Especially in sport jiu jitsu - where the De La Riva and Single-Leg X guards abound - the knees tend to take a beating. Most practitioners will experience a tweak, or sprain... or worse (but hopefully not)... at some point in their career. It's just the nature of the beast. 

That being said, I thought I'd write this blog about the most common knee injuries and symptoms you might encounter and what you can, or will, have to do about it. Read on...

Appreciate Your Knees

First of all, I think it should be said that you'll never really appreciate how much you use your knees - for everything - until you hurt them. Think of them as efficiently designed pieces of equipment, in which every part plays a specific role in the overall performance of the whole. Break one thing, and not only does the entire thing get out of whack, but you risk compromising the other individual parts if you try to continue using it. So before you tell yourself, "Eh, it'll be okay," make sure you figure out what happened and whether it will, in fact, be okay.

Bursitis 

Bursitis is the inflammation of the fluid-filled sacs, called bursae, that act as cushions at the joints, helping to decrease friction between moving tissues, such as bone, muscle, tendons, and skin. Bursitis is often caused by repetitive minor impacts - oh so common in many sports - but can also result from more serious trauma to the area. Symptoms include rapid swelling around the joint that is also warm and tender to the touch. Bursitis will usually clear up with rest, icing, elevation, and over-the-counter inflammatories, but more serious cases can be drained, or injected with corticosteroids. Some athletes are still able to train with it, but because it is so painful to the touch and jiu jitsu involves a lot of knee-to-ground contact, the best option is to rest until it clears up.

Meniscus Tear

Your meniscus - actually, there are two menisci in each knee - are the tough, wedge shaped pieces of cartilage between your femur and tibia, which cushions the joints and helps keep it stable. In sports, these tears can happen when the foot is planted and the knee twists, particularly in an aggressive motion. Sound familiar? Yup, jiu jitsu is full of that stuff. Symptoms include pain, stiffness and swelling, limited range of movement, unstableness in the knee, and even locking of the knee (depending on the type and severity of the tear). Many athletes continue training with meniscus tears, especially minor ones. If the tear is in the blood-rich outer "red" zone of the meniscus, it may even heal on its own. However, severe tears - indicated by locking up or significant instability of the joint - will require arthroscopic surgery to trim or repair the meniscus. 

MCL/LCL Sprain or Tear

The Medial Collateral Ligament (MCL) and the Lateral (or Fibular) Collateral Ligament (LCL) are the two supporting ligaments on either side of the knee, connecting the femur to the tibia and fibula, respectively. These ligaments "control the sideways motion of your knee and brace it against unusual movement." However, unusual movement is what jiu jitsu is all about (think knee slice, De La Riva and reverse De La Riva, rubber guard... the list goes on), so these ligaments are easily compromised. Takedowns and uncontrolled jumping or landings can also put these ligaments at risk. Injuries to these ligaments are graded, with 1 being a mild over-stretching, 2 being a more severe over-stretching to the point of looseness (sometimes referred to as a partial tear), and 3 being a complete tear. Symptoms include pain in the area, swelling, bruising, instability and inability to bear weight, and "feeling of the knee giving away." The scary part about a Grade 3 sprain is that "often there will be no pain or severe pain that subsides quickly," so it's easy to dismiss it as a mild sprain. Additionally, because the ligament is completely torn, the knee is deprived of an entire stabilizing structure, so it's easier to injure the meniscus or even the ACL. Most of these injuries can be treated without surgery, with rest, icing, anti-inflammatories, and physical therapy, and can  take anywhere from a few weeks to four months. However, some Grade 3 cases will require surgery. 

ACL Sprain or Tear

Even mention an ACL tear, and nearly every jiu jitsu practitioner around you will wince and squirm. The anterior cruciate ligament (ACL) is one of the major ligaments running diagonally within the knee joint, providing rotational stability to the knee. The ACL runs in front, and the posterior cruciate ligament (PCL) runs in back, creating an X-shape behind the patella. The ACL can become injured by rapid changes in direction (especially pivoting while the foot is still planted), stopping or slowing down suddenly, incorrect landing, or direct blows to the knee. Symptoms, include pain, swelling, loss of full range of motion, and discomfort while walking or performing any kind of turning movement. ACL injuries are also graded from 1 to 3, with a fully torn, Grade 3, tear requiring surgery. Unfortunately, most ACL tears cannot simply be repaired, and must be reconstructed via a tissue graft from a healthy patellar, hamstring or quadricep tendon, taken either from your own body or that of a cadaver (how delightfully morbid). Recovery from an ACL tear can often take more than six months. Interestingly, women are more prone to ACL injuries than men. The good news is, you can help prevent ACL injuries through a proper strength training program; stronger and more balanced muscles will help protect the joints from - and during - uncontrolled movements. 

And of course, don't just rely on your WebMD skills - however ninja they might be - for diagnosing knee injuries. If in doubt, get it checked out by a licensed medical professional. The sooner you know for sure what the problem is, the faster you'll be able to fix it, and the sooner you'll be back on the mats.

Train on... safely. Oss.