Issue 207

July 2024

Paul Brown uncovers the gritty evolution of MMA, revealing how cutting-edge recovery protocols are propelling fighters to new heights. This is the ultimate inside look that you can’t miss.

MMA has evolved. It may have started as backyard brawls, but it is now a physical, psychological, and tactical mastery of combat. It's difficult to envisage the early champions stepping into today’s polished production, wearing ‘Venum’ shorts and gold gloves. The early days were characterized by fighters who relied on their base skillset coupled with years of trial and error. Where fighters once had to bounce between gyms to erase their skill gaps, we now have full-time training facilities where coaches can provide athletes with everything they need. With the UFC’s multi-billion-dollar acquisition by Endeavor came a massive investment in the well-being of their most prized assets: the fighters. In 2017, the UFC invested $12 million in its first Performance Institute. This facility provides the athletes with the best practices in training, nutrition, weight cutting, rest, and recovery. The time needed to be a pro-MMA fighter means the workload far outweighs that of other sports. With that comes an increased need for strategic recovery.

THE OLD WAYs

To learn about the new age of recovery protocols, we spoke with Heather Linden, a Doctor of Physical Therapy and the senior director of PT at the UFC Performance Institute. The focus was on the latest treatment therapies and recovery methods fighters have used in the long term and what ones are new in the field.

“Previously, I would say from a long-term perspective of what athletes used to use all the time would be simple methods of contrast,” explained Linden. “Maybe cold and heat. Those are probably the biggest recovery modalities we’ve used for ages. I would say back in the day, cryotherapy and cold treatment was always used for inflammation and pain relief, kind of to reduce the D.O.M.S (delayed onset muscle soreness) that athletes would experience. Research keeps going, and people learn more and more about cryotherapy. And there’s a whole controversial part about cryotherapy that came out in about 2014 or 2015 that says cryotherapy can actually reduce the amount of muscle hypertrophy (growth) that you gain. So, if athletes are trying to bulk up or gain a lot of muscle strength, cryotherapy was actually shutting that down, and that was the wrong modality to use.” 

This constantly changing approach maps how what was once on the edge is now thought to possibly work against an athlete, so it needs constant refinement.  

THE FUTURE OF RECOVERY 

When asked about the latest options available to fighters, Dr. Linden revealed that the landscape of athlete care continues to improve.

“Now it’s kind of like you get your pros and cons with everything,” she explains. “Every recovery modality goes through its’ wave of being a popular modality, and then it kind of disappears when something new and better comes up. It’s very cyclical. We’ve seen hyperbaric chambers back in the day be very important with athletes, and in the last few years, they’ve come back and resurfaced. We’ve seen cryotherapy being used again. It’s a huge fad right now. You see all these athletes with the cryo at their house so they can do the different cold tubs and stuff like that in their backyards.”

“You saw heat modalities used previously, primarily to warm up tissue or reduce soreness, before you trained. But nowadays, there’s so much evolution when it comes to sports recovery and technology. It’s pretty cool. There are some things we see now that athletes are incorporating that they didn’t use before, such as a shockwave device which is used quite frequently for recovery and treating little injuries.”

“We use laser therapy, we use infra-red red-light beds, we are using flotation therapy pods with our athletes, we still have the cryotherapy, and we still have the heat modalities. You see, sauna is well used now from a recovery aspect, not just for heat acclimation and/or cutting weight. And you see more advanced orthobiologics (a type of regenerative medicine from natural tissues) being used to help athletes recover, whether it’s stem cells, PRP, different things like that.”

“Back in the day, when I first became a therapist - about twenty-one years ago - it was pretty basic. It was your cold tubs, hot tubs, maybe a Normatec or something like that being used as a pneumatic compression device to pump out things, but now I think recovery and technology has really allowed athletes to recover even better than they ever have and increase their longevity within their respective sports.”

When Dr. Linden was asked for her opinion on the most powerful treatment methods and recovery modalities, she was happy to fill in the gaps.

CRYOTHERAPY

“The best option out there for cryotherapy is gonna be your cold tub,” explains Linden. “That’s your biggest ‘bang-for-your-buck’ tool from a cellular, inflammation, or pain relief aspect. You’ll see the cryotherapy chambers also being used. It’s pretty much the same thing. You’re getting the same cooling effects of the cryo, but I would say you’re getting a better effect if you can tolerate going into a cold tub. That’s where you’ll get the biggest bang for your buck when it comes to cryotherapy.”

“There are two main reasons why you use cryotherapy. One is going to be for reducing inflammation and helping with pain relief. The other reason you would use it is more in a mental capacity. So, you’re powering neurochemical responses that sharpen and reset your mind. So, are you using it for tissue, or are you using it for a mental component?”

“And the tub and the chamber are the two main things we see athletes today use, and I will always say that the cold tub is your best bet. But there are athletes out there who just don’t like water. Maybe they can’t swim or have different reasons for avoiding water, so they prefer the cryo chamber.”

“The cryo chamber is a slightly quicker method to use. We normally recommend five to seven minutes if you’re using a cold tub, although you might be in there longer if it’s more for a mental component. In a cryo chamber, it’s much quicker. You’re in and out of there in two-and-a-half minutes. You can definitely get similar benefits, although research does show it might not be quite to the same extent as it would be with a cold tub.”

STEM CELLS

“Stem cells are the new buzzword. There are three types of stem cells. We have stem cells that are from our adipose or fat tissue, we have stem cells from bone marrow, and then we have the embryotic stem cells.”

“Those different types of stem cells can morph into different types of cells, and as we train, obviously, our cells get damaged, and we want to repair them as fast as possible. When it comes to adipose or fat stem cells, they are the least likely to mold into certain aspects of connective tissue. Bone marrow cells can mold a little bit more, but your best bet is going to be that embryonic stem cell.”

It isn’t uncommon to see American athletes traveling abroad to receive stem cell treatments. Dr. Linden explained that this is because the use of stem cells is regulated very differently in some countries compared to the United States.

“In the United States, we have FDA regulations, and they’re pretty strict about those embryotic stem cells, mainly because it has to be regulated in case you get a stem cell from someone that maybe has a disease or a disorder,” she explains. That can change the benefits of the cell and be a real risk. The FDA in America are very strict with this.”

“You see all these other countries like Mexico, Colombia and Germany doing a lot of new stem cells using embryonic cells because it’s the best moldable stem cell. They also do it intravenously (using an IV).”

“I think what we’re learning with stem cells is that we can repair tissues that maybe normally we would have to surgically repair, leaving the athlete out of action for a significant amount of time. Now, those stem cells can repair that faster, and that’s why we see athletes seeking out these stem cell companies. The biggest issue when you go to foreign countries is it’s less regulated, so we have seen athletes come back with some contamination or some adverse effects. But we’ve also seen athletes come back with some amazing responses, too.”

“It’s definitely a grey area that will continue to develop, but the fact that we can reintegrate connective tissue into our bodies where things are torn is going to be the science of the future. I think as we continue to evolve in our understanding of stem cell treatments, we will begin to understand exactly what to use it for.”

“I love using stem cell treatments with our athletes when we have some labrum tears, ligament tears, or small muscle tears. We can literally cut the recovery time from that injury almost in half if we’re getting good, viable stem cells. One thing to remember – currently, we don’t have a full understanding of how many viable stem cells we should inject. When you go to the doctor’s office in the United States, a lot of the time, you’re getting lab-manufactured stem cells. With that, we don’t know how many cells are viable and how many aren’t. We could inject those cells, and it turns out they’re all dead cells, and you get zero benefits. Or they could all be viable cells, and you get wonderful benefits.”

“I always tell athletes not to go for a stem cell treatment once and say, ‘It didn’t work.’ Maybe, at this point, we don’t know how many viable stem cells are in there. Give it a second or third chance, maybe that next injection will make the difference. And that’s why you get such an array of reactions to these treatments. Some people say, ‘Oh my gosh, it was the best thing ever,’ and you also have disappointed athletes who think it just didn’t work. Because right now, we simply don’t know the viability of those stem cells at the time.”

FLOTATION THERAPY

“Flotation therapy is something that we use at the UFC Performance Institute. Athletes are very sympathetic driven. Our sympathetic nervous system is our fight or flight, and it is especially important in a combat sports setting, right? These athletes have to be on. They’re going all the time. The problem is that your body simply can’t recover if you stay in that sympathetic drive, so you need to downregulate into your parasympathetic system, which is your ‘rest and digest’ system. That’s where recovery happens for athletes.”

“Flotation and float pods are really great for somebody who is really sympathetic driven, and they can’t get out of that fight or flight stage. They’ve finished training, and they’re still riled up and they can’t turn their minds off. Flotation devices activate your parasympathetic nervous system, which is what we need for recovery and good digestion. If you think about it in a combat sport world, it’s so important because we also need them to cut weight. If their digestive system is operating below par because they’re always sympathetically driven. That’s probably going to have a detrimental effect on their attempted weight cut further down the line.”

“A flotation device is really good to help downregulate athletes. We’re using some new technology for this too, some vibrating chairs we’re testing out that can also downregulate athletes, which I think will become really popular in the near future.”

NEXT LEVEL RECOVERY

Recovery isn't just a nice-to-have—it's now the critical backbone of a fighter's survival in the sports upper echelon. In the world of MMA, where fighters push their bodies to the breaking point, the old days of cold tubs and hot packs just don't cut it anymore. Support teams are now adding the yin to the yang, the hard grind of multiple daily training sessions counterbalanced by the precision of high-tech recovery. It's not just about getting back on your feet. It's become a way of staying on top and creating a new ceiling. With the UFC Performance Institute's cutting-edge tech and methods, fighters aren't just recovering—they're rebuilding, coming back stronger and meaner. This is the new frontier of MMA, where tactical mastery meets relentless grit on the mat and during the healing phase. The message is clear: evolve or get left behind. It’s clear the future of MMA is here, and it's tougher than ever.