Emergency care for choke holds

This Article originally appeared on BJJ.org. The entire archive of information is now available on OntheMat.comJudo is a martial art combining the use of quick movement and leverage to throw an opponent. Over 100 years ago the sport evolved (through the efforts of its founder, Dr. Jigoro Kano) from jujitsu, the ancient fighting art of the samurai. Today it flourishes as a year-round family sport as well as a highly competitive Olympic sport.

Judo offers challenging and invigorating workouts to those who master its techniques. Competition can be intense in this relatively safe contact sport, but it must be realized that, as with all contact sports, participants do get injured.

To win in Judo there are four basic methods: (1) throwing, (2) hold down techniques to the main trunk of the body, (3) arm lock submission holds, and (4) choking (shimewaza) holds.

Periodically a player will refuse to submit to choking and, thus, be rendered unconscious and even possibly go into convulsions. With some background now established, the remainder of this article can now largely deal with proper emergency procedures for a choked out judoka.

Occasionally, because the athlete refuses to submit to the choking technique, or the choke is held too long (e.g., 30 seconds), unconsciousness will occur. Of course, the first goal before having to rely on resuscitative measures, is prevention. To ensure maximum safety for the athlete, the following criteria should be followed:

Choke holds should be taught only by qualified and certified instructors.One should be familiar with the anatomical structures of the neck and where the pressure is to be applied to the carotid triangleDevelop a knowledge of the physiology of choking, and know that only a relatively minimal pressure is needed to cause unconsciousness.Immediately recognize the state of unconsciousness and immediately release pressure on the neck.Apply the proper resuscitative methods if unconsciousness is prolonged.Prevent vomit aspiration and maintain a patent airway by placing the athlete in the recovery position (on his or her side).

Structure of the neck

The most effective method of shimewaza uses the principle of “maximum efficiency with minimal effort” by applying pressure directly on the carotid triangle without applying the pressure diffusely around the neck. The anterior cervical triangle of the neck (Fig. 1) contains the superior carotid triangle, within which there are the common carotid artery and branches, the carotid bodies, internal jugular vein, vagus nerve and branches, superior laryngeal nerve and the sympathetic trunk.

Physiology of choking

The amount of pressure directed to the superior carotid triangle of the neck (Fig.2) and needed to render an adult unconscious is no more than 300 mm Hg. A proper performed choke, stated in general terms, requires no great amount of strength.

According to the Society of Scientific Study in Judo (Kodokan, Tokyo, Japan), the state of unconsciousness is caused by temporal hypoxic condition of the cerebral cortex (lack of oxygen to the brain).

To perform a shimewaza (or choking technique), the player applies pressure on the opponent’s neck usually by pulling on the opponent’s collar or by directly applying the forearm to the neck by his hands (forearm) or judogi (uniform) and in doing so obstructs the blood flow of the common carotid artery (not the vertebral artery). The complete obstruction of blood flow to the brain or asphyxia by complete closure of the trachea (windpipe) will result in irreversible damage (if held too long) to the body and possibly in death. However, in 99 percent of the choking techniques there is not complete blockage of the trachea.

The use of choking to induce unconsciousness is a temporary incapacitating technique of short duration whose proper execution is quite harmless.

The application of a choke hold even in judo is not easily done, especially if the opponent does not cooperate. With proper training, techniques will be used to break the hold. As for choking an opponent, the player must first control the adversary’s body and therefore prevent escape from the choke hold.

In judo, judokas are taught not only to choke, but how to submit by tapping the opponent or the mat with the hands or feet to signal surrender due to the shime’s effectiveness. However, if the judoka does not, or cannot submit in time, the effective choking technique will cause unconsciousness. During matches, the referee and judges are able to recognize that a player has been rendered unconscious and immediately stop the match.

Even in training, instructors watch students closely when they are practicing choke holds. This way, the players become trained in the feeling of being choked and learn to tap before going unconscious.

Emergency care

Unconsciousness occurs about 10 seconds after the application of an effective choke. After release, the athlete should regain consciousness in about 20 seconds. Should the athlete remain unresponsive after this period, seek medical assistance immediately. Unconsciousness in itself may be deemed a medical emergency if it is prolonged and the underlying cause is not recognized.

As with unconscious athletes (except spine-injured), an unresponsive person should be rolled on to their side while protecting the head and letting it rest on the athlete’s extended arm in the recovery (lateral recumbent) position. In this position, the airway remains open and is not blocked by a relaxed tongue. Fluids such as saliva and maybe even vomitus are also allowed to flow out of the mouth and not into the airway.

If the judoka does not awaken after 20 seconds, in addition to initiating efforts to revive him, alert medical services.

Basic cardiac life support measures (CPR) should be initiated along the following lines:

Unresponsiveness:Try to awaken the athlete with vocal stimuli (shout and call out to the athlete). Try to awaken the athlete with pain stimuli (e.g. triceps pinch and sternal rub.)Airway:Open and maintain a patent airway.Breathing:Check for breathing … Look at the chest rise, listen for air exchange, feel for a breath. Initiate 2 slow breaths if there is no breathing,Circulation:Check for the presence of a carotid pulse. If absent, commence chest compressions and artificial respiration.The type of choke holds discussed in this article have been used for years at thousands of tournaments all over the world without one reported fatality in more than 100 years of judo. As with other physical sports, judo comes with the risks of serious injury. But, as with most aggressive sports enthusiasts agree, the merit and value of participation far outweigh the risks.

[Original Editors Note: This is Boulay’s revised article published in “Coaching Review” Ottawa, Ontario, Canada, a periodical no longer in print. His article addresses Shimewazas for Judoka, and includes two photos that were omitted from Dr. Koiwai’s article to avoid duplication. John Boulay is a certified Athletic Therapists in private practice at Knatcx Sports Medical Clinic in Montreal. He is an experienced EMT and CPR Instructor-Trainer and has taught courses in emergency care and injury prevention. He is a team therapist for Judo Canada.]

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John Boulay