Biopsychosocial Approach to Managing Back Pain in Combat Athletes – Part 3 – Indirect, Tissue-Specific Load


In the last post we discussed the impact of direct tissue specific load on back pain. In this post we discuss indirect tissue-specific load, which basically refers to biomechanics, technique and equipment. 


In this context, we use the term biomechanics to describe the movements at joints and the force produced by muscles around the injured area. If we use the example of a fighter who experiences pain with large volumes of punching, we can break down the biomechanics of that technique to ascertain what may be increasing stress on the lower back. When we perform a punch, we need to generate high degrees of rapid rotational force, and this rotation occurs throughout multiple areas of the body. If we are lacking range of motion in important areas such as our hip rotation and upper back rotation then increased rotational demand may be placed on the back. A physical assessment can help determine if such limitations exist, and guide the formulation of a specific program to address these factors. 

Using the same example, if a fighter lacks sufficient strength and power through the hip of the back leg, eccentric braking ability on the lead leg, or rotational strength and control through the core, these can all have the potential to influence the load through the lower back, and can be addressed with specific training modalities. 


When it comes to technique, fighters may have seemingly poor technique but go through the careers without injury. It is more when we see injury arise after a recent change in technique that we may want to address this, and this is where strong communication between health practitioner, skills coach and S&C staff is vital.


The final aspect to consider here is equipment. This can include gloves, protectors, bags, mitts, training surface etc. If a fighter developed pain after moving to a different gym with a stickier flooring which prevented their normal twisting mechanics, and this was the only major change to their training environment, we may want to look closer at this as a possible contributing factor.

About the author

Sam Gilbert

Sam Gilbert is a registered physiotherapist with the Australian Physiotherapy Association (APA) and certified strength and conditioning specialist (CSCS) with the National Strength and Conditioning Association (NSCA). He holds a bachelor’s degree in Physiotherapy from Latrobe university (Melbourne, Australia) and a master’s degree in Exercise Science (Strength and Conditioning) from Edith Cowan University (Perth, Australia).

A 3rd Dan black belt in Shinkyokushinkai Karate under the World Karate Organisation (WKO), Sam participated for over 20 years in full contact competition, winning multiple state and national titles, and culminating in a 4th place in the heavyweight division of the Shinkyokushinkai World Cup in 2009.

As the co-founder and clinical director of Club 360, the premier multi-disciplinary health and fitness center in Tokyo, Japan, Sam has combined his practical experience with an in-depth study of sports performance in relation to combat sports, and strives to help other combat athletes reach their full competitive potential, whilst at the same time decreasing injury risk and increasing competition and training potential.

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By Sam Gilbert