJJ.

Lachlan: Are there any other ones that you tend to see that happen in BJJ that are maybe less likely in other sports that physios want to keep an eye out for?

Ribs are pretty common. Reasonably common for people to injure where the rib meets the cartilage around here, like a costochondral injury. That can happen usually from trauma or from heavy twisting. If someone's pulling your shoulder back, and you're trying to really heavily twist against it, there's a lot of rotational pressure that goes through your thorax that can injure a rib. Most jiu-jitsu people, you if you've been training long enough, you've had a rib injury. The key with ribs, if you come back too early on these ones they'll just flare up again. They're very easy to re injure. My advice usually to people is come back when there's no pain to do any of your movements for at least a week.

Lachlan: It should be pain free for a week. And it should be pain free in training and drilling. obviously you test it. Can I drill, do all these movements? Yes. Okay, now I'll do some situational training. Can I do these positions? Good. Yes. Okay, now I can go into rolling. If you have any pain, I think you're just not ready for that. Just yet because it's very common and very frustrating for people because it feels like not a real injury to some degree, like quite quickly you can often breathe, you're breathing normally like you can do all your normal thing. You feel fine, and then you go back to training.

You're like, oh if I twist I feel that it's not ready for that and then you just got to be very careful of obviously someone just, they lock their hands or their legs around your ribs and squeeze. If someone's in a position they can do that, you're going to have to ready to stop, tap, just tell them to stop.

If you tell them beforehand, you hope that they'll be aware of that, but I wouldn't rely on that because people get excited when they're training and they forget. What injuries you told them you have and then again, heavy, like heavy rotational twisting will also injure a rib. But again, sometimes you can work through, I, like my last competition I did actually was the ADCC world championship.

I injured my rib one week before that. And. I wasn't sure how much I'd be able to do, but I I'm here, I'm at the world championships, I'm going to try it, like I did some training and I realised if you looked at the whole scope of the sport, I could do 80 to 90 percent of it and the 10, 20 percent that I couldn't do, I wasn't really planning to use in my game I just, yeah, I went ahead and I got through without any injury or anything. You can get through, but that's not what I would recommend. Most people aren't getting ready for a world championship next week. Take the time to let your injuries heal. Yeah.

David: Yeah, for sure. you've had rib injuries yourself. Anything you've found helpful in rehabbing these?

Lachlan: Not really. Probably the only thing rehab wise, I'd say you're going to have to build up their capacity to rotate under load. That's probably the area where they're most likely to re injure it. I guess there's probably some strengthening you could do like through thoracic rotation which I've never done that, but just thinking about it, that's probably not a bad thing. It might reduce risk of re-injury. I think often, probably like what I've done, like you get back to training, you get to a point where you're not feeling it anymore. You're like, okay, I'm good. But maybe there is some more I could do to be strengthening it still to prevent a future recurrence of something like that.

David: BJJ is a pretty common activity for kids, it's pretty fun, they tend to love it. With kids, is there anything you tend to emphasise or you think's important for physios to know if they're treating kids that are doing BJJ.

Lachlan: We have kids class at the gym, but my wife runs them. I don't run them. She's a physio as well, actually. We met through physio and then we both ended up full time jiu jitsu. Um, In terms of injuries for kids in jiu-jitsu. , kids from my experience, they are not good at tapping. When you watch tournaments.. I'm not sure what age this stops. When there's a submission, the referee steps in and stops it. A kid's arm gets extended. They, the referee comes in and they stop it.

They don't leave the decision up to the kid to say, yes, I give up and I tap out. As you grow up, your ability to assess risk becomes greater. I think, as an adult and I think even teenagers are pretty bad with this.

So just, you know that they need to be monitored a lot more, I think, by the coach to make sure they're actually tapping at the right time. I wouldn't say I've seen enough to be able to tell you like what unique injuries would occur in kids. Maybe if your kids are doing it, you might have more to share on that than me actually. So

David: Yeah, definitely one they had to learn was when to tap, and they also had to learn how to apply submission slowly, they just want to rip a submission. They're like, oh, there's an arm bar there. They just want to jump on it and throw the arm bar and before you know it, they've hurt the other kids' arm.

So that was one that we spent a fair bit of time focusing, like slowly applying submissions rather than ripping them and then teaching what it feels like to be in a position where, you should tap. I think most kids tend to just roll around, be pretty flexible, and as long as they've got supervision, when it comes to submissions, I think they're pretty good.

Lachlan: Yeah, they seem to be able to just bounce around and be okay somehow.

David: Yeah, that's right. They tend to bounce back up and have a laugh and walk away, yeah.

okay

Alright, let's have a chat about older athletes.

Lachlan: Older athletes, another reasonably common injury is a pec major tear from arm bars, and that tends to happen, usually it's someone in their 30s from my experience, it doesn't tend to happen to the 20 year olds, but basically with an arm bar your, as I said, it's the elbows being straightened, but the the shoulders usually in about 90 degrees flexion as well. And you're fighting that like a horizontal extension of the shoulder occurring at the same time as as the elbows being extended and fighting someone who's trying to pull that on pretty hard, it's like an, a high eccentric load on the pec.

There's been a few that I've seen of those and a few I know like Bernardo Faria, who's a pretty famous jiu-jitsu guy. That's probably just one to be aware of if you get someone who's got acute shoulder pain. Approach probably pretty obvious as a clinician, whether they've got a pec tear or not, but yeah.

If you're a bit older, I'd probably just, this is more talking to the jiu-jitsu people, but just choose a style that suits your.. I don't know if everyone will.. Will you be inverting forever? I don't know. There are some flexible people who are a bit older and I've seen them do that quite well.

But it probably overall does contain a slightly higher risk. I'm a big believer that, whatever you do, if you allow time for your body to adapt to it, that you can often get away with quite a lot of things, but just inherently obviously there's a bit more strain on the body being squashed up and inverted than there is playing your half guards and on.

Yeah, you might possibly, people often gravitate towards the slower game of a half guard as they get older than they do the sort of dynamic outside legs passing and open guards.

Forearm periostitis

David: Before we got on the podcast, you mentioned there about some of the other injuries and one that actually brought up before was forearm periostitis. That's one that I haven't had a lot to do with. tell us a little bit about that one.

Lachlan: I actually had it a little bit when I was a bit younger, probably like 22, 23. Occasionally you get like someone who will complain of just generalised arm pain. They'll train and it tends to build up during the session and then for two or three hours afterwards, it'll just ache.

And that was my experience as well. And then it'll feel fine. Like no problems, once after that sort of settled down, like you're just, you're able to go about all your daily business and everything. You don't even know you've got an injury next time you train. A little bit into it, it starts to build up, and it's basically, I think it's the equivalent of shin splints, but just, it just happens that in, particularly in the Gi, I think, like when you're doing a lot of gripping and pulling, like you can essentially overload the attachment to the bone. That's just something that graduated. You got to bring them right back, gradually load up and they'll often recover. Okay. But just turning up to training and training until it hurts won't be enough. Because by that point you've usually irritated it and then you in this constant, overload cycle, you need to bring them right back and build up slowly. Usually eventually people recover from that, but I've seen some where people get quite frustrated because they keep coming back too early or doing too much too early.

There's Gi and no Gi. Do some more no Gi. Because you can't, pull it like, when you're holding the Gi you can grab it's like a material and you can put all your force in. And when you've got a good grip you can pull at your maximum force. In no Gi, usually holding a wrist or an elbow. It's like a and it's sweaty.

It's slippery if you pull at your full capacity it usually just slips off. You're actually forced not to exert maximum pulling strength. that might be something that allows them to train a lot still, but reduces the load on that area.

David: Yeah, that's a nice one. Alright, let's talk through returning some people that are injured. If you want to choose a meniscal injury or some sort of knee ligament injury that we could talk through. If someone's coming in, they're going down a non-surgical pathway, how might you think about their return to training, their return to play, return to rolling, that sort of pathway.

Lachlan: Yeah. I mean, Obviously it depends very much on the grade of the injury as well as to the timeline. If it's like an acute injury, there's going to be a certain amount of time that you just not training, while you allow some attachment of the fibers to occur.

And that's where you're going to do all your, your range of motion and your strength and whatever else you would normally do. In terms of the actual return to sport, I'd be thinking. If you're treating someone who does jiu-jitsu and you don't do it, it's going to be hard to know what is and isn't going to put stress on that. But, let's say it's a medial ligament, just because we talked about the LCL already.

Anything that puts medial stress, we want to avoid. I'd say a lot of guard, you're probably going to be okay. For example, you could first practice drilling some half guards. You could do an underhook sweep. You get half guard, you get an underhook, you drag their leg out.

You come up to your knees and you get on top. I think you can do that in a way that puts minimal, if any, stress on the knee. There's actually quite a lot of room for them to find things that they can do. And a good thing about something like a medial is, they'll feel it, it'll hurt a little bit if they're twisting it the wrong way.

So they'll know, whilst they're drilling, it's in a controlled manner where I highly doubt they're going to tear it or cause re injury whilst they're testing what moves they can and can't do, right? And because they're doing it with minimal resistance, that way they can find okay, I can do this.

It doesn't hurt. I should be able to do that. And obviously you pay attention to whether it it's sore the next day, as maybe it feels fine. And then the next day they're very sore. We need to possibly adjust it based on that. But you'd be doing drilling and then by doing the drills, they're probably also getting an idea of what positions they can and can't do in the situational training.

Usually the things that they can drill early. And obviously as it gets better, they can drill more and more things in a pain-free environment. But the things that they could do early on with no pain, they can probably, will also often be the things that they can start putting live resistance in earlier as well.

I'd try to start covering more and more different positions with specific training. And then when I feel like they've covered like, they've got a game plan on top, a game plan on bottom then I'd probably be happy for them, picking the right training partner, someone that they know quite well.

I'd be happy for them to start going live in some rolling. And just trying to funnel the roll into that area, and just having some very clear as to when, if we get here, we're stopping and we're just going to keep it in this range. And that's just a gradual progression from there back into adding more and more things, and each, everything you add, you should be first probably drilling it, like just testing it, troubleshooting it, that area with low resistance, then you're going to do specific training there to test it, a bit more with focus on your injury, but like you can actually go live. And then once you know that you're good with that, you can implement that and add that into your actual training.

It's very hard to give it a timeline cause it's going to be different for everyone, but, it's very different, the experience of the practitioners as well.

A white belt, someone new, if you've got someone who's zero to two years into the sport, I would be much more conservative than someone who's been training for 10 years.

If they've been doing 10 years, I trust that they will For the most part, they know how to control their opponent and how to control their own body during most of the movements they're doing. It's going to be a lot quicker. The return to training, obviously the injury still has to heal, but they're just safer in those positions.

David: Do you think it's worth the risk of getting people back, training and rolling while they're not fully recovered?

Lachlan: Depends what it is. It depends what the risk of re injury is. If it's a major ligament of the knee, let's say an ACL. They've had surgery on their ACL, and they want to come back and they want to do wrestling early, I'd be pretty hesitant for that because if things go wrong, they go, that's, know what it's like to go through a knee surgery. It's horrible. I would not want to go through that again. I'd be much more conservative there. If they had a grade one MCL, if it turned into a Grade 3 MCL, that would suck, but it's not, still not as bad as getting an ACL tear, for example. I'd be a little more lenient in returning there.

And if it was, something like a meniscus, which obviously sucks, it's not a fun injury to have. But, the most part, I'd be happy them to push that a bit quicker as well. You as the practitioner have to be on top of like how they're actually recovering and feeling, if they're training and then they're getting very sore the next day, I think you need to be adjusting. As long as you're monitoring that, and you gotta know the personality of your patient as well.

If anything, I'd say, if you're not in the sport, if you're a physio, you're outside the sport, you're treating someone who does jiu-jitsu, I'd be more conservative than perhaps I would, if that makes sense, just because I feel like I can, knowing the ins and outs is a big benefit.

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David: What about low back pain? if you had a patient or someone that had low back pain or a low back injury or is there anything different you'd do with them or any other ways you'd guide them back into training or positions that you think might be better for them to start with?

Lachlan: Yeah, I'd probably mostly get them working more from chest to chest position, half guard.

Things where no lifting required very little chance of getting stacked, half guard's a great one for that. If it's pain, to me, it's mostly going to be monitoring. Their response to the training as well. And that definitely includes response after training and where they get sore. A lot of the time people with lower backs, they feel great when they warm up and then the next day they regret it. you've got to incrementally build up on that and start with drilling first and then again, into the situational training. Half guard I think probably be where I start from bottom and half guard passing on top, it probably actually would be first because that's, there's almost no lifting your backs. Basically, you don't have to use your back. Essentially, that's like lying down, right? You're just lying down on top of your opponent and you're trying to work and free your leg from they've trapped your leg and you're trying to free your leg. That's the battle there.

There, mount, those sort of positions are going to be good. And then some of the open guards where you might invert and on, I think they're going to come a lot later. And wrestling, wrestling is going to be one of the last things I do. Trying to lift someone up from a single leg is usually, you're quite far out of position.

Your opponent's trying to make it as hard as possible for you to lift them. Making you put as much force as possible your back to actually achieve that goal. Those sort of things in the wrestling I'd probably leave till later.

If not even, what are you doing jiu-jitsu for? Is it just a hobby then do you need to be trying to lift people. I've got like minor, I wouldn't say an injured back, but I get occasionally I'll get like stiffness and soreness in my back.

I just don't see the need for me to try and pick someone up with a takedown, it's just not a worthwhile thing. I feel like if I do that all the time, I'm just going to end up sore or injured and I'm not competing anymore. I don't see the need for that. that's something you can discuss.

I think if you're a physio you'll struggle to talk someone out of doing the sport. They're going to want to do the sport, you can try to talk them. Possibly out of certain parts, do you need to do these sort of movements? Can you work around that and come up with a different game?

Usually, usually there's ways around whatever's causing them issues.

David: I think that's a great message to finish with. Is there anything else you want to share before we wrap this up?

Lachlan: Yeah, I have said this already, it can be done in a safe way.

If you can get your patients working on graduating back. And I think just, if you've got someone who you're not sure, like they're reasonably new to it, then I would recommend being very conservative at first as a practitioner.

David: That's one of the great things about jiu-jitsu. There's lots of different positions you can play. You can work from the top or bottom. You can use different types of guard positions like half guard. You can avoid wrestling and maybe play from the ground. even with different injuries, there's lots of different ways that people can work around it.

They can figure out a new plan or a new strategy and a way to play that changes the load on that area. Or if they're having trouble with any of those positions, they can just change to a different one. Lots of fun. There's a risk of injuries, but there is with any sport.

And I think, it's been, great to hear about the different ways that you can work around injuries and keep people training and playing as much as possible.

So tell us where can people find out more about you, what you got going on, and that sort of thing.

Lachlan: I teach at Absolute Mixed Martial Arts in St. Kilda. I have an online training website a whole bunch of different courses on all aspects of jiu-jitsu.

That's the website submeta.io.

As I said earlier on, I'm not practicing as a physio anymore you can't find me for that.

There's people around Melbourne we use there's a guy, Black Belt Rehab, who's in Melbourne, who, actually he's not a physio, he's a myo, but he's doing his PhD in loading and he's quite good, I often send a bunch of our guys there.

Yeah, he's quite knowledgeable. But there's also, there's lots of good practitioners around.

David: Fantastic. I really appreciate you coming on. You've obviously got a lot of experience as a physio in the academic side of physio as well with your PhD, the clinical side. You're highly trained in BJJ and coaching BJJ as well. Awesome to get you on and combine all that knowledge to be able to share it with people and, they can help their patients to be able to train safely and get them back and successfully I really appreciate you coming on and sharing all that with us, Lachlan, getting your insights. So, much appreciated.

Lachlan: Thanks for having me on.