Recognizing The Signs Before It Is Too Late: Vascular Neck Injuries in Brazilian Jiu-Jitsu.
Since my stroke in 2017, my mission is to spread awareness to the BJJ community surrounding the potential damage to the carotid and vertebral arteries often caused through BJJ training and competition. Whether a hobbyist or a professional fighter, being aware of this issue is vital to your well-being. Many people in the jiu-jitsu community have voiced their opinions on this topic. Most believe that strokes caused by strangulation during jiu-jitsu participation are exceedingly rare and nothing with which participants should concern themselves. After all, they have enough to worry about regarding the eminent damage to the outside of their bodies to focus on when they are fighting and training. Many of those same people believe that the message that we are working so desperately to spread is nothing more than “fear-mongering”. However, this line of thinking could cause participants in Brazilian jiu-jitsu to delay their all-important reaction time if and when the signs and symptoms of neck, or vascular injuries present.
Strokes don’t just take hobbyist and professional fighters out of the game for a few days or a few weeks so their bodies can heal. If a jiu-jitsu-related stroke occurs, that fighter’s life and the lives of those around him (or her) are forever changed. A stroke is not an injury that one can simply “walk off.” The neurological damage that can occur ranges from partial blindness to loss of motor skills, and it can even cause death.
Both hobbyists and professional fighters simply need to take the time to review the warning signs listed below. They come from a physiotherapist who created this outline after losing a close friend to the very issue I bring to your attention today. The warning signs went unheeded due to a lack of knowledge and education on the subject in our BJJ commuity.
Below is an outline which I transcribed from a vlog presented by physiotherapist Andrzej Ostapko. This vlog was created after Ostapko’s close friend Robert Gajewski friend passed away due to a neck injury that caused a stroke. Unfortunately, Robert unknowingly missed the warning signs that we all need to be better aware of. Ostapko wants to ensure this does not happen again, as do I.
To date, this VLOG has done the best job I have seen concerning breaking down the early signs and symptoms of dissections in jiu-jitsu athletes.
Brazilian Jiu-jitsu is a martial art and a relatively new sport that concentrates on groundwork, joint locks, and vascular strangles to get opponents to submit or give up in a fight.
The word of Jiu-jitsu has a Japanese root that translates to ‘gentle art.’ Although jiu-jitsu is known for its efficiency, competitiveness and is relatively considered safer than other martial arts, several injuries inevitably occur during jiu-jitsu training and competitions. As compiled by physiotherapist Andrzej Ostapko, his presentation aims to evaluate the prevalence of neck injuries sustained during Jiu-Jitsu training, with related observations and extensive research conducted on this subject.
Andrzej’s presentation outlines the symptoms of one of the most potentially fatal injuries in BJJ, Arterial dissection and does one of the best jobs I have seen so far in outlying the signs we need to know about that can help us prevent a stroke.
NECK INJURIES IN BRAZILIAN JIU-JITSU; ARTERIAL DISSECTION
Neck injuries are very prevalent in jiu-jitsu. Since fighters end up in uncomfortable positions while being deep-stacked, strangled, or trying to break free from a headlock, they are likely to sustain neck injuries during combat. One such injury is Arterial dissections, predominantly the cause of stroke in Brazilian jiu-jitsu and MMA fights. Arteries are critical structures of the body alongside discs, nerves, vertebrates, and so on. However, once an artery is damaged, it reduces blood flow that could, in the end, lead to a stroke.
There are two arteries; The vertebral and the carotid arteries, both of which are responsible for supplying the brain, face, neck, head, and other areas with oxygenated blood and nutrients. Arterial dissection is a rare condition in about one in one hundred cases (1:100000) when it comes to vertebral artery dissection. On the other hand, carotid artery dissection accounts for about 2.5 to 3 people in one hundred thousand cases (2.5:100000) of strokes. Additionally, this condition is a significant cause of stroke in all age groups, but it is an infrequent yet common cause of stroke in young people between the ages of 15–45.
The causes of arterial dissection could be 1) spontaneous or 2) traumatic.
Some people are genetically predisposed to arterial dissections. Also, traumatic incidences that impact the neck like whiplash injuries, car crashes, strangulation (commonly referred to as chokes in BJJ), and any action that involves hyperextension or rotation of the neck can cause arterial dissection.
Participating in different sports can also inadvertently lead to arterial dissection. According to a research paper published by the European Journal of Stroke in 2017, the condition has been primarily observed in sports like running, golf, scuba diving, and martial arts like jiu-jitsu.
Although it is an infrequent occurrence, this shows that arterial dissection is quite common in most sports.
HOW ARTERIAL DISSECTION OCCURS
Usually, the inner layer of the artery (which can be likened to a pipe consisting of three layers for better understanding) tears during the impact and creates a flap-like opening in the artery’s inner lining. The incision allows blood to enter the arterial wall’s direction, forms a blood clot that thickens the artery wall, and causes a significant swelling hematoma. At the same time, it restricts the blood flow to the brain. This leads to hypoxemia, lack of blood or oxygen symptoms, and others, as listed below.
For carotid artery dissection, a tear in one of the carotid arteries (located in the frontier part of the neck) could result in a hematoma. Once the hematoma breaks off, which could occur maybe after training or taking part in any severe choke, guillotine or rotation during jiu-jitsu, this can be fatal to the patient.
Similarly, if there is a blood clot in the artery and it does not dissolve in time, it could cause a switch in the body’s vital functions.
*The physiotherapist mentions a personal story of losing a friend to this condition in the above video.
RESEARCH FROM THE EUROPEAN JOURNAL OF STROKE AND OTHER SOURCES
Statistics are presented here from the European Journal of stroke, which analyses different sports types and the number of people who have developed a stroke while participating in each of those sports.
The data present in this journal was collated from 190 cases of arterial dissection written in 150 articles. Among all the other sports, jiu-jitsu records only 4 cases as of 2017.
Aside from the written cases on jiu-jitsu, the physiotherapist took time to consult with me concerning the stroke I suffered due to an arterial dissection while participating in BJJ and references me in this video.
Notes about my blog @Bizjitsu mentioned in the video:
I (Chris Martin) started this blog in 2017 to help people who went through a similar ordeal. My blog is also my mission to bring general awareness to the BJJ community about this issue’s seriousness. Via my blog, people reached out to me with their shared stories. Not long after, I gathered data on roughly 100 cases of stroke connected to Brazilian Jiu-jitsu.
Since my battle with this preventable issue began in 2017, I have taken every opportunity to interview people eager to share their experiences with suffering stroke from practicing jiu-jitsu.
In his video Andrezej recommends people check for information about stories and stroke prevention on my blog (right here on Medium), or on my YouTube Channel.
DIFFERENT SIGNS AND SYMPTOMS
Before considering these symptoms, it is essential to consult a doctor or medical professionals’ advice if any of these symptoms are encountered. This is because there is a considerable variation in the presenting symptoms, which can pose a difficulty when it comes to an initial diagnosis.
More importantly, missing the signs could be an unfortunate mistake, the result of which might lead to a stroke.
VERTEBRAL AND CAROTID ARTERY DISSECTION
Although, they both have different signs and symptoms. The vertebral artery dissection symptoms are closely related to and can be mistaken for that of the Carotid artery dissection.
However, a distinctive feature is that the latter’s symptoms are usually more associated with the symptoms of a stroke. Additionally, the vertebral is a little less common than carotid artery dissection.
Early symptoms in vertebral artery dissection include;
- Neck pain
• Headache: which is severe and described as ‘unlike any other.’ It can be mistaken for a regular headache.
The Late symptoms of artery dissection are tagged the 5D’s, 3N’s, and 1A. They include;
• Diplopia: double vision
• Dysphagia: Difficulty in swallowing
• Dysarthria: problems with speech and Drop attacks
• Nystagmus: involuntary eye movement
• Numbness on the same side of the face.
• Ataxia: lack of voluntary coordination of movement. For instance, the inability to lift one arm.
The Early signs of the Carotid artery dissection are;
• Mid upper cervical pain
• Carytodynia: Pain in the front of the neck like the constant feeling of tonsillitis (something stuck in the throat)
• Head pain in the front-temporoparietal area
• Ptosis: falling of the upper eyelid
• Lower cranial nerve dysfunction: face drop or asymmetrical face
• Headache; the pain level has also been described as ‘unlike any other.’
The late signs consist of Carotid artery dissection;
• Transient retinal dysfunctions like blackout blurred out visions for up 15 seconds, and clouded visions (as opposed to the double vision in vertebral artery dissection).
• Transient ischemic attack.
• Cerebrovascular accidents, which is a stroke.
To better understand and ascertain these symptoms in patients, it is crucial to memorize the acronym FASTER.
• Face: drop face.
• Arms: inability to lift one or both arms at once.
• Stability: the gait of the patient. Pay attention to any form of unstable walking or limping.
• Talking: inability to understand them, slurred or incoherent speech.
• Eyes: dilated pupils.
• React: Call an ambulance immediately.
Look out for these inpatients as the symptoms may accrue for about two weeks or a month after the injury has been suffered. It is crucial to pay attention to the individual, especially after chokes, guillotines, strangulation, and sparing in jiu-jitsu. Fainting once or a few times should also be monitored. Some symptoms might be rapid, while others are latent for weeks. Do not expect all the symptoms to surface at the same time.
Moreover, if you suffer a similar injury by chance, it is better to seek the opinions of family members or friends. They are in the best position to notice and point out some of the symptoms you might overlook. After that, you should seek the medical help you need immediately.
Prevention is as simple as coaches offering education to new students- where they are exposed to the warning signs of stroke that can be encountered while training and competing. This is a beautiful opportunity to bring awareness to our jiu-jitsu community.
The number of these preventable strokes will certainly decrease among participants who are educated, hence why I continue writing these articles and speaking with coaches.
Although I usually focus on posting these articles during the annual Stroke Awareness Month, this year, I waited so I could interview someone who is an actual survivor of a carotid artery dissection resulting from a clock choke in a BJJ class. Let me emphasize, he recognized the warning signs, got treated, and beat the stroke. The dissection never had the opportunity to cause a stroke, unlike my case and so many others I have spoken with and interviewed over the years.
I invite you to listen to this interview from a very knowledgeable practitioner, who recognized the signs, thus avoiding a stroke and irreversible damage to his body. This quite possibly saved his life. I hope that listening to his experience will help you or someone you love to recognize the warning signs and realize that this is an actual situation that BJJ practitioners face every time they step on the mat.
My story does not have to be your story. Hopefully, if you ever find yourself in this unfortunate situation, your personal experience will be more like my friend’s because you have listened to and internalized the information presented to you here.
My message to the Brazilian jiu-jitsu community this year (2021) has not changed much since I began speaking about the risk of strokes in jiu-jitsu after my accident in 2017, but it seems to be taking on a greater sense of urgency. Strokes from strangulation in jiu-jitsu are happening more frequently now than just four years ago.
Since my stroke caused by a carotid artery dissection in 2017, I have become vigilant in keeping track of the stories told to me by other stroke survivors. I have documented these stories in a database to aggregate the information of each occurrence, and to note similarities. My study contains information given by both BJJ hobbyists and professionals who have had a stroke either while on the mats or very soon following their training session (usually shortly after arriving home or while on their way home). My data clearly shows a rise in number.
Although Jiu-Jitsu strangulation-related strokes are rare, they can be deadly. Sadly, I can personally attest to two fatalities over the past year attributed directly to vascular damage of the neck with trauma caused by Brazilian jiu-jitsu strangulation.
Through my blog and my YouTube channel, I continue to encourage BJJ practitioners to share their stories. In addition, I also encouraged them to share their medical records with my associate, Dr. Sam Stellpflug of the Regions Hospital Department of Emergency Medicine. He is currently helping me compile a peer reviewed medical case study based on the data received from participants what will help us contribute to the safety of our sport.
The medical study by Dr. Sam will help the sport because, without this medical data, people in the jiu-jitsu community will continue to be skeptical. Additionally, the medical professionals treating these injuries often don’t realize the symptoms present as a result from injury caused by BJJ. As a result, they often focus treatment in the wrong direction. The product is a waste of precious time, which is a tremendously sensitive factor in identifying and treating strokes. Moreover, the people who participate in this martial art must know the risks involved in the sport to avoid possible stroke-onset brain damage. They must also learn to recognize the initial warning signs, ensuring they are not ignored or missed.
Until this information becomes more commonly accepted in the jiu-jitsu community and better studied and understood by the medical community, BJJ participants are at risk. Therefore, the BJJ community, including coaches and jiu-jitsu associations, must share the information presented on this topic, making it part of their programs when discussing other safety issues.
When I share my blogs within Facebook groups and Twitter, the common question I get back is, “what is the answer? Tap early and tap often?” My answer is simple. It just comes back to awareness and better education so that we don’t miss any of the warning signs that lead to stroke, and jiu-jitsu players need to evaluate their body’s response to possible stroke-inducing injuries. They need to understand the risk those injuries can cause and as well as the signs. Ultimately, they must be proactive in acting if they feel they might be in danger.
As unique as the art of Brazilian jiu-jitsu is, it is a sport where the aim is to control, strangle and force an opponent to submit. This fact renders the neck vulnerable to a wide range of attacks that could lead to injuries like arterial dissections. If not detected on time and adequately taken care of, arterial dissection could lead to stroke. It is essential to monitor both the signs and the symptoms and tackle them at an early stage. For these reasons, it is extremely important for coaches, practitioners, and medical professionals to thoroughly recognize and understand the protocols in place for neck and vascular injuries like those discussed in this blog.