Return to Jiu Jitsu After Injury: A Surgeon and PT Black Belt Talk Rehab and Reality

In this episode of The Doctor Jiu Jitsu Podcast, I sit down with my friend Mike Piekarski, PT, DPT, BJJ black belt (Dr. Kickass), to talk about why jiu jitsu rehab is different. We cover the biggest mistake grapplers make after an injury, how to modify training without losing your mind, when rehab becomes sport specific (especially after ACL surgery), and how to build longevity through smarter load management, graded exposure, and better gym culture.

Episode Highlights:

00:56 – Why Jiu-Jitsu Rehab Is Different From Other Sports
02:04 – The Movement Demands of Jiu-Jitsu Athletes
03:25 – When Athletes Should Return to Sport After ACL Surgery
04:18 – Rebuilding Confidence After Leg Lock Injuries
07:29 – Mike’s Journey From Fighter to Physical Therapist
11:50 – The Biggest Mistake Injured Jiu-Jitsu Athletes Make
19:53 – Recovery, Overtraining, and Using HRV Data
24:57 – Dangerous Positions That Cause BJJ Injuries
33:22 – Warmups That Actually Prevent Injuries
42:21 – The One Rule Every Grappler Should Follow for Longevity 

Find Mike on Instagram: @doctor_kickass
Subscribe for more episodes on combat sports injuries, recovery, and performance.

New episodes drop the first Friday of every month at doctorjiujitsu.com/podcast.

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To learn more about Dr. Megan Jimenez, check out her website: doctorjiujitsu.com

Transcript

 Dr. Jimenez [00:00:00] Hi, I'm Dr. Jimenez. I am an orthopedic surgeon and black belt in jujitsu. I'm sitting here with my good friend, Mike Piekarski. He is also a black belt. He's been a blackbelt since 2018 and a physical therapist since 2015. You guys might know him as Dr. Kickass on Instagram. It's an honor to be here with him. We've been talking and chatting and doing research for what, two years, maybe three years. 

Mike Piekarski [00:00:20] Yeah, it's been a while. 

Dr. Jimenez [00:00:21] And we're finally meeting this time for a course that you did yesterday. If you wanna do a little plug on that real quick. Sure. 

Mike Piekarski [00:00:27] So I did my first treating the jiu-jitsu athlete course, which was just a full day course where I get a whole bunch of physical therapists, athletic trainers, to come down. And we talked about how the rehab process might be different for a jiu jitsu athlete versus a traditional field athlete or just general population. And for me, it was super cool having an orthopedic surgeon there, because as a PT, it's kind of like, I get to learn so much from orthopedics surgeons in general. So to kind of hear something on the other side, It would just. You know, it made the course for me just a little bit, it just added that little depth, and I could definitely tell that there were a lot of the people who attended appreciated your insights. 

Dr. Jimenez [00:01:04] Well yeah, and it was awesome because a lot of orthopedic surgeons, I think, aren't super keen on what goes into physical therapy, and its not by our fault, we're not trained in it, we do a surgery, onto the next surgery, or I go see a PT, but not all PT is equal, and I think your flair for it, treating jujitsu athletes, which is where I'm going as well in orthopedics, and treating juJitsu athletes is very different than the regular athlete. What are the big differences that you see? When you treat, because you're treating clinics still, but you also have your online Jiu Jitsu focus, which is probably your bigger focus. What do you see is the big difference between other athletes and Jiu-Jitsu athletes when you're treating? 

Mike Piekarski [00:01:42] Well, so I would say a big thing with certain things is you look at the demand of the sport. So a field athlete, they need to run, they need the jump, they needed to cut. And that's not necessarily the focus of Jiu-Jitsu. Like obviously these are things that you can do. You still wanna develop their athleticism, but it doesn't have to be the major focus. One of the big things that I look at is, we look at what I call my movement milestones, and these are movements or positions that are somewhat unique to Jiu Jitsu. And from there, you can kind of boil down what does the injured joint need to be able to do. And then from there you make sure that the joint can do everything that it's supposed to do and then you can then build in the sport specific movement like kneeling, framing, posting, et cetera. And then we kind of build from there. So in my opinion, that is where sport specific PT or rehab should be is understanding the demand of the sport. And those are some of the things that I typically see. 

Dr. Jimenez [00:02:38] Is your rehab pretty similar in the early stages after a surgery, and when do you switch a focus to hey, Jiu-Jitsu is where we need to return to around what, I guess, time frame or, you know, you do an ACL surgery. At what point are you switching from that more athletes-focused early recovery to sports-specific? 

Mike Piekarski [00:02:58] So I would say the way that I look at is, is acute subacute phase is pretty similar. It's when we get to that strength and conditioning, can start thinking about return to sport phase where it gets a little bit different. So specifically for ACL, it would be between month four or five. So a lot of times because I do work with people online for return to coaching. So it's kind of like when, you know, their insurance ends, which usually is around month four, five, but we know that, you now return to support is month nine. That's usually kind of when I take over that role so I can do that last 20% to ensure that the athlete's actually ready to get back to sport and they don't re-tear their ACL.

Dr. Jimenez [00:03:37] So if an athlete tears their ACL, for example, heel hook, how I tore mine, how many people tear ACLs, when are you putting them back into that position to start mentally getting ready for that position again and stressing the leg for that position? 

Mike Piekarski [00:03:50] Um, so I do, you know, I remember, you're not the course. I talking about doing like long range rotational isometrics. And I think where I'm going to go with my course is I'm going to take one of those lectures. I'm gonna put it online and then I'm going to spend like a more in-person time where like I get someone on the mat and I do it. But literally what I would be doing is, is like, I would get someone in the mat. And I'd be like, or the table. So they're not even on them. And I'm doing isometrics. So it'll look like I'm heel hooking somebody. But I'm just doing low level isometrics. So they're resisting, they're doing that yielding isometric that I discussed. I mean, I could be doing that month two, three, but it could, it's all low. Like, so I'm doing low-level isometric. So they are getting exposed to rotational stress fairly early on. If I am working with an athlete at that month five mark where they'd already done PT, most PTs aren't doing those rotational stresses. So it might be month five. But for me, like I could do it fairly early. For something like meniscus repair where you want to specifically, if it's like a complex tear, you want avoid those rotational movements, I might wait until month four. But I think meniscous repair is probably like a more conservative in that sense. So like literally it would look like I'm heel hooking someone on the table. 

Dr. Jimenez [00:05:04] And just a low velocity, a very low amount of stress. Do you think that's more for the mind or for the body? 

Mike Piekarski [00:05:12] I do it more for the body, but there is the mind component as well, because a lot of times, I mean, you know what it's like, when you were going through ACL rehab, where you're like, okay, and now I'm in a heel hook, is this person gonna try to break my leg? So now, one of the things that I like doing from a psychological confidence standpoint is like, we do all the, I kind of ran you through the course where we have my movement milestones, and then the graded exposure to sport, so they're going through jiu-jitsu, but they're not getting the leg attacked. And then at some point. I would want to get their leg attacked in a controlled way. So when I do that approach on the table, I feel like that helps them. Cause like, oh yeah, like I've been heel hooked by my PT. Not really heel hooked, you know what I mean? 

Dr. Jimenez [00:05:52] I've been put in these positions in a safe manner. 

Mike Piekarski [00:05:55] Yes, yeah. 

Dr. Jimenez [00:05:56] And even when I was returning back after the clear from my doctor, which I did behave and wait for, at that point I went back and I went with small people, my size, and I just said, don't go after my heel, just put me in an Achilles grip. Put me in outside actually where I got injured and just let me work, but don't try to put anything on, don't force anything, let me just figure it out and get my mind, because I get put in that position and my heart rate would go through the roof. 

Mike Piekarski [00:06:21] Exactly because I 

Dr. Jimenez [00:06:23] Nervous, I had seen it so many times on tape by an ACL tearing, right? 

Mike Piekarski [00:06:27] Oh, you got a tape of it? Oh, yeah. Oh, no. Yeah, yeah, yeah... 

Dr. Jimenez [00:06:29] Yeah, yeah, so then you can watch it and watch it because I didn't know what happened when it happened Yeah, so that was the interesting piece. I kept going sure and then afterwards. I was like, okay, let's do another match Yeah, it wasn't until I watched that 

Speaker 3 [00:06:39] Sure.

Dr. Jimenez [00:06:39] I was actually getting a tattoo the next day and I was showing my tattoo artist. He's like, wow, it's a miracle You didn't break tear anything and I'm like, damn I definitely did, you know, I didn't even realize it was a little swollen and I wasn't unstable. Sure And so different ways different ACL patterns sure you experience it. Okay, so kind of going back Let's go to your origin story a little bit. Sure black belt physical therapist We joke around because yesterday we rolled for the first time finally. We're both going after each other's legs I know but in a very controlled way. Yeah, right. I didn't t feel in danger. We were safe Well, you grip something, you let go and we move along and that's how I wish more people could train. Sure. But do you think, or how does being a physical therapist and a black belt tie into each other and then how did your brand get started? 

Mike Piekarski [00:07:20] So I'll start with my origin and then I'll kind of go from there. So I had started Jiu Jitsu 2006, I was in college, actually I think what happened was I started I was where I went to college there was a club and it was like I'm surprised we didn't all get destroyed because there was the guy running the club was a white belt. So like it was the Wild West, like we were doing heel hooks on each other day one, you know we had no idea that they were bad. And then I found a guy local when I, you know, I'd be on break. So that's when I really like, so my first coach at the time was a purple belt. So, which is, you, it's kind of interesting now that people start with black belts and they don't realize like back in the day what it's like, like you don't really have access to black belts. 

Dr. Jimenez [00:08:01] We have access to tape, we have access to Instagram, social media, really. And you just, people would black out their windows, right? Because it was like, our gym gets this and your gym. It wasn't this like interaction cross-training experience either. 

Mike Piekarski [00:08:14] So I started jiu-jitsu and then I'm like, this is cool. And then my coach was fighting and then one time he approached me, he's like, are you interested in fighting? And I'm a nerdy, unathletic guy. I was like, I can't fight. And then I started preparing for it because I was helping him and I started having fights and then, I had my pro fight and I got my nose broken and I was already thinking this way at the time because I'd been in pro MMA gyms where I could see those people. There was a few guys that I used to train with, they were in the UFC. But they were like the best of the best. They were natural athletes and they were super dedicated. And then you'd see those people who weren't quite at that level and they're kind of in these local shows making peanuts for money and they are like hoping to get that one win so they can get to the UFC. And like I realized like I don't have the athleticism to be a UFC fighter. You know, as much as, like I could train as much I want, but you know, the athletic system, it just wasn't there. So I was like, okay, well I need a more realistic long-term career path. Originally, I was thinking about being a personal trainer. I was thinking about being a physical therapy assistant, and then I realized I don't like listening to rules. So I was like, well, I'll just be a PT so I could do my own thing. And then it wasn't until I graduated that I realized that I could kind of merge the two because I wasn't thinking doing PT for jiu-jitsu because at that time jiu jitsu was so small, there's no money. You know, I'd be in the clinic and I'd be training with people. And then some of my training partners would come see me. Like, I want to work with you because at the time I was a brown belt and I keep a black belt. They're like, I wanna work with you because you understand jujitsu. I'm like, oh yeah, I guess I do. But then, you know this is why I made the course is even though I do, I did understand juJitsu. It wasn't as, you know, systematized as like my course was. It like, it was just more haphazard. So then what I did is I, you know, kind of took my rehab process. I put it on the, on paper and then I kind of allowed myself to streamline the process so then I could teach others kind of what I do. 

Dr. Jimenez [00:10:10] Yeah and I love your courses online too. I go through them and even when my partners at work, other orthopedic surgeons, they're like hey I've got this guy that likes jiu-jitsu, I just did this ankle reconstruction. What the hell do I do? Because nobody knows the terms. They don't know how to tell them to go back and so I always go to your stuff and I'm like all right what would Mike like what would mike recommend at this stage and then we try to help the local physical therapists because most people don't know what a delhiva is. They dont know what these positions are and they don't how the injuries occurred when you tell them the lingo. So People do come to us because we understand the lingo. 

Mike Piekarski [00:10:40] Yeah, and one of the things too for my jiu-jitsu rehab course, like, you know, I reach out to you and a few other surgeons because I didn't want to say, hey, you can get back to jiu jitsu at this time. And a surgeon looks at it and like, what are you, you, and then they hate me as the, you know. So I kind of wanted to see like, What would a surgeon be okay with? Because, I mean, you doing jiu jitsu, you're obviously probably less conservative than other, but there's a lot of surgeons out there that are like very, very conservative. So, you know, I kind of wanted a good balance, getting a good idea. So like, I didn't get someone on the mat too slow as well, but I also didn't want to make it too fast where they're going to be re-injured. 

Dr. Jimenez [00:11:15] Yeah and that's why I appreciate the collaboration when we work together getting those athletes back. It's so much more helpful. We talked about that too yesterday with a lot of the PT's because it's tough to find the PT when there's hundreds of PT's and then you're just sending your patient out with a little protocol. Yeah, yeah, yeah. It's hard. Okay, so what is the biggest mistake you see Jiu Jitsu athletes make when they get injured? 

Mike Piekarski [00:11:36] I think it's just that they ignored the injury. They just think, oh, my elbow popped. It's fine. It'll be back the way it was. And, you know, that's not always the case, especially as we get older. We don't heal as well. And then, you, these minor injuries start becoming these chronic disabilities. And this is why you look at all these black belts and they just, you know, they only can play a very limited game because they've so many injuries that like they can't do the game they did when they're in the twenties, twenties and thirties. 

Dr. Jimenez [00:12:02] And ignoring it early. So, I mean, you probably get these texts a lot. I get these text all the time. Hey, my elbow popped again. Sure. I was like, okay, what did you do the last time it popped? Sure. I just put a sleeve on it and went and kept going. It's like, OK, it keeps popping, so when are we gonna make, do something different? Sure, sure, sure. Definition of insanity. We keep doing the same thing. How do you talk to these athletes? Because I feel like I can never get through and sometimes I am that athlete, right? Yeah, for sure. Like, oh, my neck is a little sore, but I'm not stopping. Yeah. The game modification, I think, is a big deal, and we can go into that, too. But how do you talk to these athletes and help them make better decisions for longevity? For them in 10 years, for them in 20 years. 

Mike Piekarski [00:12:38] Sure, I mean, so, you know, there's some good, and I'm very guilty of this too. Like if there's a minor injury, like I'm still training, but it's kind of, and this is kind of difficult. What's a mild injury and what's something where you actually have to do something about it. So, you now, if you have like a tweak and like within a few days you're back to normal, like it might not be something you can't be on the mat. Or, you it's not even, it's just not a bad idea to just go straight to activity modification. So when tweaks your neck. Maybe you're gonna just do more focused on ghee because there's gonna be less of those guillotines from headlocks, not that they're not there, I still do them in the ghee, but you know, with you have other options and ghee chokes tend to be cleaner and they're nicer on the neck. So that's a super easy one. So I'll use those objective testings that I ran someone through. You know, like when we look at ACL reconstruction or like whether someone needs a reconstruction or they can go non-operative, like being a copper. A lot of those tests that I do to clear someone, I could just clear to see if they're a coper. Like, you know, to identify a copers, I think like there's like those one criteria is like, can you hop on one foot before we even see if that, like if they can do that and their knee doesn't buckle, like they could potentially be a copered. 

Dr. Jimenez [00:13:44] Yeah, can you explain that, Cooper, a little bit more, what that means? 

Mike Piekarski [00:13:47] So a copper is someone and you know, I don't know if there's any science on why someone's a copper, but there are some people that have no ACL and they don't need surgery. They can do sport. They have no instability. Um, I would be fascinated to know why, you know? Like if it, is it based on with the injury, does it just like, you know, the ACL scar in a way that you have that stability? Is it a neuromuscular control issue? 

Dr. Jimenez [00:14:09] That's what I think it is, more neuromuscular, and age is a big one, right? Because the older patients, I tend to offer non-operative more for them. But people are under the misconception that they have to get an ACL surgery. And I get soldiers all the time that come in to me and they're like, my ACL is torn, I have to a surgery. Well, not necessarily, let's talk about that. And so the COPR thing, there is a COPR classification and there's criteria that people meet to see if they will be a COPER. The problem with Jiu Jitsu is, and probably a lot of sports, I think I see it more in Jiu-Jitsu because of the lack of insurance, maybe lack of trust in the medical field, but they will tear their ACL, hear a pop, not know, and just keep going. Because especially with leg locks, not even getting to a heel hook, just the entanglements and the rolls, there's little pops that happen and could be ACLs, but people keep going. They don't even know. And then sometimes I'll go visit a gym and see some friends and they're like, hey, can you check my knee out? I had a pop two years ago, I know ACL. Like, oh, you haven't had an ACL for two years, how does it feel? And sometimes they're lucky and they're okay. But you still have to do the PT. 

Mike Piekarski [00:15:10] Correct, yep. 

Dr. Jimenez [00:15:10] So even if you're going to non-up, you've got to go to physical therapy. And that's kind of the trade-off. People don't want to do that. 

Mike Piekarski [00:15:15] Yeah. And you know, they do a lot of, there's a lot to research in Australia because of socialized medicine. Like you might, if you tear your cell, you might not be getting surgery for like two, three years. So they really push rehab over there. And there's lot of times that if somebody is not a copper, if go through like a full course of rehab, you actually can become a copper. And then jujitsu specific, it's also very style based. Like if you're a guard player, like you probably could get away, even if you have a little bit of instability, like you could probably get away with it. Versus if you were like a. You know, a speed loose passer. 

Dr. Jimenez [00:15:45] Like, yeah. 

Mike Piekarski [00:15:46] Yeah, like those type of athletes, maybe you want an ACL. 

Dr. Jimenez [00:15:51] I want to talk about modifications when you're training. So people have injuries, we don't want to be out. We don't wanna be out, I think you quoted a paper yesterday that if they're out more than a week, the mental satisfaction goes down and you become sad. 

Speaker 3 [00:16:06] Good for you. 

Dr. Jimenez [00:16:07] And so after a week of not training in martial arts. So I think, for example, I have a neck injury right now. And so yesterday, I was rolling with your wife, who was like, I had such a good time rolling with her because it's very difficult to find 120 pound female high level that are technical and safe. Like I felt safe doing my whole game with her. But at one point, you know, she was very savvy with leg rocks and defending. And I had to invert to continue getting the leg lock, but I bailed. I was like, that's not worth my neck. And it looked probably ridiculous because I just like flapped my legs out and I bail to a turtle. That's hard to do. And I really had to think about it. And when you're not with safe partners, you might not think that because you're so busy protecting yourself that you're thinking that way. How do you recommend people train while protecting injuries? 

Mike Piekarski [00:16:50] Big thing, if you can control your training partners, we all know those people that you say go light and then they roll like it's ADCC finals. So avoid those people. If you can stick with people your size. I mean, not everybody has this option. I mean like with women, there's just not a lot of people your sized. But finding the smaller people, usually I would say a higher belt knows how to flow. Let them know and then if you, one of the things which is hard for me to give like global advice. But you take something like a neck injury and if you kind of see how these neck injuries occurs, so anytime someone's gonna grab my neck, so it's takedowns or I'm doing a lot of like smash passing, half guard. These are things where all you can do if you're the opponent is grab the neck or the arm. So if you do something like loose passing, standing passing, like the neck is nowhere nearby. So that would be obviously something you can do a lot. The guards. Assuming you have the awareness to not invert as obviously it can be safe. You know, and sometimes people, some people don't necessarily want to modify, but for the most part, if I can get them back to doing something, you're like, I can have you do this. It's not inverting, it's not what you do, but it's jujitsu. And then, you know, cause like, you now, I'm also an instructor, so I always push my students. I'm like, you don't always have to play your A game. Like you should be developing. You should never be the same Grappler that you were six months before. So even though it's not your game, like you just start working on stuff and then that becomes your thing. Like, you know, that's why I use the example of Gordo, you know the creator of Half Guard, like he had a knee injury, couldn't play normal guards, he just played Half Guard so he could still do jiu-jitsu and then he revolutionized it and now we have modern Half Guard. So it was like something where, you know the injury pushed his technical innovation. 

Dr. Jimenez [00:18:35] And that's every injury I've had. I've developed a different part of my game. Before my neck, my neck has been bad for years. But before it got bad, I was inverting and doing these things with big people, not knowing any better, getting stacked, and then it got back. And so all of a sudden I was forced to play top game. So every time that my neck eggs up, my passing gets phenomenally, substantially better, because then I just do that. But you have to talk to your partners. Like my fiance is 215 pounds, and I'm like, hey babe, my my neck is hurting. So I'm just going to be passing right now. And he loves to wrestle, so it's very hard for him. So he has to work on his bottom game, too. So that's a great tactic, I think. Let's talk about rest. Even without injuries, we all overdo it. We're trying to do twice a day. We're try to train every day. How do you talk to your athletes about rest? What do recovery days look like? What do deload weeks look like, and how do you recommend that? 

Mike Piekarski [00:19:28] So in a perfect world, what we would do is you would, because for the most part, you should kind of know what your training schedule looks like between jujitsu, strength and conditioning, and then like life stress, because these are all things that play in, like you'd be an orthopedic surgeon, like you have a lot more stress than I do. Like, at least I feel like when I go in the OR, like I get stressed just observing, you know? But like that affects your, you now, how your recovery. So. You know, what you can do is load management is super key. Like you can't just be like, I'm gonna train hard every day, every session, you know, twice a day. That just your body won't be able to handle that. And it's like a gradual accumulation. So people see these high level grapplers that could be on performance enhancer. So it allows them to train more, but if they're not, you know like they didn't just do that in one day, they built their way up. So it should be great exposure to adding new stressors. One of the things that I'll do is I might have like, if I do two training sessions in a day, or I do a skill training and a physical capacity training, I kinda say, hey, this is a skill day, but I'm also gonna do a heavy leg day. Maybe I'm doing a moderate intensity training. So one of the ways that I can do, I like doing a lot of takedowns, or at least, because it's something that I want to be better at takedounds. So if I know that I'm gonna be tired from strength conditioning, I might just be like, all right, I'm just gonna pull guard today. But then if I'm not doing a double, be like okay, now I'm going to... Do takedowns, you know, and I've done that where I would try to do two jiu-jitsu sessions a day and I'm getting older, so those, I don't recover as well. You know, so I can't do two hard days, it might be like a hard session and the next session's a little bit lighter, where you know maybe, and a lot of like light sessions like when I roll with my wife, like I just put myself in like really deep submissions and try to work my way out because like she's not gonna hurt me and it's something I have to do anyway, you now, so it's a way that I can still get something out of it even if I'm going light. And then when it comes to like ways you can know when you need to, I like using a lot of objective data. So I'll use resting heart rate. I got a Fitbit, which kind of tells me so I can kind of see how my body is recovering. Also use a heart rate variability. So I will use the Morpheus, which is in the morning, I check it and kind of gives me a recovery and an HRV. So it kind of lets me know how I feel. 

Dr. Jimenez [00:21:43] Is that a chest strap or is that something you stand on or? 

Mike Piekarski [00:21:45] So there's two versions. So I have one of the older ones, I think, to get rid of it. So it's like a forum strap that I use in the morning. And then I use the chest strap when I actually, if I'm actually gonna do cardio training. I think they've switched and they've gotten rid of the forum, but like, because I have that, I can still use it. And I've, sometimes the data will give me different if I use a chest strap for the morning and like. 

Dr. Jimenez [00:22:07] I heard the chest strap is a little more accurate. It is, yeah. From some of the podcasts I've been listening to. 

Mike Piekarski [00:22:10] Yeah, so like when I do conditioning, like when I do condition programming for my athletes, they have to have a chest strap on there. I won't let them, like I work once with a guy who had like an Apple watch and the data was so horrible, it was useless. Like I wasn't, like he, I might not have even done any objective data because it wasn't helpful. 

Dr. Jimenez [00:22:29] And when your HRV is off, like probably too high. 

Mike Piekarski [00:22:32] So it goes both ways. So if it's too high, then you're more likely in a parasympathetic nervous state. So maybe you're recovering from something, maybe you were getting sick. So high isn't always good. And then if you're low, that usually means you're sympathetic, like you're overtaxing yourself. And I've listened to some coaches where they feel like it's just noise, it doesn't tell you anything. I mean, I can see, because let's say my recovery day is poor and it says you're in the red zone. I can still train if I want. But then what I notice is then the next two or three days I'm still in the red. So it's kind of like I can train hard because let's say like this weekend, I was expecting to do a lot of training. So it was like I'm gonna roll even if my recovery is bad because I wanted to train with a lot of the people here. Thankfully it wasn't bad. So you don't always get to control the situation but then there's that repercussion of now I feel like I'm digging myself a hole and now I have to take a few days off to kind of bounce back. So. For me, subjectively and objectively, I think they're fairly close. For some people, they just go by how they feel, which is fine. 

Dr. Jimenez [00:23:39] As long as you're listening. 

Mike Piekarski [00:23:40] Yeah, exactly. I have multiple clients slash old training partners that stopped using the Morpheus because they're like classic overtrainers. They're like, well, it tells me not to train. I'm not going to listen to this. They just stop using it. 

Dr. Jimenez [00:23:54] I'm guilty of that too. I'm going to that too Yeah, I think as we get older too, I mean 30s is not old but for jujitsu We were talking that is kind of a little bit on the older side. Yeah things change Yes, right. I don't go as hard in the paint as I used to. Yeah, and I look for partners that are safer Sure. Okay, let's go on to some injuries specific injuries Sure, you post a lot on Instagram about different positions and knowing when you're in a dangerous position Sure. I think that was part of what happened with my ACL. I didn't realize how much danger I was in Yeah, especially in competition. Your brain kind of just goes blank I'm here to win. And so how do you, what are the most, or some injuries that you've seen occur where somebody might not know that they're in a dangerous position? 

Mike Piekarski [00:24:35] I would say just a lot of leg entanglements. I would think thinking about one of the big ones, lockdown's a big one. You hear a lot people getting injured with lockdown. And it could be a variety of things where if you don't train with anyone who's done the template in a style, like they don't even know what this is. 

Dr. Jimenez [00:24:50] Or don't think it's that dangerous. I've seen a lot of ACLs pop. 

Mike Piekarski [00:24:53] Yeah. I see a lot of injuries that happen from leg entanglements are people that just like disregard the entanglement and they just try to bust through. You know, there's a good example of TJ Delashaw when he fought Corey Sandhagen. So Corey Sandhan gets him an inside heel hook and like TJ Delachaw just completely ignored the leg lock. He just kind of like shrugged his leg, popped his knee and got out, but he ended up tearing his meniscus at his LCL. He ended up winning the fight, but he was out for a year. And then, you know, I think he had one other fight, which might have been, I think he'd maybe one comeback fight after that. Maybe two, but like that was when his shoulder was so unstable. So it's kind of like, you know, he lost a year of his career just because he blatantly just ignored the leg lock. You know, you know, a good example, if we look at UFC fights, there was also Corey Sanhagan versus Figueredo, where Corey Sanhagen had him in a 50-50, and he went for the sweep. And we just talked about 50- 50. A lot of people, they think. I mean, yeah, the point of 50-50 is to get to a leg entanglement. But if you resist, and I've worked with a training partner where I swept him from 50- 50 and he was fighting it and he popped his LCL, um, thankfully he was only grade two and he didn't need surgery. But you know, it is one of those things. I think that's a big one that people don't realize that, you know if you ignore, like if you fight it and your knee is a somewhat of provocative position, it can be damaged. 

Dr. Jimenez [00:26:13] Yeah, I think that happened to me last year, a 50-50 position where the clock was running out, trusted training partner, but I didn't have my leg reinforced and my foot was on the hip. But you're almost locking your own knee in place, right, if you take your toes around the hip line, and then my partner kind of tried to blast through my knee, and I felt a stretch, thankfully, and, you know, everything was, it was just a sprain, everything was clean, it just a spring to the ACL, but I was very grateful because I didn't want to do an ACL again. But, you know, it took me out of Worlds last year, out of Wands, or out of a Worlds Nogi, and I learned a lot. It's like, hey, I need to be better about protecting myself and maybe reinforcing that leg, or realizing, another friend, she had her ankle popped because of a delahiva. I think she had a very tight delahive hook, and then the opponent tried to blast through or tried to like rip the delahivia aggressively, and her whole ankle popped. She's recovering from surgery now from that. Reverse delahivas, too. Anything where you have a hook in like that. 

Speaker 3 [00:27:10] Sure, sure. 

Dr. Jimenez [00:27:11] And people can, and if people just blast through, I think just being more cognizant of not doing these blasting or super spinny motions, anything really quick like that when your knees compromise. Yeah, but it's hard to do because your instinct takes over. Okay, maintenance physical therapy. People laugh at me because I have standing appointments with physical therapists and just to take care of various injuries that I've had for a long time. Is there something that you recommend people do every day, every other day? Should everybody be doing some kind of maintenance? 

Mike Piekarski [00:27:44] So my maintenance, I know, you know, I didn't get to show it tomorrow, but there's videos, but I use something called the car controller to give you the rotation, which essentially is an end range rotational movement, and I can do it through every joint on my body. And the reason why I do that is because one, you don't lose range of motion because of age. I mean, it can get worse, but I think it's more from disuse and injury, and the injury could make cause the disuse. So I kind of think, Cars have a few different roles. So one, I can use them as a joint maintenance. It's kind of like joint flossing. It's like with flossing your teeth, you're just kind of getting rid of all the bad stuff. Same sort of thing. Like, you know, when people go to jujitsu, like even if somebody, if someone's torquing on your shoulder with a kimura, not bad enough where you're damaged, but you're putting that little bit of stress. I mean, there might be just this micro trauma that overall, you if someone does that day in, day out for years and years, now you'll notice your shoulder is getting. More limited. So I like doing control articular rotations. I think they're very beneficial. I also think they are a good, very self-assessment because as you're going through something, if you start feeling like, oh, when I'm taking my shoulder in this range, I feel pain. 

Dr. Jimenez [00:28:56] And comparing to their side. Other side, yeah. Yeah, okay. That's tight in that. What would be an example of like a car for a shoulder? 

Mike Piekarski [00:29:01] Shoulder, okay, so normally I would have more room. So what I'm gonna do is I'm going to start with this. I'm go across midline. I'm a go as high as I can to this max elevation. I'm keep my chest nice and tall. I'm start to externally rotate my shoulder or internally rotate. And I'd go all the way back. I shouldn't be moving my shoulder or my chest. This is just so I don't hit this thing. I'm all the go all way round and then I reverse. So essentially what I am doing is I am. Doing a rotational, so not only am I doing a big rotational movement, but I'm kind of taking that glen or euma joint and I'm spinning in the socket as I go. So typically what you're gonna see when you run through someone, if someone has like a closing angle pain or classically for people who aren't in the medical field, that's like an impingement, right? So what should happen in a healthy shoulder is you should have more of a stretch in the lat. But if I'm getting a pinch in the front, what that's telling me is that shoulder. There's aberrance joint movement. Like it could just be like it's sore, but it might be that there's like something going on. And especially if there's very like, I get a very sharp vocal pain when I'm going into internal rotation that gives you information. And then usually what I can do is then I can get them on the table and I can check their rotation. Be like, oh, now your internal rotation's really poor. Maybe this is something I need to address. 

Dr. Jimenez [00:30:14] When you do these, do you do this for yourself every day? You try to make sure certain joints are where you're kind of sore. 

Mike Piekarski [00:30:20] Sure. I do, so what I do is I do them daily. I probably realistically do them five days a week because you know, I do everything, but I do the daily and then what I'll do is also do them before I do a workout. So if I'm doing Jiu Jitsu or I'm a strength conditioning program, if I do strength conditioning, it might be like related to what I'm doing that day. So if doing like a upper body day, I might be doing elbow, wrist, shoulder, whatever. 

Dr. Jimenez [00:30:45] I do cars for my hip every time I run. 

Mike Piekarski [00:30:47] Oh, yeah. 

Dr. Jimenez [00:30:47] I run because of tight hip flexors and tight IT band. I think that's helped tremendously with running. 

Mike Piekarski [00:30:54] So, uh, that's one, um, you know, if I'm doing jujitsu, like if anything sore or it's like, okay, well what I, what I like to do, so like, you know, this week we're doing leg entanglement. So it'd be like, all right, well, I'm going to do hip because I'm going to a lot of leg dexterity. I'm gonna do knee because of that rotational movements. And then I do some ankle stuff. 

Dr. Jimenez [00:31:11] Your knee car, would that just be like internal external rotation of the tibia or the shin bone? Yep. 

Mike Piekarski [00:31:15] So what I do is, you can start from 90 degrees. I can just rotate back and forth. And that's the rotational component. And then what I can do is I can add a linear component where I start to externally or internally rotate. I straighten as much as I can. And then I internally rotate from there. So essentially, it becomes a rotational movement. Usually when I teach people, because if I said to the average person, I want you to rotate your leg, you're going to look like I'm a psycho. So usually what I'll do is just start with just in place. This would be called a Capsular Control Articular Rotation because I'm just working on that rotation. Then initially in the initial phase, I usually will do the transition at that 90 degrees because it's easiest. So I'll have them bend and straighten, rotate, bend and straight. And then as they get better, then I can have it like being circular. 

Dr. Jimenez [00:31:59] And I think most people don't understand how much motion there is to the knee. Correct. We just think it's kind of bending and straightening. But there's so many extra various valgus in and out. And then there's that rotation that people don't appreciate. And that's a lot of how ACL tears happen, is that rotation. 

Mike Piekarski [00:32:14] Yeah, so like what are the big things in, you know, as an instructor, like I have run some of my students through cars, but then there's always the big thing for class. It's like, how much time do I want to devote to this? Because it's like the more that I do, it's learning a jujitsu technique. So it's, and I'm big on like training time should be for training. So like if I have 90 minutes, my warmups are those games. So it was like, I'm not having people run in place. Like we're just doing. Low-level grappling activity. So everything should benefit. But it'll be very fascinating is, you know, cause a lot of my students are also current or former patients. You can see people doing their exercises while they're waiting, you now, which is hilarious. 

Dr. Jimenez [00:32:57] OK, so for warm ups, everybody is so warm up averse. And I'll tell you, I even trended towards warm up aversion myself when I teach, because I was like, we only have an hour. So you really only have 40 minutes of instruction, for example, and then maybe 30 minutes, and then the other for training if people want to roll. And a lot of people, it's their workout. People come in after work, and they don't want to hear you talk for an hour, what warm up would you recommend for like five minutes that might be helpful for a class that's only an hour. Just to get everybody's joints moving a little bit better and ready for the. 

Mike Piekarski [00:33:32] What I would do in a perfect world, if I can teach my people to do it before class, because everyone's waiting, so I'd have them do, where do we know that you're gonna get hurt? It's gonna be shoulder, knee, and your spine, maybe neck, whatever, elbow. So I'm gonna have them to do a few of those before. And then my warmup, like I said, is low intensity grappling. So like a lot of times I'll warm people up, we're starting with pummeling, because that's an important skill. I might be doing hand fighting, because you're competitively moving, it's really important. Yesterday, you know, I did. So just like these like CLA games, I just pick specific low intensity ones. So like a guard retention game where it's like, I'm just trying to get inside control or I'm trying to touch you with my feet. Passers just trying clear the feet line. So it's a way that they're getting to do jujitsu, but it's low intensity. So, and then one of the things that I don't know if you're supposed to do in CLA traditionally, but I will still do as I explain why. Because I think a lot of times, a lot the motor learner people will say that if you explain to them that you might be somewhat controlling their ability to learn because you're molding it. But I've also been in stuff where we've done these games and I didn't understand the point where it like, so it didn't actually click. But if I'm like this, and I tell everyone very, very simple, like this silly game when I'm passing, I'm thinking I do that with every single person when I pass. It's like check in the box, clear the feet net. Clear the feet line, clear the knee line, clear the frame, unpack. I might even be, or I might roll with a lighter blue belt and I'm doing it with them, and then I said, you know that game that we did in the beginning? I just did that for 30 seconds and you didn't know. So then they realized, oh, here's a black belt and he's doing it. So what I would like to think is that what gets buy-in where the student's like, oh, this actually does make sense. And then, because now they're warming up, they're getting warm, now they are ready for that harder training. Because the big problem with warmups is people will do, you know, and we've all been in those classes. I don't want to say that they're necessarily run by Brazilians, but they're like 30, 45 minutes of like conditioning and you're exhausted, which the problem with that is if you do that now, it's going to affect your motor learning. So you're not going to be as good at processing. Right. And then it's like, why did I spend 40 minutes doing conditioning when I could have done it on my own? And this coach probably isn't a strength and conditioning coach. So it's, like, what are we doing here? You know what I mean? 

Dr. Jimenez [00:35:55] Sometimes for comp classes, I love that. And it has its role, but probably not every class. For a comp class, you do all that and you're exhausted. You have to know how to also compete when you're exhausted. It doesn't have to be every class, you have to get your foundation first. OK, moving on to some other coaching things. If you could change one thing about how gyms manage injury prevention, or not even change it, but what could you recommend to gym owners that might be seeing a lot of injuries. They happen to jiu-jitsu, frequently. And so how could you recommend people? 

Mike Piekarski [00:36:29] So I think a lot of injuries is based on the culture. So I really, really push in the gym a culture of learning versus winning. You know, like I tap, like, I'll tap to color belts. I don't care. I tell people, I'm like, I see this blue or purple belt, I tap to them. So if I'm a black belt and I tap to a color belt and you're a blue belt and you tap to a bluebelt, why do you care? Like, why are you upset? You know? So I kind of focus on that and it's like, cause look, if you're always just playing your A game I'm gonna be like, cool, I'm the best. Like right now we're in the middle of nowhere Eastern Washington, so it's like I'm the best guy in this little town, who cares? Nobody cares, right? So you'll never get, one, you'll never be able to actually add technical skill because any time you add a new skill, you're not as good. So if you're like, well, if I go with this, I'm like, I wanna do this, but then they might tap me and I'm scared, so I'm just not gonna do it. You'll just never get progress. We've seen all those people, and this is something that I got plateaued at. Purple belt, because I would just try to win every role, and then I was a purple belt for five years. I'm like, why am I not getting better? Probably because I had the wrong mentality, right? 

Dr. Jimenez [00:37:33] Using the same couple moves that you're good at, which when you're going for competition, sure, you know, sharpen that stuff, but regular days, I'm always trying to learn new things and teach new things to my students. 

Mike Piekarski [00:37:43] Yeah, it's one of the things I tell people of like, you don't have a competition on the books. You should be focused on motor development. You have a composition on the book, then you switch from motor development to competition prep. So that's when you can start to refine, you know? So I think that's a big one. And like I said, because I focus on that, I think students get their, you now, focus on control. Like, you were doing leg locks, we were very controlled. It was never like, I'm trying to destroy your leg. And like, you I've been with people and I'll catch their leg and I just hold and I kind of see. And I'm not a big fan of catch and release because if I catch and I release that doesn't, so now then you don't have the awareness, like you were caught. But then also like I do think understanding breaking mechanics is important. So what I mean is once I have the control I can apply it slow. So I'm giving someone plenty of time to tap. And you know, if you watch some of those videos that I showed yesterday, how many times did something happen where they could have tapped but they didn't? They had plenty of times to tap, you know? So I think as long as you give somebody time... You know, like I said, I've never heard anyone out with leg locks. I've been here and I heel hook white belts and kids and I don't care. But, you know. 

Dr. Jimenez [00:38:50] I teach all levels because I think it's important just to understand how to apply them, how to defend them. Sure. And so I teach that in my class. But I do teach more of a catch and release because I'm more nervous that the other person's going to roll the wrong way. Oh, sure, sure. And inside versus outside heel hooks. Inside heel hooks I think are more dangerous, more catastrophic. You can get a much tighter bite on it and the rotation isn't as easy to get out of. Correct. But just the mechanics of it, the way that your leg is rotating to the outside you can do more damage to the knee. And if somebody rolls the wrong way. 

Speaker 3 [00:39:22] They're gonna hurt their own. 

Dr. Jimenez [00:39:22] They're going to destroy their knee, so I do have my people catch them. If they're not going to tap, you move along. 

Mike Piekarski [00:39:28] Well, what I mean is I will release, I will catch it, but what I mean is, I don't just catch it and then let go and then they don't realize, because there's some people that just catch it and they let go. I probably do that too much. 

Dr. Jimenez [00:39:37] I probably do that too much where I catch it because I'm so nervous. 

Mike Piekarski [00:39:40] Since I've been in it. Sure, sure, sure. 

Dr. Jimenez [00:39:42] But yeah, no, that's a good point, and just understanding, look, this is a checkmate. 

Mike Piekarski [00:39:45] Yep, yep. Another thing I would say is teaching break falls, like watching people break fall yesterday, I would like say that I was kind of, obviously there's a lot of different skill levels. I know so many jujitsu gyms that just kind of breeze through break falls. I think that's just a super easy skill that everyone should know. I really think everyone, even if they don't do grappling, should know, like you should learn how to fall. I was running once and I tripped and I just did a roll without thinking about it. I'm like, oh, that was kind cool. But I didn't think about it, I just it. Especially. 

Dr. Jimenez [00:40:13] Especially aging populations and here where it snows and the ice, we see so many older people breaking hips and wrists and backs and things because they just fall on ice. 

Mike Piekarski [00:40:23] Yeah, there was a super interesting study, I think it was somewhere in Britain. It was at least, it was the British Journal of Sports Medicine that released it, but it was like doing a community practice of break falls. It was specifically like a judo practitioner was teaching older people how to fall. And it was, when I was in PT school, I did a clinical in-service, and this is 12 years ago at this point now, but I remember like, this would be a cool idea. So then, and I just talked. You know, is a skilled nursing facility because you have to do your rotations, right? And I'm like, this would be a cool idea. And then seeing how like someone actually did a paper to show, you know? And I've shown a seven-year-old woman had a break fall. Again, I'm not Hariah Goshen, her into a mat, you know, but I'd like, there's the ways you can regress it. And I think those are super important because if you fall correctly, you can minimize injury. Now you're not scared of takedowns. And so many people are like, yeah, I don't want to do takedOWNs because I don't want to get injured. But it's like now you're. A novice if you do do them. 

Dr. Jimenez [00:41:22] Yeah, learning how to fall is huge. We don't, we definitely don't focus enough on that. And I think that's something I took away from yesterday. Go try and teach some better break falls because my break falls aren't great. Like I've fallen on my head more times than I can count just not doing it appropriately or not wanting to concede. 

Speaker 3 [00:41:35] Yeah.

Dr. Jimenez [00:41:35] And I think that's super important. OK, so kind of finishing up here a little bit. If you could give one piece of advice to white blue belts, maybe even younger, because I probably could have used the advice when I was in my 20s starting out. What would you recommend for longevity in the sport? 

Mike Piekarski [00:41:55] I mean, just tap. I mean tapping and training doesn't mean you're losing. Who cares? It doesn't, you know, I think like, I tapped a lot of black, but I just, I just stopped caring. I think you just get to avoid a lot of unnecessary injuries. Just have a more of a, a skilled development mindset than a winning mindset. Competition is different. Obviously you're at a world championship. You know, I've been there. I've, you now I've got my joints popped in a competition, you know, whether it's good or bad, it happened and I get that. You know, but like in training, like who cares? Like you losing in training doesn't mean you're bad at jiu-jitsu, it's just you got caught, right? So I think those are two super easy ways where you can minimize unnecessary injuries and then with you take that mindset, you'll probably get better jiu jitsu quicker in addition to having less injuries, which we know is probably the biggest limitation for mat time. 

Dr. Jimenez [00:42:44] All right, well, thanks for being here. I know we said we were going to keep it short, but we ended up talking a little bit. And where can people find you? 

Mike Piekarski [00:42:50] So find me on Instagram. It is the word doctor underscore kick-ass That's probably the easiest way and then you know Facebook YouTube is there. You know, I have links to all my rehab courses on my Instagram 

Dr. Jimenez [00:43:05] Yeah, really great stuff for physical therapists, athletic trainers, even myself. I enjoy it to help with recovery from surgeries and making sure that people are doing the right things and not going back too soon. All right, well thanks Mike. 

Mike Piekarski [00:43:16] Yeah, thanks for having me.