Ep 223: SPORTS CORNER: Ultimate Physical Therapy for Ultimate Fighting Championship (UFC), with Dr Olivia Abdoo

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[00:00:52] Hello, and welcome to JOSPT Insights, the podcast that aims to help you translate quality research to quality practice. I'm Claire Ardern, the editor in chief of the Journal of Orthopedic and Sports Physical Therapy. It's great to have you listening today. Dr. Olivia Abdu is the sports medicine manager for the Ultimate Fighting Championship in Las Vegas, Nevada, where her primary role involves working with professional MMA athletes. She completed her doctorate of the training in the United States.

[00:01:19] She studied physical therapy at California State University, Long Beach, and further honed her experience through sports residency at Duke University, followed by Division I Sports Physical Therapy Fellowship at Wake Forest University. My name is Dan Chapman, owner of Summit Physical Therapy and Performance in Baltimore, Maryland. And I'm Chelsea Kuman, a physical therapist and athletic trainer at Stanford University Athletics.

[00:01:41] Olivia, thank you so much for joining us on JOSPT Insights. We are so excited to get into everything MMA and UFC, what like a unique skill set and expertise to share with everyone. Thanks so much for having me. So first, let's start off in our Sports Corner episodes. We want to go through, and I think this one might be a little bit more specific, an overview of UFC because UFC includes like all kinds of martial arts.

[00:02:03] So can you go over like just an overview of that sport, what it includes, any rules, competition, practice differences? Yeah, just hit us with the overview. UFC is pretty much the highest level of professional mixed martial arts athletes. And so mixed martial arts really just includes a variety of combat sports.

[00:02:23] In my mind, I kind of divvy it up into striking, wrestling and grappling. So striking can be anything from boxing, Muay Thai, karate, wrestling, which is what we kind of like are most familiar. We think of like NCAA, right? Women's wrestling, highest grossing participation sport in the U.S. right now. And then grappling kind of on the ground, jiu-jitsu, Brazilian jiu-jitsu, things like that.

[00:02:48] So it's really a lot of sports all in one that makes rehab super unique and interesting for this population. Rules-wise, most fights that happen, they're all three rounds, five-minute rounds, each with a one-minute round break in between. Usually the main events or like a championship fight are five five-minute rounds.

[00:03:12] And so at the UFC, we have about 44 events per year that happen not only in the U.S., but all over the world. And so our sports medicine team here will cover every single event per year. And so we rotate and travel to cover all those events where we are providing treatment throughout the week. And then we provide fight night event coverage that includes a lot of the acute injury management.

[00:03:38] So we have ringside physicians and our head medical docs that will evaluate athletes post-fight. And then we come in to splint, clean up blood, get them ready for media. Education will observe if they get put into like a little medical hold in case they have like a tough bout or they're presenting with any concussion-like symptoms. But day-to-day here, so the way the UFC works is I work at the Performance Institute that our headquarters based in Las Vegas.

[00:04:07] We have about 700 contracted athletes. And any UFC contracted athlete can utilize our services here at the Performance Institute free of charge. So not only do we have sports medicine, we have nutrition, strength and conditioning, sports science, sports psych, pretty much everything that an athlete could possibly need. That is free of charge for athletes. So we probably have about 60 or so athletes that live in Vegas and utilize us full-time year-round.

[00:04:37] We've now been getting a lot of athletes that come through to do their full fight camps here. And a fight camp is usually about eight weeks long and it's that prep phase prior to their fight. And then we get a lot of athletes rolling through randomly either their coaching or cornering for different athletes. Or they'll come in and do, we have our tier one diagnostics that we will provide for athletes. So it's pretty much, when you think of interdisciplinary collaboration, it's one of kind of our highlights here.

[00:05:05] Athletes can come in and get a full gambit of a battery of tests done where every single department has a hand in that. We'll take all of that data and compare it to weight class norms to give insights for athletes on performance, injury mitigation, fight statistics. And that includes kind of everybody here at the PI. So we get a lot of people rolling through. We also will see other professional athletes.

[00:05:31] We see a lot of NFL, NBA, WNBA athletes that come through here. A Joe Schmo can't just walk off the street and come and see us. So the way PT works for us is all of our athletes can be seen for a one-on-one treatment for one hour. If they need to, a lot of times post-op, we'll see them twice a day, every day. And then we work really closely with our strength and conditioning team to develop those long-term rehab protocols, depending on where people are at.

[00:05:59] It sounds amazing to have access to all of that. It sounds bonkers. You guys are, it sounds like you guys are all over the place. Yeah. Yeah, we're all over the place. So far, I've been to Brazil, Paris. Paris, I'll go to Azerbaijan, Australia. Everything that you thought of, like, you dream of as a PT, like, you really get it here. But at the same time, they're all independent contractors, right? So they don't have to listen to you at all.

[00:06:26] So that's one of the really tough parts with these athletes is you can provide this whole program and provide all these suggestions and restrictions and limitations. And they don't have to listen to you at all. I think the mindset of these athletes is really unique and much different than a lot of other type of athletes that I've worked. You have to. They're getting hit. I mean, like. Yeah. You know, I would say it's outside of boxing, right?

[00:06:52] We think of that like the most individual sport with so much on the line in the sense of, like, obviously, it's combat, right? So most of these athletes will train anywhere from two up to four times a day every day. Their rest day is like a 10-mile run up a mountain. So, like, there is no education on recovery. There's so many cultural difference. Like, a lot of our fighters from Mexico, they love to run.

[00:07:21] So their volume of running is super high. And that's how they do their cardio. That's how they make weight. But really getting creative in how you manage some of that. So if I have an athlete that comes in, let's say, grade one AC sprain, throwing uppercuts and hooks or killing them with striking. Okay. Well, I can't say you can't do your striking class, right? I have to come up with little ways to almost compromise to be like, hey, can we just not throw hooks on that side?

[00:07:48] Or can we do two-minute rounds instead of five-minute rounds? Can we do five rounds instead of 12 rounds? Because we are never fighting 12 rounds. So it's really getting creative on, like, the amount that you can give athletes is super challenging. But it keeps you on your toes and gets you thinking of really creative ways to manage and mitigate some of that. So let's talk a little bit about the – you mentioned this. This is a good segue. Like, the top injuries that you see. And where do you think they're coming from? Because there's a mixture of striking.

[00:08:18] There's a mixture of grappling. So there's a lot of different demands in the sport. What are the top injuries that you find yourself running into? Yeah. So we'll kind of break it down by each of those pieces. So striking, we see a lot of head injuries, a lot of lacerations. We, like, about 15% of our head-related injuries from striking are concussion. A lot of hand injuries as well with striking as well as knee injuries.

[00:08:45] So when it comes to, like, knee injuries, we do see a lot of, like, ligament, ACL, PCL. We get a lot of MCL. And not just in striking, but we see that kind of across. But one of the more interesting things that we're finding with our athletes is we actually don't see a whole lot of those, like, acute one instant moment where the ACL goes, this traumatic event that you see in a lot of other cutting sports.

[00:09:09] We actually, most of our athletes, we think, are kind of getting this chronic wear and tear on the ACL from kicking on that, like, pivot leg as they go and throw a kick. They're constantly going into that extension, internal rotation, a little bit of valgus motion every time they throw a kick. So they kind of get this chronic wear and tear. And most of the times, one day it goes and they don't even notice because they've been coping for either their whole career, like, over the last couple months.

[00:09:35] They'll get some other knee injury, go get an MRI, and then it shows the ACL is gone. So then the whole conversation is, well, we got to fix the ACL. It was the ACL. But you can actually see scarring and, like, you know it's chronic. And they've become incredible copers. And so probably about 10% of our top-ranked athletes don't have ACLs and never get them fixed.

[00:09:57] And so we've been really pushing to build out education, not only for athletes, but other clinicians and physicians to really push, like, okay, you see an image and you make a decision, right? We usually say surgery. Okay, send it. Go for it. But really, it's like, but have you even looked at the athlete, right? We come in now, athletes will fly into Vegas, and we will do our full battery of testing on them. Plus, we will watch how they train.

[00:10:25] We will get them in with their partners and watch them train and get feedback not only from the athlete but from their partners to say, hey, does it feel different? Do you think they're hesitating? Where are we at? And giving them the whole picture of, like, hey, we actually might not need to go down this route, right? Because we know the long process, just the trauma of surgery impacting recovery in itself, right? Do they actually need to do that? So that's been a huge piece on our end.

[00:10:53] And we're really trying to develop a couple of research studies looking at just MRI-ing our athletes, doing return-to-play testing, looking at psychological readiness and things like that, and looking at fight statistics as well and seeing, like, is this making a difference? Helping us make better decisions on going conservative versus surgical route for these athletes. But that's probably one of the most unique pieces that we're seeing here. And in reality, it's actually not even just ACLs.

[00:11:23] We see torn biceps, torn pecs, broken hands, all sorts of things that we don't necessarily—I think in the usual PT realm, even sports PT realm, we go towards that surgical route. But I've just seen the amount that, like, performance remains really high even if we're not doing those big interventions with some of these athletes. So trying to build out that decision-making process to be a little more thorough, thoughtful, and not just kind of, like, what has always been done.

[00:11:53] What a unique sport set, skill set to see that chronic injury in. Those research studies would be fascinating. Wrestling, we see a lot of MCL, LCL injuries. We see neck injuries with wrestling. When they go for those shots, we get a lot of stingers. A lot of our athletes have chronic stenosis, wear and tear, disc stuff going on that we're constantly doing.

[00:12:19] I think the first week I worked here, all I did was treat neck. We get a lot of radiculopities in that sense. So, like, wrestling, I always see a lot of chronic neck issues and flare-ups there. Grappling, we get a lot of shoulder, elbow. We get a lot of UCL tears. A lot of chronic labral issues. You get the full gamut of, like, bony things, fractures, stress fractures. We get a lot of athletes that overtrain.

[00:12:46] So on top of just the nature of the sport, right, combat, right, we can mitigate injury as much as we can. There's always going to be injury, but it's also a weight-making sport, right? So that has a wildly significant impact on not only how athletes recover, you know, looking into, like, are there higher risk of injuries?

[00:13:09] So now we're doing a really—we're kind of, like, revamping all of our injury epidemiology at this point to get into the nitty-gritty of this. And hopefully within the next year, we can provide way more information. But if we think about it, over the eight weeks of camp, not only have they ramped up training through all of that, they have to manage their weight. So they're in a caloric deficit.

[00:13:30] Then you add an injury on top of that, which requires calories and energies to not only heal, but you also need to train, but you're descending weight. And we, you know, we won't even touch on the acute weight descent, which is, like, the night—two days before where athletes are pretty much pushing themselves to the brink, getting no sleep, and then they have to have the best performance of their life in 24 hours. It's an insane sport.

[00:13:56] So there's so many different moving parts that are really unique to this sport and such a big gap in physical therapy education and knowledge that I think there's, like, such a big opportunity to fill that and learn from that. Because, as I said before, right, women's wrestling is going up. We know more—like, there's so many athletes, not only because MMA is one sport, but you have every single different sport on top of that.

[00:14:19] It's a huge gap in our knowledge and our treatment and our care of these athletes that I think we can do a much better job of expanding and caring for. Yeah. I work with the wrestling and lightweight rowing teams, which are also cutting sports here at Stanford. And it is always just—it is always a challenge to add the injury on top of it. Like, it's hard enough just to meet the performance demands, and just adding the injury on top of it is so hard. And it is definitely a team effort.

[00:14:47] There is—every person is involved in the sports medicine team in that. And we work really, really closely with our nutrition team. So, our nutrition team also travels and covers every single event as well as our own chefs. And so, we, during a fight week, will—our nutrition team is incredible. So, we will pretty much track weight throughout a fight week, individualize every single meal for that athlete.

[00:15:14] And we do that actually throughout the year for athletes that engage with us as well. Every single piece of their nutrition and care is so micromanaged and really well organized. And when we do have an injury, we, like, totally lean on our nutrition team not only for, like, supplementation or anything else to support the injury recovery, but then making sure that we're all on the same page that, like, okay, well, they still have to make weight in two weeks where are we at?

[00:15:40] Yeah. So, I mean, it's—that has also been a huge growth experience is working so closely with our nutrition team here to make sure our athletes are getting where they need to go as healthy and safely as possible. Okay. So, overview of the badness of the sport, overview of the top injuries that you're seeing and all the reasons. So, let's end with kind of just, like, any of your—you've already hit on, like, your modification,

[00:16:05] your compromising kind of stuff, and the, like, the importance of the, like, the whole team and the dietitians and all of that and all those considerations. Are there any other just, like, tips that you would want to give for other rehab clinicians? I'm thinking about, like, the typical rehab clinician is probably going to see, you know, a little—somebody who's in a grappling sport or somebody who's in a striking sport maybe or somebody who's wrestling, right? Are there any kind of, like, tips for rehab clinicians from those perspectives that you'd want to share with them?

[00:16:33] Stuff that you've picked up on, stuff that you find really valuable for, you know, sports PTs who don't work at UFC full-time and maybe could steal a little bit of your expertise? Yeah, for sure. I mean, I could think of a bunch of things, but I probably have, like, my top two things. I think one, truly from, like, stuff you can start implementing Monday or whenever for this is, like, the range of motion and the things that these athletes have to do is so expansive.

[00:17:00] And I think as PTs, sometimes we get stuck in training in very specific safe ranges of motion. Like, I'm thinking of the knee or the shoulder, right? Like, staying with that—staying those, like, safe ranges, right? 90, 60, 30, whatever. But these athletes need to be able to put their heels to their butt and be able to be strong and push out of that by pushing somebody up or wrestling where they're going from standing to the ground. Like, all those ranges of motions are huge.

[00:17:28] And you have to be able to build not only strength, force production, neuromuscular control, and all those ranges for every body part. So they have to—the tissue has to tolerate all those positions. And so not forgetting that piece. So, like, for the upper extremity, for, like, grappling and wrestling, like, getting into closed-chain positions where they're rotating through almost, like, 180 one over the other. I'll do, like, a bear crawl position where they actually have to turn all the way over

[00:17:57] so they're facing up towards the ceiling and then they rotate all the way back. I mean, there's a million different things you can do. But that kind of goes into my second piece is, like, your athlete is the expert in their sport. Have them show you things that they need to do, right? It's just kind of like with anything. If you're not familiar with basketball or anything like that, but particularly for combat sports because there's such a variety of stuff, it's, hey, bring your partner in for one of your sessions and run me through the things that you are not confident with, the things that you get pain with.

[00:18:27] And then let's, you know, take it back a few steps and now we can kind of build better rehab, Thera-X that is going to build up your tolerance for those positions before you go in there where it's super uncontrolled. That's kind of just, like, snippet of things that I would start looking at for those athletes. And I just watched a million videos all the time. I go to practices, especially if you're really interested in working with the MMA community. You probably have a lot of gyms in your area.

[00:18:57] Just go, show your face and be like, hey, I really want to work with this population. I'm trying to learn more. Can I just observe a class? Then people will start coming up to you because they learn that you're a PT, you're a sports medicine. You're like, hey, my hand might be broken. Can you help me? Like, that's how you open the doors because a lot of these athletes, you know, going back to just the scope of the sport is these athletes don't get paid unless they fight. There's very little incentive to not fight

[00:19:24] unless you're one of the very, very top athletes. And even then, the top athletes can get paid quite a lot. Bottom tier new athletes that are just getting contracts don't make a lot of money. So they're going to do everything that they possibly can to get there. And a lot of the times they come from really, really tough backgrounds where they've never had support. So you can be that support for them. Amazing advice. Also, I mean, not just on the clinical side of strength and control throughout the range of motion,

[00:19:54] learning from your client or your patient to learn more about the sport, but also just getting to know the community and be a support system for your patient is amazing advice. We're going to touch more. I know we did a whole overview here of a whole bunch of different injuries. We're going to dive into concussion rehab specifically in another episode before we kind of transition over to that concussion side. Is there anything else that you wanted to speak to?

[00:20:22] Yeah, I think one of the big things at the UFC performances to do that we really push is education, development, growth, innovation. So we're always open to sharing our protocols, our ideas, and learning and developing. We're not really secretive about what we do. And, you know, so if anybody's ever interested in learning more about the stuff that we do, our protocols, our return to play battery, you know, our concussion protocols,

[00:20:50] like we are always trying to expand the MMA clinician community as much as we can. So we're always really easily accessible in that sense. So, you know, we are globally at the top level of MMA professional sports, but we're always trying to grow and develop. And there's a lot of brilliant minds out there. So we kind of like pride ourselves on that. Doors are really always open and always looking to collaborate and grow with, with the rest of the clinical community out there.

[00:21:20] What an amazing offer. So, yeah, if there's a clinician listening to this who's working with a grappler, wrestler, striker, what have you, and they feel stuck or they just need to, you know, a sounding board to reach out to, how could they contact you? So you can either grab me on Instagram. It's at OliveAbdu. Shoot me a DM. Or you can email me. It's just O-A-B-D-O-O at UFC.com. Dr. Abdu, thank you so much. Thanks, guys.

[00:21:50] And one more time, we want to thank Dr. Abdu for joining us here on the show. And as always, we want to thank you for listening to JOSPT Insights. Thanks for listening to this episode of JOSPT Insights. For more discussion of the issues in musculoskeletal rehabilitation that are relevant to your practice, subscribe to JOSPT Insights on Apple Podcasts, Spotify, TuneIn, Stitcher, Google, or your favorite podcast app.

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