Elevated cerebral perfusion and preserved cognition in elite Brazilian Jiu-Jitsu athletes: Evidence for neuroprotection

The vascular neck restraint of mixed martial arts: understanding the pathophysiology, hemodynamics, and long-term consequences

OBJECTIVES

B Mixed martial arts (MMA) brings various forms of martial arts 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 stoppages. 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 the establishment of MMA fighter safety profiles and health-care professional management guidelines.

Executive Function Strengths in Athletes: a Systematic Review and Meta-Analysis

OBJECTIVE

Whether athletes possess superior executive functions still needs further examination. Therefore, the aim of this study is to explore the executive function advantages of athletes and the differences in these advantages between open- and closed-skill sports through systematic review and meta-analysis.

METHODS

Computer searches of CNKI, Web of Science, PubMed, ScienceDirect, and SPORTDiscus databases were conducted. After document selection, data extraction, and quality assessment by two researchers, data processing, statistical analysis, and visual presentation were performed using SPSS 25.0, Stata 16.0, and GraphPad Prism 8 software.

RESULTS

A total of 41 articles were included, including 3845 athletes with a mean age of 9.6-42.8 years. Athletes showed more positive inhibitory control (Z = 5.18, standardized mean difference (SMD) = -0.631, 95% confidence intervals (CI) = -0.869 to -0.392, p = 0.000) and working memory (Z = 3.42, SMD = -0.382, 95%CI = -0.601 to -0.163, p = 0.001) compared to the general group with no sports experience. Elite and sub-elite, and sub-elite and amateur athletes all showed more positive performance on the cognitive flexibility task compared to the latter. In addition, open-skilled athletes performed more positively on working memory and cognitive flexibility tasks compared to closed-skilled athletes. Egger linear regression analysis revealed a possible publication bias for inhibitory control, whereas there was no publication bias for working memory and cognitive flexibility. Univariate meta-regression analysis revealed that date of publication (β = 0.145) and sample size (β = -0.002) were sources of heterogeneity between studies for the inclusion of cognitive flexibility (p < 0.05). The sensitivity analysis of the one-by-one elimination method and the cut-and-patch method found the results to be relatively robust and reliable.

CONCLUSION

Athletes have superior executive function performance that increases with sports experience. In addition, open-skilled athletes showed more positive executive function. The result has guiding significance for the selection and training of athletes in the future.

Cognitive Assessment in Grappling Athletes Following Choke versus Nonchoke Submissions

PURPOSE

Participation in Brazilian jiu-jitsu and mixed martial arts has increased over the last three decades. These sports feature submission attacks, including strangles. These strangles, termed "chokes" in this context, primarily limit blood flow to the brain via compression of neck vasculature. There has been discussion in literature of the possibility of measurable cognitive effects following transient choking episodes. The present study used the King-Devick test (KDT) platform, a tablet-based reaction time and accuracy task designed to measure participants' number recognition, cognition, and verbal expression. This task requires functional vision, saccadic eye movements, comprehension, and expression.

METHODS

Volunteer participants were screened for exclusion (prior brain injury) criteria and survey information before testing. Athletes were tested with the KDT immediately before a Brazilian jiu-jitsu training session, again immediately after succumbing to either a choke ("Choke" arm) or nonchoke ("Non-Choke" arm) submission while sparring, and again after a 10-min rest period following the postsubmission test. Analysis was done on test failures, total test times, and individual difference scores between baseline and subsequent testing.

RESULTS

Sixty-two (32 Choke, 30 Non-Choke) participants were analyzed. There was no significant difference between Choke and Non-Choke in test failures ( χ2 (1,62) = 1.25, P = 0.263), total times ( t (60) = 0.62, P = 0.540; 95% CI, -3.44 to 6.51), and individual difference scores ( t (60) = 0.29, P = 0.776; 95% CI, -2.41 to 3.21).

CONCLUSIONS

There were no significant differences between study arms in any of the three analyzed measures. This suggests that cognitive functioning, as measured by the KDT, is not affected by transient choking episodes.

Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students

Although sexual choking is now prevalent, little is known about how people engage in choking in terms of frequency, intensity, method, or potential health sequelae. In a campus-representative survey of undergraduate and graduate students, we aimed to: (1) describe the prevalence of ever having choked/been choked as part of sex; (2) examine the characteristics of choking one's sexual partners (e.g., age at first experience, number of partners, frequency, intensity, method); (3) examine the characteristics of having been choked during sex; and (4) assess immediate responses of having been choked including the extent to which frequency and method (e.g., hand, ligature, limb) of having been choked predicts the range of responses endorsed by participants. A total of 4254 randomly sampled students (2668 undergraduate, 1576 graduate) completed a confidential online survey during Spring 2021. The mean age of first choking/being choked was about 19, with more undergraduates than graduate students reporting first choking/being choked in adolescence. Women and transgender/gender non-binary participants were significantly more likely to have been choked than men. Participants more often reported the use of hands compared to limbs or ligature. Common responses to being choked were pleasurable sensations/euphoria (81.7%), a head rush (43.8%), feeling like they could not breathe (43.0%), difficulty swallowing (38.9%), unable to speak (37.6%), and watery eyes (37.2%). About 15% had noticed neck bruising and 3% had lost consciousness from being choked. Greater frequency and intensity of being choked was associated with reports of more physical responses as was use of limb (arm, leg) or ligature.

Approach considerations for the management of strangulation in the emergency department

Patients with a history of strangulation present to the emergency department with a variety of different circumstances and injury patterns. We review the terminology, pathophysiology, evaluation, management, and special considerations for strangulation injuries, including an overview of forensic considerations and legal framework for strangulation events.