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Knee injuries in MMA

This is an excerpt from Training and Conditioning for MMA by Stéfane Dias,Everton Bittar Oliveira,André Geraldo Brauer Júnior & Pavel Vladimirovich Pashkin.

By Charla-Yvonne Girtman, Howard Gelb, Tone Ricardo Benevides Panassollo

Knee injury is one of the most common injuries in any sport. In a study that tracked injuries in different sports over 10 years, Majewski and colleagues (2006) reported that 39.8 percent of injuries were to the knee, with 49.48 percent being an anterior cruciate ligament (ACL) injury. In UFC fights, knee injuries represented 13.2 percent of all injuries (UFC, 2021). The same study reported the knee as the most common nonfight injury in MMA athletes. Knee injuries can occur either directly, as in the case of Thiago “Pitbull” Alves, or indirectly, through knee sprain or joint overload.

Pitbull received a kick in the lower leg, and the force of that kick destroyed the ACL and posterior cruciate ligament (PCL) of his left knee. The two ligaments, along with other knee structures such as the meniscus, lateral collateral ligament (LCL), and the medial collateral ligament (MCL), play an important role in stabilizing the knee joint. An ACL injury combined with a PCL injury can end an athlete’s career, especially if their recovery is incomplete and does not include medical care, physical therapy, and a good strength and conditioning program.

Fortunately, Pitbull had excellent support from a range of professionals during his rehabilitation, and the athlete continued his career in search of more wins. He underwent successful surgery and subsequently demonstrated excellent knee stability. Pitbull’s knee injury occurred by direct contact to the knee, and it would have been difficult to prevent it. However, exercises to improve muscle strength and joint stability can prevent noncontact injuries to the knee. The exercises used during Pitbull’s treatment are included in this section, because these exercises can be used during rehabilitation and to prevent injury.

Prevention of Knee Injuries
Strong hamstrings and quadriceps muscles minimize the risk of ACL and other injuries in the knee joint. In case of rehabilitation, amplitude of movement and range of motion will progressively increase according to the rehabilitation phase. We recommend the use of closed-kinetic chain exercises to improve muscle strength in this area such as: squats, lunges, Romanian deadlifts, side lunges (see figure 6.15), and unilateral leg presses (see figure 6.16) with a reduced range of motion. Open-kinetic chain exercises (i.e., leg curls and leg extensions) are important to include in the ACL and knee injury prevention program. During ACL rehabilitation, some open-kinetic chain exercises need to be avoided, but this is beyond the scope of this book. Resistance training exercises can be done until failure (muscle fatigue) or based on sets and repetitions, according to the objective of the rehabilitation phase.

Proprioception exercises are an essential part of a rehabilitation program, but they are also important for injury prevention. Proprioception refers to the conscious perception of limb and body position and motion in space (Aman, et al. 2015). The purpose of proprioception is to stress the joint providing instability, forcing the muscles to activate and keep the joint stable (see figure 5.2 in chapter 5). There is no need to add loads during these activities, but closing the eyes, using a different surface (BOSU or foam), or adding specific movements during the exercise can make them more complex. These exercises are usually based on time (for example, 30 seconds) or repetitions (10 × pistol squats on a BOSU ball); see figure 6.17.

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