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Introduction: Addressing Concerns About Brain Health in BJJ
Brazilian Jiu-Jitsu (BJJ) is a martial art celebrated for its inclusivity, technique-driven approach, and reduced risk of striking injuries. However, concerns about its impact on brain health—stemming from neck chokes and occasional head trauma—have been a topic of ongoing investigation. Recent research suggests that BJJ may not only pose minimal risks to brain health, if practiced properly, but could also confer unique neuroprotective benefits. However, practitioners are still prone to other, albeit less serious head injuries.
Understanding Oral and Maxillofacial Injuries in BJJ
Prevalence and Types of Injuries
Recent research highlights the high frequency of stomatognathic injuries among BJJ practitioners. A study conducted with 179 athletes revealed that orofacial injuries were common, particularly among those with more experience. Experienced athletes were found to have a higher prevalence of injuries such as lacerations to the oral mucosa and skin abrasions in the facial region, often occurring during training sessions. This trend was consistent with findings from other studies, which showed that the majority of these injuries were not severe but were still frequent.
Challenges with Mouthguard Use
A significant finding from the study was the lack of mandatory mouthguard use in BJJ. Unlike other contact sports like boxing, where mouthguards are required, BJJ does not enforce their use. The study revealed that 62.6% of athletes did not wear a mouthguard at all, with common justifications being difficulty breathing and discomfort during training. Among those who did use mouthguards, boil-and-bite mouth guards (type II) options were the most common. These mouthguards are not ideal because they do not offer adequate protection or comfort and may not stay in place during impact, thus failing to prevent injuries effectively.
The Role of Dentists and Preventive Measures
The absence of mandatory mouthguard use and the prevalence of injuries suggest a need for increased involvement of dental professionals in BJJ. The study highlighted the critical role dentists play in educating athletes on the importance of mouthguards and their correct use, advocating for more custom mouth guard options (type III mouthguards) that offer better protection, comfort, and adaptation to individual anatomy. This intervention could help reduce the incidence of injuries like tooth fractures and soft tissue lacerations, which were commonly observed among athletes.
Understanding Brain Injury Risks in BJJ
How Does BJJ Differ From Other Combat Sports?
Unlike striking sports such as boxing or MMA, BJJ focuses on submissions, joint locks, and positional control, prohibiting all strikes. This makes BJJ significantly safer regarding traumatic brain injury (TBI). However, the sport is not without risks. Practitioners may experience concussions from accidental impacts during takedowns, throws, or transitions, and concerns have been raised about the effects of repeated neck chokes.
Recent epidemiological research has added valuable data to these concerns. A cross-sectional study on U.S.-based BJJ practitioners revealed that 25.2% reported experiencing at least one concussion related to BJJ. Moreover, female practitioners faced a significantly higher risk (43.0%) compared to males (22.9%). These findings emphasize the need to address gender-specific vulnerabilities and improve concussion awareness within the community.
Concussions in BJJ
Concussions in BJJ are rare but possible. Common causes include:
- Unintentional impacts: During sweeps, takedowns, or clashes with the mat.
- Traumatic brain injuries (TBI): These can range from mild to severe but are typically infrequent in BJJ.
Recognizing Symptoms of Concussions:
It is vital to monitor for concussion symptoms, such as:
- Headaches
- Sensitivity to light
- Dizziness or difficulty balancing
- Nausea and vomiting
- Brain fog or mood changes
Concussion Protocols
The article "The National Football League Concussion Protocol: A Review" by Jaclyn Jacobi, MD, Erin B. Wasserman, PhD, and Bert Vargas, MD, highlights the NFL's structured and evidence-based Return-to-Participation (RTP) protocol, which could serve as a valuable model for Brazilian Jiu-Jitsu (BJJ). The NFL has refined this protocol to ensure the safe return of players following concussions, and its effectiveness in one of the most high-impact sports globally underscores its adaptability and reliability.
Key components of the RTP protocol include:
- Five Phases of Recovery: A progressive approach ensures athletes are symptom-free before escalating physical activity, minimizing the risk of exacerbating injuries.
- Individualized Recovery Timelines: The protocol avoids rigid timelines, allowing players to recover at their own pace while maintaining safety standards.
- Baseline Neurocognitive Comparisons: Athletes must return to their preseason cognitive baselines through advanced neurocognitive testing before being cleared for contact. A baseline test reflects your normal brain functioning and provides a critical reference point. If you sustain a concussion, medical professionals can use your baseline report to determine when your brain has returned to its normal state after the injury.
We highly encourage everyone to establish their baseline. You can take a baseline test at Baseline Testing. This simple step can provide invaluable data to guide recovery for your doctors and ensure safe participation in your sport.
Given the parallels between the NFL's challenges and those in grappling sports, adopting or adapting this protocol for BJJ is a logical step. Implementing such a system could significantly improve concussion detection, management, and recovery in BJJ, offering athletes a clear path to return while safeguarding their long-term health. If it works for a high-impact, high-stakes environment like the NFL, it stands to reason that it can also provide meaningful benefits in BJJ, where similar concerns around head and brain health are increasingly prominent.
Below is the Return-to-Participation (RTP) protocol tailored for Brazilian Jiu-Jitsu by Uziki MMA:
| Phase | Activity | BJJ Context | Purpose |
|---|---|---|---|
| Phase 1 | Symptom-Limited Activity | Rest and avoid activities that worsen symptoms (physical or cognitive). Light stretching, mobility exercises, and balance drills can be introduced as tolerated. | Allow initial healing and prevent symptom aggravation. |
| Phase 2 | Aerobic Exercise | Under supervision, introduce low-impact cardio (e.g., walking or cycling) and light dynamic movements. Continue balance and mobility exercises. | Reintroduce cardiovascular activity without risking symptom return. |
| Phase 3 | BJJ-Specific Exercises | Gradually increase intensity with supervised solo drills (e.g., shrimping, bridging, and positional escapes). Strength training can be reintroduced at a moderate level. Avoid any partner or live rolling activities. | Start rebuilding BJJ-specific movement patterns and strength while maintaining safety. |
| Phase 4 | Controlled Partner Training | Continue cardiovascular and strength exercises. Introduce controlled partner drills with no live sparring. Focus on positional training and low-intensity technical work. Perform neurocognitive and balance testing to ensure baseline levels are met. | Reintegrate into light partner training while ensuring cognitive and physical readiness. |
| Phase 5 | Full BJJ Activity | Upon clearance from a qualified medical professional, resume full training, including live rolling and sparring. Coaches should monitor initial sessions to ensure no symptoms return. | Safely return to full-contact training with assurance of complete recovery. |
Neck Chokes and Brain Damage
The article "Impact of repeated sportive chokes on carotid intima media thickness and brain injury biomarkers in grappling athletes" by Samuel J. Stellpflug and colleagues aimed to investigate whether repeated exposure to choking techniques in grappling affects carotid intima media thickness (CIMT) and brain injury biomarkers (NFL, hGFAP, t-Tau, and UCH-L1). The study involved 39 participants—20 grapplers with over five years of experience and more than 500 choke events, and 19 age/sex/body size matched controls. Despite finding no significant difference in CIMT or brain injury biomarkers between the grapplers and controls, the study did not detect adverse effects from repeated choking exposure in these measures.
Chokes in BJJ, primarily blood chokes, compress the carotid arteries to induce temporary unconsciousness. Evidence suggests that short-term strangles (lasting 8-15 seconds) are safe for healthy individuals. However, prolonged chokes (over 3 minutes) or underlying health conditions, such as arterial plaques, can pose risks.
Lastly, the article "Cognitive Assessment in Grappling Athletes Following Choke versus Nonchoke Submissions" by Samuel J. Stellpflug and colleagues aimed to determine if transient choking episodes in grappling sports affected cognitive function. The study used the King-Devick test (KDT), which measures number recognition, cognition, and verbal expression. The test was administered to 62 participants before a training session, immediately after either choking or non-choking submission, and again after a 10-minute rest. Analysis showed no significant differences between the Choke and Non-Choke groups in test failures, total test times, or individual difference scores, indicating that transient choking did not impair cognitive function as measured by the KDT.
New Research: BJJ’s Positive Impact on Brain Health
Higher Blood Flow and Cognitive Function
Groundbreaking research from the University of South Wales has provided new insights into BJJ’s effects on brain health. Using Duplex ultrasonography and neuropsychological tests, researchers examined cerebral blood flow and cognitive function in elite BJJ athletes.
Key Findings:
- Increased Resting Cerebral Blood Flow: BJJ athletes exhibited higher resting global cerebral blood flow compared to age- and fitness-matched controls.
- Preserved Cognitive Function: The athletes showed no cognitive decline, suggesting a protective effect from BJJ training.
Benjamin Stacey, a lecturer in Clinical Science, hypothesizes that the benefits may stem from:
- Choke-induced preconditioning: Short bursts of reduced blood flow followed by recovery could strengthen the brain's resilience.
- High-intensity interval training (HIIT): The cardiovascular demands of BJJ are known to support brain health.
Long-Term Implications
While more research is needed, preliminary findings suggest BJJ may promote long-term brain health by enhancing cerebral blood flow and preserving cognitive function.
Minimizing Risks in Training
Practical Steps to Avoid Brain Injuries
To ensure safe training, practitioners should adopt the following measures:
- Choose safe training partners: Avoid uncontrolled movements that can lead to accidental blows.
- Learn proper falling techniques: Mastering breakfalls reduces the risk of head injuries during throws and sweeps.
- Build neck strength: A strong neck minimizes concussion risks and improves overall resilience in grappling.
- Focus on proper technique: Accurate execution prevents accidents, including head clashes.
Recognizing and Addressing Concussions
In the rare event of a concussion, prioritize rest and seek medical attention for severe symptoms. Avoid training until fully recovered to minimize the risk of further injury.
Summary: A Unique Blend of Safety and Benefits
BJJ’s structure—excluding head strikes and emphasizing controlled techniques—positions it as a safer martial art compared to striking disciplines. Concerns about brain damage from chokes or concussions are largely mitigated by proper training and care.
Moreover, recent research highlights potential neuroprotective benefits, such as increased cerebral blood flow and sustained cognitive health. These findings underscore the importance of further exploration into BJJ’s long-term effects, not only to alleviate concerns but also to uncover its full potential as a brain-healthy martial art.
Train smart, stay mindful of risks, and enjoy the unique benefits that BJJ offers for both body and brain.