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Stellpflug SJ, Dummer MF, Martin CD, Vera JA, LeFevere RC. Cervical Artery Dissections and Ischemic Strokes Associated with Vascular Neck Compression Techniques (Sportive Chokes). J Emerg Med 2022; 63:49-57. [PMID: 35934648 DOI: 10.1016/j.jemermed.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/03/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Strangulation as a fight-finishing maneuver in combat sports, termed "choking" in that context, occurs worldwide millions of times yearly. This activity can be trained safely, but devastating injuries can occur. OBJECTIVE Our aim was to present a case series of cervical artery dissections and ischemic strokes associated with sportive choking. Sharing these cases is meant to draw awareness, to assist emergency physicians in caring for these athletes, and to provide a platform for further research. METHODS Institutional Review Board approval was obtained. Participants consented for medical information transfer and anonymous academic reproduction. The minimum medical record information necessary for inclusion was a report of diagnosis-confirming advanced imaging. Participants were contacted for primary information in addition to what the medical records could provide and to confirm some information in the record (e.g., pertinent medical history, demographic characteristics, choking event description, medical care, and commentary on their current health). Medical records and additional first-hand information were reviewed and participants were included if they had a diagnosed dissection or stroke likely associated with a sportive choke. RESULTS Ten cases met all criteria for inclusion. There were 5 cases of carotid artery dissection, 3 cases of vertebral artery dissection, and 2 cases of ischemic stroke without dissection. Nine of 10 participants survived and 3 of 10 have returned to submission grappling training. CONCLUSIONS Cervical artery dissections and ischemic strokes can occur in association with sportive choking. Emergency physicians must be aware of the widespread nature of this activity and must be vigilant in approaching management of patients with symptoms consistent with these injuries.
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Affiliation(s)
| | - Matthew F Dummer
- Department of Emergency Medicine, Regions Hospital, Saint Paul, Minnesota
| | | | - Joshua A Vera
- Hazel Hawkins Memorial Hospital, Hollister, California
| | - Robert C LeFevere
- Department of Emergency Medicine, Regions Hospital, Saint Paul, Minnesota
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Stellpflug SJ, Weber W, Dietrich A, Springer B, Polansky R, Sachs C, Hsu A, McGuire S, Gwinn C, Strack G, Riviello R. Approach considerations for the management of strangulation in the emergency department. J Am Coll Emerg Physicians Open 2022; 3:e12711. [PMID: 35445212 PMCID: PMC9013263 DOI: 10.1002/emp2.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Patients with a history of strangulation present to the emergency department with a variety of different circumstances and injury patterns. We review the terminology, pathophysiology, evaluation, management, and special considerations for strangulation injuries, including an overview of forensic considerations and legal framework for strangulation events.
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Affiliation(s)
| | - William Weber
- Section of Emergency Medicine The University of Chicago Chicago Illinois USA
| | - Ann Dietrich
- Department of Pediatrics and Emergency Medicine University of South Carolina School of Medicine Columbia South Carolina USA
| | - Brian Springer
- Department of Emergency Medicine Wright State University Dayton Ohio USA
| | - Robin Polansky
- Department of Emergency Medicine Cedars-Sinai Medical Center Los Angeles California USA
| | - Carolyn Sachs
- Department of Emergency Medicine University of California, Los Angeles Los Angeles California USA
| | - Antony Hsu
- Department of Emergency Medicine St. Joseph Mercy Hospital Ann Arbor Michigan USA
| | - Sarayna McGuire
- Department of Emergency Medicine The Mayo Clinic Rochester Minnesota USA
| | - Casey Gwinn
- Training Institute on Strangulation Prevention Alliance for Hope International San Diego California USA
| | - Gael Strack
- Training Institute on Strangulation Prevention Alliance for Hope International San Diego California USA
| | - Ralph Riviello
- Department of Emergency Medicine The University of Texas: San Antonio San Antonio Texas USA
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Stellpflug SJ, Taylor AD, Dooley AE, Carlson AM, LeFevere RC. Analysis of a Consecutive Retrospective Cohort of Strangulation Victims Evaluated by a Sexual Assault Nurse Examiner Consult Service. J Emerg Nurs 2022; 48:257-265. [DOI: 10.1016/j.jen.2022.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/01/2022] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
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Stellpflug SJ, Menton WH, LeFevere RC. Analysis of the fight-ending chokes in the history of the Ultimate Fighting Championship™ mixed martial arts promotion. PHYSICIAN SPORTSMED 2022; 50:60-63. [PMID: 33347362 DOI: 10.1080/00913847.2020.1866958] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Knowledge of sportive chokes is vital to the practice of Sports Medicine when providing care at mixed martial arts and submission grappling events. This is a descriptive analysis of fight-ending chokes to help provide data on the topic not previously presented. METHODS An analysis was done on every fight-ending choke in the history of the UFC™ mixed martial arts promotion. Investigators focused on the frequency of chokes, types of chokes, handedness of the chokes, and whether chokes resulted in loss of consciousness. This analysis was done using existing fight outcome reports and video analysis of every choke that ended a fight in UFC™ history. RESULTS During the study period there were 904 such chokes, comprising 15.5% of fight outcomes and 76.2% of grappling submissions. The makeup of right (50.1%) and left (49.9%) handedness of the chokes has been essentially identical (χ2 [1] = 0.0011, p =.947, phi =.00). Most of the fight-ending chokes culminated in voluntary submission; however, 11% resulted in loss of consciousness. The rear naked choke (RNC) was significantly more frequent than other chokes, comprising 49.1% of the total choke finishes; 19 other choke types accounted for the remaining 50.9%. CONCLUSION Fight-ending chokes have been common in MMA. Many types of chokes have successfully ended UFC™ fights, with the RNC accounting for almost half of fight-ending chokes. Loss of consciousness occurred in 11% of fight-ending chokes. Right and left handed chokes were utilized equally.
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Affiliation(s)
| | - William H Menton
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Robert C LeFevere
- Department of Emergency Medicine, Regions Hospital, Saint Paul, MN, USA
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Fares MY, Salhab HA, Fares J, Khachfe HH, Fares Y, Baydoun H, Abboud JA, Alaaeddine N. Craniofacial and traumatic brain injuries in mixed martial arts. PHYSICIAN SPORTSMED 2021; 49:420-428. [PMID: 33151104 DOI: 10.1080/00913847.2020.1847623] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective: Mixed-Martial-Arts (MMA) has witnessed a rapid growth over the recent years. This study aims to explore the patterns and trends of head injuries in MMA.Design: Descriptive epidemiological study.Setting: Ringside physician reports of the Ultimate Fighting Championship (UFC) fights between 2016 and 2019 (inclusive) were screened. Data were extracted from the Nevada State Athletic Commission (NSAC) database. Play-by-play video analysis was also conducted.Participants: UFC fighters involved in fights sanctioned by the NSAC, between 2016 and the end of 2019 (N = 816).Independent variables: Sex, location of head injury, type of head injury, injury mechanism, number of significant head strikes, type of finish, and weight division.Main outcome measures: Head injury rates were calculated. A one-way analysis of variance (ANOVA) was used to explore any statistically significant differences between injury rates of different locations, types, and types of finishes. An independent t-test was used to determine whether any significant differences existed between the two sexes, and a Joinpoint regression analysis was used to determine the statistical significance of the trends of head injury rates across different weight divisions. P-values <0.05 were considered significant (95% CI).Results: A total of 288 head injuries in 408 fights were recorded during our study period. Head injury rate constituted 35 injuries per 100 athletic-exposures (AE) in sanctioned fights. Traumatic brain injuries (TBI) were the most common type of injury, with a rate of 16 per 100AE, significantly greater than that of fractures (p = 0.003). Males had a head injury rate of 37 per 100AE, higher than that of females which was 23 per 100AE. Technical Knockout (TKO)/ Knockout(KO) was the type of finish with the highest rate of head injuries, significantly greater than that of decision or submission (p < 0.001). In general, head injury rates were higher as weight divisions increased.Conclusion: Head injuries are prevalent in MMA. Preventive measures need to be implemented to ensure fighter safety and limit injury risk.
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Affiliation(s)
- Mohamad Y Fares
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon.,Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Hamza A Salhab
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon.,Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Youssef Fares
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Hasan Baydoun
- Department of Orthopedics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joseph A Abboud
- The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nada Alaaeddine
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
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Tulendiyeva A, Saliev T, Andassova Z, Issabayev A, Fakhradiyev I. Historical overview of injury prevention in traditional martial arts. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00785-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stellpflug SJ, Schindler BR, Corry JJ, Menton TR, LeFevere RC. The safety of sportive chokes: a cross-sectional survey-based study. PHYSICIAN SPORTSMED 2020; 48:473-479. [PMID: 32271638 DOI: 10.1080/00913847.2020.1754734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives: Sportive choking or strangling, known as a 'choke' in the combat sports community, is the practice of compressing the jugular veins and carotid arteries to threaten unconsciousness by lowering cerebral perfusion pressure. This is commonly practiced within combat sports and police/military combatives. The safety profile of sportive choking is underrepresented in the literature. The authors sought to explore the safety of sportive chokes. Methods: A convenience sample of visitors to two combat sports internet forums completed an anonymous web-based survey on choking experience and related symptoms. Descriptive statistics were used to describe the obtained data. Bivariate analysis was performed to elaborate on relationships between grappling experience and the number of times choked, between the number of times choked with pre-syncope/syncope, and between the duration of symptoms and the number of times choked with pre-syncope/syncope. Results: Overall, 4421 individuals completed the survey. One hundred and fourteen were excluded, leaving 4307 analyzed respondents. Ninety-four percent were male, 89.2% were ages 18-44 years. Seventy-nine percent had >1 year of grappling experience and 30% had >5 years. Of the 4307, 1443 (33.5%) reported being choked >500 times, 3257 (75.7%) have been choked to near-syncope, and 1198 (27.8%) have been choked unconscious. Two of the 4307 (0.05%) reported ongoing symptoms from chokes. Of the respondents, 94.3% felt applying a choke would be a safe and effective way to control a street fight; 83.6% felt that vascular neck restraint, the police combative equivalent of sportive choking, would be appropriate as an alternative escalation of force option. Conclusion: Based on a convenience sample of 4307 respondents' self-reported data, sportive choking appears to be safe. Only 0.05% experienced ongoing symptoms, which were likely not related to brain ischemia.
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Affiliation(s)
| | - Broc R Schindler
- Department of Emergency Medicine, Regions Hospital , Saint Paul, MN, USA
| | - Jesse J Corry
- Department of Neurology, United Hospital , Saint Paul, MN, USA
| | - Thomas R Menton
- Saint Paul Police Department, Training Unit , Saint Paul, MN, USA
| | - Robert C LeFevere
- Department of Emergency Medicine, Regions Hospital , Saint Paul, MN, USA
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Stellpflug SJ, Menton WH, Dummer MF, Menton T, Corry J, LeFevere R. Time to unconsciousness from sportive chokes in fully resisting highly trained combatants. INT J PERF ANAL SPOR 2020. [DOI: 10.1080/24748668.2020.1780873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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