Body Beautiful: Inside The Abdominal “Box” Part 2 of 2

Body Beautiful: Inside The Abdominal “Box” Part 2 of 2

All Powers Physio Chris Tack details the types of injury incurred from body blows, and how best to administer them.

David Loiseau back kick KO
David Loiseau back kick KO

Following on from our first part of this two piece article, we will go from examining the physiology of abdominal blunt trauma injuries to looking at what happens when MMA athletes take a strike to their body. We will discuss the different forms of injury which may occur and which strikes are best place to cause the required damage.

As mentioned there are a variety of injuries which can be caused by effective strikes to the abdomen.

The most common sites of injury seem to be the spleen and liver, followed by the small and large intestines, kidneys, bladder, diaphragm then pancreas.

Anatomically we can identify certain areas of risk due to strikes and potential targets as:

Visceral structures (organs): kidneys, spleen, liver, stomach, intestine, diaphragm
Anterolateral muscle wall
Bones and cartilage: ribs, xiphisternum
Nerve centres: solar plexus

Soft tissue injuries

Obviously a degree of soft tissue/ muscle damage may be expected from a competitive fight and the most common findings would be a contusion (bruise) to the area struck. This is caused by destruction of the dermis and subcutaneous tissues (skin and underlying connective tissue), rupture of blood vessels and subsequent haemorrhage into the tissues. Bruising is caused by the body’s reaction of increased blood flow and clotting response.

Xiphoid Process/ Sternum

This area is at the end of the breast bone and can be considered either a cartilaginous injury or can be the site of a fracture. The disparity is dependent upon the age of the fighter who is struck in the chest. Between the age of 15 and 29 the xiphoid process fuses to the body of the sternum with a fibrous joint (non-movable). As such, in younger individuals the density of the area is less but plasticity to absorb a blow is higher. As you get older being struck in this region is more likely to result in a fracture as the ossified joint is unable to absorb the stress of a blow.

The area is particularly painful to strike, but a risk is always that if a fracture occurs the end of the process can break off and result in lacerations of the diaphragm.

The technique of choice for this site should be a straight knee, straight punch or front kick in order to translate the force in a direct linear plane into the region.

A straight punch can be used to target the xiphoid process

Rib Fractures 

The rib cage is a protective shell over the most important bodily organs for our survival (heart and lungs). They also take up a large part of the thorax and abdominal cavity. This means that a large degree of strikes thrown to the body will strike either directly or in a glancing fashion to the rib bones.

Due to the density/rigidity of bones, it means that many high powered strikes can be too much for the plasticity of this tissue – resulting in fracture or dislocation. This is a common injury in MMA which is managed well in almost all cases.

Famous cases of this injury demonstrate that different fighters have different methods of dealing with this problem. For example, a traumatic strike in the semi-finals of the third series of The Ultimate Fighter from opponent (and eventual winner) Kendall Grove led Canadian mixed martial artist Kalib Starnes to verbally submit and leave the competition.

Alternatively it is widely known that UFC middleweight champion and phenom Anderson Silva reported that a week before his UFC 117 encounter in Oakland with number one contender Chael Sonnen, he was training at Black House with Japanese Judoka, Olympic gold medalist and MMA fighter Satoshi Ishii when he injured his ribs. He went on to report that in the first round of his UFC 117 victory he felt his rib injure further and this led to limitation of his breathing. X-ray following the fight (which saw a chemically enhanced Sonnen dominate Silva) showed a “crack” of one of his ribs.

This shows that some fighters have the ability to push through this type of injury, whilst others have to stop.

Whilst a simple “crack” or bruising is common, there are variations of this injury which may be more serious. Lower rib fractures can be associated with organ lacerations, such as the spleen and liver. A “flail” chest is particularly dangerous and is when two or three ribs fracture in succession in two different locations. This causes the unanchored portion of the rib/ chest wall to move inward with inhalation and outward with exhalation. This can cause laceration of the pleural sac and collapse of the lung.

A shovel hook punch combines the accuracy, force transference and direction to damage the ribs at their weakest point.

The whole arsenal of body shots can cause damage to the ribs however some shots are more efficient than others. Due to the small surface area of the knuckles shovel-type hooks are the weapon of choice for this target. Aimed at the curve of the lower ribs a precise rotation of the hook into the density of the lower rib bones is effective in causing pain and increases likelihood of fracture due to the smaller width of the bone in that area.


Dana White says regularly that the Zuffa era UFC has never had any serious injuries to the fighters under his banner. However, the history of the UFC in it’s entirety cannot say the same. In fact at UFC 9 (May 1996) one bout saw probably the most serious injury a top flight organisation has ever seen. In the 1st fight of the main card Superheavyweight kick boxer and karateka Zane Frazier took on Tae Kwon Do specialist Cal Horsham.

In a fight which lasted just 3 minutes and 17 seconds, Worsham got not only a win but also the most serious life threatening injury in the UFC’s history. Worsham smothered Frazier with strikes and charged him, taking a knee to the chest in the process. Despite then getting a submission from strikes, Worsham spent a week in the hospital; spending most of it in a critical condition. “ Nasty” Zane Frazier even in defeat had lived up to his nickname by causing a series of injuries including broken ribs, serious heart damage and a pneumothorax (collapsed lung). It was not until he was backstage that Worsham collapsed.

This demonstrates the danger professional fighters put themselves in every time they step into the fighting arena. Even the most protected of our bodily organs can be damaged. Some more than others…


This organ has a wild variety of functions in humans and includes detoxification, protein synthesis and production of various chemicals for digestion. It is also a very large organ with very little protection, leaving it open as a target for precise strikers.

The most proficient of which we have already mentioned – Bas “El Guapo” Rutten. Rutten, a black belt in both karate and Tae Kwon Do, first experienced the glory of the liver shot as a victim on his first day in a Dutch kickboxing gym in his early career. He has previously described how on his first day sparring he was dropped with a body blow and he could not understand how it had effected him.

He obviously took that lesson to heart as he demonstrated in his fight with Jason DeLucia in their Pancrase battle (1996) where he repeatedly knocked down his opponent with scything shovel hooks and straight punches to the body, eventually earning a TKO win and rupturing DeLucia’s liver. Before this he had success with a knee to the same area against Minoru Suzuki, giving him a TKO finish in the same organisation (1994).

K-1 kickboxing champion Ernesto Hoost famed “Perfectly” finished the current UFC fighter Mirko Cro Cop back in the 1999 K-1 Grand Prix; and Cro Cop returned the favour to many of his opponents including Heath Herring and Josh Barnett during his Pride FC days.

More recently David Loiseau (vs. Charles McCarthy); Pete Sell (vs. Scott Smith); Cung Le (vs. Sammy Morgan); and Lyoto Machida (vs. Tito Ortiz), all showed the vulnerability of the liver in MMA. In fact in last seasons series of The Ultimate Fighter Team Koscheck lightweight Nam Phan finished Team GSP opponent Cody McKenzie with a punch to the liver to win and progress to the semi finals.

David Loiseau demonstrates a TKD spinning back kick to the liver (vs. Charles McCarthy)

The liver is located in the upper right quadrant of the abdomen leaving it open to left hook punches and left body kicks. It is also a good target for combinations which turn the opponent away to their left such as a 1-2- body kick combo.

Liver strikes present a increased risk due to the delicateness of the organs tissue, large blood supply and large capacity of hazardous biochemicals (e.g. bile). Common injuries include lacerations, contusions and haematomas.


The spleen is the second most commonly injured intra-abdominal organ. Lacerations of this organ are commonly associated with haematomas. The spleen has a tendency to bleed profusely when it is injured and therefore when ruptured can result in septic shock and the closing down of the main bodily organs. This is not just a career but also a life threatening condition. However, the injury needs to lacerate a blood vessel to lead to this condition, and as such trauma to this organ is less of a risk than liver rupture.

Spleen lacerations are occasionally associated injuries following left lower rib fractures (20% of cases).

The spleen is found within the left upper quadrant of the abdomen. Its functions include removing old red blood cells; recycling iron and holding a reserve of blood in case of circulatory shock.

A flying knee to the spleen moves inwards and upwards in its transference of energy.

Its position leaves in vulnerable to round house and straight kicks, right body hooks, round house knees from the Muay Thai plum or wrestling clinch. Aim for the left side of the opponent’s abdomen just below their pectorals. Extra efficiency of the strike can be made by aiming in a oblique direction (across towards their right shoulder) so that the force is transferred forward, up and inwards.


No… not a Japanese MMA organisation (“Pancrase“)… In fact the pancreas is centred in the upper portion of the abdominal cavity, just below the diaphragm and is a large organ which can again suffer lacerations or contusions. Indications of injury can include enlargement of the organ due to swelling and fluid accumulation.

The pancreas is an endocrine organ which is responsible for the production of hormones and the release of digestive enzymes through pancreatic juice into the small intestine.

Due to the hazardous chemicals this organ contains it is very dangerous should it be ruptured and the contents leaked.

A knee from the clinch can be aimed up into the pancreas on the right side of your opponent’s body.

The most effective strikes to this area are straight knees and teep kicks and body punches. A flying knee can cause enough force when aimed at this area to finish a fight immediately. Strikes should be aimed to just below the bottom rib to the centre or just to the right of the opponents body.


The kidneys organs (of which we have two) have various functions, including homeostatic regulation via balancing of electrolytes, balancing acid-base levels in the body, filtering blood, and regulation of blood pressure.

They are located towards the back of the abdominal “box” either side of the spinal cord. They can be at risk of contusion or laceration. In the case of kidney contusions it may lead to blood in the urine; and with lacerations may lead to urinoma (which is where urine is leaked into the abdomen). Medical attention should be sought should these symptoms occur.

When an opponent shows you his back, round house punches can be aimed straight at the kidneys. 

Their location is beneficial to some extent in that there is less vulnerability due to their posterior position. As such in the stand up portion of a fight they are generally protected. However, they still remain at risk of certain techniques such as knees to the body when “turtling up” on the floor during a grappling exchange; hammer fists or punches during the wrestling clinch against the cage or ropes; and in the case of precise strikers these organs can occasionally be targeted with hook punches and roundhouse kicks when you have a footwork and movement advantage over your opponent.


The bowel is made up of the small intestine (duodenum, jejunum, ileum) and the large intestine (cecum and colon). It takes up a large portion of the abdominal cavity and makes up the connection between the stomach and the anus. Its main function is the absorption of nutrients from food and the break down of this food to allow passage from the body.

The bowel can be damaged through contusion or perforation along its length. Gas leakage into the abdominal cavity can be picked up on CT scan and can be a sign of bowel perforation. Due to its hazardous function, bowel injury can be associated with complications such as infection, abcess, bowel obstruction and fistula (abnormal passageway) formation.

The bowel, whilst having a significant muscle protection barrier by the overlapping of the abdominal muscle wall sections (e.g. rectus femoris, external and internal obliques, TVA), is at risk of strikes for a couple of reasons. Firstly it has an anterior and central placement in the abdominal cavity meaning it is an always open target. Secondly it is a large organ taking up a significant part of the bottom of the abdominal “box”. Thirdly it has a complex and sensitive nerve supply which means it is more likely to be pain provocative when injured.

A forward, straight strike can be aimed at the belt line to target the bowel system. 

To aim your strikes it is most beneficial for this organ to transfer your force and energy straight forward into your target. For example, a jumping front kick/teep can allow your to put your body weight into a blow to this organ just at the point above the belt line. Other techniques could include a low upper cut punch, a straight low knee at the belt line, and switch roundhouse body kick (if your opponent is turned to the side slightly).

Solar Plexus

The solar plexus is also known as the celiac plexus. It is a complex network of nerves located in the abdomen where some large blood vessels branch out of the aorta (specifically the celiac trunk, superior mesenteric artery and renal arteries).

The plexus is located towards the back of the abdomen behind the stomach but in front of part of the diaphragm. It is at the level of the L1 vertebrae meaning it is quite central and below the level of the diaphragm.

The plexus is made up in part by the greater and less splanhnic nerves and right vagus nerves. It is commonly cited that this is the cause of the sensation of having “the wind knocked out of you”. However, blunt trauma to the thorax/ abdomen is more likely due to the production of a significant differential pressure across the diaphragm. This pressure is enough to strains and “deadens” the diaphragm causing it to spasm and contract. This is what causes pain and the cramp sensation which accompanies a well placed body blow. You are unable to catch your breath in this stage due to the inability of the diaphragm to relax. If when you are struck your abdominals are tensed then this dissipates the pressure change through the muscle and prevents the spasm of the diaphragm.

So the location of the plexus is more than likely coincidental to the sensation of being “winded”. However, the fact still remains that the plexus is made up of nerve which when traumatised can cause significant pain. The nerve which are effected supply the abdominal cavity itself so damage to the nerve can potentially cause reduced function of the organs and viscera within the cavity.

An uppercut when aimed at the solar plexus in the centre of the diaphragm can knock the wind out of your opponent. 

Any strike targeted to the two inches below the sternum in the centre of the abdomen can stimulate this effect. The best shots to cause a plexus injury are those heading forwards and upwards (e.g. an uppercut/knee strike).

So concludes our examination of the possible targets of your body strikes in MMA. Remember that direction of force and precise placement through technique and velocity (speed x power) is what will help you end your fights through body strike TKO. Dont go head hunting – use the body to do damage.
Make sure you head over to Chris’ blog, and follow him on Twitter for more unique anatomy related articles.