Issue 033

January 2008

Roan ‘Jucao’ Carneiro suffered a broken foot in March 2006 as a result of this kick from Frenchman Gregory Bouchelaghem. 

Hands and feet are delicate pieces of kit. They have lots of small parts that can easily be damaged by trauma or overuse. In this article we’ll consider a few of the common injuries that tend to occur in mixed martial arts.

The hand has 27 bones and numerous joints, ligaments, muscles, tendons, nerves and blood vessels, all of which have to work together to enable them to function normally. Until something goes wrong, we take our hands for granted. Few people who have not experienced a hand injury really stop to consider how difficult life would be without them.

In MMA, we combine both the impact of boxing and the grabbing and gripping of grappling sports. Each of these brings its own set of problems. A study of injuries in professional MMA competition found that hand injuries were the second most common kind of injury, second only to facial cuts and lacerations.

The classic striker’s injury is a fracture of one of the metacarpal bones. This is a common injury in both boxing and MMA. Wrapping the hands correctly before a fight reduces the risk, but does not eliminate it. Fighters have been known to continue fighting with a broken hand, sometimes even going on to win the fight.

Fractures may also occur to the fingers, to the carpal bones at the base of the wrist and to the bones of the forearm. This can happen from a fall onto an outstretched hand, or from impact with an elbow. 

Another injury associated with punching is “boxer’s knuckle”. This is damage to the tendon that runs over the knuckle or the tissues that hold it in place. It can leave a fighter unable to properly straighten his fingers, and may need surgery to correct.

Also commonplace is damage to the joints of the hand and their supporting ligaments. In extreme cases, a joint (often in one of the fingers) may be dislocated completely. Even more minor joint injuries can cause considerable swelling that may take weeks or even months to go away. In the meantime, there may be ongoing problems and limited movement. For a long time afterwards, the person may find that the slightest knock or stress on the joint will cause a great deal of pain.

If a finger is bent backwards awkwardly, during grappling for example, it can cause damage to muscles and tendons as well as the joints themselves. Rarely, it can result in a tendon rupture, or even an avulsion fracture where the tendon actually tears a fragment away from the bone it is attached to.

As well as injuries that happen from a sudden trauma, there are also injuries which creep up on us after months or years of training. The repeated impact from hitting pads and bags, for example, can cause wear and tear on the many small joints in the wrist. The best way to minimize this is by wrapping your hands well before training.

Pain in the hand and wrist may also come from problems at the elbow, shoulder or neck. This is something which needs to be examined by a doctor, physiotherapist, osteopath or other trained sports injury professional, especially if there is any numbness, tingling, pins and needles or pain in the arm when moving the neck.

Foot injuries can be similar to the problems we’ve already discussed with hands.

Metatarsal fractures are well known to every football fan, and can be caused by impact from a badly targeted kick. Toes can be bent backwards or caught in clothing (a good reason to wear a rashguard rather than a baggy T-shirt). One of the best ways to prevent toe injuries is to check there are no gaps in the mat you are training on. I know people who’ve literally had toes torn off from catching them in the mats while sparring. 

Recurrent joint problems, especially in the toes, are both common and painful. These can be especially frustrating, especially when they keep recurring. As with most other parts of the body, rehabilitation is possible – but MMA is unusual amongst sports in that it is practised in bare feet, so it may not be a request that your physiotherapist is used to.  

Sprains of the joint at the base of the big toe are sometimes known as “turf toe”. This can be caused either by having it bent upwards awkwardly, or from the strain of pushing off on the toe. 

Protection of hands and feet can play a role in preventing hand and foot injuries. Correct hand wrapping, especially when hitting bags and pads; shin and instep protection for sparring with kicks in the gym; wearing wrestling boots in training to protect a recurring toe injury are all examples of this. Tape can also be used to protect thumbs, fingers and toes and is especially popular with gi grapplers. Ideally, try and get professional advice on how to apply the tape effectively.

If you have a serious hand or foot injury, it is important to get it checked out immediately. Very occasionally, surgery may be needed for example if there is a displaced fracture, or a ruptured tendon. In other cases, treatment may be needed to prevent further damage, by splinting an injured finger or putting the hand in a cast in the case of a carpal fracture. 

For more minor injuries, applying ice, compression and elevation soon after the injury can help to reduce the initial swelling and is thought to reduce recovery time and improve healing. With both hands and feet, though, it is important to be careful in applying ice and compression. Cutting off the circulation or giving yourself frostbite won’t help the situation. Ice should never be applied directly to the skin – always wrap it in a damp cloth or use a purpose made ice pack. 

Gentle mobilization of the injured part is also important since joints that aren’t moved while they are healing tend to stiffen up. In the case of serious injuries, this should always be done under the guidance of a qualified professional such as a physiotherapist or osteopath. For more minor injuries such as a slight finger joint sprain, for example, you can help yourself by regularly bending and straightening the joint and gently trying to encourage a normal range of motion.