Strokes and BJJ
With all the neck cranks, tight chokes and failed break-falls I thought it might be interesting to take a look at BJJ to see if there was an association with strokes. After combing through research I came across only one case report on the matter that was published in 2017 (1).
The report states, “A previously healthy 27 year-old professional male Brazilian jiu-jitsu fighter presented to the emergency room with headache, right motor deficit, and aphasia, all commencing 16 hours earlier. The patient had experienced a bout of severe neck pain one week earlier while practicing a submission maneuver known as the Rear Naked Choke or Lion Killer, with persistent pain locally thereafter....".
It was later found that “This particular dissection involved the origin of internal carotid artery.” The mechanism by the stroke had occurred was by 1) carotid artery compression, creating a point of fixation and 2) subsequent hyperextension of the neck, with contralateral head rotation. The resultant traction would suffice to stretch and rupture the intimal layer of carotid artery distal to its point of fixation.
Along with medical treatment, the patient was followed up 1 year later and was continuing to undertake physical therapy focused on retraining gait. The author mentioned that if the patient had sought medical evaluation earlier that he may have had full recovery.
Also rare, there have been other case reports of stroke occurring in wrestling, Judo and MMA (2)(3)(4)(7). At this stage it’s impossible to say how likely a stroke will be caused in BJJ due to a significant lack of research, although as usual it might be wise to avoid neck cranks and tap early. Although I am no expert on the matter, my personal opinion is that in the grand scheme of things BJJ would more likely prevent a greater number of strokes through exercise as opposed to causing them. Something else to consider would be the use of performance-enhancing drugs and to what level they may have a role in the causation of strokes in the sport.
Regardless, It is a good skill to know how to recognise the symptoms of a stroke. Headache and neck pain are very common, and can sometimes be there only indication (5). There are other numerous signs and symptoms to look out regarding strokes, and it should be known that they can present very differently. A pneumonic used to identify some of the more common symptoms is “FAST”; facial droop, arm weakness, speech difficulty, and time to call emergency services (6).
1) Demartini, Z., Rodrigues Freire, M., Lages, R. O., Francisco, A. N., Nanni, F., Maranha Gatto, L. A., & Koppe, G. L. (2017). Internal Carotid Artery Dissection in Brazilian Jiu-Jitsu. Journal of Cerebrovascular and Endovascular Neurosurgery, 19(2), 111–116. http://doi.org/10.7461/jcen.2017.19.2.111
2) Lannuzel A, Moulin T, Amsallem D, Galmiche J, Rumbach L. Vertebral-artery dissection following a judo session: a case report. Neuropediatrics. 1994 Apr;25(02):106-8.
3) Rogers L, Sweeney PJ. Stroke: a neurologic complication of wrestling: A case of brainstem stroke in a 17-year-old athlete. The American journal of sports medicine. 1979 Nov;7(6):352-4.
4) Kato Y, Hayashi T, Tanahashi N, Takao M. Carotid Artery Occlusion Caused by the Judo Chokehold Technique,'Shime-waza'. Internal Medicine. 2017 Apr 1;56(7):881-2.
5) Kim YK, Schulman S. Cervical artery dissection: pathology, epidemiology and management. Thromb Res. 2009 Apr;123(6):810-21.
7) Slowey M, Maw G, Furyk J. Case report on vertebral artery dissection in mixed martial arts. Emergency Medicine Australasia. 2012 Apr 1;24(2):203-6.