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[Physio Explained] Treating UFC athletes with Dr Heather Linden

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In this episode, we chat with Dr Heather Linden who discusses her role as the senior director of medicine in the UFC and the unique nature of working with athletes within this sport. We explore: 

  • The unique role of working with a UFC athlete
  • Specific injuries seen in this athlete population
  • The mindset of these athletes and how to utilise this in an athlete’s rehabilitation
  • The pathway of working with the UFC

Dr. Heather Linden serves as the Senior Director of Physical Therapy at the UFC Performance Institute (UFCPI). She oversees the sports medicine departments at both UFCPI locations in Las Vegas, NV, and Shanghai, China. In 2022, Heather received the prestigious “Trainer of the Year” honor at the World MMA Awards. Prior to her role with the UFC, she was part of the Sports Medicine Division at the United States Olympic & Paralympic Committee and also led an outpatient orthopedic clinic in Los Angeles.

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Our host is @James_Armstrong_Physio

UNKNOWN:

Thank you.

SPEAKER_01:

with this population, you don't tell them what they can't do because they're going to do it. So we kind of manipulate the psyche of it and tell them things they can do. Because if I were to say, hey, I want you to not go to practice today. I want you to take the day off. There's no way they're doing that. So it's like a bartering with children, right? Like it's like, okay, you can do upper body, bags, mitts, lower body. I need you to hold off on kicks due to of a lower extremity fracture. So you just have to kind of manage, give them things to do. Then they're way more compliant.

SPEAKER_02:

In today's episode, we chat with Dr. Heather Linden about the fascinating and exciting world of the UFC. Heather is the Senior Director of Medicine at the UFC, leading a huge team of healthcare and performance professionals at the incredible UFC Performance Institute. She has won multiple World MMA Trainer of the Year awards and worked at several Olympic Games. In today's episode, we cover everything from the unique role of working in the UFC and working with these extraordinary athletes, to some of the specific injuries that Heather sees in this athletic population. We cover some of the mindsets and how to utilize this in athletes rehabilitation and finally we talk about the pathway to working in the UFC. This is a great episode and Heather takes us on an incredible journey of what it's like to work in the UFC. I'm James Armstrong and this is Physio Explained. Heather, welcome to the Physio Explained podcast. It is great to have you on. This is going to be a really great episode, which I think a lot of people are going to find really interesting.

SPEAKER_01:

Thanks for having me today. I'm excited to be here. You

SPEAKER_02:

told me your role off air and it's pretty cool. What role are you in at the moment, Heather?

SPEAKER_01:

Yeah, so I'm the Senior Director of Sports Medicine for all of USC. So I manage all the conservative injury management for the entire 700 plus roster. I manage our three UFC Performance Institute facilities, which is one in Vegas, one in Shanghai, and one in Mexico City. And I have a staff of about 12 underneath me that are physios, athletic trainers, sports chiros. And we just ensure that the UFC athlete is taken care of, that their health and well-being is our priority. And we're treating them inside and outside the octagon to make sure they can perform at the optimal level.

SPEAKER_02:

Amazing. It's a huge role. And I can imagine a role that you've seen develop significantly over the last decade or so, because UFC has just gone mad, hasn't it?

SPEAKER_01:

I mean, almost seven and a half years ago was when the UFC Performance Institute was opened. Before that, there literally was nothing for this athlete population from a performance standpoint, right? So, you know, you look at all these other professional sports, they have their entire interdisciplinary team around them. Eight years ago, there was nothing for the UFC athletes. And we were developed eight years ago and brought in-house. So we have sports medicine, nutrition, strength and conditioning, sports science, and sports psychology. So all 700 athletes that are rostered have free access 24-7 to us.

SPEAKER_02:

Incredible. And out of interest, I mean, how much do they... take on that free service and how many maybe have their own that they use?

SPEAKER_01:

Yeah. So initially I would say when I started seven and a half years ago, almost eight years ago, honestly, nobody really had their own. It was kind of interesting to me. They had like maybe a strength coach that helped them out. Or if they had an injury, they would sort out a physical therapist that they might find. But really, they didn't have a team around them. So when we were developed, it was interesting because, you know, we started showing up to the events. We started opening our doors that they had free access. And they dabbled initially, but they were definitely quite hesitant. Like, who are you guys? You know, are you going to give my darkest secrets away? Getting that trust factor really was integral part of our beginning. And I would say now having a performance team around them and the capabilities, a lot of them are tapping into our services. And then we've gotten so big that we now are collaborating with great providers around the world to help manage these athletes because it is a global population. I can't be in Australia right now treating the athletes. So I work cohesively with Izzy's team, Alec Kokonofsky's team. I know all of their physios And we kind of co-manage and co-treat. You know, I was on a call this morning with an athlete that has a fracture in England and going over with their physio kind of what my return to play protocols look like, getting them back into the octagon. And really, we have a really big global network that we've tapped into support this athlete population.

SPEAKER_02:

Absolutely incredible. So I think the big question is, obviously, the listeners out there will be involved in a lot of different sports. Some of them may well be involved in combat sports, but probably might not be to this level and this intensity. So I think everyone wants to know what sort of injuries are we seeing in UFC and also leading on from that, how does it differ from other sports? Because we know it's going to.

SPEAKER_01:

Yeah, I would say, you know, the type of injuries we see are very dependent on what part of the sport these athletes are doing, right? Because it's mixed martial arts. So, you know, they might be doing striking. So we'll see a lot of shoulder labrons, things like that. But if they're doing jujitsu, we see a lot of dislocations. We see some ligament tears. If they're doing hardcore striking, we've seen lower extremity fractures when it comes to that foot fractures. I would say nothing surprises us in this athlete population. I mean, I could be doing a rehabilitation and five seconds later, someone walks in with a shoulder dislocated or a finger out of socket. And these injuries really don't surprise us because we've now worked around them. I always tell the story, my first day working a fight, the next day after the fight, they came into the physio clinic. And I was like, we need an x-ray pretty much on every part of this athlete. And every x-ray was negative. And now they can walk in and I'll be like, Oh, he's fine. He'll be good in two days. And like, I'll have coaches or other physical therapists look at me and be like, are you sure? And I'm like, no, I've seen it. You know, the human body is absolutely amazing. And with that, I think that sets us apart from other sports. I mean, we are combat athletes. They train well. excessively. One thing, you know, an injury does not hold them back where we see in other sports. Hey, they might be pulled from a game because of an injury. I mean, this athlete population are independent contractors, so they don't get to support their families, put food on the table unless they're actually competing. So, you know, they will compete with injuries going into an octagon. Rarely would I say a nothing going on walking into the octagon, right? Like there are little bumps, bruises, small little ligament issues. We've even seen athletes, you know, with minor small foot fractures and stuff go into the octagon, right? They are a tough population. They are very dedicated to the sport. I mean, I think their whole lives they've been told, rubs some dirt on it, keep going, keep going, keep going, so it doesn't phase them. Where some of the other sports that we see across the world might be pulled out from a toe fracture for two or three games. This population sends me a picture. They'll send me an x-ray. I'm like, yep, we have a few fractures in that toe. And they're like, Great, I'm competing. What do I need to do in the next two weeks so I don't make this worse? They are super excited to watch, but they're also super exciting to get on the physical therapy floor and manage all their injuries.

SPEAKER_02:

That management must be really tough though, because do you find that actually on the occasions where you are advising to hold back, whether it be within a key area of their build up to a fight or... a big fight itself, that must be really hard to manage expectations. And as you say, their need to fight to get paid. I

SPEAKER_01:

would say with this population, you don't tell them what they can't do because they're going to do it. So we kind of manipulate the psyche of it and tell them things they can do. Because if I were to say, hey, I want you to not go to practice today. I want you to take the day off. There's no way they're doing that. So it's like a bartering with children, right? Like it's like, okay, you can do upper body bags, mitts, lower body. I need you to hold off on kicks due to the lower extremity fracture. So you just have to kind of manage, give them things to do. Then they're way more compliant. If you are the typical physio, that's like, oh, that's not 100%. You can't do it. I'm sorry. You just don't last in this field. You have to give and take. You have to find what they can do. and come up with a solution. Otherwise they'll do what you don't want them to do.

SPEAKER_00:

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SPEAKER_02:

And I think there's probably an awful lot we can learn in the physio world, in other sports and in clinical settings around the world, whereby we're quite often quick to say athletes or patients shouldn't be doing it. We could probably get an awful lot more buy-in by saying what you can do and focus on the positives.

SPEAKER_01:

Yeah, I mean, it's crazy because even right now, this population, we have so many top athletes without ACLs and they're competing at the ultimate level. I have learned where previously, like education, you get, hey, there's an injury, let's get it fixed, then move, integrate back into sport, integrate back into performance. This population has taught me that there is no linear strategy, right? It's an up and down, constantly having to be adaptable, flexible, and then understanding that the body can do a lot of things. We tend to always be Approach an injury with caution. I would say this population has taught me that's not necessarily always the best case. I have seen the human body react. I've seen injuries rehab in half the amount of time. I wish that carried over into even the general population because You see somebody, even my own family with a back injury, oh my gosh, let me lay on a bed. I mean, that can be the worst thing to do for a back injury. Getting movement, getting some core activation, some stability back tends to forward progress these injuries at a faster rate than if you just stop doing anything.

SPEAKER_02:

Definitely. I suppose the level of conditioning and fitness that the athletes you're dealing with, that's got to go some way towards helping them in in recovery and resilience, I suppose?

SPEAKER_01:

I will say I've never seen an athlete not train. I think one of the common things that you'll hear sometimes at fights is when someone tires out or gets fatigued or appears to be fatigued on the TV, right? Like you're going, oh my gosh, they didn't train, they didn't prepare enough. This athlete population overprepares. I would say when we see those athletes fatigue, I would say it's more of that stress, cortisol levels, neurological, psyche. You're coming out into an octagon and it's lights. There's people. You get that adrenaline that's going. You're literally trying to almost do a human chess match where you're trying to be stronger than your opponent, faster, more endurance, smarter, all of these components. And I think that's really where we see the fatigue happen that people don't understand. stand. Like you put yourself in, let's say a bear is chasing you. You're going to have an adrenaline dump at some point, right? Think about this athlete population. They stop each round. So you're going to have things like that that happen, not in other sports, because this is the ultimate sport. I mean, I once asked a world champ, like, why do you do this? And they were like, this is a human chess match. This is the hardest, most complicated sport to be in an octagon by yourself. You don't have teammates, you know, sometimes in In teen sports, you can have a little bit of an off day and it might not go unnoticed because you have these great other teammates that pull you in and feed you into that. We don't have that here. You're in an octagon by yourself trying to be stronger, smarter, faster, spot on more than your opponent. And I think that's something that people and the crowds maybe don't always take into consideration.

SPEAKER_02:

Absolutely. A lot of the physios that you've got working there, how do they get into it? working for the UFC, what sort of pathways do you see people take?

SPEAKER_01:

So a lot of them are similar to myself. I will say right now on staff of my 13 of us, there's four or five of us that all went through the Olympic Avenue. Because we got such good experience in combat athletes, we had Olympic wrestling, both Greco and freestyle, men's and women's, right? You had boxing, you had judo, taekwondo, you had men's gymnastics. All of these kind of filter into that mixed martial arts. So I would say I do tend to maybe have a soft spot with that Olympic background that have the knowledge. I have some providers that have been football or wrestling that have really fed well. I also have some that were initial students of mine that just were exceptional. They stood out. And when they applied back for this position out of getting out of school, I thought they were the perfect fit. I think it takes a lot. I have some new employees recently that maybe haven't had the combat experience as much. And by the book, they're like, well, they should be doing this, this, and this. And I'm like, okay, I'm going to make you think a little bit harder. Why can't they do that? And they're loving it because every day I challenge them. And I think every day they challenge me, right? Here's what the research is showing. This is what we're taught. This is what we do. And I'm like, let's challenge that research. Let's see if we can get better outcomes. Let's see if we can prevent things. Let's see if we get better buy-in and trust from this athlete if we meet them in the middle a little.

SPEAKER_02:

And that's a really interesting point there as well, because as we kind of often see, In sport, quite often we see research doesn't necessarily lead the way. Actually, elite sport leads the way for the research to catch up. Are you finding new things and do you filter into research?

SPEAKER_01:

Yeah. So, I mean, at the Performance Institute, we try to be as innovative as possible. So, we're always looking at new technologies. We're feeding into research. We like to be evidence-based, but we also like when evidence meets experience. So, where we can pull in that middle ground. And I think that's what we're constantly challenging at the Performance Institute is like… evidence and then practicality. How does it meet the athlete? Because like you said before, a lot of times research isn't up to par or we're learning about research from this elite population. And I think what we do really well is we're constantly challenging. So what I did seven and a half years ago here is not what I'm doing anymore because we've challenged, we've looked at new things. Where do we get the best data for this athlete population? Where do we understand and really drive the evolution of MMA because there isn't a lot of research on MMA. It's challenging when you pull up MMA research how poor it is. So we really want to be cutting edge and leading in that, but at the same time keeping that human athlete-centered model, which is something that I think gets lost sometimes when you're only driven down the evidence way.

SPEAKER_02:

I'm also aware of sort of my viewpoint on UFC and obviously the women's element of the sport growing massively. I'm just thinking back to the last time I was watching people like sort of Ronda Rousey and people that sort of when she was fighting and then how it's carried on. Have you noticed any changes in themes within the women's element of the sport?

SPEAKER_01:

Yeah, so one of the coolest things that people don't understand about the UFC with the women aspect is We are the only sport in the world that starts our men and women at the same price point. So they make the same amount going in, which is crazy because yes, you might get the evolution. Maybe the men tend to get higher because there's more of a men's audience, but they start on an equal platform. And I will say from seven and a half years ago, the women have gotten so So much more technical. You're starting to see way more excitement and you're starting to see the technical aspect catch up. And I think that's the fun is now you can sell multiple women on a fight card and people love it. People are excited to watch it. So I think the evolution of where the women started and where they're going is just a continuous improvement. like any sport, right? It was a very male-dominant sport, so we saw the evolution of the men a little bit sooner. But now the women, I mean, you look at that fight that's coming up in two weeks at Noche in the Sphere. I mean, Valentina and Alexa Grasa, have you not seen two already amazing, entertaining fights that are so technical-driven? You know, it's awesome. And to see them again go at it is going to be amazing because it is either one of them are so high-level fighters And the quality of athlete you see between both of them is just absolutely drops anyone's jaw.

SPEAKER_02:

And also the platform, the stage that they're on, as you mentioned there, they're getting to sort of be on the biggest platforms of the world. And I kind of suppose, like in other sports, you can make an assumption that, gosh, when they fight, that's when the big injuries occur, etc. But am I right in thinking, actually, you're really seeing the injuries occur in training?

UNKNOWN:

Yeah.

SPEAKER_01:

100%. 100%. Honestly, there's very few. I would say people because you do see blood. You see lacerations, right? People think the brutality, but honestly, the amount of injuries that actually are occurring on the fight night besides a few stitches is minimal, if I'm honest. You might get one or two injuries in an entire night cut. You're like, okay, there could be a fracture there on a fibula or an arm. Otherwise, it's very much all their injuries are That's where we see the chronic injuries turn into more severe. That is also where we see majority of that occur.

SPEAKER_02:

Amazing. Heather I could carry on talking to you for hours on this and I think we definitely need to get you back on and I say that at the end of these podcasts a lot but I think there's loads more we can probably delve into into some of the intricacies of the injuries and the management of these athletes as you say they are a very niche kind of population I think it'd be really interesting to dive into some of that if that's okay with you at some point.

SPEAKER_01:

I would love to be on again and I could talk about this population I mean they make my job so exciting day in and day out so I am always here you No, number one, to give the athletes the props that they deserve. And number two, to say how cool it is to manage it and how much I've learned from them.

SPEAKER_02:

Absolutely. Hedda, thank you so much for your time. And like we just said there, we'll no doubt get you on again and I look forward to it. Thank you

SPEAKER_01:

so much.

SPEAKER_02:

Take care.