Assessment of Injuries During Brazilian Jiu-Jitsu Competition

Increasing trend in Brazilian Jiu Jitsu injuries presenting to U.S. emergency departments - a 10-year analysis and injury profile

OBJECTIVE

Evaluate injury trends in Brazilian Jiu Jitsu (BJJ) participation by presenting to U.S. emergency departments over a 10-year period and formulate an injury profile.

METHODS

The U.S. Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS) database was queried for martial arts related injuries from 1 January 2012 to 31 December 2021. Codes and narratives were examined to compile data for patients sustaining BJJ-related injuries.

RESULTS

From 1 January 2012 to 31 December 2021 there were 7,722 (NE = 282,315) ED-diagnosed martial arts related injuries with 911 (NE = 36,023) BJJ-related injuries identified. Regression analysis demonstrated an increasing trend in the annual incidence of Brazilian Jiu Jitsu injuries presenting to the ED (R2 = 0.934; SE = 2.069: p < .0001). Average age was 25.68 years of age (range 4-83). The most common injury diagnoses were sprains/strains and other/not listed at 27.68% and 26.39%. The most commonly injured body parts were the upper trunk, and the shoulder comprising 13.66% and 12.14% of injured body parts, respectively. The most commonly fractured region was toes, at 14.15% of all fractures. The most common dislocations occurred at the shoulder and knee, at 32.49% and 28.45% of dislocations, respectively. The most common mechanisms of injury specifically identified were indeterminate contact between players, fall onto ground, or fall onto another player comprising 18.62% and 17.17%, of injuries, respectively.

CONCLUSION

There was an increasing trend of BJJ-related injuries presenting to U.S. Emergency Departments. The most common diagnoses and body parts injured were sprains/strains and upper trunk and shoulder, respectively. The most commonly fractured and dislocated regions were toes and shoulder, respectively. The most common mechanisms of injury were indeterminate contact or falling. This study provides novel information concerning trends in injury and injury profiles for Brazilian Jiu Jitsu related injuries.

Martial Arts: Orthopaedic Injuries and Related Biomechanics

Martial arts are various systems of combat skills encompassing striking and grappling. Many styles have evolved into modern sports, and some have been included in the Olympics. The physicality of these can predispose practitioners to musculoskeletal injuries, such as anterior cruciate ligament ruptures; patellar, shoulder, or elbow instabilities; extremity fractures; and hand and spine injuries, which have been studied both clinically and biomechanically. The most common injury related to longer time loss from participation is an anterior cruciate ligament rupture. Higher injury incidence is associated with a higher level of experience and competition. Orthopaedic management of martial arts injuries should reflect the specific needs of each martial artist and the biomechanics of motions common to each style. Full-contact practitioners may benefit from broader surgical indications and special attention to the choice and positioning of implants; nonsurgical treatment may be appropriate for certain pediatric or noncontact practitioners. Approximately 60% of martial artists can return to the preinjury level of participation after a major injury. Injury prevention and rehabilitation programs should optimize neuromotor control and core engagement to ensure proper body mechanics. Gradual incorporation of martial arts movement into the postoperative physical therapy curriculum can benefit physical progress and help gain confidence toward full participation.

An epidemiological study of martial arts injuries in patients presenting to US emergency rooms

INTRODUCTION

With the advent of mixed martial arts (MMA) growing in popularity, there has been a described increase in its participation. The term MMA generally describes the hybridization of combat disciplines including but not limited to: karate, judo, jiu-jitsu, wrestling, taekwondo, boxing, kickboxing, and Muay Thai. With increased participation in MMA and martial arts, differing physical demands are placed on participants. Due to the physical nature of combat sports, there are injuries associated with participation. The purpose of this study is to report the incidence and characteristics of injuries seen from various martial art disciplines presenting to United States Emergency Rooms in order to educate participants and providers alike about risks assumed with participating in martial arts.

METHODS

The National Electronic Injury Surveillance System (NEISS) database was queried for martial arts-related injuries from 2009 to 2019. Cases were examined and data including patient age and gender, injury type and location, hospital disposition, and type of martial arts practiced were extracted.

RESULTS

A total of 8,400 injuries were recorded, leading to a national estimate of 310,143 martial-arts related injuries over the 11 year period of 2009-2019 (95 % CI 239,063-381,223). The most common types of injuries were strains/sprains (n = 2664, 31.7 %), fractures (n = 1,575, 18.8 %), and contusions/abrasions (n = 1,698, 20.2 %). There were 260 dislocations, with shoulder dislocations being most common (n = 96, 36.9 %). Lower extremities were affected more frequently than upper extremities (n = 3566, 42.5 % versus n = 3026, 36.0 %), with the knee being the single most common location of injury (n = 811, 9.7 %). Males more commonly sustained fractures (19.7 % versus 17.4 %, p = 0.03) and dislocations (3.5 % versus 2.4 %, p = 0.01) when compared to females. Ankle injuries were more common in females than males (10.4 % versus 6.0 %, p < 0.001). Only 2.2 % of patients required admission to the hospital. Risk factors for admission included patients >35 years of age and male sex.

CONCLUSION

Martial arts injuries are a significant source of musculoskeletal injuries among patients presenting to US emergency rooms. Lower extremity injuries are seen most frequently, with patients rarely requiring hospital admission. Using this information, both providers and participants may be better equipped to make educated decisions on injury prevention and treatment.

Upper limb injuries in mixed martial arts

OBJECTIVE

Mixed-Martial-Arts(MMA) is a worldwide growing sport that incorporates different fighting styles and disciplines and is often associated with the Ultimate Fighting Championship(UFC) . The aim of this study is to explore the patterns and trends of upper limb injuries in MMA.

METHODS

Ringside physician reports of the UFC fights between 2016 and 2019(inclusive) were extracted and screened from the Nevada State Athletic Commission(NSAC). The following variables were included: sex, weight division, injury mechanism, injury type, injury location, and type of finish. Injury rates were calculated and expressed per 100 athletic exposures (AE). An independent t-test, a one way analysis of variance(ANOVA), and a Joinpoint regression analysis were conducted to explore any significant differences or trends among variables. P-values<0.05 were considered significant(95% CI).

RESULTS

A total of 81 upper limb injuries in 408 fights were recorded between 2016 and 2019. The injury rate was 9.9 injuries per 100 athletic-exposures(AE). Striking opponents was the most common mechanism of injury(p < 0.001). The hand was the most commonly injured location with an injury rate of 6.61 per 100AE(p < 0.001). Females had a higher upper limb injury rate than their male counterparts, but the difference failed to reach significance(p = 0.454). Similarly, no significant differences existed between rates of different types of injures. Matches ending with decision had the highest number of upper limb injuries with a rate of 12.6 per 100AE; however, no significant difference was determined between the rates of different ways of finish(p = 0.115). The strawweight(20.5 per 100AE), female flyweight(19.2 per 100AE), and male flyweight(13.8 per 100AE) divisions had the highest upper limb injury rates.

CONCLUSION

The hand was the most commonly injured upper limb location in MMA, and 'striking opponent' was the most common injury mechanism. Increasing padding in gloves and implementing medical examinations during bouts can help reduce injury rates.

Association of Scapular Dyskinesis with Neck and Shoulder Function and Training Period in Brazilian Ju-Jitsu Athletes

Background and Objectives: Neck and shoulder injuries are common in Brazilian ju-jitsu (BJJ) athletes, and scapular dyskinesis (SD) is associated with these injuries. This study aimed to investigate the prevalence of SD in BJJ athletes, their neck and shoulder function and strength, and the BJJ training period. Materials and Methods: Forty-eight BJJ athletes participated in the study. Years of experience with BJJ, belt, shoulder internal and external rotation strength, neck strength, neck disability index (NDI), and SD were measured. Results: Approximately 31 BJJ athletes (64.6%) showed SD, and the nondominant arm showed a more obvious SD (n = 22, 45.8%) than the dominant arm (n = 18, 37.5%). Those with over five years of BJJ training experience showed a significantly higher rate of SD (p = 0.006) than those with less than five years of experience. Shoulder isometric internal rotation strength was significantly weaker in the obvious SD group than in the normal SD group (p = 0.014). Neck isometric strength and NDI did not differ significantly between individuals with or without SD. Conclusions: SD was common among BJJ athletes, and more experienced BJJ athletes exhibited higher rates of SD. Shoulder rotational strength was weaker with SD. Further studies are necessary on the neck and shoulders of BJJ athletes with SD.

Injuries Common to the Brazilian Jiu-Jitsu Practitioner

BACKGROUND

Brazilian jiu-jitsu (BJJ) is a martial art that focuses on ground combat, emphasizing skill over strength and submission over striking. The purpose of this study is to evaluate the nature of injuries affecting practitioners of BJJ in the settings of competition, training, and conditioning.

METHODS

An online survey was created to collect demographic and injury-specific information. This survey was distributed to the 234 schools in the United States registered with the International Brazilian Jiu-Jitsu Federation (IBJJF). The survey was also distributed to local BJJ schools and at local tournaments in the Greater New York City area. Data from a total of N=56 participants were recorded for this survey.

RESULTS

The majority of participants were male (n=44, 78.6%) and amateur competitors (n=29, 51.8%) with an average duration of BJJ training of 6.9 ± 5.9 years. The majority of participants (82.1%) train at least six hours per week and compete in an average of 4.6 ± 2.5 competitions per year. The most common injuries were to the finger/hand (78.6%) and knee (61.5%). The most commonly reported fracture was of the hand/fingers (n=6). Of the 156 total injuries reported, 133 (85.3%) occurred during practice or training rather than in competition and 76 (48.7%) required medical attention. Few injuries required surgical intervention.

CONCLUSIONS

This study provides novel information regarding injury characteristics of BJJ practitioners with respect to the level of training and use of protective equipment that can guide expectations and management for this unique group of athletes. Amateur BJJ practitioners are the most commonly injured, and largely experience injuries of the upper extremities during training or conditioning rather than during competition.

Epidemiology of Injuries during Judo Tournaments

Objective

To determine the injury incidence proportion, distribution of injuries by anatomical location; injury type; injury severity, time loss; mechanism and situations of injuries; and the relative risk of injuries by gender, age, and weight categories during judo tournaments. Study Design. It is a systematic review. Data Sources. A systematic review of the literature was conducted via searches in PubMed, EMBASE, Web of Science, CINAHL, SPORTDiscus, Google Scholar, and PEDro. Eligibility Criteria. All original studies on the incidence of injuries during judo tournaments were included.

Results

Twenty-five studies were included out of the 1979 studies. Using the modified AXIS tool score for quality assessment, seven were rated as having good quality, nine were rated as having fair quality, and four were rated as having poor quality. The injury incidence proportion during tournaments ranged from 2.5% to 72.5% for injuries requiring medical evaluation and 1.1% to 4.1% for injuries causing time loss (i.e., inability to continue game participation). The most commonly reported injury location was the head, followed by the hand, knee, elbow, and shoulder. The most frequent types of injury were sprains, followed by contusions, skin lacerations, strains, and fractures. In judo tournaments, injuries were more often sustained during standing fights (tachi-waza) than in ground fights (ne-waza).

Conclusion

The tournament injury incidence proportion ranged from 2.5% to 72.5% for injuries requiring medical attention and 1.1% to 4.1% for injuries causing time loss. The head was the most frequently injured body part, and sprain was the most frequent injury type. However, current reports on injuries during judo tournaments are heterogeneous and inconsistent, limiting our understanding of in-match injury risks. Future studies should utilize the guidelines of the International Olympic Committee consensus meeting statement on the methodological approach to injury reporting. We recommend a judo-specific extension of this statement to fit the unique features of judo sports practice.

Effect of rapid weight loss on mood states and burnout of Brazilian jiu-jitsu athletes during a competitive process

The current study aimed to analyze the psychological alterations resulting from rapid weight loss in the mood states and burnout of male Brazilian jiu-jitsu athletes. For the purpose of this study, 31 Brazilian jiu-jitsu athletes participated, divided into two groups (RWLG: rapid weight loss group and CG: control group). Data collections were performed at three moments (1: baseline, before weight loss; 2: weigh-in, during the official competition; and 3: recovery, 7 to 10 days after the competition), with application of the Brunel Mood Scale (BRUMS) and Athlete Burnout Questionnaire (ABQ). Considering the outcomes, for body mass, the athletes from RWLG presented mean reductions of 3.5 kg (4.2% of the initial body mass). For mood states, both groups (RWLG and CG) presented a moment effect for tension and confusion, with higher levels during weigh-in compared to baseline and recovery (p < 0.05). For burnout, both groups showed low levels of burnout, with no effect of moment, group, or interaction in the analyses (p > 0.05). Based on these results, it is concluded that weight loss, in the magnitude performed in this study, did not generate an additional impact on mood or level of burnout in Brazilian jiu-jitsu athletes during a competitive process.

Epidemiology of musculoskeletal injuries in combat sports practitioners

Study aim: The purpose of this study was to determine the impact of the type of combat sport and the degree of athletic proficiency on the specificity of musculoskeletal injuries suffered by Muay Thai and Mixed Martial Arts practitioners.

Material and methods: The study involved 64 practitioners of two combat sports, MT (age 26.9 ± 8.1, experience 7.4 ± 5.8 years) or MMA (age 26.2 ± 6.4 years, experience 6.6 ± 4.1 years). The research was conducted using a Google Forms survey.

Results: The groups did not differ significantly (p < 0.05) in terms of risk of injury (average 3.1 in MT, 2.6 in MMA). Injuries (mainly fractures 21% and 7% of practitioners) affected the lower limb (44% and 33% practitioners) and were significantly higher in MT, p < 0.05. There were significant (p < 0.05) correlations between training experience and the number of training hours per week compared to the frequency and severity of injuries in both groups.

Conclusion: Injuries to athletes who mainly use striking techniques are more common in the lower limbs and they are more likely to be fractures. Longer training experience, more training hours and a higher level of athletic proficiency significantly increase the risk of injuries and their severity among people practicing both types of combat sports.

Clinical Outcomes of Ulnar Collateral Ligament Surgery in Nonthrowing Athletes

BACKGROUND

Ulnar collateral ligament (UCL) surgery continues to demonstrate excellent clinical outcomes and a high return-to-play (RTP) rate with a low complication rate. Recent studies have demonstrated similar clinical outcomes for baseball players who have undergone either UCL reconstruction or UCL repair. In comparison, few studies have assessed the clinical outcomes of UCL surgery for nonthrowing athletes.

PURPOSE/HYPOTHESIS

The primary objective of this study is to provide clinical outcomes of UCL surgery performed in nonthrowing athletes at a single institution with a minimum 2-year follow-up. Our hypothesis was that these patients would have similar clinical outcomes, complication rates, and RTP rates when compared with throwing athletes.

LEVEL OF EVIDENCE

Case series; Level of evidence, 4.

METHODS

From our longitudinal elbow registry, 40 nonthrowing athletes were identified who underwent UCL surgery (repair or reconstruction) between 2011 and 2019. Participant characteristics were recorded: age, sex, laterality, arm dominance, sport, level of competition, and type of surgery (UCL repair or reconstruction). Outcomes included RTP rate and average time, American Shoulder and Elbow Surgeons (ASES) scores, and complications.

RESULTS

From the 40 patients eligible for inclusion in this study with a minimum 2-year follow-up, 37 (93%) were successfully contacted: 16 male (43%) and 21 female (57%). Mean ± standard deviation age at the time of surgery was 18.0 ± 3.7 years. From the 37 technical procedures, 28 (76%) were UCL repairs and 9 (24%) were UCL reconstructions. For these patients, 15 (41%) had partial tears, 20 (54%) had complete tears, 1 (3%) had a medial epicondyle avulsion, and 1 (3%) had an unspecified pathology. Sports included football (n = 11), gymnastics (11), cheerleading (7), wrestling (4), volleyball (2), basketball (1), and acrobatics (1). Quarterbacks were excluded from the football patients, as quarterbacks are throwing athletes. Level of competition included high school (n = 26), college (8), professional (2), and youth sports (1). The RTP rate was 93% (26/28) at a mean 7.4 months for UCL repair and 100% (9/9) at a mean 10.0 months for UCL reconstruction. Mean ASES scores were 94.4 and 98.7 for UCL repair and reconstruction, respectively. Complications were low, with 2 patients in the UCL repair group requiring ulnar nerve transposition for ulnar nerve paresthesia.

CONCLUSION

In nonthrowing athletes, patients undergoing UCL repair and UCL reconstruction show favorable outcomes at minimum 2-year follow-up. RTP and clinical outcomes are consistent with previous studies in baseball players as well as a parallel ongoing study conducted on non-baseball throwing athletes.

Comparison of the Physical Fitness Profile of Muay Thai and Brazilian Jiu-Jitsu Athletes with Reference to Training Experience

Background: In combat sports, successful competition and training require comprehensive motor fitness. The aim of this study was to diagnose the level of physical fitness and to determine the level of differences between athletes of combat sports characterized by stand-up fighting, such as Muay Thai; and ground fighting, such as Brazilian jiu-jitsu. Methods: The study examined and compared 30 participants divided into two equal groups: Muay Thai athletes (n = 15; age: 24.24 ± 3.24; body height: 174.91 ± 5.19; body weight: 77.56 ± 7.3), and Brazilian jiu-jitsu (BJJ) (n = 15; age: 22.82 ± 1.81; body height: 175.72 ± 7.03; body weight: 77.11 ± 8.12). Basic characteristics of the somatic build were measured. Selected manifestations of the motor potential of motor skills were also evaluated using selected tests from the EUROFIT test battery, the International Test of Physical Fitness, and computer tests of coordination skills. Relative strength and maximal anaerobic work (MAW) indices were calculated. The strength of the relationship between the effect of motor fitness and training experience was also assessed. Results: The athletes of both groups (Muay Thai and BJJ) presented similar levels of basic characteristics of the somatic build. Motor fitness in the tested groups showed significant differences between the athletes of these sports in static strength (p = 0.010), relative strength (p = 0.006), arm muscle strength in pull-ups (p = 0.035), and functional strength in bent arm hanging (p = 0.023). Higher levels of these components of motor fitness were found for the athletes in the BJJ athletes. In the Muay Thai group, significant very high strength of association was found between training experience and five strength tests. Furthermore, a significantly high strength of association was found in two tests. In the BJJ group, significant relationships with very high correlation were found between the variables in five strength tests. Conclusions: Brazilian jiu-jitsu athletes performed better in strength tests (static strength, relative strength, shoulder girdle strength, functional strength). High correlations between the training load and the level of physical fitness were found in flexibility and strength tests in BJJ athletes and most strength tests in Muay Thai athletes.

Back pain and body posture of non-professional Brazilian Jiu-Jitsu practitioners

Background

The aim of the study was to assess the prevalence of back pain in non-professional Brazilian Jiu-Jitsu practitioners (NP-BJJ practitioners), and to assess the relationship between their back pain and postural disorders.

Methods

The study involved 61 subjects (age: 30.7 ± 4.9 years old; body mass: 79.4 ± 12.9 kg; body height: 179.6 ± 8.4 cm; 8 woman and 53 man), 31 who trained Brazilian Jiu-Jitsu (BJJ) and 30 subjects who had never trained any combat sport. The mean time of training BJJ in the study population was 3.9 ± 4.1 years. Postural assessments were conducted with the use of the photogrammetric method. The assessment of back pain and injuries was conducted with the Oswestry Disability Index (ODI) and with our proprietary questionnaire.

Results

Among both populations, 37 subjects reported back pain. There were no differences in back pain location between the two groups or in functional state on the ODI. Significant differences between the groups in the values of the postural parameters (spinal height, length of kyphosis, length of lordosis, pelvis inclination angle) were observed. Statistically significant differences between the NP-BJJ practitioners with and without back pain in the length of the thoracic kyphosis and the differences in the height of the waist triangles were found.

Conclusions

Both in the study population and in the control group the spinal pain was minimal or moderate on the ODI. BJJ practitioners who reported back pain had characteristic postural changes in some of the analysed postural parameters in comparison to BJJ practitioners who did not report back pain.

Injury Patterns, Risk Factors, and Return to Sport in Brazilian Jiu Jitsu: A Cross-sectional Survey of 1140 Athletes

Background

Brazilian jiu jitsu (BJJ) is a growing martial art that focuses on grappling techniques.

Purpose

To quantify the 3-year incidence of BJJ-related injuries and detect common injury patterns as well as risk factors among those practicing BJJ. It was hypothesized that there would be a high incidence of injuries, they would be caused by submissions in sparring situations, and they would occur predominantly at the extremities.

Study Design

Descriptive epidemiology study.

Methods

Active BJJ athletes were invited to take an English-language online survey developed by orthopaedic surgeons together with BJJ athletes and a sports scientist. Data were recorded regarding athlete demographics, sporting activity level, injuries within the past 3 years that caused at least a 2-week time loss, injury mechanisms, and return to sport.

Results

Overall, 1140 responses were received from 62 different countries; 88.9% of all athletes were male, and 63.9% were regular competitors. Within the investigated cohort, 1052 injuries were recorded in 784 athletes, for an injury incidence of 308 per 1000 athletes per year. The lower extremity (45.7%) and upper extremity (30.2%) were predominant sites of injury, with injuries to the knee (27.1%) being the most common. The most frequent knee injuries were meniscal injuries (n = 65), anterior cruciate ligament (ACL) tears (n = 36), and medial collateral ligament injuries (n = 36). ACL tears were especially associated with long time frames for return to sport. Most injuries occurred during sparring (77.6%) and were caused by submissions (29.7%) and takedowns (26.4%). Competing regularly (P = .003), older age (P < .001), and higher belt rank (P = .003) were significant risk factors for injury.

Conclusion

Injury incidence was high among BJJ athletes surveyed, with 2 out of 3 athletes reporting at least 1 injury within a 3-year period that caused a 2-week absence from training. Most injuries occurred during sparring, and we believe that a high potential for injury reduction lies in drawing awareness to common injury patterns and sites in athletes.

KNEE INJURIES PREVALENCE IN BRAZILIAN JIU-JITSU: EPIDEMIOLOGICAL STUDY

OBJECTIVE

To evaluate the epidemiological and clinical characteristics of knee injuries in Brazilian Jiu-Jitsu (BJJ) practitioners.

METHODS

Cross-sectional study, using a mixed questionnaire, based on the Referred Morbidity Index.

RESULTS

198 amateur and professional BJJ fighters, of both sexes, aged between 18 and 60 years, participated in the study. The majority (88%) of the fighters had only one knee injury (p < 0.001). In total, 29.8% proportion of knee injuries (p < 0.001) was identified, which were mainly from the medial collateral ligament (38%), caused by a sprain mechanism (86%) and conservative treatment (65%).

CONCLUSION

A high prevalence of knee injuries in JJB fighters was found, compared to other sports that also perform rotational movements and have great body contact, such as mixed martial arts (MMA), judo, soccer, basketball and handball. Some JJB strikes, such as the key and the projection, can cause greater knee joint stress, both in the attacking fighter and in the opponent. The knowledge of the epidemiological characteristics of sports injuries is important in the elaboration of prevention and training protocols more specific to the sport and for the understanding of the complex mechanisms involved with this outcome in sport. Level of Evidence IV, Case Series.

Isokinetic Strength and Functional Scores after Rehabilitation in Jiu-Jitsu Fighter with Repair Surgery of Pectoralis Major Muscle Rupture: A Case Report

A pectoralis major muscle rupture is a rare injury that mainly occurs during exercise. This study examined the application of rehabilitation, strength and passive range of motion (ROM) change, and subjective assessment for 1 year undertaken after repair surgery of pectoralis major muscle rupture in a Jiu-Jitsu fighter. We hypothesized that the application of ROM exercises and rehabilitation strategies contributed to muscle recovery and successful return to sports. The patient was a 34-year-old man who was injured after falling during a competitive event. The patient had pain and swelling in the front of the chest and shoulder, and the distal chest was deformed. Imaging revealed a complete rupture of the pectoralis major muscle. Reparative surgery was performed by a specialist. Immobilization was performed one week after the surgery. Passive ROM exercises began with the forward flexion 2 weeks after the surgery; abduction and external rotation ROM exercises at 4 weeks; low-intensity muscle strength exercises using tube bands at 6 weeks; machine-based pectoralis major muscle exercises at 3 months. Isokinetic equipment was used to measure horizontal adduction and internal rotation strengths, and the subjective shoulder functional and ROM scores were evaluated. Recovery of shoulder function and ROM occurred at 3 months and muscle recovery at 6 months. The participant was able to return to sports at 5 months and compete at 7 months. Although this study explored only one patient's post-operative recovery, it suggests that ROM and strength exercises may be effective post-operative strategies for restoring function and strength to enable a return to sports.

The role of salivary vesicles as a potential inflammatory biomarker to detect traumatic brain injury in mixed martial artists

Traumatic brain injury (TBI) is of significant concern in the realm of high impact contact sports, including mixed martial arts (MMA). Extracellular vesicles (EVs) travel between the brain and oral cavity and may be isolated from salivary samples as a noninvasive biomarker of TBI. Salivary EVs may highlight acute neurocognitive or neuropathological changes, which may be particularly useful as a biomarker in high impact sports. Pre and post-fight samples of saliva were isolated from 8 MMA fighters and 7 from controls. Real-time PCR of salivary EVs was done using the TaqMan Human Inflammatory array. Gene expression profiles were compared pre-fight to post-fight as well as pre-fight to controls. Largest signals were noted for fighters sustaining a loss by technical knockout (higher impact mechanism of injury) or a full match culminating in referee decision (longer length of fight), while smaller signals were noted for fighters winning by joint or choke submission (lower impact mechanism as well as less time). A correlation was observed between absolute gene information signals and fight related markers of head injury severity. Gene expression was also significantly different in MMA fighters pre-fight compared to controls. Our findings suggest that salivary EVs as a potential biomarker in the acute period following head injury to identify injury severity and can help elucidate pathophysiological processes involved in TBI.

Injury Profile of Mixed Martial Arts Competitions in the United States

Background:

The popularity of mixed martial arts (MMA) continues to grow in the United States. Although prior work has provided valuable insight concerning injuries in the sport, much of the available literature is limited by factors such as small sample sizes, varying athlete demographics, and inconsistent data collection methods.

Purpose:

To report injury rates and types in MMA and analyze potential variance between competition and match variables.

Study Design:

Descriptive epidemiology study.

Methods:

We performed a retrospective review of injuries sustained by fighters during MMA contests between 2018 and 2019 using ringside physician postmatch injury reports from Wisconsin and Arizona. The prevalence of overall injuries and specific injury types was compared by location (Arizona vs Wisconsin), competition level (amateur vs professional), match result (decisions vs any other result), and match winners versus losers.

Results:

In 503 contests, 285 (57%) had at least 1 injury. In these 285 matches, participants experienced 401 injuries: 197 (49%) in professional bouts and 204 (51%) in amateur bouts. The match injury rate was higher in professional bouts than in amateur contests (68% vs 51%; P < .001). Amateur fighters had more contusions and hematomas (31% vs 22%; P < .001), while professional fighters had more lacerations (39% vs 23%; P < .001). Losers exhibited a higher match injury rate than winners (48% vs 24%; P < .001). Winners experienced a higher proportion of fractures (19% vs 9%; P = .005), and losers experienced more concussions (17% vs 2%; P < .001).

Conclusion:

Professional fighters and losers of MMA bouts exhibited higher injury rates relative to amateurs and winners. The prevalence of specific injury types varied by competition level, match result, and match winners versus losers. The results of this study may be used to better understand the current injury profile in MMA and to develop targeted strategies for injury prevention.

EPIDEMIOLOGY OF ORTHOPEDIC INJURIES IN JIU-JITSU ATHLETES

OBJECTIVE

This study aims to identify the epidemiology of orthopedic injuries in jiu-jitsu practitioners.

METHODS

Ninety-six jiu-jitsu practitioners aged between 18 and 45 years, male and female, answered a questionnaire addressing personal data and history of injuries related to the sport during the last 24 months.

RESULTS

In the period cover, 85% of the sample presented injuries related to the practice of jiu-jitsu, with an average of 60 days of absenteeism from sports practice. Fingers, shoulders, and knees were the joints most affected by orthopedic injuries.

CONCLUSION

Orthopedic injuries are quite prevalent among jiu-jitsu practitioners, often distancing athletes from the sport. Level of Evidence IV, case series / cross sectional study.

UCL Injury in the Non-throwing Athlete

PURPOSE OF REVIEW

Primarily reported in the overhead throwing athlete, ulnar collateral ligament (UCL) injuries have been extensively studied since Dr. Frank Jobe first described his technique for ulnar collateral ligament reconstruction on professional baseball pitcher Tommy John. While the framework for our understanding of UCL injury was initially established studying the repetitive valgus loading of the throwers' elbow, other sport-related activities in non-throwing athletes can impart similar valgus stress on the medial elbow placing the UCL at risk for injury. The purpose of this review is to evaluate the current literature on UCL injury specifically in the non-throwing athlete.

RECENT FINDINGS

In the four decades since Dr. Jobe's seminal description of UCL reconstruction, an abundance of literature has been published on UCL injury in the throwing athlete. The evidence evaluating the UCL specifically in the non-throwing athlete, however, is quite scarce. Several small retrospective studies have demonstrated good results with high rates of return to play with focused rehabilitation and non-operative management in non-throwing athletes. Recent evidence has also demonstrated that surgical repair and/or reconstruction of the UCL in this population can produce good outcomes. The level of evidence of these published studies is low and consists primarily of case series without control groups. Further investigation is warranted to determine the optimal treatment algorithm for UCL injury in the non-throwing athlete.

Brazilian Jiu Jitsu, Judo, and Mixed Martial Arts Injuries Presenting to United States Emergency Departments, 2008-2015

Limited research has systematically examined injuries resulting from Brazilian Jiu Jitsu (BJJ), Judo, and mixed martial arts (MMA), especially when compared to more well-known or -established martial arts. These three combative sports differ substantially regarding their rules and techniques. BJJ emphasizes ground positioning and submission, Judo rewards throwing an opponent on their back with submission ending the match, and MMA emphasizes knocking out or forcing the submission of one's opponent. We examined injuries, among people of any age, experienced from participation in BJJ, Judo, and MMA. We analyzed data from the United States (U.S.) Consumer Product Safety Commission National Electronic Injury Surveillance System to create estimates of injuries presenting to U.S. emergency departments (EDs). We compared injury profiles between sports, including estimated numbers of injuries, their site, type, and mechanism. Participation in BJJ, Judo, and MMA resulted in an estimated 39,181 injuries presenting to U.S. EDs from 2008 through 2015. Strains and sprains were the most common diagnoses for BJJ and Judo participants, whereas abrasions/contusions were the most commonly diagnosed MMA injury. Being struck resulted in the majority of injuries for all three sports. The head was the most injured body region for BJJ and MMA, whereas the leg was the most injured body region for Judo. Finally, the majority of BJJ and Judo injuries occurred during noncompetitive grappling, whereas most MMA injuries occurred during competition. Our study adds to the limited literature examining injuries from BJJ, Judo, and MMA using data from a probability sample and is an initial step towards understanding the national burden of injury from participation in these sports. Given the quantity and severity of injuries sustained by participants, additional research is needed to assess the riskiness of participation and the effectiveness of interventions, such as improved personal protective gear and mats, as a means to prevent commonly occurring injuries.

Injury rate and pattern among Brazilian jiu-jitsu practitioners: A survey study

OBJECTIVE

To determine the 6-month incidence rate and pattern of Brazilian jiu-jitsu (BJJ)-related injuries and characterize associations between injuries and experience level, demographic factors, and training variables.

DESIGN

Descriptive epidemiology study.

SETTING

Online survey.

PARTICIPANTS

1287 adult BJJ practitioners.

OUTCOME MEASURES

6-month BJJ-related injury incidence, anatomical pattern of injuries, and injury-associated demographic and training variable identification.

RESULTS

59.2% of practitioners reported at least one injury over 6 months. The knee was the most common site. Logistic regression analysis demonstrated 6-month injury incidence was negatively associated with years of training and body weight, and positively associated with training days per week and instructor status. More experienced athletes were more likely to report low back injury, while less experienced athletes more frequently reported head, upper extremity, and elbow injuries. None of the following variables were predictive of injury risk: gi preference, instruction on break-falling, and participation in a structured beginner's program.

CONCLUSIONS

The risk factor analysis is applicable to BJJ instructors interested in reducing student injury risk. The widespread pattern of injuries and the distinction between types of injuries sustained at different levels of experience are notable findings that sports medicine practitioners should keep in mind when working with BJJ athletes.

Injury in Brazilian Jiu-Jitsu Training

BACKGROUND

Brazilian jiu-jitsu (BJJ) is a grappling-based martial art that can lead to injuries both in training and in competition. There is a paucity of data regarding injuries sustained while training in BJJ, in both competitive and noncompetitive jiu-jitsu athletes.

HYPOTHESIS

We hypothesize that most BJJ practitioners sustain injuries to various body locations while in training and in competition. Our primary objective was to describe injuries sustained while training for BJJ, both in practice and in competition. Our secondary objectives were to classify injury type and to explore participant and injury characteristics associated with wanting to quit jiu-jitsu after injury.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

We conducted a survey of all BJJ participants at a single club in Hamilton, Ontario, Canada. We developed a questionnaire including questions on demographics, injuries in competition and/or training, treatment received, and whether the participant considered discontinuing BJJ after injury.

RESULTS

A total of 70 BJJ athletes participated in this study (response rate, 85%). Ninety-one percent of participants were injured in training and 60% of competitive athletes were injured in competitions. Significantly more injuries were sustained overall for each body region in training in comparison with competition (P < 0.001). Two-thirds of injured participants required medical attention, with 15% requiring surgery. Participants requiring surgical treatment were 6.5 times more likely to consider quitting compared with those requiring other treatments, including no treatment (odds ratio [OR], 6.50; 95% CI, 1.53-27.60). Participants required to take more than 4 months off training were 5.5 times more likely to consider quitting compared with those who took less time off (OR, 5.48; 95% CI, 2.25-13.38).

CONCLUSION

The prevalence of injury is very high among BJJ practitioners, with 9 of 10 practitioners sustaining at least 1 injury, commonly during training. Injuries were primarily sprains and strains to fingers, the upper extremity, and neck. Potential participants in BJJ should be informed regarding significant risk of injury and instructed regarding appropriate precautions and safety protocols.

CLINICAL RELEVANCE

Clinicians should be aware of the substantial risk of injury among BJJ practitioners and the epidemiology of the injuries as outlined in this article.

Epidemiology of Judo-Related Injuries in 21 Seasons of Competitions in France: A Prospective Study of Relevant Traumatic Injuries

Background

Judo is a full-contact fighting sport that may lead to severe injuries. There are limited data available on the incidence of judo-related injuries. The French Judo Federation has established a surveillance system to document the frequency and type of injuries during judo competitions.

Purpose

To describe the incidence rates and types of judo-related traumatic injuries during 21 seasons of competitions in France with respect to athlete (judoka) age, sex, and level of performance.

Study Design

Descriptive epidemiology study.

Methods

Between 1993 and 2014, each physician in charge of each judo competition filled out a form in which he/she documented the number of competing judokas, the number of fights, the number of medical interventions, the specific type of traumatic injuries for each intervention, the number of fight interruptions, and the number of athletes removed from the competition venue because of an injury. The age, sex, and level of performance of each judoka were also documented. Variance analysis was applied to assess whether differences in incidence rates of injuries between groups were significant (Student t test and chi-square test).

Results

Surveillance of 421,670 fights demonstrated 3511 injuries in 316,203 judokas (incidence proportion, 1.1%). Among the injuries recorded, the most common were sprains (54.3%), fractures (15.6%), and dislocations (12.5%). Female athletes exhibited significantly higher incidence rates for knee sprains and elbow dislocations, whereas male athletes exhibited a higher incidence rate for shoulder dislocations (P < .001 for all). Regarding age, higher incidence rates were observed in young adults (aged 18-20 years) for acromioclavicular sprains and in children (aged 10-14 years) for clavicle fractures compared with adults (aged 21-35 years) (P < .001 for both). Both young adult and adult athletes had a higher incidence rate of shoulder dislocations (P < .001). Regarding the level of performance, athletes competing at higher levels had a higher incidence rate of sprains to the knee (P < .001).

Conclusion

During 21 years of surveillance of injuries in judo competitions in France, the incidence proportion of injuries was 1.1%. Significant differences in incidence rates demonstrated when considering age, sex, and level of performance may help in developing strategies to prevent traumatic injuries in the future.

Epidemiology of Sports Related Concussion in Brazilian Jiu-Jitsu: A Cross-Sectional Study

Brazilian Jiu-Jitsu (BJJ) is a rapidly growing grappling sport with a wide spectrum of participants. This cross-sectional study examined the lifetime prevalence of concussion in adult BJJ practitioners in the United States using a 17-item survey. A total of 778 (11.4% female) BJJ practitioners with a median age of 31 years completed the survey. Overall, the lifetime prevalence of the self-reported BJJ-related concussion was 25.2%. However, the prevalence was higher among females than males (43.0% versus 22.9%; X²(1,740) = 15.129; p < 0.001). Factors independently associated with significantly increased odds of having sustained a BJJ-related concussion included a prior history of concussion (OR 1.76, 95% CI 1.14⁻2.74; p = 0.011) and female gender (OR 1.95, 95% CI 1.04⁻3.65; p = 0.037). The median return to sports time was three days, with 30.3% of participants returning on the same day as being concussed. The present study represents the first epidemiological research examining the concussions in BJJ. The results underscore the need for increased education on concussions and return to sports guidelines among BJJ coaches and practitioners.

Nonoperative Treatment for Partial Ruptures of the Lateral Collateral Ligament Occurring in Combination With Complete Ruptures of the Anterolateral Ligament: A Common Injury Pattern in Brazilian Jiu-Jitsu Athletes With Acute Knee Injury

Background:

Combined partial lateral collateral and complete anterolateral ligament (PLCCALL) injuries are a specific injury pattern seen in Brazilian jiu-jitsu (BJJ) because of the knee varus-flexion mechanism that frequently occurs during grappling.

Purpose/Hypothesis:

The purpose of this study was to evaluate the incidence of this injury pattern in a series of BJJ athletes with an acute knee injury and to evaluate clinical and functional outcomes after nonoperative management at a minimum follow-up of 1 year. Our hypotheses were that PLCCALL injuries are common in BJJ and that nonoperative treatment is associated with excellent clinical outcomes and return to the preinjury level of sport.

Study Design:

Case series; Level of evidence, 4.

Methods:

All BJJ athletes who presented with an acute knee injury between July 2013 and June 2017 and who underwent magnetic resonance imaging (MRI) of the knee were included. A specific emphasis was placed on identifying those whose imaging demonstrated PLCCALL injury. Clinical evaluation included physical examination as well as Lysholm and International Knee Documentation Committee (IKDC) scores.

Results:

Of the 27 patients analyzed, 7 (25.9%) had MRI-proven PLCCALL injuries. The mean follow-up after nonoperative management was 41.3 months. The mean IKDC and Lysholm scores were 94 and 92 before the injury, 26 and 36 at the initial assessment after the injury, and 83 and 78 at 12-month follow-up, respectively (P < .00001). All 7 patients had returned to their preinjury level of sports by the 12-month follow-up. The mean time between injury and return to competition level was 4.7 months (range, 4-6 months).

Conclusion:

PLCCALL injury is a specific but infrequent injury pattern in BJJ. The prognosis of this injury after nonoperative treatment appears to be excellent. Improved functional scores (IKDC and Lysholm) and changes on MRI demonstrated that the anterolateral ligament has intrinsic healing potential, as the images showed complete healing of the previously documented rupture of the anterolateral ligament from its proximal attachment.

Sport-Related Portal Vein Thrombosis: An Unusual Complication

Portal vein thrombosis (PVT) is an uncommon condition usually associated with hypercoagulable states or liver cirrhosis. PVT due to sports-related injuries is rarely reported and, to the best of our knowledge, only two cases have been reported thus far. Brazilian jiu-jitsu (BJJ) is a form of martial arts and is considered very safe with minimal risk for injury. It has growing popularity worldwide. Here, we report the first case of PVT secondary to abdominal trauma related to the practice of (BJJ) in an otherwise healthy 32-year-old man with no other traditional risk factors for PVT.

Could current factors be associated with retrospective sports injuries in Brazilian jiu-jitsu? A cross-sectional study

BACKGROUND

Brazilian jiu-jitsu is characterized by musculoskeletal disorders and high occurrence of sports injuries. The present study was aimed to analyze some internal factors, as well as to describe occurrence and characteristics of retrospective musculoskeletal injuries in different age groups of Brazilian jiu-jitsu practitioners.

METHODS

One hundred ninety-three Brazilian jiu-jitsu practitioners, which were divided into three age groups: Adolescent, Adult, and Master. Besides anthropometric characterization, standard clinical tests were conducted to analyze the global and segmental joint flexibility, lumbar spine range of motion, and handgrip strength. Sports injury occurrence and total physical activity were obtained from an adapted morbidity survey and International Physical Activity Questionnaire - Short Form (IPAQ-SF), respectively.

RESULTS

A total of 247 cases of retrospective injuries was registered (1.27 injury/ participant). Occurrence of rectus femoral muscle retraction in the right leg was increased within Master. Adult and Master have exhibited higher occurrence of sports injuries than Adolescent group (p < 0.05). Joint injuries were the most common sports-related injuries by all Brazilian jiu-jitsu practitioners. While female gender and exposure time constituted the most predictive variables for sports injury occurrence in Adolescent, graduation level was more associated with sports injuries occurrence in Adult.

CONCLUSIONS

Joint injuries derived from combat demands were the main sports injury in all age categories of Brazilian jiu-jitsu. Master subjects presented a higher occurrence of clinical changes and retrospective musculoskeletal injuries in relation to other age groups. Female gender and exposure time constituted the main predictive factors in adolescent subjects, while graduation category was more directly associated with retrospective injury onset in the Adult group.

Internal Carotid Artery Dissection in Brazilian Jiu-Jitsu

Carotid artery dissection is a significant cause of stroke in young patients. It may be asymptomatic and go undiagnosed, or minimal transient manifestations may follow, commanding a higher index of suspicion than ordinarily exists to avoid misdiagnosis. Reported herein is a 27-year-old man who suffered extracranial internal carotid artery dissection while practicing a Brazilian Jiu-Jitsu submission maneuver. The patient's condition suddenly deteriorated one week later due to distal embolization and stroke. Despite endovascular treatment, with stenting of the cervical carotid artery, neurologic deficits remained. Of note, the objective in martial arts, which is to kill or incapacitate, has yet to be fully tempered in transitioning to sport. Brazilian Jiu-jitsu, a relatively new and fast-growing form of martial art, places emphasis on submission maneuvers. Related injuries are not common knowledge and are poorly described in the literature. This account is intended to shed light on the risk of this discipline. Through education and improved supervision, vascular injuries of this nature and the potentially lethal or disabling consequences may thus be prevented in young athletes.

Prevalence of Injuries during Brazilian Jiu-Jitsu Training

Brazilian jiu-jitsu (BJJ) is a martial art that focuses on groundwork, joint locks, and chokeholds. The purpose of this study is to determine the prevalence of injuries sustained during BJJ training. A 27-question research survey was e-mailed to 166 BJJ gyms in the United States. Demographic information, belt level, weight class, training hours, competition experience, and injury prevalence data were collected. The majority of respondents were Caucasian (n = 96) males (n = 121) with an average age of 30.3 years. Overall, the most common injury locations were to the hand and fingers (n = 70), foot and toes (n = 52), and arm and elbow (n = 51). The most common medically diagnosed conditions were skin infections (n = 38), injuries to the knee (n =26), and foot and toes (n = 19). The most common non-medically diagnosed injuries occurred to the hand and fingers (n = 56), arm and elbow (n = 40), and foot and toes (n = 33). In general, athletes were more likely to sustain distal rather than proximal injuries. Athletes reported more frequent medically diagnosed injuries to the lower extremity and more frequent self-diagnosed injuries to the upper extremity. Upper extremity injuries appear to be more frequent but less severe than lower extremity injuries with the opposite being true for lower extremity injuries.

Sports injuries and ill-health episodes in the Cali 2013 World Games

Background

The World Games is a multisport event, second in importance only to the Olympic Games. Systematic surveillance of injuries and ill-health episodes is an essential part of modern integral healthcare given to athletes.

Aim

To describe and analyse injuries and ill-health episodes affecting competitors during the Cali World Games 2013.

Methods

This is a cross-sectional study of injuries and ill-health episodes suffered by competing athletes. Entries to the registry were systematically recorded by official doctors and medical staff at the Games, and included attention to emergencies at the sport venues and data of reports received from health facilities around the city.

Results

In all, 2824 athletes, 1216 women and 1608 men, participated in the 2013 Cali World Games. There were 88 injuries and 29 ill-health episodes, for an overall incidence of 31.2 injuries and 10.3 ill-health episodes per 1000 athletes, over an 11 day period. The highest incidence of sport associated injuries affected jiu-jitsu athletes. Hands were the most common site of injury. Injury rates for men and women were 35.5 and 25.5/1000 athletes, respectively, (RR=1.41, 95% CI 0.90 to 2.19, p=0.066). National delegations with less than 25 athletes suffered more injuries compared to larger delegations, with 40.9 vs 29.2 injuries per 1000 athletes (RR 1.4, 95% CI 0.85 to 2.30, p=0.12). The gastrointestinal system was the most affected by illness. The sport where most competitors suffered ill-health episodes was softball. The rate of ill-health episodes in women was 15/1000, and for men 6.8/1000 athletes (RR=2.16, 95% CI 1.03 to 4.56, p=0.038).

Conclusions

3.1% of the athletes had sport-related injuries, and 1% had at least one episode of ill health. These are low numbers compared to other multisport events such as the Olympic Games. Men had a higher incidence of injuries, and women a higher incidence of episodes of ill health. Future World Games should improve data-collection strategies and develop preventive measures accordingly.

Injuries Sustained by the Mixed Martial Arts Athlete

Context:

Mixed martial arts (MMA) is rapidly growing in popularity in the United States and abroad. This combat sport joins athletes from a wide variety of martial art disciplines, each with characteristic and distinguishing injury profiles, together in competition. Because of increasing participation by professionals and amateurs alike, injuries sustained by MMA athletes have been on the rise.

Evidence Acquisition:

A review of relevant publications using the search term mixed martial arts and each of its component combat sports (eg, Muay Thai, Brazilian jiu-jitsu) from 1980 through 2015 was completed using PubMed and Google Scholar.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

The majority of studies on MMA injuries evaluate those sustained during competition, which range in incidence from 22.9 to 28.6 per 100 fight-participations. Striking-predominant disciplines such as boxing, karate, and Muay Thai have high rates of head and facial injuries, whereas submission-predominant disciplines such as Brazilian jiu-jitsu, judo, and wrestling have high rates of joint injuries.

Conclusion:

Numerous studies have evaluated injuries in athletes who participate in MMA and its component disciplines during competition but much remains to be discovered about injuries sustained during training and in specific patient populations such as adolescents and women.

Isolated lateral collateral ligament complex injury in rock climbing and Brazilian Jiu-jitsu

We report two occurrences of high-grade tears of the lateral collateral ligament complex (LCLC), consisting of the anterolateral ligament (ALL) and fibular collateral ligament (FCL). One injury occurred in a rock climber and the other in a martial artist. Increasing awareness of isolated injuries of the LCLC will allow for appropriate diagnosis and management. We review and discuss the anatomy of the LCLC, the unique mechanism of isolated injury, as well as physical and imaging examination findings.