Twists, Taps, and Torn Ligaments: Managing Knee Injuries in Brazilian Jiu-Jitsu

Brazilian Jiu-Jitsu is brutal on knees. That’s the truth of it. Over the years I’ve seen countless competitive BJJ athletes with knee injuries, be it from rom takedowns gone wrong, awkward guard positions, or twisting out of submissions under load.

Whether you’re smashing through guard, twisting out of a submission, or getting caught in a leg entanglement you didn’t see coming, your knees are copping a lot of force. And unlike elbows or shoulders, knees don’t give you a warning crack or pop before something serious goes wrong. Sometimes, the first sign you’ve pushed too far is when you can’t walk properly the next day.

As a physio, I’ve worked with athletes across a lot of sports. BJJ is one of the most mechanically unpredictable. That doesn’t make it unsafe. It just means that if you train regularly, understanding how the knee works, and how it breaks, is essential.

Let’s get into it.

Why the knee?

The knee is a hinge joint. It’s made to bend and straighten. It’s not made to twist, rotate, or hold weight while it's bent sideways.

In BJJ, the knee is constantly put into positions it doesn’t love. You’re kneeling, squatting, driving sideways, resisting torque. You’re loading through unpredictable angles with someone else’s body weight on top of you. That’s where injury risk spikes.

Add a bit of fatigue, one explosive bridge, or a heel hook that goes too far before you can tap, and you’ve got a problem.

The usual suspects: common knee injuries in BJJ

MCL sprain

This one’s incredibly common. The medial collateral ligament (MCL) sits on the inside of the knee and stops it from collapsing inward. In BJJ, it’s easy to injure this when your leg is trapped, or you’re forced into a twist under load.

Often happens when trying to resist a pass, or when someone sits into your knee during an awkward transition. Grades range from minor tweaks to full tears. The good news is that most MCL injuries heal well without surgery — but they do need proper load management.

Meniscus injury

The meniscus is the shock absorber of the knee. It gets caught between the femur and tibia, especially in deep knee flexion, kneeling, or twisting under load.

Symptoms often include pain on the side of the knee, swelling, catching, or a feeling of something “not right” inside the joint. Not every meniscus tear needs surgery, but training through it without proper rehab can make it worse over time.

ACL tear

Less common than MCL or meniscus issues in BJJ, but far more serious. The ACL stabilises the knee during rapid direction changes. In BJJ, it’s vulnerable during takedowns or when the knee twists suddenly under pressure.

A torn ACL usually comes with a pop, rapid swelling, and instability. Some BJJ athletes choose to rehab without surgery, but it depends on the severity and your training goals. Either way, it needs a structured rehab plan and close supervision.

Heel hook-related injuries

This one gets its own category.

The heel hook targets the rotational stability of the knee, not just the ankle. The damage often happens before you feel pain. That’s what makes it so dangerous. When heel hooks are applied quickly or without control, they can injure the ACL, MCL, meniscus, or all three.

If you're rolling with heel hooks, control and communication are non-negotiable. Tap early. Train with people you trust. And don’t be the person who cranks a submission in the gym just to prove a point.

What rehab looks like

At SurfEdge Sports Physiotherapy, I don’t just treat pain. I focus on getting athletes back on the mat. That means rehab isn’t just a few exercises and a pat on the back.

Here’s how we do it:

1. Proper assessment

We figure out exactly what’s going on - not just which structure is irritated, but why it failed. If needed, we refer for imaging. But we always start with a full history and hands-on testing.

2. Realistic goals

Are you aiming to compete again, or just get through open mat without swelling up? We tailor the rehab to suit your goals, your timeframe, and your body.

3. Control before chaos

Strength is essential, but in BJJ, control matters more. You need stability in awkward positions, under fatigue, while thinking five steps ahead. That’s what we train. We start with basic motor control, then build into sport-specific drills that reflect how you move on the mat.

We also include brain endurance training - working on cognitive load and decision-making under pressure. In BJJ, your brain gets as much of a workout as your body. Reacting fast, staying sharp, and solving problems while fatigued is part of the sport. Training your brain to stay engaged when you’re tired can reduce injury risk and improve performance, especially during long rounds or comps.

4. A staged return to training

We don’t jump from the clinic straight back into rolling. First, it’s drills. Then positional sparring. Then light rolls. Then competition prep. If you skip steps, you risk starting the whole cycle again.

Can you prevent knee injuries in BJJ?

Not completely. But you can stack the odds in your favour:

• Warm up properly, especially hips, knees and ankles

• Strength train regularly, not just bodyweight stuff

• Learn to fall and move safely during takedowns

• Don’t train submissions you don’t understand

• Tap early, every time

• Know when your body is telling you to take a break

Prevention isn’t just about stretching. It’s about building resilience and making smart decisions on the mat.

When to see a physio

If your knee feels unstable, clicks or locks, swells after training, or if something just doesn’t feel right — come in. The earlier we catch it, the better your recovery will be.

You don’t have to train through pain. And you don’t have to guess whether you’re safe to keep rolling. That’s what I’m here for.

Training through injury might feel tough, but training smart is tougher. That’s where real gains happen.

Book an appointment at SurfEdge Sports Physiotherapy and let’s keep your knees (and your BJJ game) in good shape.