FAKTR Podcast #82 FAKTR Podcast: Common Conditions for MMA Part 2
Jessica Riddle 00:00:55 - 00:01:48
Hi, guys, welcome to another episode of the FAKTR Podcast. I'm your host, Jessica Riddle. Welcome and thanks for listening. In our last episode, we discussed common submission and takedown techniques in the world of mixed martial arts, and our guest instructor, doctor Nate Stegus gave an in-depth overview of the injuries that can occur in these scenarios. We also discussed fighter evaluation and rehab strategies, ways to manage pain and inflammation, and strategies for restoring range of motion post injury. In today's episode, doctor Nate will talk more about ways to manage pain and inflammation, strategies for cross training, and the importance of incorporating strength and conditioning programs for these unique athletes. We will also discuss the best methods for optimizing recovery and talk through ways to track progress and athletic development. Let's cue the intro music and dive in.
Dr. Nate Stegehuis 00:01:58 - 00:02:54
Then we'll go to the lower half, straight ankle, goes into plantarflexion and inversion. It's gonna stress the ATFL and retinaculum and other structures around here a lot. Good fracture in ankles, brain strain, the surrounding structures. Dislike if you pull hard enough, if you rotate it enough, and do some ligament instability, tarsal tunnel. I'm experiencing a little bit of that right now. It's not great, but it's when you see what it is, a kinda treat kinda like an ankle sprain or like just a typical ankle sprain, like if someone was coming in after just playing basketball. It's similar mechanism, and then you can take that protocol and that experience that you have with those type of injuries and apply to this. We use the compression, the Vodafloss, Praktifloss, whatever you have for this to restore the range of motion and response really well to that.
Dr. Nate Stegehuis 00:02:54 - 00:03:29
And then to add resistance to ankle could be a little challenging at times. If you have, like, a rocker or wobble board, that's that's pretty good. Kettlebells with shifting weight with a knee over toe, that works pretty well. We have the monkey feet here. If anybody's tried the monkey feet, it's amazing. It's really, really simple to incorporate the weight through the range of motion. And then I have them do this is called shots. Basically, you want to have them try to lean the knee all the way over the toe and then explode off of it.
Dr. Nate Stegehuis 00:03:29 - 00:04:02
There you go. This is also 1 of the more important aspects of Brazilian jiu jitsu. It's gotta be able to take them down. Knee bar similar to arm bar but for the knee, maximum is about maximum knee extension 0 to about 15 degrees. So when you after you lock it out and hip up, that's usually the end of that. Think of knee hyperextension injuries. Like, in football and stuff, you're gonna think of ACL, other collateral crucial ligaments can be involved, ligaments. And I check out the hamstrings as well just because it's in the lengthened position.
Dr. Nate Stegehuis 00:04:02 - 00:04:29
So a lot of times, if ACL, MCL, like, all the ligaments are fine and stuff, but if you feel some pain around the knee and stuff, maybe it could be like a hamstring tear or some kind of, like, nerve entrapment around that area you can do. So chronic, you get knee barred a bunch and stuff. You can get some instability over time. Hamstring mobility, just in general and stuff. Just something to look out for. Let's use the venom around the knee. Helps out greatly with a lot of things, especially involving the knee. Just helps get it warm up, get it ready for motion.
Dr. Nate Stegehuis 00:04:30 - 00:05:13
TRX is really good in the early stages that we like to do because it helps take the body weight or take any extra weight and strain off of it. It'll get the range of motion back to where it needs to be, and then after that, you add your resistance. Body weight squats, good place to start. Monkey feet, monkey feet are great for nearly any lower body 1. I can add in the hamstring curls and quad extensions. Anything else that you could find with that? Bulgarian splits. And then Nordics with Nordics, I would recommend starting at the most regressed. So start off at about maybe, like, 15, eventually building up the tolerance to get it full if that's 1 that's bothering them.
Dr. Nate Stegehuis 00:05:14 - 00:06:20
And then for the grappling and striking drills and stuff, if they use a lot utilize a lot of kicks, just start kicking kicking the heavy bag just lightly and stuff, building up building that tolerance back up, getting used to takedowns again, seeing if they can roll around and fight off submissions, and then positioning and doing technical get up as Luke is demonstrating right there, and then you return. Heel hook, I'm gonna spend about a few minutes on this 1 just because it is very prevalent, and it's probably 1 of the more devastating injuries. It's pretty controversial with a lot of people. And what happens is you're going to isolate the lower leg. You're gonna clamp on to the upper part of the femur so you can extremely rotate the lower part of the leg around either an internal or external rotation. And what it does is it simultaneously attacks both the ankle and the knee joint. So you can look up on YouTube peel hook injury. It's not for the squeamish because it can be particularly devastating.
Dr. Nate Stegehuis 00:06:21 - 00:07:07
In a lot of places, it's been outlawed, and a lot of schools won't teach it to their lower level. You gotta be at least probably like a purple belt or above. Just depends on where you go just because of the potential for serious damage. There's other organizations and other competition boards that outlaw it. So if you try, you're immediately disqualified. So but it's it is good to know about it because the ones that do allow it as typically a no gi 1, people go for it because it's it's 1 of the quickest ways to win. Because as you'll see, 1 of the first things to go is the cruciate and collateral ligaments of the knee. Because once you isolate the knee joint, there's no real defense for it.
Dr. Nate Stegehuis 00:07:07 - 00:07:29
And what they say is you're good until you're not. So you're not gonna feel anything. It's gonna feel fine. Like, okay. I can fight this off, fight this off, fight this off, and then boom. There's there goes a ligament or boom. There goes a meniscus tear or whatever happens. And a lot of the times, if they're fighting it off, the tibia can create a spiral fracture as well.
Dr. Nate Stegehuis 00:07:29 - 00:08:09
It's just it's nasty little submission and can be very devastating. Take people out for a very long time. Rehab considerations, if I do have pretty extensive injury, might wanna opt for a ortho consult before you get started. But if you can, similar concepts, you know, compression, heat, elevate, control pain, inflammation, restore the range of motion. Slowly is gonna be typically a long very long recovery with that. Add your resistance. Build back up with balance issues, your strength issues, whatever else that comes from it. Incorporate the grappling and striking, and then return to practice.
Dr. Nate Stegehuis 00:08:09 - 00:08:44
Typically, anybody that gets caught in a really bad heel hook, it's gonna be at least almost a year just because I've seen how devastating that is. I always get a little nervous whenever I see people do that in competition and I'm doing coverage here. So then we'll go into the blood and airway chokes. These are some of them. Obviously, these aren't all the ones that we could do. I would be here for 4 or 5 hours with you. But a lot of them will have similar presentations, so we'll just kinda motor through the mechanisms, and then we'll go to how to recover from them afterwards. First 1 I'll talk about is guillotine choke.
Dr. Nate Stegehuis 00:08:45 - 00:09:34
It involves compression of the carotid arteries, bilaterally, and you can see with a little bit of cervical flexion to the affected side. It is not pleasant to be in from personal experience. It can be performed standing or on guard. Either way does not feel good. The potential injuries, loss of consciousness is the first thing. Typically, they say it takes about 10 seconds of compression to cause the loss of consciousness, and then anything from 30 seconds to 4 minutes can induce some brain damage. So if you're training with someone and you don't pay close attention, you have them holding on to a choke for too long, don't realize that they're out and stuff, you can cause some damage. So I would have the athletes be sure that they pay attention to what they're doing out there.
Dr. Nate Stegehuis 00:09:34 - 00:10:23
Cervical's brain strain, this is typically from trying to pull your head out of the attack. If you're holding on for trying to get out for dear life, my guys holding on for you, you could definitely I see a lot of cervical and upper back strain that goes along with that. Tracheal damage, basically, bruising, just feeling like you've been compressed because a lot of the force goes through from the forearm when you're locking your hands on the opposite side like that. TMJ damage, I've experienced. I had a black belt, and I attempted to get out of the guillotine. He proceeded to squeeze down on my jaw, and I felt it to detach for a second, so that was fun. I had a nice little headache for a few days after that, so that's also a possibility if they come in with that. Nerve irritation, just check your check your nerve roots and see if there's anything referring down into the arms.
Dr. Nate Stegehuis 00:10:23 - 00:11:05
Rear naked choke, this is 1 of the most popular ones. It's compression of the carotid arteries and trachea. People that go for the back typically wanna go for this 1. MMA, this is 1 of the most effective ways to end a fight because once you slap on 1 of these and it's tight, it's almost impossible to get out of. So loss of consciousness, tracheal sprain strain, cervical strain. TMJ, the initial way to block the rear naked is to duck your chin like such. So if someone comes along to their arm, covers that, and puts enough pressure on it, you can aggravate the TMJ joint pretty easily as well. DARS choke, compression carotid artery is resistant from the opponent's arm.
Dr. Nate Stegehuis 00:11:06 - 00:11:44
Kinda similar in setup to the rear naked, but this is gonna be from side control. You get a arm trapped, compress it down through there. Similar potential injuries, neck, should neck, shoulder, TMJ. Triangle choke, you can do head and arm or from guard with the legs, similar mechanism, similar injury. And then the rehab is gonna be similar. You're gonna control the pain and inflammation, restore the range of motion. Traction can help if it's more of a chronic issue than an acute issue. We use the Iron Neck a lot here, especially with all our grapplers just because it's great for injury prevention.
Dr. Nate Stegehuis 00:11:45 - 00:12:17
Having a strong neck in general never hurt anybody. We put the iron neck into doing drills such as sprawls, any type of shoots and stuff just adds a nice little layer to rehab, and we see a lot of good results with that. Carpoline grappling, the striking drills, shadow boxing, just something to get the head off off midline, make sure that they can defend themselves, light submission defense. You just hold them. Don't, like, crank down on them if you want. Positioning trans transitions, and then let them loose after that. Striking injuries real quick. Pretty self explanatory.
Dr. Nate Stegehuis 00:12:17 - 00:12:53
I mean, if you've ever stubbed your shin, like a bed post or anything like that, I mentioned that coming at you about 50 miles per hour. Gonna have the have the potential to fracture some bones. Concussion's a big 1. You get knocked out and stuff. Back of your head hits the mat. Fractured ribs, people that throw kicks and stuff, they'll be targeting the liver and spleen, so you can get some internal organ damage, hematomas, especially on the face and stuff. You can see people with huge knots after especially if it's a long fight. Bone bruises, fractured teeth.
Dr. Nate Stegehuis 00:12:53 - 00:13:22
People that especially, like, if someone's fighting, say, like, a Muay Thai heavy person, holding on to the head, getting a knee right underneath, the mouth guard can only handle so much. You can fracture a jaw, have some teeth knocked out. It's pretty pretty nasty when that happens. Fractured tib fib. If someone is checking a kick, I've seen an uptick of it over the last couple of years. They last part like, Conor McGregor was 1 of them. He tried to kick and then tip fib fracture. Anderson Silva, 1 of the best fighters of all time.
Dr. Nate Stegehuis 00:13:22 - 00:13:56
He's had it. Chris Weidman's had it. So it's just that too much force, and the bone does not adapt to it. So it breaks and pretty nasty. Lacerations to the face, that's pretty easy. Over time, so if you take enough punches, your TMJ, you'll have chronic pain in that. Post concussive symptoms, make sure they they're still experiencing it. I'll hold them out of practice and have them see a neuro, get the all clear from that because you don't wanna have the double impact, any potential of that.
Dr. Nate Stegehuis 00:13:56 - 00:14:36
Hand injuries is a big 1. Punching someone in in the face, you'll have a chance of getting a boxer's FAKTR. Any of the metacarpals, really, but, typically, it's gonna be the 5th metacarpal. The DIP, so your distal and your proximal interpharyngeal joints, that's why people will the old school jiu jitsu people will tape up their fingers as up beforehand just to add a little bit extra because when you're gripping, especially on gis and stuff, it's really high intensity, a lot of speed velocity and strength that goes behind it. Really easy to hurt your fingers that way. You can do some grip strengthening. There's they've got equipment out there for grip strengthens. You can have them grip rice, just get back to normal activities.
Dr. Nate Stegehuis 00:14:37 - 00:15:18
Grip strength is really kind of an underrated, but, very important part of martial arts too. So if they're experiencing that, that's another bit of advice you can give to them. And then certain techniques can just be more devastating than others. There's an oblique kick, which basically causes extreme hyperextension of the leg, valgus stress, hits to the back of the head. There are a lot of these are largely illegal for that, but they do happen sometimes. So just allow sufficient time for it to heal and refer out as needed. So this is a question. I'll let everyone answer that if they feel like answering, and it's gonna be what is the most commonly diagnosed ailment of athletes.
Dr. Nate Stegehuis 00:15:18 - 00:15:23
This is what people actually go to see their primary care or see a doctor for.
Jessica Riddle 00:15:24 - 00:15:33
K. Someone said headaches. I imagine head and neck is probably gonna be gonna be up there at the top. Lacerations. K.
Dr. Nate Stegehuis 00:15:34 - 00:15:44
Alright. So, yeah, headaches and lacerations. That's those are pretty good. But next brain. Okay. I was gonna wait for 1 more, so glad we got 1 more here. Alright. Skin infections.
Dr. Nate Stegehuis 00:15:45 - 00:16:15
So staph MRSA ringworm. This is rampant. It can be very rampant. Once someone gets it in the gym, maybe they don't realize that they have it, but just the nature of the beast here and the environment. MMA gyms are hot, sweaty, not a lot of ventilation, and you're grappling, and you're in close contact for a long period of time. So it's pretty nasty. It can get pretty bad. It can be yeah.
Dr. Nate Stegehuis 00:16:15 - 00:16:45
Those those keys don't wash themselves. That's right. Yeah. Absolutely. Yeah. Approximately 17% of all collegiate wrestling injuries involve skin infection. So, like, that's all injuries is all it's it's pretty bad. And it can be spread through cuts, blisters, or exposed skin, so that's why if someone has a cut, if someone has a open wound and stuff, we largely tell them to wait till it heals before you get back because you naturally have staph, MRSA, all that stuff on your skin.
Dr. Nate Stegehuis 00:16:45 - 00:17:25
If you have, like, an increase of it, you have that open. It's just a easy portal in, and the stuff can can spread even with antibiotics and aggressive treatment. It could still cause some devastating injuries and could potentially be fatal if and then treated appropriately. So if you see that on someone, someone has this big boil, it's hot, and just looks off, just send them to the primary care. Have them make sure you wash down everything that was in contact with it, and tell them to stay off practice till they get that taken care of. Alright. Case study. This is the 1 that with permission from the athlete, this is the 1 that I've been training her for years now.
Dr. Nate Stegehuis 00:17:26 - 00:17:51
In March of 2022, she had a particularly devastating injury. This was just a practice. This wasn't even during during a competition. But she called me up late at night. She said that she hurt her knee and she can barely walk down. I was like, okay. Well, I'll come into the gym tomorrow, and we'll see what's going on. And when I got there, she was on crutches, so I knew it was bad because she's really, really tough to weight class champion, amateur champion.
Dr. Nate Stegehuis 00:17:51 - 00:18:33
So this has to be pretty devastating if it's causing her to do this. Moderate decrease in flexion and extension with pain, positive McMurray's with noticeable click and bogginess along the lateral aspect. All her collateral and crucial ligaments were intact, so I didn't really think it was ACL or anything that we'd have to go immediately into, like, a surgical consult or anything like that, but she had some strength deficits, no numbness tingling, distal to the side of the injury. But I was figuring she probably tore her meniscus pretty good. Got the MRI several weeks later. Buckingheld tear, left lateral. You see right here, this little this little break. So I told her that let's just let's rehab you.
Dr. Nate Stegehuis 00:18:33 - 00:19:46
And if you wanna get surgery later, you can always opt for that. But let's get you upright so you don't get deconditioned too much and see if you can stay at least semi say, practicing for at least a little bit while we get everything else figured out. So we just wanted to focus a lot on pain mitigation and light resistance, just getting her able to try to get to as much full extension and get it as strong as we could. I had her on the exercise bike just adding up little by little over the 1st couple weeks. By week 3, she was pretty quick heeler, so she was able to do a little bit more. We started light jogging for just a couple minutes at a time just to test the tolerance, some agility drills, BGJ ground, mobility, such as, like, shrimping, doing her get ups and stuff. And at week 4, she was able to stay up and support her weight and do a little bit more as the days went on, obviously. We did some light judo drills, had her do some takedowns, very light, probably about 40, 50% of competition speed, and she was able to do it.
Dr. Nate Stegehuis 00:19:46 - 00:20:23
And we had her doing drilling up to hers. When it came to this, we were able to give her a protocol and give her her standard that she could exercise and train to her to her tolerance. And really helped after week 7 and stuff. I saw her semi regular basis going forward just to keep track and make sure there's no regressions. She went to the arthroscopic several months later, and she continues today. And she actually has her first fight over about 14 months this Saturday. So I'll be excited to see her go after that. So it's really good.
Dr. Nate Stegehuis 00:20:23 - 00:20:55
It's really enriching, especially when you see if you can be, like, a small part of these people's journeys and stuff. It's really enriching, and it's a very fun way to use your license. Alright. Last little bit for a little bit of advice. If buyers come up to you and they just wanna ask stuff, I always tell them, tap early, tap often. It's not worth, yeah, it's not worth taking off a year of your life just to try and fight out of something in practice. Make it make at least 1 day a week for recovery. A lot of people a lot of fighters wanna go every single day and stuff, and eventually eventually something's gonna break down.
Dr. Nate Stegehuis 00:20:55 - 00:21:16
So try to make time to recover. Hydrate, eat clean. Wash your geese, wash your equipment, wash yourself, especially after being in contact with people. Out sleep, the composition sleep is highly underrated. And when it comes to recovery, if you don't sleep good, everything else kinda just falls apart. Minimize the outside distractions. There's a lot of information out there. Not all of it's great.
Dr. Nate Stegehuis 00:21:16 - 00:21:34
So if they'll they'll come up to you and ask you about certain stuff that might seem a little silly, but just kinda put them in the right direction. And then be safe and be good to your partners. It's not no nobody wants to go out and hurt anyone, so just be safe with it and have fun.
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Dr. Nate Stegehuis 00:22:21 - 00:22:39
And always remember to provide thorough examination, your movement screenings, and correlate the findings with the fighter style and treat accordingly. That's the set principle. And then provide support and reassurance. That's it. So, yeah, it was hopefully not too information laden. Hopefully, everyone got a little little bit about that. Now we'll open it up to questions.
Jessica Riddle 00:22:40 - 00:22:57
Awesome. Thank you so much, doctor Nate. You talked a minute ago about kind of how you encourage rest and recovery. Could you expand a little bit on how you help your athletes come up with a system or a schedule for rest and recovery in between their practices and then any matches they have?
Dr. Nate Stegehuis 00:22:58 - 00:23:42
There's there's not really, like, a a specific 1. Everyone's gonna have different needs depending a lot on their, like, personal schedule. Like, some people, like I said, some people have jobs. Some people have more time to give to recovery. But I know people that are are fighters, and then they work they're the bouncer at a nightclub at night, so they could sleep, like, 4 or 5 hours. So, like, if they can only sleep a little bit during the night, not maybe, like, up to about, like, maybe a 7 or 8 hours, that would be ideal. I tell them to try to get a nap in after practice to try to, like, get these little bits and pieces of recovery as they can as opposed to just 1 large 1. But it'll come down to it'll come down to the specific athlete and kinda, like, what they what else they have, the outside factors that they have going on in their lives.
Jessica Riddle 00:23:43 - 00:24:15
Absolutely. And I think that's that's definitely key there is kinda individualizing that to each patient and their needs. Another question that came in, someone was asking about if you have any standard recommendations for an amateur fighter that's training several days a week, how do you kind of balance their soft tissue therapy, their injury prevention weekly or biweekly? They come in. They have a really rigorous training schedule. How are you balancing in their sessions with you and their rehab amongst all of that?
Dr. Nate Stegehuis 00:24:15 - 00:24:47
Yeah. So this will come down to basically with their in fight camp or if they're not, they're in fight camp. I like to see them at least once a week just to kinda make sure that they're on schedule. No. Nothing new pops up that we can kinda get a a jump on. If they're outside of fight weekend, just wanna, like, recover. So if you use, like, cold plunge or sauna or you get adjusted soft tissue therapy, whatever like that, typically, like, every other week, if they can swing it. If not, once a month is is fine too.
Dr. Nate Stegehuis 00:24:47 - 00:25:55
But for bike camp, yeah, we we try to see them at least weekly, keep them on track, make sure there's no there there's nothing that wouldn't keep him from performing their best during the fights. That's a really big that's a big opportunity for you and the fighter to, like, kinda bridge that relationship. If you go out and they're feeling a 100%, and they go as far as they want with their career, that's 1 of the more enriching parts of the job. It's less frequency when they're not in a fight, I I would say. But, again, it'll come down to if they have, like, a chronic issue, like, if they have chronic deficits, I see a lot of boxers with, like, rotator cuff syndrome because if they're volume punchers, meaning, like, they're not knocking people out in 1 fight, they're not doing Mike Tyson type work and stuff, they're going to absorb all that force throughout the matches and practices into their rotator cuff. So they might need 1 a little bit more frequently than someone that's just doing jiu jitsu or someone that is not as reliant on their striking. So it's it helps to be familiar with your with your fighters type of style as well.
Jessica Riddle 00:25:56 - 00:26:37
Absolutely. Are there any things that have been surprising to you that you've seen in terms of interventions and things that you might work on rehabbing that make a big difference. So for example, a lot of sports docs will talk about how looking at things like breathing dynamics can make a huge difference for for their power lifters, which isn't something that you would necessarily think intuitively like, hey. I need to look at their breathing first. Is there something like that that you've seen across the board with your fighters that you're like every single time when I have a new patient come in that I know is involved in MMA, This is something I look to every single time, and if we can make this change and fix this, it makes a huge difference.
Dr. Nate Stegehuis 00:26:38 - 00:27:06
Yeah. There's a couple. 1 of the more interesting ones that I found was was called your frames. Basically, I haven't put their hands up, and then I'll test to see if they can hold it. And a lot of times, they'll have 1 arm or even both arms sometimes that just you can slap them down right away, and they just can't hold that position. So we can work on some upper core strength and stability. If they have an ability, like, doing the neck flexion tests and stuff, we can go for cervical stability with that. Like, the iron neck is great for that.
Dr. Nate Stegehuis 00:27:06 - 00:28:04
Planks, overhead dead bugs with the ball. You can get creative with it. But, yeah, I've seen especially with it because, like, being able to hold your opponent off is such like a vital part of your offense and defense. And some of the times, some of the guys just can't do it. Like, maybe they weren't even they didn't even notice that they weren't able to or something. But once we shore that up and stuff, they say that they typically feel a big difference, not only in pain and function wise, but definitely in performance as well. So if people have a movement screen that they do and stuff, and then they could find that and correlate that to the fighter's preference and stuff, that's great. I like to do something really specific to them, like, when it comes to, like, holding their frames or seeing if they can hold their punches, like, seeing how much force that they can generate behind it, and then just kind of reverse engineering from that, attacking that tissue, restoring that mobility, strengthening up that area, whatever.
Dr. Nate Stegehuis 00:28:04 - 00:28:07
So that typically yields pretty good results.
Jessica Riddle 00:28:08 - 00:28:14
Absolutely. The next question that came in is specifically regarding Brazilian jiu jitsu athlete.
Dr. Nate Stegehuis 00:28:14 - 00:28:15
Jessica Riddle 00:28:15 - 00:28:20
With experienced fighters increasing their volume and experience that are experiencing hand soreness.
Dr. Nate Stegehuis 00:28:21 - 00:28:21
Jessica Riddle 00:28:21 - 00:28:27
Would you suggest more grip strength training, or is there a more worthwhile intervention for that?
Dr. Nate Stegehuis 00:28:27 - 00:29:11
I think that would depend. If they're having difficulty, like, the was it the Fromance? Yeah. If they're having, like, difficulty, like, holding that, you can look up the chain, see if there's a nerve entrapment somewhere, release that, and then doing some grip strength training. I don't think it ever hurts someone to get strong in a certain area, especially with with grip strength because it's used so often. But I would definitely test the muscles to see if there's any nerve kind of dysfunction going on there and then apply that and then see if that helps with improving the grip. And if you wanna go for strength, I like to have people do more endurance based, so lower weight, just higher reps. Maybe that would help more than just trying to holding up as much weight as possible when it comes to the grips.
Jessica Riddle 00:29:12 - 00:29:15
Absolutely. The next question here is regarding hypermobility.
Dr. Nate Stegehuis 00:29:16 - 00:29:17
Jessica Riddle 00:29:17 - 00:29:48
The first part of the question is, do you always test your fighters to see first if they are hypermobile so that you know if that's a consideration consideration to look at? The second piece of that question is if you encounter an athlete that is hypermobile, are there specific taping jobs that you're doing for that when you know they're preparing for a fight? Are there specific ways that you kind of cater your rehab to help strengthen those areas where they may be experiencing a lot of that hypermobility, especially your grappling athlete?
Dr. Nate Stegehuis 00:29:49 - 00:30:35
With that and stuff, taping might not be allowed in some of the competitions and stuff, so I try not to have them reliant upon that. If they're gonna stay in here for, like, a long rehab session, then I might utilize that. It depends on the athletic commission and if they allow for people to be taped because I don't want them to be, like, reliant on it then not use it and then feel off and stuff when it comes to that. Hypermobile people and stuff, like, I will do my passive active stuff if they're off the charts with that. Obviously, I know I'm not gonna waste too much time on trying to restore the motion. I'm just gonna go down the chain and start to find the weaknesses, typically if they're hypermobile. Like, say, for instance, I had a fighter the other day, and her hip internal rotation was, like, off the charts. I'd never seen as much internal rotation as that.
Dr. Nate Stegehuis 00:30:35 - 00:31:24
But when I tried to have her resist me and stuff, she couldn't hold it. So all that mobility is great and all if you're, like, throwing kicks, but, eventually, it's gonna it can eventually cause some issues. So I was more focused on strengthening up that range than trying to get, as much mobility as I can out of it. It actually works it works pretty well in jiu jitsu, but if you can't hold the position, especially with, like, hip mobility, hip strength, and stuff, they can't hold that, then how are they gonna hold someone to guard for a while? So it's something that you can relay to them to kinda let the light bulb turn on. Like, okay. We can set you up with a program, straight to conditioning program. I had him out to Luke out there. He's a MMA fighter as well, so he knows the program.
Dr. Nate Stegehuis 00:31:24 - 00:31:41
And we just kind of rinse and repeat until we get the desired result. And, typically, they respond really quickly because a lot of a lot of these athletes have never heard don't really know all this concept. They think they didn't really realize that they were weak in a certain area, and that has something to do with jujitsu. So that could definitely help out a lot.
Jessica Riddle 00:31:42 - 00:32:01
Wonderful. Another question here. Someone was saying that a lot of professional teams and collegiate teams have training rooms and open access to care that amateur fighters don't. How do you create the relationships with athletes that benefit them? Do you do memberships, standing treatment times, direct care, or fight camp offerings?
Dr. Nate Stegehuis 00:32:02 - 00:33:03
We do fight camp offerings and memberships here. We do, like, monthly like, month to month Because we understand, like, fighters will have certain financial restrictions as well as timing restrictions and stuff. They can't always make it in, but ones that are, like, really dedicated and are able to and stuff, they'll come in and will have programs for them. They can come in and use the recovery stuff, the cold plunge, the compression sleeves, red light, stoma, weight lifting, whatever they want. So if they need soft tissue, then we go from there too. A big way to open that realm to the access of care too is just to go to the gym and start practicing because, like, I've made so many connections as of with athletes and stuff just by going there and practicing with them. It's a great time for both physical and mental health. Jujitsu and missed martial arts has been 1 of the best things for many, many people that I've talked, but it's it's good to overall health and to get a better understanding of what they're going through, and that'll help to gain rapport with them and help give them better treatment.
Jessica Riddle 00:33:03 - 00:33:33
Do you have specific guidelines that you give your athletes when it comes to frequency of practice during rehab? Let's say someone comes in to you with a rather acute injury. Obviously, you have your rehab schedule that you're putting them on for when they come see you. How do you have that conversation with them about type of practice, type of workout? Like, what do they need to do while they're still in that acute phase? How do you get them to tap the brakes a little bit on their typical training schedule?
Dr. Nate Stegehuis 00:33:34 - 00:34:18
That's easier said than done because a lot of them a lot of them like to go a 100 miles per hour at all time. So it's just really good to kinda reiterate the importance of your recommendations. And it helps to know the head coach. The head coach is typically the owner of the gym. If you can get in good with them and the athlete doesn't mind you discussing, like, the case with them, you can also correlate with that, like, coordinate, see how it is. Typically, if there's an injury during fight camp, like a specific 1, they'll probably just pull them out so you don't have to worry too much about altering that. But if it's just like a everyday 1 and someone, if you don't think they're good to go grapple, like, 5 rounds intensely and stuff, you could just be like, hey. Just go have speed for, like, 1 or 2 and stuff, see how it is and stuff.
Dr. Nate Stegehuis 00:34:18 - 00:34:28
Build back up your tolerance, and then over time, you can release them to a full activity. But open communication is just and just stressing the importance of it is highly important. And
Jessica Riddle 00:34:29 - 00:34:35
1 last question here. Someone was asking for your top 5 recovery tools that you use in practice.
Dr. Nate Stegehuis 00:34:35 - 00:34:55
We use a lot of the venom. I would say oh, boy. What else do we use? Iron Neck. Yeah. Iron Neck, the venom, the monkey feet, those are really specific tools, which I like. I use the decompression table a lot. That helps for me. It helps for a lot of, like, the more chronic people as well.
Dr. Nate Stegehuis 00:34:55 - 00:35:09
And when we get the cold plunge in, that'll be probably the 1 that a lot of people like to use the most, but, like, sauna and cold plunge, definitely. Especially because now it's it's a craze everywhere in the recovery world. So that helps out. People get some good benefit out of that.
Jessica Riddle 00:35:10 - 00:35:25
Wonderful. Well, thanks again, everyone. Okay. 1 final question here from someone here in the chat. Do you have any specific baseline testing that you do for concussions? How often are you doing concussion screening with these athletes? Is that something you encounter a lot?
Dr. Nate Stegehuis 00:35:25 - 00:36:09
So the the new 1 I think they came out with the SCAD 6 not too long ago. You can reference that for concussions. The SCAD 5 or SCAD I think the SCAD 6 came out pretty. But if you're at a competition, if you're the only 1, typically, if they you feel like they have a concussion, like, I'm just gonna stop the fight or, like, keep them from competing anyway. I would if there's a a neuro in the what do you call it? In the ringside, because a lot of the MMA ones, they'll they'll require you to be a MD or be a neurologist. They'll have that. So so that's typically, I try to stay in my lane when it comes to that. If they have, like, recurrent concussive symptoms, like, they're experiencing, like, brain fog, they have headaches constantly, they can't sleep, they have nausea and stuff, keep going, then I'll just refer them out.
Dr. Nate Stegehuis 00:36:09 - 00:36:22
You can pretty much know if someone's acting different and they just took a major blow to the head, like, if they got head kick, got knocked out and stuff, and then they're just feeling funky for about a week. And so if you could just send them up the send them up the chain, practice within your scope, and hope for the best.
Jessica Riddle 00:36:23 - 00:36:44
Wonderful. Thank you so much. And, obviously, concussion is is such an important thing to look at with these athletes. As you mentioned, pull them out, like stop the fight, pull them if if you have that suspicion for sure. And obviously you have to work within the constraints of your scope of practice and then what you're allowed to do ringside. I know that's very important across the board with different sports and and different organizations in that regard.
Jessica Riddle 00:36:59 - 00:37:55
That's it for today's episode. Be sure to tune in for episode 83 where we feature a fascinating new training with doctor Nivas Habib on vagus nerve stimulation. In this 2 part series, we will explore how the vagus nerve's regulatory pathway impacts inflammation, the role of acetylcholine in modulating immune responses, and we'll learn how these mechanisms can be leveraged to improve conditions such as autoimmune disorders, neurological diseases, and more. You don't wanna miss it. Episode 83 drops in 2 weeks. If you enjoy our content, please be sure to like, download, and subscribe to this show, and share a link with a friend. Every share helps us fulfill our mission to provide world class free education to health providers around the globe. If you're interested in listening to past episodes and viewing all of our recorded webinar replays, be sure to visit our website atfactorpodcast.com.
Jessica Riddle 00:37:57 - 00:38:28
We have a few exciting interview style q and a episodes planned for the future, so be sure to send us any questions that you may have for today's instructor, doctor Nate Stegus when you visit the episode page on our website. You can even click a button and submit your questions through voice message, which I think is pretty cool. We'll be sure to cover all of your q and a submissions in a future episode or on our YouTube channel. And finally, don't forget to check out our show notes for any special offers, discounts, or links from our sponsors. We'll see you next time.
Jessica Riddle 00:38:31 - 00:39:12
Hey, guys. If you like what you heard today, I encourage you to visit our website at FAKTR hyphen store dot com. That's spelled FAK trhyphen store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands on FAKTR Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.