It is well established that blows that rattle the brain have both short and long term health effects for combat sport athletes. Strikes to the head have been shown to cause concussion symptoms as well as lead to chronic traumatic encephalopathy (CTE). Blows to the head also have the potential to cause fatal traumatic brain injuries (TBIs), such as cerebral hemorrhages.

With the evidence mounting that striking sports are more dangerous than once thought (with modern science showing that even blows to the head that do not result in concussion can result in CTE), MMA may one day find itself at a critical moment where the sports’ survival — in its current form — is at risk.

If blows to the head in MMA become a thing of the past, it may fall on the foundational discipline of Brazilian jiu jitsu to provide the biggest thrills inside of the Octagon. For decades the sport has been blessed with grapplers who are able to win fights, in exciting fashion, without taking or delivering obvious damage to the brain.

However, two recent studies argue that even BJJ might have profound affects on the brain health of fighters.

This week on CombatSportsLaw.com Erik Magraken continued his exploration on whether chokes can lead to cognitive impairment and even CTE.

Magraken has been reporting on the issue since last year, when an article titled ‘Verterbral Artery Dissection in Active-Duty Soldier Due to Mixed Martial Arts Choke Hold’ was published in the peer-reviewed journal Federal Practitioner. That article highlighted a case study regarding a military service member who had been choked in a BJJ match and later reported severe nausea and vertigo. The service member eventually suffered a stroke.

In January, CombatSportsLaw followed up on that story with a report on a more recent study titled ‘Dangers of Mixed Martial Arts in the Development of CTE’, which was published in the International Journal of Environmental Research and Public Health.

That study included the story of a 40-year-old subject who practiced MMA for a decade and was later diagnosed with CTE. The study claimed the subject’s CTE largely resulted from repetitive sub-concussive brain trauma received both in training and competition.

Additionally, the study referenced repetitive choking as playing a possible role in the subject’s CTE development. Included in the study were the lines, “What is perhaps little discussed is the role of asphyxia in the contribution towards long-term behavior and memory changes in the MMA athlete over time.”

The study went on to claim that, ‘Neurological injury due to compression of the neck could potentially occur,” in MMA and that studies into hanging deaths had shown that a force of two kilograms was sufficient to compress the jugular veins to the point of causing cerebral edema (swelling of the brain). The study also cited that five kilograms of force on the carotid arteries could cause hypoxic brain injury (oxygen deprivation) and that 15 kilograms of force was sufficient to cause severe hypoxia and death.

The study points out that people who suffer from hypoxic brain injuries are at risk of developing persistent cognitive, behavioral, and neurological problems.

However, not everyone is buying the connection between chokes and potential brain injuries. Dr. Samuel J. Stellpflug, an emergency medicine practitioner, wrote an official reply to the study in which he claims there was an absence of evidence to accompany the study’s claim.

Stellpflug’s entire reply is available on CombatSportsLaw.com. A small portion of the reply is available below:

The literature linking CTE or [Hypoxic-Ischemic Brain Injury] and repeat execution of choking techniques in MMA and grappling sports is nonexistent. This lack of evidence is especially significant given the hundreds of thousands of athletes, both past and present, who participate in choke-inclusion sports worldwide. I understand and respect the authors bringing up choking techniques in the context of this article, but it would be most reasonable to bring up as a question for possible further study with inclusion of the above information as opposed to likely falsely theorizing that the particular presented patient may have suffered some of his CTE-related neurological decline from repeated chokes.

Stellpflug also argued that the study was wrongly associating the affects of being strangled with the kind of chokes that are executed in grappling sports.

This was not the first time Stellpflug has responded to a study linking chokes to CTE. He also penned a response to an article titled ‘The King-Devick Test in Mixed Martial Arts: The Immediate Consequences of Knock-Outs, Technical Knock-Outs, and Chokes on Brain Functions’, published by the National Center for Biotechnology Information (NCBI).

In that response, writing with Dr. Robert LeFevere, Stellpflug took issue with the NCBI study that showed fighters who had lost fights via knockouts, technical knockouts and chokes experienced a similar degree of cognitive impairment.

Stellpflug and LeFevere claimed that this study failed to take into account any damage fighters received from strikes to the head prior to losing a fight by a choke.

Stellpflug’s reactions to these recent studies shows there is a lack of consensus in medical science regarding the connection between chokes and brain injuries. The path to finding consensus is through more studies and discourse. Hopefully that will lead to more definitive evidence, and then disclosure, on any danger that comes along with combat sports.