Study: Chokes may lead to hypoxic brain injury

The effects of mixed martial arts and boxing on the brain are beginning to be understood. Grappling is seen by many as a safer form of combat training, but a recent study suggests that may not be the case.

In a study titled “ Dangers of Mixed Martial Arts in the Development of
Chronic Traumatic Encephalopathy
” (h/t Combat Sports Law), researchers have suggested that it isn’t just striking that could cause brain damage as grappling could also be a cause for concern.

The journal article in question included the following snippet:

“What is perhaps little discussed is the role of asphyxia in the contribution towards long-term behavior and memory changes in the MMA athlete over time. As mentioned, a neck choke is identified as the cause of match stoppage when a competitor submits or the referee stops the match, as the afflicted competitor appears to be syncopal or asphyxiating….In the course of an MMA athlete’s career, it is certain that they would receive such transient asphyxiation episodes multiple times from participation in matches, or even during training, given the fact that the neck choke is a commonly accepted move of offence. Neurological injury due to compression of the neck could potentially occur. In studies pertaining to suicidal hanging, a force of 2 kg was found to be sufficient to compress the jugular veins to the point of causing cerebral edema, followed by the carotid arteries with 5 kg of force, which might cause hypoxic brain injury. Compression of the airways needs a greater force of about 15 kg, which leads to severe hypoxia and death [28]. Doppler sonography reveals that it is possible to completely stop the blood flow of the carotid and vertebral arteries in a neck choke hold, which is characterized by pressure on lateral parts of the neck [29]. The issue of hypoxic ischemic brain injury (HI-BI) may develop in

the long term in MMA athletes as they are subjected to frequent repeated transient asphyxiation and strangulation, leading to intermittent hypoxic events to the brain. Common mechanisms involved in the development of HI-BI include cardiopulmonary arrest, respiratory failure, and carbon monoxide poisoning. It is also known that about 30%–60% of patients who develop HI-BI as a result of cardiac arrest will develop persistent cognitive, behavioral, and neurological problems [30]. Impairment in attention, particularly vigilance and processing speed, together with memory problems have been observed in survivors with HI-BI. In addition, there are also reports of visual spatial dysfunction, apraxia, agnosia, and affective and personality changes in patients who had HI-BI [30]. In our patient, we performed repeated neuropsychological testing, which revealed decreased performance of his attention span and memory over time. There is a possibility that the patient could also have suffered some degree of HI-BI in addition to CTE, which reduced his overall cognitive abilities.”

The effects of jiu jitsu and grappling arts need to be the subject of more studies before we can begin to understand their impact on brain health. While this article is does provide food for thought, it appears that grappling is the lesser of two evils when compared with striking and its exposure to sub-concussive blows.


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