Tap or Nap! BJJ Chokes From a Doctor’s Perspective

MMA Insider

Chokes in MMA are commonly seen as highlight-reel material, but have you ever wondered what really happens during a choke, or what’s the best way to help someone who’s just been choked out while training? 

We got Doctor Warren Wang, longtime BJJ practitioner, gym owner, and ONE Vice President of Medical Services, to shed some light on chokes as part of a series of regular columns by the veteran fight doctor.

Anyone familiar with the grappling game knows the saying “tap or nap”. Just to name a few, we’ve got the Rear Naked Choke, Arm Triangle Choke, Brabo Choke, Cross Choke, Triangle Choke, and the list goes on and on. But in reality, by definition these are not really chokes. 

Choking is the act of airway blockage. Drowning in water or choking on food while eating are classic examples of choking. Chokes in grappling or MMA competitions are really strangulations. Wikipedia defines strangling as a compression of the neck that may lead to unconsciousness or death by causing an increasingly hypoxic state in the brain. 

Strangling involves one or several mechanisms that interfere with the normal flow of oxygen into the brain: compression of the carotid arteries or jugular veins causing a lack of blood to the brain, or compression of the laryngopharynx, larynx, or trachea causing a decrease in oxygen intake.

The chokes we see in competitions that lead to an athlete tapping or napping should be classified as vascular chokes. The two main arteries that lead to the brain are known as the carotid arteries. The compression of these leads to hypoxia (low oxygen level) in the brain which shuts down an athlete’s consciousness. Once the pressure is relieved, blood flow and oxygen will be restored to the brain and the athlete will wake up on his own.

How many times have you seen an athlete getting his legs lifted after being choked out? This is known as the Trendelenburg position. In the past, this position was used for patients in hypovolemic shock, with the reasoning that it would help maintain blood flow to the brain. This is no longer recommended, because research shows it to be counterproductive. Having the athlete in a supine position and unconscious may be fatal. As explained, the athlete is not unconscious due to low blood pressure. There is absolutely no need to lift the legs of a choked-out athlete.

The best way to manage an unconscious athlete is the same approach one should take with any fallen pedestrian. The standard pedestrian CPR approach as presented by the AHA (American Heart Association) should be the guideline when approaching an unconscious athlete. First, call for help from a nearby coach, training partner, or cageside physician. Second, checking for breathing movements – in 100 percent of choked-out athletes, there will be breathing and a pulse. 

So, all one needs to do is to prevent secondary injury and clear the athlete’s airway by removing anything from his mouth, usually the mouth piece. Then turn the athlete’s head and body to one side, thus preventing the athlete from choking on his own tongue or vomitus. This is known as the recovery position. This keeps the airway open and prevents further head injury from possible seizures due to hypoxia. These simple steps can help anyone save a napping athlete.

Train hard, train smart, and stay safe!

Doctor Warren Wang is ONE Championship’s Vice President of Medical Services. He is a member of the American Ringside Physicians, Taiwan Society of Emergency Medicine, and Taiwan Medical Association.

Doctor Wang has been an active part of MMA in Asia for several years, both as a resident medical consultant and referee for several organisations. He also owns and teaches at the Taiwan Brazilian Jiu-Jitsu Academy, and is the Chairman of the Chinese Taipei Jiu-Jitsu Association.