Disclaimer: I'm not a doctor, just a random guy on the Internet who has had his fair share of injuries and has been lucky enough to work with some great doctors to find some things that worked for me.
I was prompted to dash off this quick blog post in part to share some information with my friend +Christofer Hoff,, a fellow BJJ-practicing geezer and fellow security guy who has recently joined the ranks of those of us with neck/back injuries.
On my side, I've got L3/L4 disc degeneration and I've had partial rotator cuff tears in each shoulder at different times. I've been lucky enough to avoid shoulder surgery and by being careful about warm-ups and rehab, I'd say I've recovered 85-90% range-of-motion in my shoulders while avoiding further injury.
The typical BJJ / Judo warmup
I notice many, many BJJ practitioners will extensively warm up their neck, shoulders, hips and legs before practice. The typical instructor-led warm-up you seen in BJJ or Judo involves things like running, "butt-kicks", "high-knees", side-to-side skipping, pushups, "shrimping" drills, shoulder circles, neck rotations, plus forward and backward rolls.
While these are great overall warm-up exercises to get your blood pumping, they don't focus enough on the thoracic spine or the posterior chain, key parts of the "core" that have to work properly if you want to avoid injury.
Thoracic spineThe thoracic spine or "T spine" consists of the middle part of the back which is involved heavily in twisting and trunk rotation, motions which are very important to both striking and grappling. Note that when I talk about "T spine", I'm not just talking about the vertebra and discs but also the soft tissue in this area including the paraspinal muscles, traps, rhomboids and the serratus anterior muscles which help to stabilize the scapula.
While it's pretty common in BJJ to hear about cervical (neck) injuries and lumbar (lower back) injuries, one seldom hears complaints about thoracic (mid-back) injuries. This is because problems in the T spine tend to lead to injuries in other parts of the "kinetic chain", namely the lower back, neck, and shoulders. What follows is my (admittedly amateur) attempt to explain why this happens.
All 3 regions of the spine (cervical, thoracic, and lumbar) are responsible for flexion (bending forward) and extension (bending backward). The T spine is unique because it bears additional responsibility for trunk rotation. If your T spine is limited in its ability to rotate, your body will place rotational stress on the lumbar spine (which isn't really designed to rotate), causing lower back injuries. In these situations, people may focus their efforts on rehabilitating the lumbar region while ignoring the original cause of the injury (poor thoracic mobility).
Likewise, if you sit at a desk most of the day like me, even if you are very active outside the office you will likely end up with poor thoracic mobility, manifesting as slight hunching, rounding of the traps shoulders, and "closing" of the chest. Often times, those with rotator cuff injuries will be led to focus rehab on the shoulder stabilizers without looking into the fact that poor thoracic mobility may be what led to your shoulder injuries in the first place. This is why Michael Boyle lists thoracic spine mobility in the #1 spot on his list of mobility drills that everyone should do, noting:
"The nice thing about t-spine mobility is that almost no one has enough and it's hard to get too much"
Posterior ChainThe posterior chain is the group of muscles on the rear side of the body from the deltoids and traps all the way down through the glutes, hamstrings, and calves.
You hear a lot about knee injuries in BJJ. While some of these knee injuries are inevitably due to awkward take-downs, knee-bars, etc. a fair number of knee injuries in sports are actually caused by poor posterior chain conditioning. Many athletes are "quad dominant", meaning they rely too much on their quad strength without adequately recruiting the glutes and hamstrings -- this is a sure recipe for placing too much stress on the knee leading to injury.
Doing squats, deadlifts, and barbell glute thrusts with proper form will really help to strengthen the posterior chain but will also train your body to recruit the proper muscle groups when needed. If you're already doing squats and deadlifts, the barbell glute thrust or glute bridge, popularized by Brett Contreras, is a great addition to your lifting regimen.
I've taken to showing up early for class (along with the other old guys) and adding the following warm-up exercises to my regimen to make sure the glutes, hamstrings, and lower back are warm enough. You can run through this whole series quickly in less than 5 minutes.
- Simple trunk rotation for 60 seconds, left and right twists with elbows up. Don't force the range of motion.
- Bird-dogs (opposite arm/leg): 25 each side
- Bird-dogs (same side arm/leg, takes some getting used to the balance at first), 25 each side
- 25 deep "air squats" with proper form, make sure you get your quads down to at least parallel with the floor, remember to press up through the heel like with any squat.
- T spine openers. I love these - cut to the 2:00 mark at this video to see a decent explanation.
- Walk-outs with yoga pose (repeat entire sequence 3 times). This video shows a variation, but basically you want to stand straight up, then bend over and walk your hands out to a pushup position (taking at least 10 "steps" with your hands), then repeat the sequence shown in the video (bring right foot to right hand, twist right for 10 seconds, twist left for 10, back to pushup position, bring left leg up, twist left for 10, twist right for 10, then back to pushup, then walk your hands back up). Repeat the sequence 3 times.
- Glute bridge: lay on your back with your knees bent and feet close to your butt. Bridge up, hold, and then back down. Yeah, it looks like aerobics class - deal with it :)
Taking it to the next level
These warm-ups will really help to prevent injury and boost your performance. If you really want to have big gains in your mobility and posterior chain performance, I'd make the following 4 recommendations:
- Hit the foam roller every day. Yeah, I know it hurts at first, but if you stay on top of the foam roller (no pun intended) after a couple weeks you'll find it won't hurt as much. Typical foam rollers have a hard time getting into the T spine area, so I'd recommend the Trigger Point myofascial release package, which includes not only a few different sized rollers but also their "quad balls", which are great at getting into the shoulder blades and T spine. It's not cheap at $129 (down from $189) but I find that I use it all the time -- the fact that the small roller fits into my gym bag means I can take it with me wherever I train.
- Spend one workout a week focusing exclusively on mobility. Pick up the 3-DVD set "The Encyclopedia of Joint Mobility", a stretching and mobility program by Steve Maxwell. Steve is a BJJ black belt and his exercises are very relevant and focused on martial artists.
- Find a great soft-tissue specialist who specializes in "active release" therapy. If you are in Southern California, I can recommend the great docs at Back To Function, who helped me rehab my shoulders and avoid rotator cuff surgery. If you've never had soft tissue work done before, don't think of it as a nice therapeutic massage: think of excruciating pain, pouring sweat, and cursing at the doctor the whole time. You'll feel great afterwards (this may be due to the endorphins, I'm not sure) but more importantly you'll stay healthy and avoid injury.
- Extra credit: If you haven't already, pick up a copy of the "Magnificent Mobility" DVD by Eric Cressey and Mike Robertson. This DVD takes a whole-body approach with great focus on the core and posterior chain. There is also the sequel, "Inside-Out: The Ultimate Upper Body Warmup" which focuses, as you might guess, more on the T spine and upper body. They're both great products.