3 Highly Effective Techniques I Used To Help This Jiu Jitsu Fighter (Case Study)

Show Notes

In this episode of the Dr. JJ Thomas Podcast, Dr. JJ dives into the transformative journey of a Jiu-Jitsu athlete who faced a daunting ankle injury just days before a major competition. Dr. JJ's approach is not just about quick fixes but understanding the intricate anatomy involved, ensuring a holistic and sustainable return to sport. This episode is a testament to the power of targeted physical therapy and the resilience of the human spirit, offering hope and guidance to anyone facing similar obstacles. Join us as we delve into the anatomy of healing, underscored by a commitment to caring, honesty, and the pursuit of excellence in physical therapy.

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What is The Dr. JJ Thomas Podcast?

Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.

Molly: 00:00

Hi, guys. It is Molly here. I just wanted to come on here and get a shout out to doctor JJ from Primal Physical Therapy. I recently injured my ankle right before the ADCC Atlantic City Open. I had messaged her and right away she responded.

Molly: 00:18

She fit me in the next day. She took care of me. She did some needling. She did some laser therapy. I saw her a few times, and, yeah, she knew exactly what the issue was, and we fixed it right away.

Molly: 00:33

I went to my competition. I felt great. I didn't feel my injury at all. We were also working on past injuries. I'm excited to continue to work with her.

Molly: 00:42

I highly recommend her, definitely check her out. 10 SARS. Thank you, doctor JJ, your best.

Dr. JJ Thomas: 00:52

Welcome to the doctor JJ Thomas podcast. Hey, everybody. Welcome to the doctor JJ Thomas podcast. I'm doctor JJ Thomas. Today's format, we're gonna do a clinical rounds.

Dr. JJ Thomas: 01:04

For clinical rounds, this structure of our podcast is intended for clinicians, and what we're doing is I'm going to share real scenarios that I've had with my patients and take you through how we how we, went through and evaluated those patients, and treatment strategies, and then integration into return to sport or return to whatever activity they're they're missing from. So we have a great one today. One of my favorite Jiu Jitsu athletes reached out to me about 2 weeks ago, which happened to be 10 days before a competition for her. And she reached out via text kinda late at night. I actually woke up and got it at like midnight, totally, my kinda thing.

Dr. JJ Thomas: 01:45

And she was a little bit panicked. She was like, JJ, I was training tonight and I got heel hooked, and those of you that know that do a little bit of jujitsu, understand what that means. And those of you that don't, essentially, you get locked at the ankle, at the basically at the calcaneus, and it can get torqued into this like inversion inversion type pattern, which obviously makes you very susceptible to potential, injury there, and she'd had a prior injury before that was actually, pretty debilitating in terms of she wasn't able to get back as fast as she would like. So she texted me and she's like, I'm I'm competing in 10 days, I heard something pop, I'm I'm I know it's gonna be swollen tomorrow, any chance you can see me tomorrow? So as luck would have it, we were able to get her right in, and when I've got when she first walked in, I was I was she was limping a little bit, but when I got her on the table, I was actually really pleasantly surprised to to see that she wasn't that swollen.

Dr. JJ Thomas: 02:48

I'm gonna go ahead and share with you the if we go to the, just for those of you that may not be clinicians, I'm gonna zoom in on the anatomy here. With a heel hook, the 2 so here's the if you can see the foot, the lower leg, and you can see the muscles and tendons, and these I'm gonna turn this to the side a little bit, so you can see. My thumb's in the way. So you can see these 2. I'm gonna highlight that guy.

Dr. JJ Thomas: 03:18

That's the anterior talofibular ligament, and this guy, the calcaneofibular ligament. So these 2 ligaments are the ones that most often get aggravated. Sorry, this is clicking crazy. 12, those 2 right there. The ATFL and the Calcannofibio Ligament.

Dr. JJ Thomas: 03:39

These 2 are the 2 that most often get aggravated with a heel hook and they can be pretty pretty debilitating like I said. But you also know as a clinician that when they're, torn, you're gonna have a swelling response with it. Lucky for Molly, my patient, it wasn't hardly swollen there. She was tender there, so it's still a little bit suspecting of, but she was tender at the ATFL attachment. So I was a little bit concerned for her even though there wasn't a lot of swelling.

Dr. JJ Thomas: 04:09

However, the more we tested it, I put her into passive inversion and she's like, it's kind of uncomfortable, this is just less than 24 hours after the insult, so if it really was torn at the ATFL, she she would have been pretty uncomfortable there. But what's even more interesting is lucky as luck would have it for her is once I started palpating more and looking for other sources of pain, what we found is that the perineal muscles were actually painful on exertion. So resisted eversion actually aggravated her symptoms. And, so then I started seeking around. We all know I'm gonna go back to my anatomy here.

Dr. JJ Thomas: 04:48

We know that there are 3 fibular muscles, peroneal muscles as I call them. There's the peroneus longus, brevis and tertius. Right? So tertius is the one right here that crosses right over where the ATFL kind of attaches. But also, she was tender all the way up on the belly of I need my glasses here.

Dr. JJ Thomas: 05:11

She was tender all the way up on the belly of perineus longus, or fibularis longus as they call it now, as it comes down under the calcaneofibular ligament. So again, that's torqued in that heel hook. So what I started doing is searching up the chain. Okay. Resisted eversion is bothersome for her, she doesn't have a lot of swelling, so that's looking really good in the department of, hey, maybe she didn't actually tear her ATFL and her calcareneofibular ligament.

Dr. JJ Thomas: 05:38

Maybe she tweaked her peroneals and if we lessen the tension on these tendons down here, then we'll make her better faster. So what we did day 1 was I needled perianus longus, perianus brevis, and perianus tertius. And immediately afterward, passive dorsiflexion was better, resisted eversion no longer was painful, and she was able to walk without a limp. Not only was she able to walk without a limp at that point, but I gave her a couple of exercises, we're gonna go through them, because now that range was free and she was had much less pain and there was no swelling, what do you do next? We always wanna load that.

Dr. JJ Thomas: 06:19

Right? Because she needs to load that thing in 10 days pretty heavily. So let's load it now safely. So what we did day 1, I'm gonna I'm gonna demo for you. The first thing we did was dragon walks.

Dr. JJ Thomas: 06:31

So they're one of my favorites for rotational control. I'm gonna pull these up so you guys can see my ankles. Dragon walks, you basically have them step to the side, squat down, and then shift onto one side, cross behind, so we're getting ankle dorsiflexion, we're getting eversion and inversion control, getting rotational control, and then I have them spin like that and then do the other side. So they're getting both sides rotational control. So that's where I started her, step behind.

Dr. JJ Thomas: 07:04

This was her warm up. Here. So I said let's go train tomorrow. Let's just make sure we warm it up really well with those dragon walks, and that was really the main thing I gave her on day 1. So that evening, she reached out to me.

Dr. JJ Thomas: 07:20

I said, hey. How'd it go? We reached out to each other. She said, I was actually able to train. I went really chill because I didn't wanna freak anything out again.

Dr. JJ Thomas: 07:28

She said, but surprisingly, it went really well. So great. So she's continuing to do her dragon walks. I bring her in for the second visit. I check her, and, that resisted eversion is no longer painful.

Dr. JJ Thomas: 07:40

She's no longer tender on the, ATFL area anymore, but she does still have limited dorsiflexion. And there's a scar there, so I said, you know, I noticed that there was maybe an old injury there. And she said, yes, I was in a motorcycle accident quite a while ago. I have a little bit of limitation there. So, you know, I wanna get these patients performing, especially my athletes performing as as well as possible.

Dr. JJ Thomas: 08:03

A 110% is always our goal if we can. So I said, look, we're gonna make you in a heel hook. The faster you hit your end range, the faster you're gonna get tweaked in your ligaments. So let's give you more range. Let's loosen up that old injury so that now when you're training you don't hit that end range as fast.

Dr. JJ Thomas: 08:21

She's like, heck yeah, let's go. So what we did that time, because her dorsiflexion was limited, I've shown this technique, look for it on my clinical corners, I've shown it before on Instagram live. What we do is we dry needle behind the Achilles, the largest muscle bulk of the cross sectional area of this section of the ankle here is actually flexor hallucis longus and posterior tibialis. She was super tight, her motorcycle injury had, a lot of tension on the posterior tibial side, so what was happening for her, when I go to bring her into dorsiflexion, her talus was jamming up because the talus couldn't glide back behind because the flexor hallucis longus and posterior tube were getting in the way. So we needled these muscles back here, and as I said, you can look search through my YouTube and my Instagram to find that.

Dr. JJ Thomas: 09:17

And after we needled that, her dorsal flexion was way way better. So we accessed more range for her, we allowed the joint to function better, and we put her ligaments, in a safer place so that they don't get aggravated as quickly in in compromising positions such as a heel hook. So day 2 what we did is we added, okay, we're ready to load even more. So day day 2, by the way, is just, less than it was about 5 days after the first treatment, 4 or 5 days. And remember, her competition was 10 days after the original injury.

Dr. JJ Thomas: 09:50

So day 2, I said okay good, dragon walks are going well. Let's progress them. So dragon walks went from that, like, medium level here, here, here to now I said, okay, let's do a dragon walk where we go here and we go all the way over, and now I want you to curtsy all the way down. So now she had to use that dorsiflexion range, really control it, and then I had her transfer drag and walk, go all the way down and then transfer. So now we really ramped up her mobility and control at the joints where she needed it, and in those muscles that really need the capacity to support her ankle at a high level in the way she's functioning in in Brazilian jiu jitsu.

Dr. JJ Thomas: 10:39

So that's the mobility stability component from a body weight standpoint, but again, I wanna help these athletes as much as possible. So another exercise that I gave her that is really helpful for getting your, any ankle sprain anybody with an ankle sprain or a, a muscle strain around the ankle area that has to get back to rotational control, this is one of my favorites and I'll show you. Essentially, what we do is we have them stand next to a kettlebell like this, so, the kettlebell's next to the front leg. And then what they'll do is they'll step back, grab the kettlebell, and then clean it. And then they'll bring it down and control it.

Dr. JJ Thomas: 11:26

So the ankle so this is giving rotational control to the front ankle. Now this front ankle is in straight plane. Right? But because I'm functioning, so I'm essentially lunging here, because I'm functioning in a rotational plane and then I'm exploding up on it, and then I'm coming back down. I'm controlling the ankle in that rotational plane.

Dr. JJ Thomas: 11:47

So it's a great early exercise for, returning anyone with an ankle, sprain injury back to sport when they're past that phase of, where there's no more swelling, and they're really ready to start integrating back to sport, but we need to load them. So those were, the 2 exercises I gave Molly. She did really well. She went on to compete, in that 10 day period. She did great.

Dr. JJ Thomas: 12:13

She felt great. And, it really is so much fun to be able to help these athletes that, you know, I think if you don't know to really be if you don't know to really look at and listen to the patient and then look at their entire injury from different perspectives, it might have seemed like it really was an ankle sprainer, that she really did tweak her ATFL. But I think it's really important to take what they say with what you see as a clinician and do a deeper dive and really investigate into what symptom what is recreating their symptoms so that you can accurately diagnose them and then get them back on the field faster. Get on the field, get on the mats, whatever it is. So that's it.

Dr. JJ Thomas: 12:55

I hope that helped you in some way, shape, or form. If you have any questions, put them in the comments, and I hope you'll follow some more. Talk soon.