Study Publishes In Depth Discussion of Combat Sports Strangulation Safety

There is a growing dataset addressing the risks and relative safety of strangulation techniques in combat sports. In short data addressing the practices of strangling an opponent or training partners repeatedly shows relative safety however also some known risk of acute and potentially serious injury.

An noteworthy study (Approach considerations for the management of strangulation in the emergency department) was published (HT to Dr. Stellpflug) educating emergency room physicians about things to look out for when a patient comes in after suffering trauma via strangulation. A segment of the study dealt with combat sports strangulation and did a great job summarizing much of the available data to date. The relevant sections reads as follows for those interested:

3.4 Combat sports

In combat sports, such as mixed martial arts (MMAs) and Brazilian Jiu Jitsu, neck compression maneuvers, or sportive chokes, are common. In elite-level MMA >15% of fights end due to voluntary submission or LOC from sportive chokes.43 In the same series of MMA competitions, which included 5834 fights, 99 (11%) of the 904 fight-ending chokes were associated with LOC.43 This rate of LOC is likely greater in elite competitions than in training, but even in training LOC is common enough that > 25% of grapplers reported having been choked to LOC at least once.10 One third of those surveyed reported having been choked > 500 times.10 This chronic repeated transient neck compression appears safe, but injuries can occur.1044

Medical personnel should be aware of the prevalence of sportive chokes and the potential of related injuries to guide their management. The main injuries for providers to be aware of in this context, as described previously, are structural neck injuries, particularly to the arterial vasculature,4548 and ischemic brain injuries.4950 The latter are exceedingly rare in the sportive context and generally accompany an arterial dissection and/or thromboembolic ischemic stroke as opposed to prolonged neck compression. Differing from other sports-related brain injuries, the mechanism is more similar to other ischemic phenomena as opposed to blunt traumatic effect, although within striking-inclusive sports such as MMA, blunt trauma is a clear confounder.5154

The combat sports use of the term “choke” is a misnomer, because these maneuvers are strangles and almost exclusively focus on vascular compression to accomplish the goal of inducing a submission by the opponent, or LOC if no voluntary submission occurs.9 The anatomic target of sportive chokes is bilateral compression of the jugular veins and, with greater force, the carotid arteries. This reduces CPP and decreases oxygen delivery to the brain, ultimately forcing LOC if there is no submission.9 That LOC can occur in as little as 2.5–3 seconds, but averages slightly <10 seconds once the choke is fully established.22 Assessment and management of athletes exposed to sportive chokes is very much the same as strangling victims in other contexts. A special note on the physical examination is that neck marks are common and rarely representative of underlying damage, especially when athletes are training or competing in the traditional judo or jiu jitsu gi.

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