One of the reasons I love working with martial arts athletes is that it is hard to paint one picture for a typical combat sport injury. What you see includes mechanisms of both traumatic contact as well as overuse injuries from the upper quarter all the way down to the toes. What makes martial arts uniquely vulnerable to all of these injuries is not only the vastly different movements, but also the fact that it’s performed barefoot.
The barefoot aspect of martial arts is an interesting double edged sword for those training in martial arts. On one hand, it helps to develop extraordinary sensorimotor processing skills from hours of rich input into the foot during training; on the other hand, it leads to injuries that are not as commonly seen in shod sports. Today I’m going to talk a little bit about barefoot considerations for training. This post is inspired by Kate Buttino, pictured above, who not only kicks ass at BJJ but she also drew the beautiful foot and ankle sketches that you see below.
Fighters have AMAZING balance! There was an interesting study by Perrin et al that compared balance competencies of judo athletes versus ballet dancers. While many might think that ballet dancers are the quintessence of balance mastery, it was actually judoists that were found to have superior balance control across all of the sensory challenges. The authors attribute this to the goal of martial arts – to disturb the balance of the opponent in order to submit or strike. “During fights, each judoist learns to use unstable dynamic situations to turn them to his advantage, using the stimulation of muscular, articular and cutaneous mechanoreceptors to adapt to the constant modifications of posture, support, ground, and partner contact.” Although ballet dancers also demonstrate techniques involving unstable dynamic conditions, authors point out that ballet dancers generate their own controlled instability from choreography, whereas judo fighters are subjected to uncontrolled instability as a result of counter-movements from their opponents.
The very essence of barefoot technique that produces superior balance is also the cause of a unique set of injuries. Traumatic injuries of the foot that often occur during striking techniques, such as kicks and jumps, include toe dislocations, fractures, turf toe, and metatarsalgia. The ankle is also a common site for both traumatic and overuse injuries. Most traumatic injuries at the ankle involve the outside of the ankle, and are due to high level stability challenges of the sport in combination with plant and twist skills, such as turn and throw and shuffle and lunge. Finally, a common overuse injury is Achilles tendinopathy due to the strain on the calf muscles from explosive push off from the toes.
by K. Buttino
Most of these injuries are unavoidable, considered to be the nature of combat sports. However, some may be avoided with proper striking techniques and training considerations:
Striking skills include both location of foot contact as well as strategies to decrease the mechanical symptoms
Training considerations include core and low body strengthening to improve the body’s capability to exert and absorb these great forces
Balance and proprioception drills to improve activation and feedforward mechanisms in order to decrease stress on the toes and ankle
by K. Buttino
It is very important to appreciate the high levels of balance that a fighter must return to when determining exercises prescription. Just as it’s not enough to discharge a gymnast with enough shoulder stability to do a pushup but not a handstand, we must maintain higher dynamic stability milestones for our martial arts athletes. The exercises that we choose must be sport specific, which includes being barefoot on a mat.
For me, I typically start rehab with intrinsic foot exercises, such as short foot (focusing on keeping the toes relaxed or extended), as well as eccentrics for the ankle stabilizers. Concurrently, the fighters will also be working on a ton of exercises for lumbopelvic stability, glute strength, and core stiffness. As soon as I can, I like to get them through the developmental sequence once they’ve mastered the ability to demonstrate proper activation and a good movement pattern. I’ll linger in kneeling positions for the hip but will quickly get fighters on their feet to challenge their ability to activate intrinsics and ankle stabilizers with perturbations (these can get pretty aggressive!), movement, multi-tasking, and under fatigue conditions. Finally, I’ll introduce double and single leg plyometrics. Although to the naked eye martial arts doesn’t seem to require as much jumping intelligence as basketball, the importance of powerful movements coupled with stability makes plyometrics an integral piece of the full rehab picture.
What are some of the things you do to improve dynamic stability for your martial arts athletes?
Laurey Lou, PT, DPT, CSCS
See more from Laurey at combatphysio.com or Twitter/IG @Combat_Physio
See more from Kate Buttino at kbuttino.wix.com/portraits.
References:
Perrin, P., Deviterne, D., Hugel, F., & Perrot, C. (2002). Judo, better than dance, develops sensorimotor adaptabilities involved in balance control. Gait & posture, 15(2), 187-194.
Vormittag, K., Calonje, R., & Briner, W. W. (2009). Foot and ankle injuries in the barefoot sports. Current sports medicine reports, 8(5), 262-266.
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