Combat Sports Law

Research was published this week in the journal The Physician and Sports Medicine reviewing the safety of strangulation techniques in MMA.

In the paper, titled The vascular neck restraint of mixed martial arts, the authors reviewed all published medical literature to date on the topic. 25 papers in total were reviewed. In short the authors concluded that more research was needed on potential long term risks of sportive strangulations and the pathophysiology of strangulation induced unconsciousness but that “the current literature appears to demonstrate an acceptable safety profile“.

Below is the full abstract.

ABSTRACT

Objectives

B Mixed martial arts (MMA) brings various forms of martial art disciplines together as a unified sport. Sportive ‘choking,’ also known as vascular neck compression, vascular neck restraint (VNR), or carotid restraints are utilized in MMA to apply jugular and carotid compression and subdue one’s opponent. Few studies have explored the long-term consequences of VNRs, as well as the underlying pathophysiology and hemodynamics of the restraint. A narrative review was conducted in order to explore the long-term consequences of VNRs, as well as the underlying pathophysiology and hemodynamics of the restraint.

Methods

Medical literature published prior to 2025 was identified utilizing MEDLINE/PubMed and the Cochrane Library. Initial search terms included mixed martial arts, injuries, neck chokes, carotid restraints, and vascular neck restraints. Articles were then subcategorized into pathophysiology, safety profile, and medical complications of VNRs. A total of 25 research articles were included in the final manuscript.

Results

Mixed Martial Arts is the fastest growing sport within the United States, especially among the adolescent population. The head and neck region is the most commonly injured territory, with neck chokes comprising 14.1% of reported match stoppage. The pathophysiology of VNR-induced unconsciousness is misunderstood by many. The likely pathophysiologic endpoint is cerebral hypoxia due to reduced cerebral perfusion pressure, primarily from compression of the jugular veins and carotid arteries and, rarely, from carotid sinus baroreceptor compression. In addition, few studies exist regarding the long-term consequences of VNRs. The current literature appears to demonstrate an acceptable safety profile when the VNR is performed properly.

Conclusion

Further studies are needed to explore the underlying pathophysiology of VNR induced unconsciousness, as well as the long term consequences of VNR in order to guide establishment of MMA fighter safety profiles and health-care professional management guidelines.