When UFC fighters are broken, Heather Linden is on the front lines to help them feel better and get back to training. Heather has experience working with a variety of athletes and is currently the Director of Physical Therapy at the UFC Performance Institute. In today’s podcast, she shares some of her insights about keeping fighters healthy and helping them recover when injuries occur.
In this episode we discuss:
- Heather’s experience at the US Olympic Training Center
- Joining the team at the UFCpi
- 2 most common injuries she sees with UFC fighters
- Overuse vs Traumatic vs Activities of Daily Living
- Managing Your Training Schedule
- Scheduling Recovery Time Each Week
- Coordinating with Other Coaches
- Tips on Finding a Good Therapist
- and more!
Heather Linden serves as the Director of Physical Therapy for the UFC Performance Institute. Prior to joining the UFC, Heather worked at the United States Olympic Committee Sports Medicine Division and was the director of an outpatient orthopedic clinic in Los Angeles.
Heather’s previous title at the USOC was Senior High Performance Health Care Service Provider-Physical Therapist. She worked at the Colorado Springs Olympic Training Center Clinic as part of the USOC’s multi-disciplinary sports medicine team. Heather was on staff for Team USA for the 2012 London Olympic Games, 2014 Sochi Olympic Games, 2015 Parapan Am Games, 2016 Youth Winter Olympic Games, and 2016 Rio Olympic Games. Heather’s responsibilities at the USOC were injury prevention, designing and implementing rehabs, aiding in Elite Athlete Health Profiles, daily treatments, and practice/competition coverage.
Heather is an active member of the American Physical Therapy Association (APTA) and supports the Orthopedic Sections within APTA. Heather is a Credentialed Clinical Instructor by the APTA. Her certifications include Pilates Instructor, Kinesio-Tape Techniques, Mobilization with Movement, Graston, Dry Needling, Functional Movement Screen, Myofascial Decompression, Myofascial Manipulation, Dynamic Neuromuscular Stabilization, Postural Restoration, and Selective Functional Movement Assessment. Heather has diverse experience in areas from pediatrics, geriatrics, amputees to vestibular disturbances; her career specialty is orthopedic manual sports physical therapy.
Full Transcription of Our Podcast with Heather Linden
Interviewer: Corey Beasley
Interviewee/Guest: Heather Linden
COREY: Hey guys, this is Corey Beasley with Fight Camp Conditioning. And today I’m super excited to have Heather Linden. She’s the director of PT at the UFC Performance Institute out there in Vegas. Heather, how’re you doing?
HEATHER: I’m doing great. Thanks for having me.
COREY: Of course, I appreciate cutting out some time for us. Heather, for everybody that’s listening, can you can you give everybody a little two cents of who you are and what you’re doing?
HEATHER: Yep. My name is Heather Linden. I’m the Director of Physical Therapy at the UFC Performance Institute. My background is that I’m a Doctor of Physical Therapy that has been working in sports for almost 10 years now. Initially, getting into sports, I worked with the Olympic team, the US Olympic team, both summer and winter. And I traveled to three Olympic Games, and also was the medical director for the Youth Winter Olympic Games. About a year and a half ago, I was contacted by the UFC about their new Performance Institute that they were opening to kind of facilitate sports performance when it comes to MMA, and really try to prevent injuries and get our athletes a little healthier when they get into the octagon.
COREY: Nice. So how do you guys your start? I saw you got your Bachelor’s at Virginia Tech and then you got your doctorate at Old Dominion.
COREY: And then how did you end up at the Olympic Training Center?
HEATHER: So right after my doctorate, I moved to California to try to pursue sports. And I was very fortunate that the first facility that I started working at actually had a physical therapist that worked with professional boxers. And immediately I knew I wanted to jump into the sports world. But being a new grad, it’s a little bit hard because you just don’t have the experience. And even though you have the energy and enthusiasm of sport, you definitely get the door slammed in your face a little bit so you get the experience.
HEATHER: So I spent the next two years doing a lot continuing education courses, learning a lot about manual based physical therapy, doing manipulation, soft tissue mobilization, graston, cupping kind of all the different aspects and tools that you can have from a sports physical therapist. So I was looking at different avenues to pursue sports. And I had heard about the Olympic team taking volunteers. And it’s a two week volunteer rotation where you go and you work at one of the Olympic Training Centers, and you help them out because they have a pretty significant amount of athletes at that facility and a small really close knit group of providers that only have probably about 10 people to work on up to 400 to 500 athletes.
So — yeah, they pull in providers all over the world, which is actually a great asset, because then these providers end up working with different various national governing bodies, or if the athletes are traveling and need someone to bring and one of the USOC staff can’t do it, we can call on some of the volunteer population to help out. So it really developed a pretty global network of providers from all aspects and disciplines.
So I applied for that. And one thing accepted, I started my two week rotation that was going to be in aColorado Springs Facility. And that I would say is probably the flagship of all the facilities that the Olympic Training Centers have because they can host the most amount of athletes. And it also has a lot of the diagnostic equipment. So I started my first week there. And I just kind of put my head down and went to work on all the manual skills that I had been collecting over the last few years trying to get experience. And after my first week, one of the employees asked if I could come speak with them in their office and I was a little hesitant at first because you’re like, Okay, what did you do something wrong? Did you do something right? Like, no, why are these people pulling you into the office, but it ended up being for the positive. And they asked if I would consider applying for a full time position that they had just had that opened up.
So I took the next week really cleaning up my resume, adding everything to it, and then talking with their Managing Director, and just kind of seeing what they were looking for and if I was a good fit for the position and what it would take for me to move that forward.
So I had pretty much had a whole life in California doing outpatient orthopedics, I was about to own my own facility, when they asked if I would apply and I did and I got the position. And within a month I had moved my whole life to Colorado Springs and became a member of the Olympic Training Center which was a huge change for me. And it was probably my biggest stepping stone on how I’ve gotten to where I am currently.
COREY: Cool. Now, when you were at the US Olympic Training Center, I know you said in California you initially had some experience with boxers. Did that continue your involvement with combat sports at the training center?
HEATHER: Absolutely. So I had started off kind of shadowing the guy with boxers. But then at the facility in Colorado Springs, we have most of our combat sports that are out of there. So we have all three disciplines of wrestling that are there. We have boxing that our resident athletes, we have Paralympic Judo that is there, we get Taekwondo in and out. So a lot of the components of MMA are actually out of that Colorado Springs Olympic Training Center. And I think that just grew my knowledge and my experience working in the combat field.
COREY: Cool. Very good. So being out there, I would imagine, I know with the UFC PI, you guys have an amazing facility. But it is an even — what more impressed me the most I guess was the coordination between all because it’s not just you as a physical therapist, but you have S&C, you have physiologist, you have nutritionists, you have all these different resources that are right there under one roof. With the training center, kind of a situation, I guess with all the team members.
HEATHER: It’s structured very similar, I would say the biggest component is there’s a little bit more siloed effect when it came to the Olympic Training Center. We have all the resources at the Olympic Training Center. So you have multiple different professions in sports medicine, so PTs, chiropractic, massage therapists, athletic trainers, you also pull in doctors that come in weekly to help with console. And then we also have strength and conditioning sports psychologist, sports dietitian.
So it’s a huge facility that pretty much covers all aspects of performance with exercise physiologist, and everything is the same. But it’s also very siloed. So you don’t see the great collaboration as much as you want to, you kind of have to work like go to up the chain and speak to the right person who then to the right person over in that other structure and then you get to collaborate together. So it’s a little bit different than what we have here at the UFC PI. This is probably the first program I’ve worked with that’s truly integrated and multidisciplinary. There’s no egos, there’s no anything here, you know, immediately when we get a new athlete in and we’re doing profiling or looking at what their injuries are or looking if they’re having issues with weight cutting, we immediately sit down as a team. And we have roundtables to discuss them be able to come up with solutions with the athlete and the coaches. So it’s very much integrated in that sense. And I think that’s what makes it so seamless and allows us to really give the most benefit to the athlete.
COREY: Right on. I want to talk about that collaboration a bit more. But first, from your experience. I remember hearing you talk I believe it was in June. And we were out that for that coaches clinic. And he had some really good information about some common injuries. So I mean, no, it doesn’t really matter, I guess between wrestling, boxing, Judo, Taekwondo and MMA. But as far as common injuries that you’re seeing, and I know you had some really good statistics and stuff like that, what are some common things that you’re seeing with guys walking in the door?
HEATHER: I would say the number one injury that we see repetitively in and out almost every day, no matter whether an athlete trains here, or whether an athlete is coming in for an evaluation, is we see a lot of cervical radiculopathy. So a lot of neck issues with radiating symptoms down into their arms. And a lot of this, it’s just from the wear and tear of you know, grappling or history of wrestling, or just from common everyday postures that our population sits in, whether it’s driving to different practices, whether it’s looking at your phone, all of these kind of give people that forward posturing positioning, and when you had a history of some degenerationand stuff that occurs at the neck, a lot of these athletes come in and always complain of I just want you to put an elbow in my shoulder blade, and it gives them temporary relief. But we need to look at the bigger picture with these athletes, what is causing that.
So from a pastoral standpoint, mechanical standpoint, a lot of it, we see the same thing over and over. And it’s really just counter balancing kind of all their everyday wear and tear. So teaching the strength coaches to add that component in when they’re doing their warm ups or adding a few extra exercises when they’re doing their strength programs just to counterbalance what they’re doing all day in training, and then at home on their phones, or driving in and out to other practices.
So I would say that probably the most common we see iscervical injuriesthat possibly haveradicular symptomsdown into one upper extremity. We also see a lot of knee injuries. You’ll see a lot of that with jujitsu and stuff where they’re coming in with LCLsor MCLs that are strained, or meniscus injuries. And a lot of that not only can’t be helped, because you do have an opponent that’s pulling on you, but at the same time knee mechanics, posture, all of that stuff, you know, being aware of where your leg is in space, being able to get in and out of those faulty positions, are also things that can help prevent injuries. So I would say probably our top two right now that we’re seeing is going to be, cervical, into shoulder and upper extremity injuriesand then looking at possibly knee injuries are a huge component.
COREY: Right on. And then neck one, as you say, the neck when I’m sitting here leaning over, looking at my computer with my neck all forward, terrible.
HEATHER: Well we do that every day, just in general, even when we’re just doing general population activities of daily life, we see our posturing that is pretty core. And now on top of that, then we’re throwing three training sessions then where we’re still not forward posturing positioning. And then we have someone and opponents that snapping down our shoulders or pulling on necks and things like that. And all of that leads to just an increased degeneration of what you would see no matter what. So really teaching these athletes that, looking prevention wise, more for longevity of a sport and also just for a healthier lifestyle, whether they continue to sport or get out of this sport eventually.
COREY: Yeah. So you talked about the activity, the daily living, which would maybe move some of those forward, I guess, making the neck worse postures bad. But then also, I’ve heard people talk a lot about the differences between overuse versus the traumatic injuries. And I know it’s a lot of the boys are training a ton, they’re doing a lot of volume, sometimes the intensity is out of control. Between the daily living, the overuse, and the traumatic, how are you kind of getting through to some of these athletes to kind of reorganize their schedule or their training or their life to kind of minimize the damage?
HEATHER: Yep, I would say this population is definitely known for their overtraining, they always feel like they need one up on everything or if they’re not at this practice, they’re going to miss out. And I think first is just education, on recovery, education with coaches. A lot of these athletes have multiple coaches. So really finding one person that’s going to look at your full schedule as an athlete, and really put together, where are your hard days? Where are the days that you’re going to recover?
Because right now, you’ll have an athlete that goes to a practice for grappling and then they go to jujitsu, and each coach is trying to push them a little bit more. So I think number one is really mapping out exactly what their program looks like, so that they can figure out there’s times when there can be recovery. Also really utilizing the services of technology and performance. One of the things we’ve heard multiple times is that athletes it’s a weight cutting sport. Athletes are constantly trying to cut weight and just get a little bit of that competitive advantage. But if an athlete is adding 1 2 3 4 5 more sessions in a week on top of what they are already doing, just for cutting weight, we need to make sure they’re maximizing those sessions.
So really using data driven resourcesand being able to say, Okay, this is where you’re going to burn the most fat, this is where you need to be adding this practices in. And then you’re also looking at it from a recovery standpoint. I’ve always said to my athletes and this was really evident working at the Olympic Training Center, is, especially when you have young athletes, maturing and becoming, keeping the same type of schedule, you would see them a lot breakdown, because they weren’t this young body that was bouncing back as fast as they used to, they would start to get older and things would start to break.
So I always recommend them kind of taking a Wednesday afternoon, and possibly, Sunday off doing something different, it doesn’t mean that they can’t do activity, because a lot of athletes need that stimulation of doing something or they feel like they’re not achieving what they need to be doing. So just modifying that and doing something that’s going to counterbalance what their training is, whether it’s doing yoga, whether it’s doing karate, whether it’s going for a hike, whether it’s swimming, something a little bit different, that can change their body style, and allow the muscle to recover that have worked so hard during the week.
So I think looking at number one, the schedule of exactly where your practices is, two, looking at making sure they make time for recovery. And then also coaches being aware of when they see an athlete fatigue and start underperforming really being aware of what’s the most effective and impactful in that session. I always say, quality is way better than quantityand I think a lot of coaches really can understand that because you would much rather see an athlete do the proper technique, and do that in and out rather than just do a lot of quality, because our bodies really respond to what we do repetitively over and over. Our neurological system works as you know, you teach your body to do something, and it repeats it the same way.
So if you’re teaching your body to do something poorly, technique wise, when you get fatigued in your sport during a fight, you’re probably going to go to those movement patterns and those faulty movement patterns because you’re fatigued during a fight.
So training them in the proper technique where its quality and then you’re also going to see a lot of reduction in injuries. If you are absolutely gasped out and you’re trying to push just forward to get through practice, you’re going to see more injuries occur during that time. And you’re going to see the neurological component where they train those faulty movement patterns.
COREY: Right on, cool, cool, cool. So I mean, some good information just getting down, it seems like I mean, at least common sense wise down to the basics, right? Organizing your schedule, managing time – [Interviewee Interrupts]
COREY: — Making sure you’re recovering enough throughout the week, even if it’s just like you said an afternoon off and Wednesdays, and a full day off on Sundays, even if you’re out playing and goofing around and doing some other stuff, you’re still recovering and not just grinding it out in the gym all the time.
HEATHER: Absolutely. And it’s a hard for these guys, I think initially starting here in this population, they really didn’t want to hear that. But when you look back at where the evolution of sports is and really learning sports performance when it comes to recovery, prevention, and prevention is a very big term in the sense that, you’re never going to completely dismiss all injuries. I mean, that’s what makes sport. We’re expecting our bodies to be above and beyond as what the normal person is when it comes to elite sports.
So you’re going to have injuries, but it’s managing those injuries, reducing the percentage of getting an injury that can be prevented. And then also at the same time making sure your body is top notch every time you’re going in and out of training. And I think with this population, a lot of athletes that are in Las Vegas, realize now that from a sports medicine standpoint, we can be utilized on a daily basis, if something’s not quite feeling, right. So if you had a really hard grappling session the night before, and you know, you can’t look over your right shoulder, usually the population just grinds it out, and they can’t look over the right shoulder another day, another day, another day. And then that’s when we’re seeing injuries occur. But you know, if these athletes, okay, something’s not feeling, right, it’s been two days that I still can’t look over my right shoulder, I should probably look at my resources, and utilize what I have out there to help me so that I can train better. And I think that’s really what the athletes are learning. And I think there’s been a huge increase in the awareness and education in the past year and a half since we’ve been open.
COREY: Yeah, I agree. So let’s talk about that a little bit, because you’re the director of physical therapy. So a lot of people are coming to you when they’re broken, I would imagine.
COREY: They can’t look over the right shoulder. They’re like a throw, throw an elbow and my trap, right, or something along those lines. Honestly, you’re seeing that aspect, but you are one piece of a larger puzzle and I want to talk about that. Because over the years, we’ve heard a lot about collaborating with different coaches, whether they’re tactical skill coaches or S&C, people, or therapists, or whatever it is. And the lack of communication between all those different coaches and people has been a big problem for a lot of people. Would you guys, — you guys have done a wonderful job in your facility, collaborating and coordinating with all the different athletes that are coming through? So can you kind of talk about I mean, real briefly, I guess, because it’s a pretty complex system. But when an athlete walks through your doors, where do you guys start?
HEATHER: So usually Dr. Duncan Frenchwho is our VP of performance is the first pretty much contact with the athlete and the upon the first contact we’re really finding out what is that athlete missing? Why are you coming to us? Is it you had your last fight, you didn’t win? Is it you’ve had chronic injuries? Is that you’ve had weight cutting issues? Is that you’ve never had a strength program? So first, we kind of dwindle down on who’s going to be like the main head component of that.
So Dr. Duncan French sets up the schedule, so that they can kind of get a full evaluation from all aspects. And we highly recommend that the athletes bring their training partner and their coaches and anybody else that they work with. So if they work with a strength coach, or they work with a chiropractor, a PT, we are a facility that doesn’t like — we want the more people to communicate and help, we realize that we’re really small in a huge population of the sport. There’s only a staff of probably 10, or 11, that are here.
So we know the entire roster of almost 600 athletes, there’s no way we can be doing all of that. So we’re honestly really looking to develop a foundation here, where you can actually get, like very much data driven information that can guide the people that are already working with these athletes. I have a lot of athletes, from a injury standpoint, that will just go to the physical therapy, the chiropractic, the massage therapistdown the road, they’ll go to whatever’s easy, whatever’s closest and cheaper and maybe not necessarily someone that’s worked with athletes before. And it’s definitely a different population than the normal, everyday person you’re working with.
For instance, when you’re seeing a normal population of an ACL injury, you’re looking at, it’s going to be a year long rehab, and you’re seeing those people two to three times a week. Whereas when it’s athletes, we’re seeing them one to two times a day, five days a week, and we can really speed that recovery up so that athlete can be back at it like about an eight, nine month period.
So we’re definitely looking at that a little bit differently than the average population. Well we also have to realize that this population is utilizing whatever’s closest and convenient. So we need to educate them that, hey, there are people that work specifically with athletes that have the knowledge, that have the education to help get you on the right track. And then growing that database for all aspects whether its strength and conditioning, working with the people that are out there already working with these athletes and how to make them better, whether it’s the medical field, all various aspects of sports medicine, and making sure they see the right people.
I hear time in and time out, a lot of athletes will say, hey, I went to this facility and they put icing stim on me, and they made me do exercise, I really don’t feel like I did much better. Well, you have to realize that these athletes are exercising every day. So from a medical sports medicine standpoint, really getting hands on approaches, manual based therapy, looking at the root of the problem. So, we hear a lot of times athletes are like like, okay, I just went here, and they treated my shoulder because my shoulder was what, hurt, but it’s actually referring from the neck. So we need to make sure we screen the athletes correctly, do a full neurological screen every time they come in and out, especially with the histories that these athletes have, before we’re doing anything and treating the actual source of what’s compiling and what’s making those symptoms occur.
So really, what we do here is we’re just a database source, we have a lot of great technology, which we’re really fortunate to have underneath our roof. But really facilitate that and growing that global database amongst the people that are out there currently working with our athletes are ready. And if they’re not qualified to be working with our athletes, making sure that the right people are working with them that are appropriate that can increase their performance, and improve the longevity of our athletes.
COREY: Right on. Now, Heather, you kind of alluded to it a little bit but for the people that aren’t able to come to the Performance Institute and work with your team, that when people are looking for a good physical therapist, or a good manual therapist, what’s a great way to find a good person in your area? Are there certain certifications, or education or experience or combination of all of those things?
HEATHER: Yep. So number one, what you can do is we are always a resource, you can always pick up the phone and call any of our staff here about a resource. Both myself and Bobby Gaifers, who’s my colleague that work here, works with the Olympic Training Center and Med providers all over the world. So we have a pretty already global database. And at the same point, what we’re also doing is anytime an athlete comes in and works with us, or if I’m on the road for a fight, or Bobby’s on the road for a fight, we are always talking to athletes and saying, you know, who do you work with? What do you think of them? And if they’re good, we’re always asking athletes to connect us and make that connection so we can add them to the database. Because you never know when another athlete is vacationing in that area, or doing a fight camp in that area, so really developing a global network.
So number one, athletes can always contact us and say, “Hey, do you guys know of anybody that is good in that area? And if so can you connect me to that?”So that’s number one. Number two, I would say when you’re looking at what kind of providers are around your area, always ask them what are their manual qualification, like, do they actually put their hands on? Do they do a full evaluation from head to toe. It shouldn’t just look at one area of the body if it’s injured, you need to really look at a full body assessment before you even start doing anything, because a lot of these athletes have different referral patterns. So it might be their shoulder, it might be their arm, but it could be coming from their neck, or it could be I see a lot of athletes recently talked about they feel like their hamstrings are always really tight and pulled. But a lot of that just stems from the position of the where their pelvis is, and then elongating that hamstring and feeling like, that’s really tight. Even though it’s almost like a false tightness, it’s actually coming from the pelvis or the lumbar spine, they have some neural tension coming from the lower extremities.
So you’re really looking for a provider that’s going to take the time to do a full assessment from head to toe, and then one that’s actually going to put their hands on you. A lot of people will oh I use icing stim or ultrasound, well, honestly, that doesn’t — I’ve never heard of those modalities, correcting an issue. It might treat a symptom that is occurring, but it’s not actually correcting the issue where things are coming from. So educating our population on hey, make sure these people are looking at you from head to toe. If Bobby and I are doing a manipulation or an adjustment, making sure we’ve screened neurologically making sure there’s no issues from a neuro standpoint where we could exacerbate that symptom or make it worse.
So you’re really looking for someone that takes the time to do a full evaluation, you always have us as a resource to kind of ask, and we also would love to talk to that person. I had an athlete recently say, I did a dry needling techniquethat really helped them. And when he went back to his PT, she was like, oh, I don’t do it that way. And she asked me if I could call his PT, explain exactly what we did because he felt it was really beneficial for him and really helped the symptoms. And then her and I discussed it so that she could do the same process in the same technique that I did.
So it’s really being open of number one, more minds are better. So nobody knows everything, first off. So we are looking here, how can we help what’s already out there? How can we integrate with people that have the really good certifications that we’re looking for? And how do we make sure that these athletes are both taking care of?
COREY: Very cool. Well, Heather, I appreciate you sharing that some really, really good advice for people, hopefully, if they can go back, listen to this, maybe twice or three times, they’ll pick up something new every time they listen. But as far as what you’re talking about, from just collaborating, getting a good solid evaluation up front, figuring out what these athletes are needing but then also coordinating their schedule, making sure that they’re managing their intensities and volume throughout the week, as well as just taking time for recovery. And then the tips that you’ve given as far as finding a good therapist, I think my goodness; there are so many people that are out there right now. And so many methods and machines and all these different things that can become very, very overwhelming and confusing for a lot of us. So I mean, just some good bullet points and having you guys as a resource is a huge – is very valuable for the athletes that are in the UFC. So for people that are wanting — [Interviewee interrupts]
HEATHER: And I think that’s key really being that resource. A key, like you said, there’s a lot of things out there, everybody’s trying to find the next best quick fix. In the end, if there was one thing that fixed everybody, obviously, as sports medicine providers, we wouldn’t have jobs anymore. So there really is no magic wand or magic find of anything. So, constantly new technologies are being thrown at these athletes and just being a resource for them, like; Hey, have you heard of this, like, I had an athlete yesterday come to me and say; Hey, I can put a stim and it’s totally going to help me recover. And I’m like, that’s not exactly true, either.It’s just being a resource and saying, this is a technique that is out there that has been used and some athletes have liked it. And being open minded to listen to the athletes and what their needs are. We, as providers tend to want to say we can do this, this, this, and this and I’ll make it better. But usually, the athletes know what their bodies feel like. And if we actually listen to what they need, we can find the solution pretty easily.
COREY: Right on. Well, cool. Well, Heather, if people want to learn more about what you guys are doing out there or stay in touch with you, what’s the best way for them to reach out or find you?
HEATHER: So you can email me always, it’s email@example.com.And then I’m also on social media. All my social media is my first and last name Heather Linden. I will say my social media isn’t that impressive when it comes to I don’t post pictures of me working on athletes all the time and doing this. I kind of let my treatments, my knowledge speak for themselves than more word of mouth because it’s more of a privacy thing. I think, I’m not outsourcing to find more patients to see, I don’t have a business where I need to file for insurance and money. So I’m really lucky that I just get to work with the people that come through my door and I can spend as much time as possible, but I am a resource. Most of my Twitter, Instagram, everything is my first and last name. But I would say the best way is email and it’s just firstname.lastname@example.org.
COREY: OK, cool. Well, guys, I’ll put those links down below so you can stay in touch with Heather if you’d like. Heather, once again, thank you so much for your time. We appreciate everything.
HEATHER: Thanks for having me. It’s a pleasure talking with you guys.