Brazilian Jiu-Jitsu/Injuries

Injury Modifications

11 injury guides

Guidelines for safely modifying workouts when dealing with common injuries. Always consult a healthcare professional for specific medical advice.

Cauliflower Ear

Cauliflower ear (auricular hematoma) is almost inevitable in grappling without ear protection. It results from trauma to the ear, causing blood to collect between the cartilage and perichondrium (skin covering cartilage). If not drained, the blood organizes into fibrous tissue, permanently deforming the ear. Early treatment can prevent permanent changes. In BJJ, it typically occurs from having your head trapped in triangles, guillotines, and headlocks, or from ears rubbing against the mat.

Warning Signs

  • ⚠Ear feels warm and swollen after training
  • ⚠Fluid feeling in ear
  • ⚠Ear looks different than other side
  • ⚠Pain in ear

Red Flags - Seek Immediate Care

  • ●Ear turning red, hot, painful - POSSIBLE INFECTION, seek care same day
  • ●Fever with ear swelling - INFECTION, seek care immediately
  • ●Spreading redness around ear - CELLULITIS, needs antibiotics urgently
  • ●Pus draining from ear - INFECTION, needs medical care
  • ●Cartilage destruction visible - may need ENT evaluation

When to Seek Professional Care

  • →Any signs of infection
  • →Large hematoma you're not comfortable draining
  • →Reaccumulation despite multiple drainages
  • →Interested in surgical correction of chronic cauliflower

General Principles

  • •TIME IS CRITICAL - drain within 24 hours for best results
  • •Compression after drainage is essential
  • •Re-accumulation is common - may need multiple drainages
  • •Prevention (headgear) is easier than treatment
  • •Once chronic, only surgery can correct (and results vary)

Recommended Exercises

No specific exercises - this is trauma management

sets × reps

Prevention (headgear) is the key

Concussion

Concussions in BJJ can occur from takedowns, slams, accidental head strikes during scrambles, and head contact with the mat or training partners. While less common than in striking sports, concussions do occur and require proper management. Of particular concern in BJJ: training with a concussion increases risk of being choked unconscious, which could compound brain injury.

Warning Signs

  • ⚠Symptoms worsening
  • ⚠New symptoms appearing
  • ⚠Symptoms returning with activity
  • ⚠Difficulty concentrating
  • ⚠Balance problems

Red Flags - Seek Immediate Care

  • ●Loss of consciousness - seek emergency evaluation
  • ●Worsening headache - possible brain bleed, ER
  • ●Repeated vomiting - ER evaluation
  • ●Seizure - EMERGENCY
  • ●One pupil larger than other - BRAIN EMERGENCY, call 911
  • ●Cannot recognize people or places - ER evaluation
  • ●Increasing confusion - ER evaluation
  • ●Slurred speech - ER evaluation
  • ●Cannot be awakened - BRAIN EMERGENCY, call 911
  • ●Very drowsy - ER evaluation

When to Seek Professional Care

  • →Any loss of consciousness
  • →Any danger signs
  • →Symptoms not improving after 1-2 weeks
  • →Before returning to full training (recommended)

General Principles

  • •When in doubt, sit them out
  • •No same-day return to training
  • •Brain needs rest - both physical and cognitive
  • •Second impact syndrome can be fatal
  • •DO NOT allow chokes until fully recovered

Contraindicated Movements

ALL BJJ training until fully clearedAny activity risking head contactStrenuous exercise during recoveryESPECIALLY: No sparring or being choked

Elbow

Elbow injuries in BJJ primarily occur from armbars, kimuras, and americanas - the foundational submissions of the art. Hyperextension injuries range from mild strains to complete ligament ruptures. Tapping early is the best prevention, but training partners must also apply submissions with control.

Warning Signs

  • ⚠Instability or elbow 'giving way'
  • ⚠Locking or catching
  • ⚠Increasing swelling
  • ⚠Numbness or tingling in hand
  • ⚠Unable to fully straighten or bend

When to Seek Professional Care

  • →Heard or felt pop during submission
  • →Visible deformity
  • →Significant swelling
  • →Unable to move elbow through normal range
  • →Numbness or tingling in hand/fingers
  • →No improvement after 2 weeks of rest
  • →Instability with daily activities

General Principles

  • •Tap early to armbars - damage occurs before maximum pain
  • •Armbars should be applied with control in training
  • •Hyperextension injuries can become chronic if not properly healed
  • •Grip strength and forearm conditioning help prevent overuse issues
  • •Elbow pads provide minimal protection against submissions

Contraindicated Movements

Receiving armbars when symptomaticFull extension under loadHeavy gi grippingStraight arm positions under pressureExplosive armbar escapes

Recommended Exercises

Wrist curls (light weight)

3 sets × 15 reps

Strengthens forearm flexors for elbow support

Reverse wrist curls

3 sets × 15 reps

Strengthens forearm extensors for balance

Pronation/supination with light weight

2 sets × 15 reps

Builds rotational forearm strength

Bicep curls (controlled ROM)

3 sets × 12 reps

Supports elbow flexion strength

Tricep extensions (pain-free ROM)

3 sets × 12 reps

Supports elbow extension strength

Eccentric wrist exercises

3 sets × 15 reps

Helps with tennis/golfer's elbow issues

Return to Full Training

Criteria:

  • ✓Full pain-free range of motion
  • ✓No swelling after activity
  • ✓Symmetrical strength
  • ✓2+ weeks of drilling without aggravation

Progression:

  1. 1.Week 1-2: Rest, gentle ROM exercises, ice as needed
  2. 2.Week 3-4: Light drilling (no arm attacks)
  3. 3.Week 5-6: Add controlled positional sparring
  4. 4.Week 7-8: Light rolling, tap early to any arm isolation
  5. 5.Week 9+: Gradual return with maintained awareness

Finger Grip

Finger injuries are ubiquitous in gi BJJ due to the constant grip fighting. Maintaining grips against resistance, breaking grips, and having grips stripped forcefully all stress the fingers. Common injuries: PIP joint sprains, A2 pulley strains (less common than climbing), flexor tendon issues, and collateral ligament injuries. "Grip strength" overuse can also lead to forearm tendinopathy.

Warning Signs

  • ⚠Unable to make a fist
  • ⚠Finger deviating sideways
  • ⚠Unable to straighten finger
  • ⚠Swelling not improving
  • ⚠Weakness persisting

Red Flags - Seek Immediate Care

  • ●Obvious deformity or angulation - possible fracture, X-ray needed
  • ●Unable to bend or straighten finger - possible tendon injury
  • ●Finger rotated when making fist - fracture likely
  • ●Numbness in finger - nerve involvement
  • ●Dislocation that won't reduce - ER visit
  • ●Open wound over joint - infection risk

When to Seek Professional Care

  • →Obvious deformity
  • →Unable to use finger
  • →Dislocation
  • →Numbness
  • →Not improving after 2 weeks of rest

General Principles

  • •Death gripping leads to injury - learn to release grips
  • •Tape provides support but doesn't prevent injury
  • •No-gi is easier on fingers when injured
  • •Strong forearms/grip makes fingers more resilient
  • •Learn efficient grip fighting (not just strength)

Recommended Exercises

Rice bucket exercises

2 sets × reps

Comprehensive finger and forearm conditioning

Finger extensor training (rubber band)

3 sets × 20 reps

Balance flexor dominance from gripping

Wrist curls and reverse curls

3 sets × 15 reps

Forearm strength for grip endurance

Finger stretching

3 sets × reps

Maintain mobility

Grip strengthening (when cleared)

3 sets × 15 reps

Build resilience

Return to Full Training

Criteria:

  • ✓Pain-free daily activities
  • ✓Can grip without pain
  • ✓Swelling resolved
  • ✓Successful modified training

Progression:

  1. 1.Week 1: Rest from gripping, tape, RICE
  2. 2.Week 2: No-gi if tolerated
  3. 3.Week 3: Light gi with modified grips
  4. 4.Week 4+: Gradual return to normal grips

Heel Hook Knee

Heel hooks are among the most dangerous submissions in grappling because they can cause catastrophic knee injury before significant pain is felt. The mechanism rotates the tibia under a fixed femur, destroying ligaments and potentially menisci in a split second. The inside heel hook is particularly dangerous as it attacks the LCL, posterolateral corner, and can tear the ACL - these structures have less pain sensation than other knee ligaments. CRITICAL: There is often NO PAIN WARNING before serious injury.

Red Flags - Seek Immediate Care

  • ●Pop felt with immediate swelling - LIKELY SIGNIFICANT INJURY, seek orthopedic evaluation
  • ●Gross instability (knee moving abnormally) - MULTI-LIGAMENT INJURY possible
  • ●Unable to bear weight - significant injury, needs evaluation
  • ●Knee locked (can't straighten) - possible meniscus, needs evaluation
  • ●Numbness below knee - possible nerve involvement
  • ●Rapid bruising - significant soft tissue damage

When to Seek Professional Care

  • →Any pop felt during heel hook
  • →Swelling developing after training
  • →Knee instability
  • →Unable to walk normally
  • →Any concern about ligament injury

General Principles

  • •No pain doesn't mean no damage - tap when caught
  • •Multiple ligament injuries are common from heel hooks
  • •Surgical reconstruction often needed for significant injuries
  • •Recovery time: 9-12+ months for multi-ligament injuries
  • •Some heel hook injuries end competitive careers

Hip Impingement

Femoroacetabular impingement (FAI) is extremely common in BJJ practitioners due to the extreme hip positions required. Guard playing, rubber guard, deep half, and inverting all require hip ranges that can stress the labrum and cartilage. Two types: - CAM: Bony bump on femoral head (more common in males) - Pincer: Over-coverage of acetabulum Many BJJ players develop hip pain from repetitive impingement.

Warning Signs

  • ⚠Pain increasing despite modification
  • ⚠Catching or locking of hip
  • ⚠Night pain
  • ⚠Difficulty with daily activities
  • ⚠Limited range of motion

Red Flags - Seek Immediate Care

  • ●Unable to bear weight on hip - possible fracture or severe pathology
  • ●Groin pain with fever - evaluate for infection
  • ●Sudden severe hip pain without trauma - evaluate for AVN or fracture
  • ●Progressive weakness in leg - neurological evaluation

When to Seek Professional Care

  • →Pain not improving with modification
  • →Symptoms affecting daily activities
  • →Mechanical symptoms (catching, locking)
  • →Any red flag symptoms
  • →Considering continuing BJJ long-term (need diagnosis)

General Principles

  • •Anatomy matters - some hips are not built for extreme positions
  • •Not everyone can do rubber guard safely
  • •Forcing flexibility can damage cartilage and labrum
  • •Hip strengthening is protective
  • •Position modification is often necessary long-term

Recommended Exercises

Glute bridges

3 sets × 15 reps

Hip extension strength

Clamshells

3 sets × 15 reps

Hip external rotation strength

Side-lying hip abduction

3 sets × 15 reps

Glute medius strength

Standing hip circles

2 sets × 10 reps

Controlled mobility without impingement

Deadlifts (hip hinge pattern)

3 sets × 8 reps

Posterior chain strength - hip extension focus

90/90 position holds (if tolerated)

3 sets × reps

Hip mobility if pain-free

Return to Full Training

Criteria:

  • ✓Pain-free daily activities
  • ✓Can perform hip exercises without pain
  • ✓Successful modified training
  • ✓Medical clearance if symptoms were severe

Progression:

  1. 1.Week 1-2: Rest from aggravating positions, hip strengthening
  2. 2.Week 3-4: Light drilling, modified positions
  3. 3.Week 5-6: Add modified sparring (top game focus)
  4. 4.Week 7+: Gradual return to more positions

Knee

Knee injuries are among the most common in BJJ due to constant twisting, rotational movements, and leg entanglements. The knee faces unique stresses from guard work, takedowns, and especially leg locks (heel hooks). Prevention and proper recovery are critical for longevity in the sport.

Warning Signs

  • ⚠Knee giving way during movement
  • ⚠Locking or catching sensation
  • ⚠Increasing swelling
  • ⚠Pain getting worse despite rest
  • ⚠Instability during daily activities

When to Seek Professional Care

  • →Heard or felt a pop during training
  • →Significant swelling within hours
  • →Unable to fully straighten or bend knee
  • →Knee gives way when walking
  • →No improvement after 1-2 weeks of rest
  • →History of previous knee injury

General Principles

  • •Heel hooks damage knees before you feel pain - tap early, tap often
  • •MCL injuries are most common in BJJ from resisting passes
  • •Meniscus issues often come from kneeling and twisting positions
  • •Hip flexibility reduces compensatory knee stress
  • •Strength around the knee (quads, hamstrings, glutes) is protective
  • •Knee braces provide support but don't prevent all injuries

Contraindicated Movements

Leg locks (receiving or drilling) when symptomaticDeep knee flexion under loadResisting passes with planted footExplosive takedownsKneeling positions on affected kneeRubber guard and other extreme positions

Recommended Exercises

Terminal knee extensions (TKEs)

3 sets × 15 reps

Strengthens VMO for patellar stability

Single leg Romanian deadlifts

3 sets × 10 reps

Builds hamstring and hip stability

Lateral band walks

3 sets × 15 reps

Strengthens hip abductors to reduce knee valgus

Goblet squats (pain-free depth)

3 sets × 12 reps

Builds quad strength with controlled loading

Hip 90/90 stretches

2 sets × 60 reps

Hip mobility reduces compensatory knee stress

Glute bridges

3 sets × 15 reps

Strong glutes protect the knee during movements

Return to Full Training

Criteria:

  • ✓Full pain-free range of motion
  • ✓No swelling after activity
  • ✓Symmetrical strength (within 90%)
  • ✓Completed progressive return protocol
  • ✓Cleared by medical professional if moderate/severe

Progression:

  1. 1.Week 1-2: Upper body drilling only
  2. 2.Week 3-4: Add controlled positional sparring (no leg attacks)
  3. 3.Week 5-6: Light rolling with trusted partners
  4. 4.Week 7-8: Gradual return to normal training
  5. 5.Week 9+: Reintroduce leg lock defense drilling

Lower Back

Lower back injuries are extremely common in BJJ due to the unique positions and forces involved. The guard game, inversions, takedowns, and being stacked all create significant lumbar spine loading. Understanding BJJ-specific mechanisms helps guide appropriate modifications. Key BJJ-specific mechanisms: - Stacking: Opponent compresses spine during guard passes - Inversions: Repeated flexion and loading in inverted positions - Guard retention: Hip flexor engagement pulling on lumbar spine - Takedowns: Both offensive and defensive expose spine to load

Warning Signs

  • ⚠Radiating leg pain (sciatica)
  • ⚠Numbness or tingling in legs
  • ⚠Pain worsening with activity
  • ⚠Difficulty with bowel or bladder
  • ⚠Weakness in legs

Red Flags - Seek Immediate Care

  • ●Saddle anesthesia (numbness in groin/inner thighs) - CAUDA EQUINA, go to ER immediately
  • ●Bladder or bowel dysfunction with back pain - go to ER immediately
  • ●Bilateral leg weakness - go to ER immediately
  • ●Progressive neurological deficit
  • ●Severe back pain after significant stacking/compression injury - evaluate for disc herniation

When to Seek Professional Care

  • →Any red flag symptoms
  • →Radiating leg pain
  • →No improvement after 2-4 weeks of rest and modification
  • →Pain affecting daily activities
  • →Recurrent episodes

General Principles

  • •Inversions are the highest risk movement for back pain - avoid when symptomatic
  • •Learn to 'granby roll out' instead of fighting stacks
  • •Core bracing is essential during guard work
  • •Hip flexibility reduces compensatory lumbar movement
  • •Top game is generally easier on the back than bottom game

Recommended Exercises

McGill Big 3 (bird dog, side plank, curl-up)

3 sets × 10 reps

Evidence-based core stability without flexion loading

Dead bugs

3 sets × 10 reps

Core control in supine position

Hip flexor stretching

3 sets × reps

Tight hip flexors pull on lumbar spine - very common in guard players

Glute bridges

3 sets × 15 reps

Hip extension to counteract flexor dominance

Pallof press

3 sets × 10 reps

Anti-rotation core strength

90/90 hip stretches

2 sets × reps

Hip mobility reduces compensatory spinal movement

Return to Full Training

Criteria:

  • ✓Pain-free daily activities
  • ✓Pain-free during core exercises
  • ✓Successful drilling without pain
  • ✓Successful light sparring (top game focus)

Progression:

  1. 1.Week 1-2: No mat work, core stability daily
  2. 2.Week 3-4: Upper body drilling only
  3. 3.Week 5-6: Full drilling (avoid inversions)
  4. 4.Week 7-8: Light sparring, top game focus
  5. 5.Week 9+: Gradual return, consider avoiding inversions permanently if problematic

Neck

The cervical spine is vulnerable in BJJ due to chokes, neck cranks, stacking, and inverted positions. Approximately 85% of BJJ athletes experience musculoskeletal injuries, with cervical spine trauma accounting for over 4% of combat sports injuries. Prevention through strengthening, proper technique, and knowing when to tap is essential.

Warning Signs

  • ⚠Pain radiating into shoulders or arms
  • ⚠Numbness or tingling in hands
  • ⚠Weakness when gripping
  • ⚠Dizziness or visual disturbances
  • ⚠Headaches increasing with neck movement
  • ⚠Pain worsening despite rest

When to Seek Professional Care

  • →Any radiating symptoms (arms, hands)
  • →Numbness, tingling, or weakness
  • →Severe pain or muscle spasm
  • →No improvement after 1-2 weeks
  • →Dizziness, visual changes, or coordination issues
  • →History of previous neck injury
  • →Symptoms after trauma (throw, slam, fall)

General Principles

  • •The neck has limited muscular protection - technique matters more than toughness
  • •Neck injuries are more common in older practitioners and lower belts
  • •Inverted guard and stacking positions carry highest risk
  • •Tap early to chokes and neck cranks - your spine isn't worth any submission
  • •Neck strength training is protective but must avoid compression
  • •Sleep position and pillow choice affect recovery

Contraindicated Movements

Inverted guard play when symptomaticBeing stacked heavilyNeck cranks or can openers (receiving or drilling)Bridging with neck (wrestling bridge)Guillotine escapes requiring neck extensionHeavy sparring with unknown partners

Recommended Exercises

Isometric neck holds (all directions)

3 sets × 10 reps

Builds neck strength without compression

Band neck resistance (flexion/extension/lateral)

2 sets × 15 reps

Progressive resistance without spinal loading

Chin tucks

3 sets × 15 reps

Strengthens deep neck flexors, improves posture

Shoulder shrugs

3 sets × 12 reps

Builds trap strength to support neck

Thoracic spine mobility (cat-cow, rotations)

2 sets × 10 reps

Thoracic mobility reduces cervical compensation

Gentle neck CARs (controlled articular rotations)

1 sets × 3 reps

Maintains mobility, identifies restrictions

Return to Full Training

Criteria:

  • ✓Full pain-free range of motion
  • ✓No radiating symptoms
  • ✓Completed 2 weeks of drilling without aggravation
  • ✓Cleared by medical professional if moderate/severe

Progression:

  1. 1.Week 1-2: Rest, gentle mobility, neck strengthening
  2. 2.Week 3-4: Technical drilling, no guard work
  3. 3.Week 5-6: Add controlled guard work, no stacking
  4. 4.Week 7-8: Light sparring with trusted partners
  5. 5.Week 9+: Gradual return to normal training

Rib

Rib injuries are extremely common in BJJ, so much so that costochondral separation has been called 'BJJ rib'. These injuries occur from knee-on-belly, pressure passing, and forceful twisting of the torso. Recovery requires patience - returning too early almost guarantees re-injury.

Warning Signs

  • ⚠Pain increasing despite rest
  • ⚠Difficulty breathing
  • ⚠Pain at rest that doesn't improve
  • ⚠Fever (could indicate complications)
  • ⚠Persistent sharp pain

When to Seek Professional Care

  • →Difficulty breathing or shortness of breath
  • →Severe pain not improving with rest
  • →Palpable deformity
  • →Pain persisting beyond 2 weeks without improvement
  • →Fever or signs of infection
  • →Coughing blood

General Principles

  • •Rib injuries are notorious for re-injury - patience is essential
  • •Average healing time is 10-12 weeks for significant injuries
  • •Never train through rib pain using painkillers
  • •Intercostal muscles need to be trained for protection
  • •Breathing exercises aid recovery
  • •Sleep position matters - affected side up

Contraindicated Movements

All sparring until pain-freeReceiving knee-on-bellyTight side control (receiving)Explosive hip escapesTwisting movements under loadHeavy compound lifts (deadlifts, squats)Any movement causing sharp pain

Recommended Exercises

Diaphragmatic breathing

3 sets × 10 reps

Promotes healing, maintains chest mobility

Gentle thoracic rotation (pain-free range only)

2 sets × 5 reps

Prevents stiffness during recovery

Intercostal stretching (gentle)

2 sets × 30 reps

Maintains flexibility, do only when pain allows

Wall slides

2 sets × 10 reps

Upper body mobility without rib loading

Walking

1 sets × 20 reps

Maintains cardiovascular fitness during recovery

Return to Full Training

Criteria:

  • ✓No pain with deep breathing for 2+ weeks
  • ✓No pain with twisting movements
  • ✓Can sneeze/cough without significant pain
  • ✓Completed progressive return without setback

Progression:

  1. 1.Weeks 1-3: Complete rest from BJJ, gentle mobility only
  2. 2.Weeks 4-6: Light drilling, standing techniques only
  3. 3.Weeks 7-8: Controlled positional drilling (no pressure)
  4. 4.Weeks 9-10: Very light flow rolling with trusted partners
  5. 5.Weeks 11-12: Gradual intensity increase (10% every 2 weeks)
  6. 6.Weeks 13+: Return to normal training if pain-free

Skin Infections

Skin infections are an unavoidable reality of grappling sports. Close skin contact, shared mats, and minor skin abrasions create ideal conditions for ringworm, staph, and other infections. Prevention through hygiene is far easier than treatment. Training with an active infection is never acceptable - it endangers everyone.

Warning Signs

  • ⚠Any rash that is circular, scaly, or itchy (ringworm)
  • ⚠Red, swollen bumps especially with white/yellow center (staph)
  • ⚠Sores that don't heal
  • ⚠Spreading redness
  • ⚠Fever with skin symptoms
  • ⚠Clusters of small blisters (herpes)

Red Flags - Seek Immediate Care

  • ●Fever with skin infection - SYSTEMIC INFECTION, seek care immediately
  • ●Red streaks spreading from infection - LYMPHANGITIS, urgent care needed
  • ●Rapidly spreading redness/warmth - CELLULITIS, same-day medical care
  • ●Deep abscess with significant pain/swelling - may need surgical drainage
  • ●Infection not responding to antibiotics - POSSIBLE MRSA, needs evaluation
  • ●Multiple large lesions appearing - may indicate serious infection
  • ●Immunocompromised + skin infection - higher risk, prompt evaluation

When to Seek Professional Care

  • →Any infection not improving with OTC treatment after 1 week
  • →Fever with skin infection
  • →Rapidly spreading redness
  • →Red streaks extending from infection
  • →Deep or large abscess
  • →Multiple affected areas
  • →Recurrent infections
  • →Signs of MRSA (not responding to typical antibiotics)

General Principles

  • •NEVER train with any active skin infection - this is non-negotiable
  • •Shower within 30-60 minutes after every training session
  • •Wash training gear after EVERY session
  • •Check your body for any skin changes daily
  • •Mat burn and cuts are entry points for infection - keep them clean and covered
  • •A compromised skin barrier (ringworm, cuts) makes staph more likely

Contraindicated Movements

ALL training until infection is completely resolvedThere are no modifications - you cannot train with skin infectionsNo exceptions for 'mild' or 'almost healed' infections