Martial arts and combat sports: knee injuries on the mat and in the ring

How combat sports load the knee

Each martial art stresses the knee differently. Grappling sports such as Brazilian jiu-jitsu, judo and wrestling place the knee under twisting and bending forces from opponents, often in positions where the foot is trapped. Striking sports such as kickboxing, Muay Thai, karate and taekwondo involve pivoting on the standing leg, kicks that can be blocked or checked, and repeated jumping. Many styles also involve a lot of kneeling and sitting on the floor.

Unlike most sports, another person may be applying force directly to your knee, which is why some injuries happen in a fraction of a second, before you can react.

Injuries by discipline

• Jiu-jitsu and submission grappling: heel hooks and knee bars can tear the ACL, the lateral collateral ligament and the posterolateral corner, sometimes with little warning pain before damage occurs. Guard work, especially the knee being forced inwards, can injure the MCL and meniscus.
• Judo and wrestling: throws, sweeps and takedowns twist the knee over a planted foot, causing MCL, ACL and meniscus tears. Falling with an opponent onto the leg can injure several ligaments at once.
• Kickboxing and Muay Thai: a checked kick can bruise the shin and occasionally injure the knee; pivoting on the standing leg strains the meniscus and ligaments.
• Karate and taekwondo: spinning and jumping kicks load the standing knee and the patellar tendon; awkward landings can cause kneecap dislocation.
• All mat sports: prepatellar bursitis, swelling over the front of the kneecap from repeated kneeling, which can become infected.

Warning signs after training

• A pop or tearing feeling during a submission, throw or kick
• Swelling within hours, or the knee feeling loose when you stand or pivot
• Pain and instability on the outside of the knee after a leg lock
• Locking or catching on the joint line
• A red, hot, swollen kneecap, especially with fever, which can be an infected bursa and needs prompt treatment

Numbness in the foot, a cold foot or severe deformity after an injury needs emergency care, because a knee dislocation can injure the blood vessels and nerves.

Training habits that protect the knee

• Tap early to leg locks; ligaments can tear before pain warns you
• Learn and drill leg locks under supervision, and agree on intensity with training partners
• Warm up the hips and knees before sparring and rolling
• Strengthen the hips, thighs and hamstrings outside the gym
• Use knee pads for kneeling-heavy sessions, keep mats clean, and wash cuts and grazes promptly
• Reduce hard sparring when you are tired, and build back gradually after a break

Training in Doha: clubs, mats and Ramadan

Martial arts in Doha are taught in indoor clubs and academies, usually air-conditioned, so heat matters less than in outdoor sport. Mat hygiene is important in a warm, humid climate, where skin infections can spread quickly, and grazes over the kneecap can let infection into a bursa.

Many clubs move classes to after iftar or later during Ramadan. Training intensely while short of sleep and fluids raises the risk of mistakes in technique, so keep sparring lighter and focus on drilling in that month.

Returning to the mat after injury or surgery

Return to combat sports is usually later than return to running or cycling, because a partner can load the knee unpredictably. The progression is often solo movement and drilling, then technical work with a cooperative partner, then positional sparring, then full sparring.

An MCL sprain may allow a return to drilling within several weeks. After meniscus repair, deep kneeling and grappling are usually delayed for several months. After ACL reconstruction, full sparring and competition are commonly considered from around nine months or later, once strength and stability testing are satisfactory. Injuries to the lateral ligaments and posterolateral corner often need longer, and leg lock training is usually reintroduced last. Dr. Gelber agrees the steps with your physiotherapist and coach.

When to see a knee surgeon in Doha

See a knee specialist after any submission or throw that leaves the knee swollen, loose or painful, if the knee locks or gives way, or if a swollen kneecap is red and hot. Lateral ligament and posterolateral corner injuries are easy to miss but should be assessed early, because treatment options can depend on timing. At Aman Hospital, Dr. Pablo Gelber examines all the knee ligaments, arranges MRI when needed, and plans treatment around your sport and goals.