Arthritis and Brazilian Jiu-jitsu

We often document the benefits of Brazilian jiujitsu, but murmur in mention of some of the draw backs. While all sports carry risk of injury and overuse injuries, Brazilian jiujitsu in particular is known to be rough on the joints and I have heard much anecdotal evidence of finger and pain in particular in more experienced players. Below is a picture of Joao Miyao’s hands. Keep in mind he is just 24 years old.

What is Arthritis?

People are often confused as to what arthritis is and the difference between osteoarthritis and rheumatoid arthritis. The difference mainly being one is wear and tear the other is a auto immune disease.

Osteoarthritis (also referred to as degenerative joint disease or wear-and-tear arthritis) is caused by the breakdown of joint cartilage. Cartilage acts as a cushion between the bones that form a joint. Cartilage loss can cause bone to rub on bone in a joint — a condition that is very painful. The ride along of this condition can be bone spurs, bony enlargements (Heberden’s nodes and Bouchard’s nodes). This is related to but not caused by aging. It appears that mechanical stress on joints underlies all osteoarthritis, with many and varied sources of mechanical stress, including misalignments of bones caused by congenital or pathogenic causes; mechanical injury all contribute to the condition. Oh and cracking you knuckles has no effect!

Im no Joao Miyao but I’ll never make it as a hand model either

Rheumatoid arthritis is a chronic, inflammatory type of arthritis. It is also classified as an autoimmune disease (i.e., immune cells attack the body’s own healthy tissues). The synovium (lining of the joint) is primarily affected by rheumatoid arthritis, but organs body-wide can be affected as well. Multiple joints are usually involved with rheumatoid arthritis.

Incidence in Jiujitsu

Speak to more senior members of school or gym and more than likely they will have stories pertaining to hand injuries, joint pain, mangled finger/toes, dislocations and more. Very little research has been done into BJJ and arthritis so numbers are hard to fathom. But BJJ’s nearest relative Judo has had plenty of research into the subject. In 1997 Strasser P et al did a study into “Traumatic finger polyarthrosis in judo athletes”  they found that “Extensive Judo seems to be a risk factor for the development of osteoarthritis of the finger joints due to chronic-repetitive micro- and substantial (macro-) injury.”

In 1984 Frey A, Müller W. found that “X-ray showed that all judokas examined have more or less severe osteoarthritis of the distal interphalangeal joints (DIP), whether Heberden nodes were present or not. At the same time, in most cases osteoarthrosis of the proximal interphalangeal joints (PIP) was found by X-ray and clinical examination. Osteoarthrosis of DIP and PIP in this young age group is due to overstress and injury to the joints involved.” It is the repeat injury, re-injury, micro trauma and over stress over a period of time that appears to accumulate and then manifest as arthritis. More than likely athletes who play a grip heavy game see a high incidence than those who don’t.

Those who play a heavy grip game risk injury of Proximal and Intermediate  Phalanges

Mitigation and treatment

Practical solutions to limiting and preventing arthritis are few in number, the ultimate solution being suspension of the activity but seriously when has injury ever stopped you grappling? So you have a few choices.

1. Introduce more no-gi training in order to give your grip a rest

2. Cycle play styles, avoid spider and other grip play that is rough on the distal and intermediate phalanges.

3. Stronger muscles can help stabilize the joint, improving range of motion and aid in pain reduction. That’s the goal of arthritis-oriented physical therapy, just be sure to work extensor and thumb strength too, as finger flexion is often over worked.

4. Some evidence suggests that hand flexibility may reduce arthritis risk http://www.ncbi.nlm.nih.gov/pubmed/15248215

5. Taking NSAIDS (ibuprofen etc)

6. Some evidence suggests people with arthritis need longer warm-ups

Supplementary Solutions

As soon as joint pain is mentioned people are quick to ask for supplementation. Often supplement sellers pray on those in discomfort to shift shoddy produce or gimmicky devices. Often avoiding acitivity that causes problems is enough to help with recovery from osteoarthritis but often people want a quick fix.

Worth Trying (evidence for):

• Omega 3 fish oils, There is evidence that rheumatoid arthritis sufferers taking long-chain n−3 fatty acids from sources such as fish have reduced pain compared to those receiving standard NSAIDs. Krill oilor omega 3 capsules comes highly recommended.
• Curcumin, In vitro and animal studies have proven that curcumin has antioxidant, antiarthritic,  and anti-inflammatory properties. See http://lpi.oregonstate.edu/infocenter/phytochemicals/curcumin/

Maybe Worth trying (some evdience or good anecdotal evidence)

• Celadrin, applied topically caused significant reduction in pain vs placebo http://www.ncbi.nlm.nih.gov/pubmed/15705022

Best avoid (No evidence)

• Powerbands and Magnet therapy research has shown that magnetic wrist straps are ineffective in the management of pain, stiffness and physical function in osteoarthritis
• Glucosamine and or Chondroitin – A meta-analysis published in the British Medical Journal published in 2010 concluded: “Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions to patients who have not received treatment should be discouraged.”

I hope that this has been a helpful insight into a fairly common issues, more than any other sport BJJ and our grappling brethern are at risk of can be a painful and in the long term debilitating condition.

This is an ongoing series of blog posts from William Wayland of Powering Through, who works with UFC and other high level combat athletes based in Chelmsford, UK Twitter. Facebook