Stand-up battles involve frequent ballistic actions expressed by the lower limb in response to external stimuli. This includes the execution of kicks, short and rapid lateral movements, and powerful changes in levels. When stand-up grappling, quick shifts of the MMA fighter's center-of-mass (COM) challenges the balance while the ankle is put in precarious positions during ground fighting from both the top and bottom positions. This highlights the considerable potential for injury to the ankle. Athletes who have sustained a previous ankle injury are 80% more likely to experience that injury again in the future (52). Thus, these athletes should be targeted for interventions. Poor neuromuscular control (10,42,43) and joint force sense (13) are reported among athletes with a history of ankle injury. As such, activities that improve both stability and the ability to manage ground reaction forces should be included for these athletes. Furthermore, a reduced firing frequency of the peroneus longus (33) has been described among this population, suggesting that preactivation of this musculature could prove beneficial (25). Additionally, only weak relationships exist between ankle strength and stability (6,29), indicating that improved motor control about the ankle should be prioritized over increased strength (25). Table 4 outlines the prevention plan for these injuries.
An exceptional base-of-support and proximal control of the COM underpins most MMA actions. This stable foundation is contributed to by precise alignment of the ankle, knee, and hip, whereas deviation from this can result in excess torque about the knee joint increasing the risk of injury to this region. Specifically, deceleration actions whereby knee valgus occurs during low angles of knee flexion, combined with excessive internal or external rotation, put athletes at greater risk of noncontact anterior cruciate ligament injuries (ACL) (40). Similar to ankles injuries, techniques whereby the athlete performs rapid changes of direction such as the entry to a takedown, rearward, or lateral movement to evade attacks, or the redistribution of the COM over a single-leg base-of-support, such as kicking techniques, put the athlete at increased risk of knee ligament injury. For athletes with poor lower-limb alignment, this will need to be rectified through increasingly more challenging deceleration and ballistic activities (19). The reader is directed to Herrington and Comfort (22) for a detailed description of these tasks. Training programs incorporating these tasks have resulted in reductions to knee ligament injuries (19,54). Additionally, hamstring strengthening minimizes anterior tibial shearing and is recommended as a prevention strategy for ACL injuries (5,15).
The strength and conditioning coach should apply attentive qualitative analysis to identify these pathomechanics (37). Any fighters displaying such movement deficiencies should be targeted for neuromuscular and motor control tasks (Table 5). These hazardous movement strategies may be more common in developing athletes where movement proficiency has yet to be mastered, or in female athletes where noncontact ACL injuries are typically more common (53). Submaximal ballistic actions such as depth drop variations, lateral movement drills, and reactionary tasks can be prescribed to improve neuromuscular capacity (18,19). Implicit coaching techniques should promote “quiet” ground contacts and “efficient” transition through eccentric, amortization, and concentric phases of stretch-shortening cycle activities (25). This will occur in conjunction with lower-limb joint congruency and greater angles of flexion at the knee and hip during vertical landing tasks (18,21). Additionally, an increased volume of hamstring strengthening exercises can be included during the body of the workout.
The full contact nature of MMA puts athletes at an increased risk of concussions, which is a factor that must be considered by all coaches. Although headgear and mouthpieces are essential equipment for the mixed martial artist, coaches and athletes should also be educated on the symptoms of this injury (Table 6), so appropriate medical interventions can be undertaken (27). In many cases, the symptoms of concussion resolve in 7–10 days. When the athlete is completely asymptomatic at rest, they may begin light exercise. More complex sport-specific tasks can then follow. Noncontact training with a greater degree of decision making and reaction should follow before resumption of higher intensity drills. If any signs or symptoms appear, the athlete should return to the previous stage of this process. Only after medical clearance should the athlete return to full contact sparring. If symptoms return, the athlete should immediately cease such activities, and once symptoms resolve the athlete should again seek medical clearance before returning to full training (38).
Fatigue has been correlated with increased injury rates among athletes in subelite collision sports with similar bioenergetic demands to MMA (16). Because of the high training workloads undertaken by the mixed martial artist, they are particularly susceptible. Effective implementation of periodization, monitoring, and tapering strategies will assist in minimizing fatigue-induced injuries (48). The reader is directed to “Periodization for mixed martial arts” by James et al. (24) for further information on training plan design.
Methods for minimizing injuries are important to the success of any athlete. This need is even more apparent in MMA, where heavy physical contact and high training volumes are commonplace. This article has identified the most common injuries in this sport and proposed training strategies for their reduction. Athletes at increased risk should be targeted, while integrating these tasks into a training plan in a way that minimizes the impact on training time will improve compliance. However, further research is needed to more accurately identify the most common preventable injuries in this sport in addition to the effectiveness of the proposed training interventions on their reduction.
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