In October 2013, JITS FRANCE presented its magazine N°5 with a very interesting article on strangulation, causes and consequences of fainting.

We would like to thank the authors of this article, doctors SEIFI and MOUDEN as well as JITS France (Raphael LEVY) for allowing us to publish this article on our site as it was written and thus make you rediscover it.

Enjoy reading and learning how to tap!

 

Strangulation, causes and consequences of loss of consciousness

As a doctor for 3 years now on all kinds of sports competitions and encountering different types of injuries ranging from boo-boos to life-threatening accidents, I occasionally have to wake up a nice 100kg dummy who forgot how to tap.

Ah, this beautiful technique that is the Mata Leao, how many times have I found myself in the sh… having to raise my legs by 30 kilos. How efficient!

The history of Brazilian Jiu Jitsu brings back this saying from the Gracie family which says that strangling is a superior technique to hitting: when you give your opponent a hook, he will always be able to fight with a broken arm, if he falls asleep, the victory is total.

Except that in fact he’s not sleeping: he’s unconscious, and the difference is as big as kissing Kyra Gracie instead of André Galvao.

This was to clarify the ins and outs of the stranglehold that the magazine JITS contacted my colleague Dr. Mouden and myself, nice doctors and bad Brazilian Jiu Jitsu practitioners.

So how does strangulation work? Is it as bad for your health as it sounds?

 

What’s a strangulation?

There are two types:

Respiratory Strangulation (Ex Ezekiel Choke)

This is a compression of the trachea that causes a powerful reflex mechanism including coughing and vomiting, as if to disengage from a foreign object within the trachea. Without this reflex, strangulation could lead to a possible rupture of the trachea and accompanying complications.

Blood strangulation (ex: mata leao, triangle choke, cross choke)

It’s thought to be vascular compression that causes fainting.

The blood would no longer reach the brain!

 

But what exactly is it?

Even if we have an idea of the physical mechanisms that cause these kinds of fainting spells, in talking to my colleague, I realize that neither he nor I have any real certainty from our medical school books.

The basic idea was that since Brazilian Jiu Jitsu is a young discipline, there are few doctors who have studied the subject.

So, we plugged into judo, and there, to our dismay, because after a search on Pubmed (database of all existing medical articles) few satisfactory results: judokas do not strangle much apparently …

But it is not every day that we can combine the useful with the pleasant, so there is only one solution: discover the truth by using a doppler ultrasound device ourselves.

An ultrasound device is an expensive machine that allows you to see under the skin in real time thanks to ultrasound and which, when it has a Doppler mode, allows you to observe and quantify blood flows, whether arterial or venous.

After trying it on myself I can see that my idea works and will allow me to advance science and Brazilian Jiu Jitsu. I am therefore looking for masochistic volunteers.

At the hospital, equipped with my almost €100,000 ultrasound machine, I go through the intensive care unit and strangle any nurse who agrees to play the scarf game with me, and 15 Dopplers from the neck vessels of innocent young girls.

Later (and with a few 90-100kg stretcher-bearers) I have a beginning of a trail.

The results are simple:

As soon as the constriction begins, the jugular venous flow is immediately stopped. Blood can no longer flow out of the brain and after a few seconds the headache and then the feeling of unconsciousness appear.

If the strangulation is continued, the intracerebral hypertension induced by the accumulation of blood will prevent any new blood flow through the carotids and the brain will no longer be oxygenated. From that point on I let go of the little nurses, because I need them to work.

I then try on the big guys in the hospital and myself, a really tight choke this time.

There, not only is the flow of veins stopped, the carotid flow is very quickly slowed down, but the measured diameter of the carotid arteries also decreases. So I let go of the choke before the accident because at the hospital we are not insured against Brazilian Jiu Jitsu practitioners.

The mechanism that leads to fainting is therefore mixed, arterial and venous, and leads to complete syncope by cerebral anoxia, very different from sleep since sleep is good for health.

 

So what are the risks of a strangulation?

Since 1882 there have been no fatal accidents in judo competitions!

In 1991 Italian doctors practiced electroencephalograms to measure the cerebral electrical activity while measuring the variations of the cerebral flow and strangling until syncope 7 judokas, the results are rather reassuring: no after-effects at the course, and even if decreases in cerebral activity appear, the measurements return to normal after releasing the stranglehold, at most after 20 seconds according to a comparable study conducted in Frankfurt.

Therefore, you might think, you reader who is just tapping at the end of the rope, that you are saved, but you are wrong.

Although there were no fatal accidents, there have been several reports of carotid dissection.

Basically a rupture of the main blood supply to the brain.

 

The consequences?

At best an operation, at worst death, and most often in between: a motor disability until the end of life, but one can also end up dumb and/or stupid.

Similarly, there are probably carotid micro lesions, the same ones that are found in autopsies of suicidal hangmen and other masochists in love with scarves.

Who knows what they can cause in the long term, leading to carotid dissections or strokes?

In 1991 in England this time, a young judoka is reported to have suffered permanent anoxic lesions of the left temporal lobe of the brain following repeated strangulations, including a “softening of the brain” leading to loss of memory and decreased intelligence.

 

What can we conclude from this?

Unfortunately something quite obvious: that repeated cerebral anoxia inevitably has long-term consequences on the functioning of our brain and therefore on memory, intelligence and movement coordination.

But judokas strangle less than we do and we must therefore expect an increase in the frequency of these accidents and their severity. So to evaluate these risks, we should ideally study serial stranglers.

The police are the best able to enlighten us about strangulations.

Yes! The police, and I’m not talking about Derrick! I’m talking about the American police.

So we need to look at Americans and their forensic records, and this at a time when doctors had the right to look for anything and everything.

Thus, in the 1980s, police and prison services used systematic strangulation to immobilize the “bad guys”: le shime­waza (cross choke).
And as in the land of the Star-Spangled Banner we like people who go all the way, strangulation is maintained to the point of unconsciousness for the safety of the ‘good guys’.

The result is dramatic: in 1987, 14 deaths were reported, although the strangulation was released just after they became unconscious.

These same Americans established that a well executed strangulation leads to total unconsciousness in 10 to 20 seconds maximum.

So in judo as in Brazilian Jiu Jitsu there is a thin window for tapping.

Blood Strangulation

When should I tap?

Beyond the imminent feeling of unconsciousness, you have to know your body and the signals it sends us: For example, the small spots you can see are called “phosphenes” and are signs of retinal anoxia, if you start to see them, there is little chance that you will manage to get out of the triangle!

Also, the headache sensation is caused by intracranial hypertension, and it’s probably too late to stop.

Since one loses consciousness within an average of 15 seconds after the onset of these symptoms, the range for tapping is narrow.

 

What happens when I don’t tap?

No one has yet seriously studied this, so there is no certainty, but by asking different specialists (neurologists, radiologists, forensic doctors and resuscitators), all agree on the same point:

If there is a loss of consciousness it is cerebral anoxia, and if there is repeated cerebral anoxia throughout life, there will be consequences later on.

With each loss of consciousness there are neurons that die, and neurons are cells that never regenerate …

 

One of the main points that is too often forgotten is that not everyone is born equal when faced with illness.

If you have neurodegenerative diseases (Alzheimer’s, Parkinson’s and other dementias of the elderly) at the age of 70, with 20 years of Brazilian jiujitsu behind you, and you haven’t tapped enough, you risk contracting these diseases earlier and perhaps even more severely.

You might think that if you tap you’re safe, but you’re wrong…

 

In conclusion

A final study by our Italian friends has compared the cerebral after-effects, in particular thanks to electroencephalograms in professional and amateur boxers and judokas.

Carried out in 1998 this study had only found long-term after-effects in professional boxers.

Gentlemen, judo is therefore a combat sport which, a priori, leaves fewer neurological after-effects than British boxing.

But because of the more frequent strangulations, Brazilian Jiu Jitsu is more dangerous for the brain than judo and its long-term effects have not yet been studied.

So the immediate risk is not zero.

Every time we lose consciousness the long-term consequences for our health are real.

So you have to know your limits, respect your body, your sport and your opponent: sometimes you have to know how to lose with panache!

And if your playmate lacks panache: release the strangulation, when the mechanical obstacle is lifted the blood will return to the brain and unless you’ve held on too long, he should wake up on his own in less than 20 seconds.

Of course nothing prevents you from helping him with the good old recipe, you speed up the blood supply to the brain and thus its oxygenation by raising the feet, and also sprinkle it with a few strokes in the buttocks to season it… uh sorry, I meant to stimulate it!

What if it doesn’t work? Check that he’s still breathing and quickly call someone who has a first-aid certificate, and cross your fingers too, it can help.