The Ultimate Guide to Preventing and Treating MMA Injuries: Featuring advice from UFC Hall of Famers Randy Couture, Ken Shamrock, Bas Rutten, Pat Miletich, Dan Severn and more! (2016)

In 2008, Sean Sherk was training for his upcoming fight with BJ Penn when his right hip began to hurt. “The Muscle Shark” was known for his intense training routines, and it wasn’t often something bothered him enough to have it checked out. He went to a doctor and underwent an MRI, which revealed a torn labrum. At the time, the UFC vet recalls, “Surgery wasn’t an option.” To help get through his training camp, Sean began to wear tight compression shorts, which provided extra support for his hip. “I like them so much, I even wear them while riding my snowmobile,” says Sean.

The hip, like the shoulder, is a ball-and-socket joint. The socket is in the pelvis and is called the acetabulum. The ball is the top of the femur (thigh bone). Also, like the shoulder, it has a ring of cartilage called the labrum that circles the rim of the socket to help deepen and stabilize it. When a labrum tears, it can be very painful; however, more recent advances in orthopedic surgery have allowed labral tears in young athletes to be repaired surgically using small arthroscopic instruments.

Front view of the hip socket and labrum with some of the surrounding muscles that can get injured.

CREDIT: JOE KANASZ

Surrounding the hip joint are many large muscle groups including the hip flexors (such as the iliopsoas); the quadriceps, which run over the front of the thigh to the knee; the hamstrings in the back; the adductors between the legs; and the abductors on the outside of the leg. Any of these muscles can be injured due to a sudden trauma, overuse, or generalized inflammation of the joint from other injuries.

ADDUCTOR INJURIES

During his UFC 100 fight with Thiago Alves, Georges St-Pierre went for an arm-bar from his back during the fourth round. While attempting the submission, he felt a tear in his groin and knew something was wrong. With Alves raining shots down on him, GSP secured his guard and wrapped Alves’s arm to protect himself. The pain was so bad, GSP began to pray that he make it through the round. Shortly after, GSP managed to push Alves’s hips back and stand back up. Despite suffering an adductor tear, he was able to stand back up and dominate the fight enough to win by unanimous decision.

The adductors are large muscles on the inner thigh that help bring the legs together. These muscles are especially important in a strong guard and a triangle choke. Like any muscle, both the meaty part of the muscle, called the “belly,” and the tendon, which attaches the muscle to the bone, can be injured. Adductor strains, sometimes called “groin pulls,” are particularly painful and can require months of rehab time. A doctor or certified athletic trainer can usually pinpoint the location of an adductor strain, but an MRI may be useful to rule out tears or complete tendon ruptures.

SNAPPING HIPS

A snapping hip will affect many athletes, and it can be caused by several factors. Some aren’t of any real concern and may just be from normal wear and tear, which can be the case with knee clicking as well. However, there are some causes that can be diagnosed and treated by a doctor. The first is the snapping of the iliotibial band, which runs along the outer side of your hip and leg. This thick band can snap over the greater trochanter, the sharp point on the side of the hip. Sometimes the sac around the greater trochanter can also get inflamed, leading to bursitis, which is an inflammation of the bursa sac — a lubricated cushion situated between a bone and the neighboring soft tissue.

Another cause of a snapping hip can be the iliopsoas muscles (hip flexors) sliding over the head of the femur. This is one of the most common causes of a snapping hip. Both of these causes of a snapping hip can usually be treated with rest and physical therapy. However, in the rare case where proper physical therapy doesn’t work, surgery may be recommended.

The last cause of a snapping hip can be from a tear in the labrum. This can sometimes be treated with physical therapy, but if that fails, a surgeon may need to go into the hip arthroscopically and repair the labrum as well as shave off any bone prominences that may have led to the labral tear. UFC and Pride veteran Antônio Rodrigo Nogueira ended up requiring hip arthroscopies on both hips. His hips had bothered him for four years during his transition from Pride to the UFC, especially when he fought Randy Couture. The pain was so bad, he could barely sleep for four days before his fight with Couture. He would sit in ice baths to help with the pain. He would be late to training because his hips were so stiff in the morning. Eventually, “Minotauro” underwent surgery on both of his hips within a month of each other. However, despite having surgery on both hips, Minotauro managed to recover and fight seven months later in his hometown of Rio de Janeiro at UFC 134, defeating Brendan Schaub by KO in the first round.

HAMSTRING RUPTURES

The hamstrings are the large muscle groups that run behind your leg and help you bend your knee. These can often be stretched with hyperextension by a knee bar or being kicked behind the leg. Sometimes, if the leg forcefully hyperextends, the hamstrings can rupture off of your ischial bone, which is the bone you sit on. If this happens, the fighter will experience an immense amount of pain and bruising of the entire leg. This can be treated with either surgery or rehab, and you should have a discussion with your surgeon regarding your recovery goals. Usually, a more active person will undergo surgery to maintain their active lifestyle and performance despite the long road of physical therapy and rehab after the surgery. A less active person can skip surgery and try to recover through rehab.

UFC Heavyweight Champion and Hall of Famer Mark Coleman suffered hip trauma that may have caused the need for early hip replacements. He also points out what orthopedic doctors know, but patients may not be aware of — that pain from the hip joint may actually be felt as groin pain or knee pain. It’s important that you seek medical advice as soon as you feel any pain — there’s always a chance it’s a symptom of something more serious and harmful. As Coleman recalls, “In hindsight, it was an accumulation of getting my hips hurt on a daily basis. I didn’t know I had an actual hip injury until I got images of my hip. The pain would be in my groin or my knee. I didn’t want to go in and hear bad news. I wanted to try and get every fight out of me before someone pulled the plug. I was very lucky. I got hurt wrestling many times, but nothing that didn’t heal up. Then I entered MMA. The wear and tear over the years and then getting older added up. The pain was there, but I dealt with it. I would just focus on making it to my next fight. Eventually, all my cartilage was gone and I needed a hip replacement. I was 44 years old my last fight. I always thought I would keep fighting or at least teach a long, long time. When you go into a fighting career, you need to keep in mind that something may end up hurting you long-term and something may end up nailing the coffin shut. As an athlete, I failed to get the proper x-rays. When you don’t have the time or money to see the doctors, it’s hard to get good care. Once I had the replacement, my knee didn’t hurt anymore, my back didn’t hurt anymore. My hip felt great. It would be ideal for any young fighter coming up to have good insurance so they can see doctors on a regular basis. And take advantage of it. Go see your doctor.”

Ken Shamrock has had his fair share of hip injuries and recovery efforts, and he knows a fighter’s “power comes from the center of their body and [an injury] takes away their ability to generate power and drive.” It’s easy for these injuries to be made worse without adequate rest and rehab at the first signs of pain.

In his experience as a world champion grappler and co-founder of American Top Team, Ricardo Liborio has noticed that the wrestlers like Mark Coleman who come to train are more susceptible to hip injuries than their jiu-jitsu based counterparts. “I believe wrestling causes a lot of hip injuries, more than jiu-jitsu. A lot of it probably comes from the sprawl. I think we have less hip injuries at ATT, because we are more jiu-jitsu based.”

Since it’s common for hips to get tight with wrestling and striking, a fighter has to work to prevent them from getting overdeveloped. As Frank Shamrock understands, “I have to consciously keep my hips and IT band relaxed and stretched. I use a foam roller every morning down my back and hips to help loosen up. I consciously release points of tension.” Remember that tight muscles can make you predisposed to injuries, so keep relaxed and limber.

Like many other fighters, Gilbert Melendez echoes Shamrock’s antidote: “I also work on my flexibility, especially after kicking. I like the butterfly stretch, doing splits at all angles, and while doing the splits, rotating my toes and body. I also like dynamic stretching, kicking my legs up and back, and also facing the wall and doing pendulum swings with my legs.” One of Gilbert’s coaches, Cesar Gracie has noticed that hip injuries tend to occur more with throws. “In my experience, hip injuries usually occur with judo throws. It’s usually an injury to the hip flexors. When your hip flexors hurt, you need to really focus on stretching and deep massage such as acupressure. Some of our guys, like Nick Diaz, are good at hip stretching every day. Because he keeps his hips loose, his kicks are more fluid and it takes less effort to get his kicks off the ground.”

Some hip injuries come from direct impact with your opponent and the ground, especially with judo-type throws. Understanding what surfaces you are falling onto and how to properly fall is something Carlos Newton instills in all of his students. “As a martial artist, you have to learn how to fall and pay attention to your body position whenever you are going to fall or get thrown. And know when to stop or yield. I knew I wanted to do martial arts for a long time — until I was an old man. I realized if I wanted to go down that long road, I needed to avoid training in new places I wasn’t familiar with. If you are at a new gym or venue, you may have felt that the mats were cushy when you walked in, but when you get thrown on them, you feel they don’t actually absorb the impact well. I suggest you walk around and get to know the place, get to know the mats, and get to know your surroundings. Develop a relationship with the mat and know if it literally has your back when the time comes. Don’t let people peer pressure you into going harder or training in an uncomfortable position. Look them in the eye and say you will be back tomorrow. I pass these messages on to my students.

In my experience, jigsaw puzzle mats are not good for high impact. I like conventional judo mats. But also ask what’s below the mats, what kind of surface is the mat on. Is it on a wood-frame floor with some deflection or something much harder? Careful selection of floors matters. Judo mats on a concrete floor may actually be worse than jigsaw mats on a wood floor.”

HIP STRENGTH AND FLEXIBILITY EXERCISES

Maintaining flexibility and range of motion in hips is important, especially for wrestlers.

You can stretch the lateral structures, including the IT band with rotational movements.

Stretch the front of the hip by placing your knee on a mat or block and slowly walking your front leg forward into a deep lunge.

A foam roller on the side or front of the hip can help with recovery and soreness.

Plank and lateral posting exercises help your core but you can also add leg raises to increase the workload and bring your hip muscles into the equation.

A partner can hold your legs while you slowly lower to the ground for eccentric exercises, which both stretch and strengthen the muscles.

Eccentric exercises throughout the body are good workouts for tendonitis. Alternating arms and legs helps establish coordination.

Pelvic lifts work the lower muscles,

while adding a leg raise at the end really gives you a workout.

My hamstring injury happened around 2005-2006. I had a six-fight win streak going and had gotten a title fight versus the champion Matt Hughes. I was training with Jason “Mayhem” Miller, Quinton “Rampage” Jackson, and Tito Ortiz. We were pretty warm and had a sweat going, but I didn’t stretch out. I never really focused on that.

We all started grappling with each other. I gave Mayhem my back and he got his hooks in, so I stood up. He leaned over and tried to grab my ankle and foot. I resisted, and suddenly I felt and heard a “pop.” Everyone thought I broke my femur. I fell down in shock. I almost threw up from the pain.

At the time I had a stick shift so I drove one and a half hours in L.A. traffic in agonizing pain. I went home, fell asleep, and woke up with everyone concerned. I started to get concerned that it was more than a pulled muscle. I went to a specialist, who thought I had a bad muscle pull and prescribed Vicodin.

I still hadn’t dropped out of the fight. We went to Vegas and started training more for the fight. I tried to throw Manny Gamburyan and fell flat on my face from the pain. Manny and I went back to the hotel and I got undressed to take a shower, and Manny, my cousin, said there was something wrong with my leg. The whole back of my leg was black and blue. Fifteen minutes later Dana White called me to ask about the injury, and I told him I had never pulled out of a fight. I didn’t know what to do. Dana sent a driver to take me to the doctor, who examined me and told me I have a hamstring tear.

The doctor said I could treat my injury with either surgery or physical therapy. Dana thought surgery would be better and the UFC would cover it. I didn’t like surgery and I didn’t want to pull out of the fight. Eventually, the pain started to get so bad I couldn’t tie my shoes. I ended up not fighting Matt Hughes.

I got a fight eight weeks later to Nick Thompson. Randy Couture was in my corner and I won in the first round. But the pain continued, and a huge ball of scar tissue started to form. I didn’t do any rehab and didn’t seek out any good advice. I didn’t know what to do and eventually got very depressed. This led to my addiction to pain killers and putting my career in the toilet. Even today, I don’t have the motion in my leg and often get shooting pain from the scar tissue.

I can’t stress this enough, if you have a serious injury and you don’t do anything about it, it will mess you up. I used to jump from my knees into an arm-bar, and I could tap a guy in no time. There is no way I can do that now. My right leg can hamstring curl 145 pounds, my injured leg can barely get 40 pounds. I still roll and submit people, but it’s not the same. I had to change the way I do almost everything. You need to treat an injury before it’s too late. Like my father says, you need to mold the metal while the iron is hot.

You should seek out good advice. For the injury I had, if you have the time and money, you can either do surgery or you can take the time to do the therapy right. Before this injury, I never took any pills in my life. I remember when I was a kid, my mom used to have to dissolve the pills for me since I was afraid of choking. At my worst I was swallowing 10 pills at once. Not taking care of an injury and not getting good information can be the beginning of the end. It’s like a car; if you leave it alone, it will end up getting worse, costing more money, and other parts of the car will start to fall apart. Treat your body the right way. I found this out the hard way. One injury can end your entire career. It’s part of the sport, but it comes with the package. There are a lot of ways to deal with injuries other than medication. If you have an injury, treat it the right way and don’t focus on pain medication. Take it in moderation, only if you have to. It’s very addictive stuff. It can rip your life apart. Time will heal your pain. The pills won’t heal your injury. Healing comes with nutrition, doctors, and therapy.

If you are involved in any sport, especially mixed martial arts, you need to warm up. There is a reason coaches have been teaching students to warm up for 1,000 years. You need to warm up. You need to be sweating from your stretching in the gym, especially before grappling. Do it in a safe, active way. I never believed it until I got hurt. For my warm-up, I like 10 minutes of jumping rope, then gradually more stretching until all your muscles are warmed. No one is superhuman. We are not made from iron — you need to treat your body with respect.