Guest post by Dr Kickass, Mike Piekarski, a Doctor of Physical Therapy, Former MMA Fighter, Brazilian Jiu Jitsu brown belt. Follow him on instagram.
Jiu jitsu rehab series: Knee injuries
Knee injuries are fairly common in grappling martial arts, either faulty takedowns or joint locks (kneebar, heelhook or toehold).
1️⃣Do ligaments heal?
This can depend on the ligament(s) affected and the level of damage. The cruciate ligaments (ACL, PCL) have a poor healing capability however the PCL does not always require surgical intervention. The collateral ligaments (MCL, LCL) have a better vascular supply and can heal, depending on the severity of ligament damage. Severe LCL injuries may require surgical intervention but grade I or II may respond well to nonoperative management (Kisner 2012).
2️⃣Is my knee healed when it no longer hurts?
This is where one must look at the physiology of ligament tissue healing. The remodeling phase of ligament healing may take up to 1 year.
“Remodeled ligament tissue is morphologically and biomechanically inferior to normal ligament tissue [and], ligament laxity results (Hauser, Dolan 2011).” This means even though your knee may not hurt your ligament is weaker and prone to re-injury.
3️⃣If I am prone to re-injury how do I get my ligament stronger?
Just like muscle they heal via appropriate stress so adaption can occur.
“Force is the language of cells” Andreo Spina. By putting appropriate loading on the ligament you encourage cell production and fibroblast migration to the damaged/weak area.
“Repetitive loading on injured [ligaments and tendons] has profoundly beneficial effects including enhanced cellular synthetic and proliferative effects, increased strength, size, matrix organization and collagen content of ligaments and tendons (Hauser, Dolan 2011).
In regards to the collateral ligaments you want to perform isometric loading. Isometric loading is a safe way to stress the ligament without over stressing it.
References: Hauser, Ross A., and Erin E. Dolan. “Ligament injury and healing: an overview of current clinical concepts.” Journal of Prolotherapy 3.4 (2011): 836-846
Kisner, Carolyn, and Lynn Allen Colby. Therapeutic exercise: foundations and techniques. Fa Davis, 2012.