Assessment of Brazilian jiu-jitsu related injuries by severity, type and area

Abstract

Brazilian jiu-jitsu (Bjj) is a martial art that uses falls and joint locks to submit an opponent. The objective of this present article is to determine the incidence and describe the most common types and severity of injuries in Bjj athletes, related to their level of practice. We evaluated 126 male athletes (26,0±7,93), at the University Hospital, Department of Orthopedic Surgery and Physical Therapy at Federal University of Sergipe. Regarding their belt levels we had the following data: blue (33,3%), purple (20,6%), white (22,2%), black (13,6%) e brown (10,3%). The mean years of practicing was 5,77±5,07, and the mean frequency of training days were 4,82 ±1,70 per week with training sessions of 2,4 ±1 hour long, each. An inclusion criterion was a minimum of 2 years experience in Bjj. The difference was not statistically significant in frequency of practices among the groups categorized by belt rank. Ligament sprain was the most frequent injury found, ranging from mild to severe. These lesions occurred most often during practice than during tournaments. The most frequent sites of injuries were shoulder and knee.

Headnote

ABSTRACT

Brazilian jiu-jitsu (Bjj) is a martial art that uses falls and joint locks to submit an opponent. The objective of this present article is to determine the incidence and describe the most common types and severity of injuries in Bjj athletes, related to their level of practice. We evaluated 126 male athletes (26,0±7,93), at the University Hospital, Department of Orthopedic Surgery and Physical Therapy at Federal University of Sergipe. Regarding their belt levels we had the following data: blue (33,3%), purple (20,6%), white (22,2%), black (13,6%) e brown (10,3%). The mean years of practicing was 5,77±5,07, and the mean frequency of training days were 4,82 ±1,70 per week with training sessions of 2,4 ±1 hour long, each. An inclusion criterion was a minimum of 2 years experience in Bjj. The difference was not statistically significant in frequency of practices among the groups categorized by belt rank. Ligament sprain was the most frequent injury found, ranging from mild to severe. These lesions occurred most often during practice than during tournaments. The most frequent sites of injuries were shoulder and knee.

Keywords: Brazilian jiu-jitsu; Sports injuries; Martial Arts.

INTRODUTION

Brazilian jiu-jitsu is a modern combat martial art that uses takedowns and joint locks to submit an opponent. (Scoggin et al, 2014; Jones et al, 2012; Andreato et al, 2015)

Nonetheless, during practice and tournaments, it has been reported several musculoskeletal injuries, where Pinto et al (2004) reported a high incidence of articular lesions among fighters. On top of that, Jensen et al (2017), reported that Brazilian jiu-jitsu is a practice with an increased risk of damage to the joint segment.

Within the same though, person-to-person combat sports, notably the ones requiring most full contact, such as BJJ, Judo and collegiate wrestling, end up leading to more physical exhaustion proportioning the development of more orthopedic-related injuries. (Agel et al 2007, Jarret et al 1998, Pasque & Hewett 2000, Snook 1982, Llinás et al, 2016; Jensen et al, 2017) However, more sustainable medical literature is needed regarding combat sports-related injuries. (Jarret et al 1998, Pasque & Hewett 2000, Scoggin et al, 2014; Drury et al, 2017)

Thus, the objective of this present study was to evaluate the most common types and severity of injuries in Bjj athletes, related to their level of practice and belt rank.

METHODS

We evaluated 126 Brazilian jiu-jitsu male athletes (26,0±7,93). The consults took place at University Hospital, Department of Orthopedic Surgery and Physical Therapy at Federal University of Sergipe. Most of them were blue belt (33,3%), followed by white belt (22,2%), purple belt (20,6%), black belt (13,6%) and brown belt (10,3%). The mean years of practicing was 5,77±5,07, and the mean frequency was 4,82 ±1,70 days of training per week with training sessions of 2,4 ±1 hour long, each.

As criterion of inclusion, it was required a minimum of two years experience of practice. All participants were evaluated by a board certified orthopedic surgeon, including the history of the present illness to verify the existence of orthopedic related injuries, history of previous lesions, mechanism and setting of the last injury, if caused by self or not, severity and previous treatments.

We followed a specific protocol regarding ethics in research with humans according to resolution n° 466, from 12/12/2012 of the Health National Department, enforced research laws involving humans, in agreement with ethic principals from the Helsinki's Declaration (1964, modified in 1975, 1983, 1989, 1996, 2000 and 2008), of "World Medical Association".

The athletes gave their were oral and written consent.

Instruments

From the severity stand point, we categorized according to the International Injuries Registration Severity Scale cited by Birrer (1996), stratified as mild, mild to moderate, moderate, moderate to severe and severe. (Table 1).

Procedures

All of our data were obtained based on the demand of the Department of Orthopedic Surgery and Physical Therapy at Federal University of Sergipe. Our department is a reference in orthopedic and trauma care to athletes in many modalities in Sergipe, such as full contact sports, volleyball, gymnastics, soccer, etc.

Statistics

The statistical analyses were performed using the Statistical Package for the Social Science (SPSS), version 22.0, including the measures of mode, median, mean ± standard deviation (M±SD). In order to verify the variable normality, it was utilized the Kolmogorov Smirnov test Kolmogorov Smirnov, considering the sample size. We used ANOVA (two way), Post Hoc of Bonferroni, to check the possible differences among groups split by age. To measure the size of effect, it was utilized the Cohen f2 test, with scores ranging from 0,02 a 0,15 as little effect, 0,15 a 0,35 as moderate and more than 0,35 as great (Grissom e Kim 2005). (p < 0,05)

RESULTS

Table 2 summarizes the correlation between the frequency of practice and experience by belt level. Table 3 represents the severity, setting, area and type of injury stratified by belt level in Bjj athletes.

DISCUSSION

From the training hours stand point, our data showed that despite of the lack of difference between subjects in different belt ranks, black belt athletes tend to practice longer hours than less experienced fighters. Nevertheless, all subjects demonstrated a mean practicing time of 10 to 14 hours a week.

Some authors report that more experienced athletes is more prone of having injuries caused by their practice (Oliveira et al 2010, Rainey 2009), and that makes them more vulnerable of having worse injuries and chronic lesions. On the other hand, Rainey et al (2009) found just the opposite relation among MMA fighters. Less experienced athletes showed a larger number of combat-related injuries than more experienced ones. This relationship between experience and number of injuries has been described very often. (Lystad et al 2015, 2013, Buse 2006, Barroso et al 2011, Ramos et al 2015)

Confirming our study, some authors have shown a high rate of injuries (70-82%) during practicing sessions. (Buse 2006, Loosemore et al 2006)

Barsottini et al (2006) described an incidence of 71% of orthopedic injuries during practicing. At the same time, Corso CO & Gress FAG, (2012) reported that 90% of fighters have been injured during a practice session of Bjj. Oliveira et al., (2010) agreed with those authors saying that most of the lesions occurs on a practice setting.

Regarding the area of injuries, severity and type, our study demonstrates mild or severe, mostly ligament sprains and the most common affected sites are shoulder and knees, excepted for black belts where the location changes to shoulder and elbows. Other lesions that might be caused by practicing Bjj are contusion, dislocation, fracture and muscle strain. Studies show that the most frequent injury is ligament tear (sprain) affecting 61,5% of athletes, meanwhile the least frequent lesion is muscular distension affecting 2,6% of them. (Souza et al 2011) McPherson & Pickett (2010) assessed 46 Brazilian jiu-jitsu fighters where most of them presented with ligament sprain. Oliveira et al., (2010) realized most of the subjects evaluated had shown dislocation injuries, as opposed to the small number of fractures (5,26%) among black belt athletes. Guedes (2009), has also assessed the most common lesions and he has found a 52% rate of dislocation, followed by ligament sprain (21%) and fracture (21,1%).

From the body area wise, the most prevalent locations were the shoulder (21,7%) and knee (20,5%) followed by hand, ankle, elbow, foot and wrist. It is also remarkable that the upper extremity has been more affected by it (52%). Scoggin et al. (2004), had described as the elbow the most prevalent location for lesions. Kreiswirth et al. (2014), had obtained in their study, 64,5% of the injuries at the upper extremity, involving the elbow and knee. Baffa & Barros (2002) highlighted the knee as the most frequent location of injuries in the body with 37,5%. The shoulder joint was the most prevalent (16,7%) of injuries by Corso et al., (2012)

CONCLUSION

We observed no statistically difference between the frequency of practicing in between the groups categorized by belt level.

Ligament sprain was the most prevalent lesion found, mostly mild or severe. Regarding the setting where the injuries had occurred, practice sessions were where it happened the most in comparison to tournaments. And the body regions most affected by lesions were shoulder and knee.

Acknowledgments:

Nothing to declare

Conflict of interests:

Nothing to declare

Funding:

Nothing to declare

Footnote

* Corresponding author: Department of Physical Education, Federal University of Sergipe, Săo Cristovăo, Sergipe, Brazil. E-mail: [email protected]

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