0:00

Thank

0:02

you.

0:05

with this population, you don't tell

0:08

them what they can't do because

0:10

they're going to do it. So we kind

0:12

of manipulate the psyche of

0:14

it and tell them things they can do.

0:16

Because if I were to say, hey, I

0:18

want you to not go to practice today.

0:20

I want you to take the day off.

0:23

There's no way they're doing that. So it's

0:25

like a bartering with children, right?

0:27

Like it's like, okay, you can do

0:30

upper body, bags, mitts,

0:33

lower body. I need you to hold off on kicks

0:35

due to of a lower extremity fracture. So you just have

0:37

to kind of manage, give them things to do. Then

0:39

they're way more compliant.

0:44

In today's episode, we chat with Dr. Heather

0:46

Linden about the fascinating and exciting

0:49

world of the UFC. Heather is

0:51

the Senior Director of Medicine at the UFC,

0:53

leading a huge team of healthcare and performance

0:56

professionals at the incredible UFC

0:58

Performance Institute. She has

1:00

won multiple World MMA Trainer

1:03

of the Year awards and worked at several

1:05

Olympic Games. In today's episode, we

1:07

cover everything from the unique role

1:10

of working in the UFC and working with these

1:12

extraordinary athletes, to some of the specific

1:15

injuries that Heather sees in this

1:17

athletic population. We cover some of the mindsets

1:20

and how to utilize this in athletes

1:22

rehabilitation and finally we talk about

1:25

the pathway to working in the UFC.

1:27

This is a great episode and Heather

1:29

takes us on an incredible journey of what it's

1:32

like to work in the UFC. I'm

1:34

James Armstrong and this is Physio

1:36

Explained. Heather,

1:41

welcome to the Physio Explained

1:43

podcast. It is great to have you on. This

1:45

is going to be a really great episode, which I think a lot

1:47

of people are going to find really interesting.

1:50

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

1:52

You

1:53

told me your role off air and it's pretty

1:55

cool. What role are you in at the moment, Heather?

1:58

Yeah, so I'm the Senior Director of Sports Medicine

2:00

for all of USC. So I

2:03

manage all the conservative injury

2:06

management for the entire 700

2:08

plus roster. I manage

2:10

our three UFC Performance Institute

2:13

facilities, which is one in Vegas,

2:16

one in Shanghai, and one in Mexico

2:18

City. And I have a staff of about 12

2:21

underneath me that are physios, athletic

2:24

trainers, sports chiros.

2:26

And we just ensure that the UFC

2:29

athlete is taken care of, that their health and well-being

2:31

is our priority. And we're treating

2:33

them inside and outside the octagon to make

2:36

sure they can perform at the optimal

2:38

level.

2:39

Amazing. It's a huge

2:41

role. And I can imagine a role that you've

2:44

seen develop significantly

2:46

over the last decade or so, because UFC

2:48

has just gone mad, hasn't it?

2:51

I mean, almost seven and a half years ago was

2:53

when the UFC Performance Institute was

2:56

opened. Before that, there literally

2:58

was nothing for this athlete population

3:00

from a performance standpoint, right?

3:02

So, you know, you look at all these other professional

3:05

sports, they have their entire interdisciplinary

3:07

team around them. Eight years ago, there

3:10

was nothing for the UFC athletes. And

3:12

we were developed eight years ago and

3:15

brought in-house. So we have sports medicine,

3:17

nutrition, strength and conditioning,

3:19

sports science, and sports psychology.

3:22

So all 700 athletes that are rostered

3:24

have free access 24-7 to

3:27

us.

3:28

Incredible. And out of interest, I mean, how

3:31

much do they... take on

3:33

that free service and how

3:35

many maybe have their own that they

3:37

use?

3:38

Yeah. So initially I would say when I started seven

3:40

and a half years ago, almost eight years ago, honestly,

3:42

nobody really had their own. It was kind

3:45

of interesting to me. They had like

3:47

maybe a strength coach that helped them out. Or

3:49

if they had an injury, they would sort

3:52

out a physical therapist that they might find.

3:55

But really, they didn't have a team around

3:57

them. So when we were developed,

3:59

it was interesting because, you know, we started showing

4:01

up to the events. We started opening our doors

4:03

that they had free access. And they dabbled

4:06

initially, but they were definitely quite hesitant.

4:09

Like, who are you guys? You know,

4:11

are you going to give my darkest secrets

4:13

away? Getting that trust

4:15

factor really was integral part of our

4:17

beginning. And I would say now

4:20

having a performance team around them and the capabilities,

4:23

a lot of them are tapping into our services. And

4:25

then we've gotten so big that

4:27

we now are collaborating with great

4:30

providers around the world to help

4:32

manage these athletes because it is a global population.

4:34

I can't be in Australia right now treating

4:36

the athletes. So I work cohesively

4:39

with Izzy's team, Alec

4:42

Kokonofsky's team. I know all of their

4:44

physios And we kind of co-manage

4:47

and co-treat. You know, I was on a call this morning

4:49

with an athlete that has a fracture

4:52

in England and going over

4:54

with their physio kind of what my return

4:56

to play protocols look like, getting them back into

4:58

the octagon. And really, we have

5:01

a really big global network that we've

5:03

tapped into support this athlete population.

5:05

Absolutely incredible. So I think the

5:08

big question is, obviously, the

5:10

listeners out there will be involved

5:12

in a lot of different sports. Some of them may well

5:14

be involved in combat sports, but probably

5:16

might not be to this level and

5:18

this intensity. So I think everyone wants to

5:20

know what sort of injuries are

5:22

we seeing in UFC and also

5:25

leading on from that, how does it differ from other

5:27

sports? Because we know it's going to.

5:29

Yeah, I would say, you know, the type of

5:31

injuries we see are very dependent

5:33

on what part of the sport these athletes

5:36

are doing, right? Because it's mixed martial arts. So,

5:39

you know, they might be doing striking. So

5:41

we'll see a lot of shoulder labrons, things

5:43

like that. But if they're doing jujitsu, we

5:46

see a lot of dislocations. We

5:48

see some ligament tears. If

5:50

they're doing hardcore striking, we've seen

5:52

lower extremity fractures when it comes to that

5:54

foot fractures. I would say nothing

5:57

surprises us in this athlete population.

5:59

I mean, I could be doing a rehabilitation

6:02

and five seconds later, someone walks in with

6:04

a shoulder dislocated or a finger out

6:06

of socket. And these injuries really

6:09

don't surprise us because we've now worked

6:11

around them. I always tell the story,

6:13

my first day working a fight,

6:15

the next day after the fight, they came into

6:18

the physio clinic. And I was

6:20

like, we need an x-ray pretty much on every

6:22

part of this athlete. And every

6:25

x-ray was negative. And now they can walk

6:27

in and I'll be like, Oh, he's

6:29

fine. He'll be good in two days. And like, I'll

6:32

have coaches or other physical therapists

6:34

look at me and be like, are you sure? And I'm

6:36

like, no, I've seen it. You know, the human body

6:39

is absolutely amazing. And

6:41

with that, I think that sets us apart

6:43

from other sports. I mean, we are

6:45

combat athletes. They train well.

6:48

excessively. One thing, you know, an

6:50

injury does not hold them back where we see

6:52

in other sports. Hey, they might be pulled from a game

6:55

because of an injury. I mean, this athlete

6:57

population are independent contractors, so

6:59

they don't get to support their families, put

7:02

food on the table unless they're actually

7:04

competing. So, you know, they will compete

7:06

with injuries going into an octagon.

7:08

Rarely would I say a nothing

7:13

going on walking into the octagon, right? Like there

7:15

are little bumps, bruises, small

7:18

little ligament issues. We've

7:20

even seen athletes, you know, with minor small

7:22

foot fractures and stuff go into the

7:25

octagon, right? They are a tough

7:27

population. They are very

7:29

dedicated to the sport. I mean, I think

7:32

their whole lives they've been told, rubs some dirt

7:34

on it, keep going, keep going, keep going, so it doesn't

7:36

phase them. Where some of the other sports that

7:38

we see across the world might

7:40

be pulled out from a toe fracture

7:42

for two or three games. This population

7:45

sends me a picture. They'll send me an x-ray.

7:48

I'm like, yep, we have a few fractures in

7:50

that toe. And they're like, Great, I'm competing.

7:52

What do I need to do in the next two weeks so I don't make this worse?

7:55

They are super excited to watch, but

7:57

they're also super exciting to get on

7:59

the physical therapy floor and manage all

8:01

their injuries.

8:02

That management must be really tough though, because do

8:04

you find that actually on the occasions

8:06

where you are advising to hold back,

8:09

whether it be within a key

8:11

area of their build up to a fight

8:13

or... a big fight itself, that must be

8:15

really hard to manage expectations.

8:18

And as you say, their need to fight

8:20

to get paid. I

8:22

would say with this population, you

8:24

don't tell them what they can't

8:26

do because they're going to do it. So

8:28

we kind of manipulate the psyche

8:31

of it and tell them things they can do.

8:33

Because if I were to say, hey, I

8:35

want you to not go to practice today.

8:37

I want you to take the day off.

8:40

There's no way they're doing that. So it's

8:42

like a bartering with children, right?

8:44

Like it's like, okay, you can do

8:47

upper body bags, mitts,

8:50

lower body. I need you to hold off on kicks

8:52

due to the lower extremity fracture. So you just have

8:54

to kind of manage, give them things to do. Then

8:57

they're way more compliant. If you

8:59

are the typical physio, that's like,

9:01

oh, that's not 100%. You can't do

9:03

it. I'm sorry. You just don't last

9:06

in this field. You have to give and take. You

9:08

have to find what they can do. and

9:10

come up with a solution. Otherwise they'll

9:12

do what you don't want them to do.

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9:49

And I think there's probably an awful lot we can learn in

9:51

the physio world, in other sports and in clinical

9:54

settings around the world, whereby we're quite

9:56

often quick to say athletes or

9:58

patients shouldn't be doing it. We could probably get

10:00

an awful lot more buy-in by saying what

10:03

you can do and focus on the positives.

10:05

Yeah, I mean, it's crazy because even right

10:08

now, this population, we have

10:10

so many top athletes without

10:12

ACLs and they're competing at the ultimate

10:15

level. I have learned where

10:18

previously, like education, you get,

10:20

hey, there's an injury, let's get it fixed, then

10:23

move, integrate back into sport, integrate

10:25

back into performance. This population

10:27

has taught me that there is no linear

10:30

strategy, right? It's an up

10:32

and down, constantly having

10:34

to be adaptable, flexible,

10:36

and then understanding that the body can do

10:39

a lot of things. We tend to

10:41

always be Approach an injury with

10:43

caution. I would say this population

10:45

has taught me that's not

10:47

necessarily always the best case. I

10:50

have seen the human body react. I've

10:52

seen injuries rehab in

10:55

half the amount of time. I wish

10:57

that carried over into even the general population

10:59

because You see somebody, even

11:02

my own family with a back injury, oh

11:04

my gosh, let me lay on a bed. I mean,

11:06

that can be the worst thing to do for

11:08

a back injury. Getting movement, getting

11:11

some core activation, some stability back

11:13

tends to forward progress these

11:16

injuries at a faster rate than if you just

11:18

stop doing anything.

11:20

Definitely. I suppose the level of

11:22

conditioning and fitness

11:24

that the athletes you're dealing with, that's got

11:26

to go some way towards helping them in in

11:29

recovery and resilience,

11:31

I suppose?

11:32

I will say I've never seen an

11:34

athlete not train. I think one

11:36

of the common things that you'll hear sometimes

11:38

at fights is when someone tires out or

11:40

gets fatigued or appears to be fatigued

11:43

on the TV, right? Like you're going, oh

11:46

my gosh, they didn't train, they didn't prepare enough.

11:48

This athlete population overprepares.

11:51

I would say when we see those athletes fatigue,

11:54

I would say it's more of that stress, cortisol

11:57

levels, neurological, psyche.

11:59

You're coming out into an octagon and

12:01

it's lights. There's people. You

12:03

get that adrenaline that's going. You're

12:06

literally trying to almost

12:08

do a human chess match where you're trying to

12:11

be stronger than your opponent, faster,

12:13

more endurance, smarter,

12:16

all of these components. And I think that's really

12:18

where we see the fatigue happen that

12:20

people don't understand. stand. Like you put

12:22

yourself in, let's say a bear is chasing

12:25

you. You're going to have an adrenaline dump

12:27

at some point, right? Think about this athlete

12:29

population. They stop each round.

12:32

So you're going to have things like that that happen,

12:35

not in other sports, because

12:37

this is the ultimate sport. I

12:39

mean, I once asked a world champ, like,

12:41

why do you do this? And they were like, this is a human

12:43

chess match. This is the hardest, most complicated

12:46

sport to be in an octagon by yourself.

12:48

You don't have teammates, you know, sometimes

12:51

in In teen sports, you can have a little bit of an

12:53

off day and it might not go unnoticed

12:56

because you have these great other teammates that

12:58

pull you in and feed you into that.

13:01

We don't have that here. You're in an octagon by

13:03

yourself trying to be stronger,

13:05

smarter, faster, spot on more

13:07

than your opponent. And I think that's something that

13:10

people and the crowds maybe don't always take

13:12

into consideration.

13:13

Absolutely. A lot of the physios that you've

13:15

got working there, how do they get

13:18

into it? working for the UFC,

13:20

what sort of pathways do you see people

13:22

take?

13:22

So a lot of them are similar to myself. I will

13:25

say right now on staff of my

13:27

13 of us, there's four or five

13:29

of us that all went through the Olympic Avenue.

13:32

Because we got such good

13:34

experience in combat athletes, we had

13:36

Olympic wrestling, both Greco

13:39

and freestyle, men's and women's,

13:41

right? You had boxing, you

13:44

had judo, taekwondo, you had

13:46

men's gymnastics. All of these kind

13:48

of filter into that mixed martial arts. So

13:51

I would say I do tend to maybe

13:53

have a soft spot with that Olympic

13:55

background that have the knowledge. I

13:57

have some providers that have been football

14:00

or wrestling that have really fed

14:02

well. I also have some that were initial

14:05

students of mine that just were exceptional.

14:07

They stood out. And when they applied

14:10

back for this position out of getting out of school, I thought

14:12

they were the perfect fit. I think

14:14

it takes a lot. I have some new employees

14:17

recently that maybe haven't had

14:20

the combat experience as much. And

14:23

by the book, they're like, well, they should be doing this, this,

14:25

and this. And I'm like, okay, I'm going to make you think

14:27

a little bit harder. Why can't they

14:29

do that? And they're loving

14:31

it because every day I challenge them. And I think every

14:33

day they challenge me, right? Here's what the

14:35

research is showing. This is what we're taught.

14:38

This is what we do. And I'm like, let's challenge

14:40

that research. Let's see if we can get better outcomes.

14:43

Let's see if we can prevent things. Let's see if we get better

14:45

buy-in and trust from this athlete if we meet

14:47

them in the middle a little.

14:49

And that's a really interesting point there as well, because

14:51

as we kind of often see, In sport,

14:53

quite often we see research doesn't necessarily

14:56

lead the way. Actually, elite sport leads

14:58

the way for the research to catch up. Are

15:01

you finding new things and do you filter

15:03

into research?

15:04

Yeah. So, I mean, at the Performance Institute, we

15:06

try to be as innovative as possible. So,

15:08

we're always looking at new technologies. We're feeding

15:10

into research. We like to be evidence-based,

15:13

but we also like when evidence meets

15:16

experience. So, where we can

15:18

pull in that middle ground. And I think that's

15:20

what we're constantly challenging at the Performance

15:22

Institute is like… evidence and

15:25

then practicality. How does it meet the athlete?

15:27

Because like you said before, a lot

15:30

of times research isn't up to par

15:32

or we're learning about research from

15:34

this elite population. And I

15:37

think what we do really well is we're

15:39

constantly challenging. So what I did seven

15:41

and a half years ago here is not what I'm doing

15:44

anymore because we've challenged, we've

15:46

looked at new things. Where do we get the best

15:48

data for this athlete population? Where do we

15:50

understand and really drive

15:53

the evolution of MMA because there isn't

15:55

a lot of research on MMA. It's challenging

15:58

when you pull up MMA research

16:00

how poor it is. So we

16:02

really want to be cutting edge and leading

16:04

in that, but at the same time keeping

16:06

that human athlete-centered model,

16:09

which is something that I think gets lost sometimes

16:11

when you're only driven down the evidence

16:13

way.

16:14

I'm also aware of sort of my viewpoint

16:16

on UFC and obviously the women's

16:19

element of the sport growing massively.

16:21

I'm just thinking back to the last time I was watching people like

16:23

sort of Ronda Rousey and people that sort of when she

16:25

was fighting and then how it's carried on.

16:27

Have you noticed any changes in themes

16:30

within the women's element of the sport?

16:32

Yeah, so one of the coolest things that people don't

16:34

understand about the UFC with the women aspect

16:36

is We are the only sport in

16:38

the world that starts our men and women

16:41

at the same price point. So they make the

16:43

same amount going in, which is crazy

16:45

because yes, you might get the evolution. Maybe

16:47

the men tend to get higher because there's more

16:50

of a men's audience, but they

16:52

start on an equal platform. And I will say

16:54

from seven and a half years ago, the women

16:57

have gotten so So much

16:59

more technical. You're starting to see

17:02

way more excitement and

17:04

you're starting to see the technical

17:06

aspect catch up. And I think that's

17:08

the fun is now you can

17:11

sell multiple women on

17:13

a fight card and people love it. People

17:15

are excited to watch it. So I think

17:17

the evolution of where the women started and

17:19

where they're going is just a continuous

17:22

improvement. like any sport, right?

17:25

It was a very male-dominant sport, so we saw

17:27

the evolution of the men a little bit sooner.

17:29

But now the women, I mean, you

17:32

look at that fight that's coming up in two weeks

17:34

at Noche in the Sphere. I mean,

17:36

Valentina and Alexa Grasa, have

17:39

you not seen two already

17:41

amazing, entertaining fights that

17:43

are so technical-driven? You

17:45

know, it's awesome. And to see them again

17:48

go at it is going to be amazing because it

17:50

is either one of them are so high-level

17:53

fighters And the quality of athlete you see

17:55

between both of them is just absolutely

17:57

drops anyone's jaw.

17:59

And also the platform, the stage that

18:01

they're on, as you mentioned there, they're getting

18:03

to sort of be on the biggest platforms of the world.

18:06

And I kind of suppose, like in other sports,

18:08

you can make an assumption

18:10

that, gosh, when they fight, that's when the

18:12

big injuries occur, etc. But am

18:15

I right in thinking, actually, you're really seeing the injuries

18:17

occur in training?

18:18

Yeah.

18:18

100%. 100%. Honestly,

18:21

there's very few. I would say people

18:24

because you do see blood.

18:26

You see lacerations, right? People

18:28

think the brutality, but honestly, the amount of injuries

18:30

that actually are occurring on the fight night

18:32

besides a few stitches is minimal,

18:35

if I'm honest. You might get one or

18:37

two injuries in an entire night cut. You're like,

18:39

okay, there could be a fracture there on

18:42

a fibula or an arm. Otherwise,

18:44

it's very much all

18:46

their injuries are That's

18:48

where we see the chronic injuries turn into more

18:50

severe. That is also where we see

18:53

majority of that occur.

18:55

Amazing. Heather I could carry on talking to you

18:57

for hours on this and I think we definitely

18:59

need to get you back on and I say that at the end of these

19:02

podcasts a lot but I think there's loads more we can probably

19:04

delve into into some of the intricacies

19:06

of the injuries and the management of these

19:09

athletes as you say they are a very

19:11

niche kind of population I think it'd

19:13

be really interesting to dive into some of that if that's

19:16

okay with you at some point.

19:17

I would love to be on again and I could talk

19:19

about this population I mean they make

19:21

my job so exciting day in and day out

19:24

so I am always here you

19:26

No, number one, to give the athletes the props

19:28

that they deserve. And number two, to say how

19:30

cool it is to manage it and how much I've learned from them.

19:33

Absolutely. Hedda, thank you so much

19:35

for your time. And like we just said there, we'll

19:37

no doubt get you on again and I look forward to it. Thank

19:40

you

19:40

so much.

19:41

Take care.